Posts Tagged ‘Nurses’

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Ebola: Infection Control Resources Make All the Difference

September 16, 2014

This post is follow-up to our widely shared post (“Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective”) by AJN clinical editor Betsy Todd. The author, Amanda Anderson, is a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. Her last post for this blog is here.

Ebola virus viron

By CDC microbiologist Cynthia Goldsmith, this colorized transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. CDC image library.

I don’t know a single nurse who likes caring for multiple isolation patients. The process of donning a new gown, pair of gloves, and mask each time you enter an isolated patient’s room is arduous and time-consuming. Personal protective equipment (PPE) clogs the garbage cans and can be hot and confining.

PPE has been in the news quite a bit lately because of Ebola. An interview with Liberian nurses by Hunter College’s Diana Mason on her WBAI radio show Healthstyles revealed that the Liberian Ministry of Health estimates 75% of virus victims are women—mostly nurses and caregivers. Nurses in West Africa might really love some of those pesky yellow isolation gowns.

Ebola can be a messy virus. Infected people have copious diarrhea and vomiting, often containing blood. The basics of care for Ebola patients should not be new to us; HIV and hepatitis can be spread in many of the same ways. We’ve got little to fear if we follow CDC guidelines for PPE and infection control. But in parts of Africa, where supplies we take for granted are scant, nurses and caregivers can’t even hold the hand of a dying patient or family member, much less clean them, without fearing for their lives.

As Mason’s interview reveals, many nurses are assigned 25 or more patients each shift in hospitals that lack electricity, running water, and gloves. (In an article for Buzzfeed, Jina Moore describes a nurse working in an Ebola ward who wears the isolation kit sent to her by the Liberian Ministry of Health. The kit includes a shower cap, gloves, and rubber bands for her wrists. Her ankles and neck are exposed, peeking out from her own short scrubs.) Read the rest of this entry ?

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Enterovirus D68: Precautions, Surveillance, Yes; Alarm, No

September 15, 2014

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

EV68-infographicAs news coverage focuses on the latest clusters of suspected—and, in some instances, confirmed—cases of human enterovirus D68 (EV-D68) as they occur in successive regions of the U.S., here’s a quick primer on what is known about EV-D68.

Is this a new, dangerous virus?
EV-D68, a non-polio enterovirus, is not a “novel” virus—the term used to describe emerging infections such as SARS and MERS. It’s more accurate to describe it as the CDC does: it is an “increasingly recognized” cause of respiratory infections, especially in children.

EV-D68 was first isolated in 1962. While reports of EV-D68 since then have been sporadic, the CDC in 2011 reported on clusters of this viral infection in Georgia, Pennsylvania, and Arizona as well as in Asia and Europe. It’s likely that there are hundreds or even thousands of EV-D68 infections every year in the U.S. But as with many other viral infections, they will range in severity, and an infection that looks like “a cold” isn’t usually brought to the attention of a health care provider.

According to the CDC, most enterovirus infections are actually asymptomatic; this may be the case with EV-D68 as well.

Diagnostic testing for EV-D68 involves RT-PCR and gene sequencing. Most hospital labs therefore are unable to test for it. Some readily available diagnostic tests do identify “enterovirus” but don’t type the virus further; some tests misidentify EV-D68 as a rhinovirus. (Specimens from suspect cases in the U.S. therefore almost always are handled by CDC labs.)

Because treatment is symptomatic, the lack of a widely available test for EV-D68 is not an issue for the patient. But as more sensitive and specific tests become more widely available, more cases will be correctly identified, and we can learn more about the course of the disease.

Genetically similar to cause of common cold.
EV-D68 belongs to a genus of viruses that includes polioviruses, rhinoviruses, coxsackieviruses, and echoviruses. It is not “polio-like.” Biologically and epidemiologically, it is most similar to human rhinoviruses, which cause the common cold.

Severe respiratory infections in children? Visitor restrictions?
While we are seeing reports of severe respiratory illness in patients with suspected or confirmed EV-D68, it should be noted, as the CDC points out, that many/most of those hospitalized with this and other respiratory infections are people with chronic conditions such as asthma or other health issues. Visitor restriction is a routine response in any hospital when there is a cluster of respiratory infections in the community. Read the rest of this entry ?

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End-of-Life Discussions and the Uneasy Role of Nurses

September 11, 2014

Amanda Anderson, BSN, RN, CCRN, is a critical care nurse in New York City and enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She is currently doing a graduate placement at AJN two days a week, working on a variety of projects. Her personal blog is called This Nurse Wonders.

