Posts Tagged ‘Nurses’


Nursing Ethics: Helping Out on the Unit vs. Teaching Nursing Students Crucial Skills

September 23, 2015

By Jacob Molyneux, AJN senior editor

scalesJust as no two hospital units are exactly alike, rarely are two ethical conflicts exactly alike. There are too many variables, too many human and situational differences. This month’s Ethical Issues column, “Teaching Crucial Knowledge vs. Helping Out on the Unit,” explores potential ethical and practical issues faced by a clinical instructor who must balance the duty to teach essential skills to nursing students against the staff’s need for help in meeting patient care needs.

Will there be an easy, cut-and-dried answer? Probably not. In the course of their analysis of a hypothetical scenario, the authors make the following point:

Because new situations arise all the time, and every situation varies in its ethically relevant aspects, rigid rules often cannot guide ethical action. Instead, analytic skills and transparent negotiation are crucial for resolving conflicts between values as they arise in day-to-day interaction—and for supporting the solutions we choose.

While people skills may be as important as abstract ethical analysis in dealing with real world situations, determining which ethical principles or priorities are coming into conflict may provide us with a certain measure of clarity in our approach. The authors frame the conflict described in the article in the following way:

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Unexplained Deathbed Phenomena: Honoring Patient and Family Experience

September 21, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by luke andrew scowen/flickr creative commons

luke andrew scowen/flickr creative commons

When my dad died, a special little travel clock that he’d given me years before stopped working. It restarted a week after his death, and continued running for years. I have no explanation for this sudden lapse in timekeeping, but it made me feel closer to my dad.

I’ve heard many other stories of unusual events surrounding the death of a loved one. I was therefore delighted to read this month’s Viewpoint column, “Letting Patients and Families Interpret Deathbed Phenomena for Themselves.” In this short essay, Scott Janssen presents some intriguing research findings and a compassionate argument for speaking openly about these occurrences. He writes:

“It’s an open secret among those of us working with the dying – there’s a lot of strange stuff going on for patients, as well as for the clinicians and family members who care for them, that rarely if ever gets talked about: near-death experiences, synchronistic coincidences (stopped clocks at time of death, for example), out-of-body experiences, and visitations from deceased loved ones.”

Janssen, a former hospice social worker and now a psychotherapist, sees such phenomena as part of “the normal continuum of experiences at the end of life.” He calls upon clinicians to create safe contexts in which patients and families can share these experiences without fear that they will be judged, ridiculed, or dismissed by caregivers.

It’s food for thought in the midst of our high-tech workplaces and death-denying culture. Read the rest of the article in this month’s AJN.

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Revisiting Katrina’s Lessons 10 Years Out, from a Nursing Perspective

August 31, 2015

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Hurricane Katrina Hits New Orleans, August 29, 2005/ Wikimedia Commons

Hurricane Katrina Hits New Orleans, August 29, 2005/ Wikimedia Commons

This past week we’ve seen many media retrospectives on the devastation Hurricane Katrina visited on the Gulf Coast on August 29, 2005. I remember it vividly—as AJN’s news director at the time, I cut short a Labor Day vacation and flew to Mississippi on September 10 to report firsthand on how relief efforts were progressing.

I visited the emergency shelter staged at the Meridian Naval Air Station and then drove as far as I could south from Meridian toward the Gulf of Mexico. I got as far as Hattiesburg, Mississippi, before I had to turn around because there were no open gas stations and my gas tank was at half-empty. The devastation along the highway was remarkable; trees were completely flattened and debris of all sorts was scattered about as if a giant trash can had been overturned. And this was still about 70 miles inland from the Gulf.

Over the following months and then years, AJN published a number of articles and reports on health-related issues that arose from Hurricane Katrina (see the list below). We highlighted the heroics of many nurses who found ways to deliver care with few resources, discussed ethical considerations involved in some truly life-and-death decisions, monitored progress in the years following the storm, and reported on changes in disaster preparation that followed the storm. As with the 9/11 attacks, Hurricane Katrina spurred self-assessment by many groups, with politicians and spokespersons avowing that there would be changes so that such disastrous consequences would never happen again. And then, of course, there was Superstorm Sandy in 2012 . . .

Selected Coverage of Hurricane Katrina (these articles will be free until September 10)

Nurses Rising to the Occasion

“New Orleans Evacuees in Mississippi”
After Katrina, nurses help to convert a coliseum into an all-purpose clinic.

“Her Niche in Nephrology Nursing”
A dialysis nurse recognized for her efforts after Hurricane Katrina. Read the rest of this entry ?


Medicare Turns 50: Familiar Opposition in 1965, Essential and Continuing to Evolve Now

July 30, 2015
President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

On this date in 1965, exactly 50 years ago, Medicare (part of the Social Security Amendments of 1965) was signed into law by President Johnson. The debate over government-sponsored health insurance is not new, and opposition to the creation of Medicare was similar to the opposition to the Affordable Care Act and driven by many of the same organizations and arguments.

According to a timeline at, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article in the May 1958 issue after a health insurance bill was introduced in 1957. Yet again, one of the staunchest opponents was the AMA. In the September 1958 issue, “at the request of the American Medical Association,” AJN published an article by the AMA’s general manager explaining the AMA’s opposition. Then (as in recent years we continue to see from opponents of both Medicare and the ACA), the alternative plans proposed by the AMA and others were weak and lacked comprehensiveness. By contrast to the AMA’s position, in 1958 the American Nurses Association (ANA) formally expressed support for federal health insurance for older Americans.

Medicare continues to evolve in numerous ways, and will face unprecedented challenges in the coming years as the number of seniors continues to increase. Medicare has its flaws and waste and inefficiencies, and some of the quality measures it uses to decide compensation rates for hospitals are controversial with nurses and others. There is always room for improvement, always negotiation among competing parties, never enough money.

But some very positive news came out this week about steep reductions in Medicare patients’ mortality and hospitalization rates and in costs for hospitalized “fee-for-service” Medicare patients.

So it’s complicated, as might be expected. But where would be without Medicare? It might not be pretty.—By Shawn Kennedy, editor-in-chief, and Jacob Molyneux, senior editor

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Working a Shift with Theresa Brown

July 20, 2015

bookBy Maureen Shawn Kennedy, AJN editor-in-chief

Many of you may be familiar with Theresa Brown, nurse and author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between, as well as a blogger for the New York Times. Brown also writes a quarterly column for AJN called What I’m Reading (her latest column, which will be free until August 15, is in the July issue). Her new book, The Shift: One Nurse, Twelve Hours, Four Patients Lives, will come out in September, and I was able to read a prepublication copy. (You can pre-order it.)

I don’t usually write book reviews. I think of most books like food: what one person finds delicious may be less savory to another. But I’m making an exception because this book is an accurate and well-written portrayal of nursing (at last!).

Anyone who wants to know what it’s like to be a nurse in a hospital today should read this book. Patients, families, and non-nurse colleagues tend to see nurses as ever-present yet often in the background, quietly moving from room to room, attending to patients, and distributing medications or charting at computers. But what they don’t understand about what nurses do is what Brown so deftly describes—the cognitive multitasking and constant reordering of priorities that occur in the course of one shift as Brown manages the needs of four very different patients (she was working in a stem cell transplant unit at the time); completes admissions and discharges; and communicates with families, colleagues, and administrators. Read the rest of this entry ?


Family Caregivers Increasing in Age, Numbers: How Can Nurses Help?

June 10, 2015

By Shawn Kennedy, MA, RN, AJN editor-in-chief

AJNFamilyCaregiverSupplementLast week, a new report from the National Alliance for Caregiving and AARP detailed the landscape of family caregiving in the United States. The majority (60%) of caregivers remain female (40% are men, a percentage that continues to rise). They average 49 years of age. In most cases, they are caring for a relative (typically, a 69-year-old female). On average, the caregiver spends 24 hours each week helping with daily activities and has been doing so for four years; one-third of caregivers still maintain a full-time job.