Evelyn Simak/ via Wikimedia Commons

Evelyn Simak/ via Wikimedia Commons

Nurse and writer Theresa Brown wrote a piece for this past Sunday’s New York Times on the dilemmas physicians face when their patients want to stop aggressive treatment (the latest installment of Brown’s quarterly column, What I’m Reading, is in the September issue of AJN [paywall]).

Brown’s Times column talks about physicians who have trouble letting patients go and instead push for more unnecessary and often unwanted treatment. She describes a case in which—after palliative care has been decided upon by the patient’s family members, the palliative care team, and even the heartbroken oncologist—the patient’s primary care physician intervenes and pushes for still more futile treatment. (Much of the article delves into the broader issue of palliative care and the benefits it has for patients in many stages of chronic illness.)

Have you ever disagreed with a physician’s choice to continue treatments in a situation where you thought these treatments were against a patient’s real desires or best interests? Have you felt cornered in your care? What conversations did you start—or want to start but maybe felt you couldn’t?

Many times, we nurses at the bedside are afraid to speak openly with our patients about end of life, especially when physicians have different views on what should be the patient’s treatment goals. The situation feels thorny, fraught. Moral distress—when you know the right thing to do for your patient but don’t feel you have the ability to do it—can lead to burnout, high turnover rates, and many emotional stressors among nurses. Often, we simply can’t say what we want to say, despite a duty to our patients to accurately educate them on their care and conditions. Read the rest of this entry ?

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Blogging: As Many Voices as There Are Nurses

August 20, 2014

By Jacob Molyneux, AJN senior editor

Blogging - What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

A recent check reveals that a good percentage of the blogs on our nursing blogs list have been relatively active over the past few months. A few have been less so. I didn’t see any posts about the ice-bucket challenge, and that’s okay. Here are a few recent and semirecent posts by nurses that might interest readers of this blog:

Hospice nursing. At Hospice Diary, a post from a few weeks back is called “Dying with Your Boots On.” An excerpt:

As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat, black leather boots and a crooked smile.  I stepped out of my car and told him for a moment I thought he was the garden scarecrow, until he tipped his hat.

Nurse-midwifery. A post on At Your Cervix: Tales of a New CNM, First Year gives a short nuts-and-bolts glimpse of the author’s daily work life as a certified nurse-midwife. Those considering this specialty may benefit from one person’s experience of the pros and cons of one workplace:

I thought (as I was taught) that I would have more autonomy in practice . . . the two physicians are truly the “bosses.” Everything needs to be run by them . . . I definitely have more autonomy in the office setting. There was a big difference in reading/learning about prenatal care and GYN care, versus doing it. I didn’t learn (or have clinical experience in) nearly enough GYN clients! I think the number of GYN clients for clinicals was only about 35.

For the ‘research-minded nurse.’ At the INQRI blog—that is, the blog of the Interdisciplinary Nursing Quality Research Initiative, which has a stated goal “to generate, disseminate and translate research to understand how nurses contribute to and can improve the quality of patient care”—you will find even-handed and brief summaries of recent nursing research on topics such as the potential for hourly nursing rounds to improve patient care.

Renewal. If you’re taking a vacation and going somewhere more peaceful this summer, sometime AJN blogger Amanda Anderson has a contemplative post, “The Place Where Noise Becomes Sound,” at her blog This Nurse Wonders. It starts like this:

Summer has finally found me. Somewhere in the long train ride west, between naps and riders and minutes of staring at passing trees, I listened.

Read the rest of this entry ?

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The Gaza Conflict, Through the Lens of Nursing

August 13, 2014

By Jacob Molyneux, AJN senior editor

In 2005, AJN published an article looking at the experiences of nurses in Israel and in the Palestinian territories (free until September 15; choose ‘full text’ or ‘PDF’ in upper-right of the article landing page). Here’s an excerpt:

“[N]urses in the region have many of the same problems American nurses have: disparate educational levels, struggles for professional recognition and workplace representation. The nurses I met came into the profession for diverse reasons and are working in a remarkable variety of settings, carrying on in the face of political, professional, economic, military, and personal difficulties. Yet I was amazed at the things these nurses have in common with each other—and with us. As I listened to them describe their motivations and aspirations and watched them work, the seemingly impenetrable barrier created by the ongoing military and political conflict melted away.”

Photos and captions from 2005 article about Palestinian and Israeli nurse. Courtesy of Constance Romilly.

Photos and captions from 2005 AJN article. Courtesy of Constance Romilly. Click to expand image.