An estimated 34.2 million adults provided unpaid care to an adult 50 years or older in the previous 12 months; nearly one in 10 caregivers is 75 years or older—a typical example given in the report was a 79-year-old female caring for a 77-year-old spouse with Alzheimer’s disease, aging issues, or heart disease. Half of caregivers were thrust into caregiving and felt that they had no choice about taking on the responsibility of a loved one’s care; 22% of caregivers feel that their own health has suffered.

To raise awareness of their needs, in recent years AARP has championed the plight of family caregivers, collaborating with government and consumer organizations, and health care professionals. AJN, too, has worked with AARP on several projects to provide nurses with information to support family caregivers, as noted below.

The needs of family caregivers will only increase, according to the data on aging in a report from the U.S. Administration on Aging, A Profile of Older Americans: 2014. According to this report, “The 85+ population is projected to triple from 6 million in 2013 to 14.6 million in 2040.”

This means more people in the “oldest old” category—the group that typically needs assistance with daily living.

We’d like to offer some resources from AJN to help nurses support family caregivers, who often get overlooked by health care professionals and are unprepared for all the caregiving tasks they may need to do (see, for example, Carol Levine’s guest editorial in our September 2008 issue, which details her personal experiences and eloquently describes the problems caregivers often face). Read the rest of this entry ?


A Nurse Epidemiologist’s Notes on Issues Raised by a Recent Death from Lassa Fever

June 5, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription-polymerase chain reaction (RT-PCR) can be used in the early stage of disease. The virus itself may be cultured in 7 to 10 days, but this procedure should only be done in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, can be used to make a post-mortem diagnosis.

Some aspects of last month’s case of Lassa fever in New Jersey seemed to parallel the story of Thomas Duncan, who died last October in Dallas after contracting Ebola virus disease in Liberia.

A man arrived in the U.S. from Western Africa. He was screened for Ebola at the airport and instructed to monitor his temperature for 21 days. The next day, he developed a fever. Instead of calling the county health department, he headed to a hospital. He reportedly didn’t mention his travel history to staff, and was sent home on antibiotics. His condition worsened, and three days later he returned to the ED. When clinicians learned that he had recently arrived from Liberia, he was isolated, admitted, and tested for Ebola and Lassa. Positive for Lassa fever, he died soon afterwards.

Like Ebola, Lassa is a zoonotic hemorrhagic fever endemic to Western Africa. As with Ebola, the early symptoms of Lassa fever are nonspecific: fever, headache, malaise, nausea, vomiting . . .

But here the similarities end. Unlike Ebola, 80% of Lassa fever cases are mild or asymptomatic, and the overall case fatality rate is just 1%. (The risk of dying rises to 15%–20% if the disease progresses and requires hospitalization.) The most common complication of Lassa fever is deafness—one-third of those infected experience some degree of hearing loss—which occurs in both mild as well as severe cases.

Missed opportunities? This recent and upsetting story once again highlights the limitations of communicable disease follow-up based on self-monitoring and accurate individual reporting. Airport temperature screening of passengers arriving from certain geographical areas (which appears to be of questionable value) is supposed to result in the isolation and testing of anyone with a fever. But the vast majority of disembarking passengers are afebrile. They are instructed to monitor their temperature for a prescribed period of time (depending upon the disease of concern), and to call their local health department if they develop symptoms.

There are, of course, many holes in this surveillance “safety net.” Passengers may not reveal their connection to an epidemic area because of fear of reprisal, denial of their own at-risk status, or language-related misunderstandings at the point of screening. They may or may not subsequently monitor their health. When fever develops and becomes undeniable, they may not know how to contact their local health department, or if they do call, may quickly become impatient if met with a busy signal or no answer. Panic about what symptoms might mean will cause some people to run to the nearest ED for medical care; health department notification is not a high priority when you think you’re fighting for your life. Read the rest of this entry ?


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