The current conflict between Israel and those living in the Palestinian territories is another chapter in a long story. Our focus at AJN is not on the politics of the situation or the rhetoric of blame coming from supporters of both sides. Most of our readers already have opinions on the topic, and there are other, more appropriate places you can engage that argument.

The stress and suffering, deaths, injuries, and loss of infrastructure have been well documented. We see lots of images of bombed-out concrete buildings that seem always to have been ruins in some nameless place, with little evidence of the lives only recently played out there. Still, one at times stumbles upon photos of people caught in the shelling, the scarred, maimed, or dead lying in rows on stretchers. These are hard to look at or forget.

As has been noted by many international aid groups and the UN, the health care system in Gaza is under great strain and in urgent need of donations, with a number of hospitals destroyed and others without power or basic medical supplies. In shelters where many are seeking refuge from the bombing, the overcrowding and lack of adequate sanitation is giving rise to disease. A number of groups are mobilizing teams of surgeons and nurses to travel to Gaza and treat the wounded. Others are gathering medicines and medical supplies to send. Read the rest of this entry ?

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Marijuana Legalization and Potential Workplace Pitfalls for Nurses Who Partake

July 30, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Mount Hood, Oregon as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi

Mount Hood, Oregon, as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi

Wednesday, July 9, 2014, marked the first day of legal, recreational marijuana sales in the state of Washington, not long behind similar new laws in Colorado earlier this year. As in Colorado, the marijuana supply in Washington was initially insufficient to keep up with demand; stores ran out of cannabis before all customers waiting hours in line got through the front door.

The following weekend, my husband and I (we live in Portland, Oregon) took a road trip through the Columbia Gorge on the Washington side of the river.

“Hey, we could buy a joint here, and share it,” I joked. (Neither of us actually partakes.)

My husband, a pharmacist, remarked, “It may be legal, but testing positive at work could get either of us fired or invite state board investigation.”

For my husband and me, as Oregon residents, the point is moot: no amount of THC in our urine or blood is legal. For Washington and Colorado residents, however, the newly legalized status of marijuana creates confusion for employers and employees alike. In Washington and Colorado, a drug test positive for THC is no longer illegal, but being under the influence of legal substances like alcohol, for instance, violates employer policies.

This fact was illustrated in the news on the very first day of marijuana sales in Washington. A Spokane resident was fired when his purchase became public. Since then, the man has been rehired. After considerable media coverage, the company decided that, since he had the day off when he made the purchase, he was not under the influence while at work, the possibility of which is the underlying rationale for their drug testing policy.

Does being a nurse or health care provider add another layer of complexity to this issue? I think so. Positive drug tests are not acceptable for the majority of nurses and health care professionals. Smoking a joint legally in Washington over the weekend means that THC may remain detectable in urine for about a week, and longer for regular smokers.

You can see the dilemma: It may be legal for a nurse, pharmacist, or surgeon to smoke cannabis in Washington, or Colorado, but you probably also want to know that they are not under the influence of any mind-altering substances, legal or otherwise, during patient care. And, crucially, a positive drug level indicating intoxication has not been established for cannabis, as it has for alcohol. Read the rest of this entry ?

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VA Nursing Leadership Silent on Veterans’ Wait Times Scandal

July 9, 2014

By Gail M. Pfeifer, MA, RN, AJN news director

Audie L. Murphy Veterans Administration Hospital in San Antonio, TX / Wikimedia Commons

Audie L. Murphy Veterans Administration Hospital in San Antonio, TX / Wikimedia Commons

I’ve been trying to arrange an interview with a nurse in a leadership role at the VA’s Office of Nursing Services (ONS) for over a month now, with little success.

Granted, an excessive wait time for an interview pales in comparison with how long many veterans have had to wait for health care. Still, this has given me a tiny taste of what it must be like to enroll with the Veterans Health Administration for services: you can contact them, but you have to wait a really long time to even schedule a first appointment.

A substantive interview with AJN might have been a golden opportunity for the ONS to get out ahead of the story that has plagued the VA since the Phoenix scandal about lengthy waiting times at the VA broke in early May. (I did finally get a response of sorts. More on that below.)

To recap: The allegations in May that the Phoenix VA system had manipulated data about appointment wait times to hide the fact that veterans were not getting timely appointments galvanized public and Congressional attention.

But such problems in the VA health care system are not new, as a May 18th interim report by the VA Office of Inspector General makes clear, noting that since 2005 it has issued 18 reports on a local and national level identifying scheduling problems leading to long wait times and negative effects on veterans’ care. In 2010, the VA even established an Office of Specialty Care Transformation in the Office of Specialty Care Services to address veterans receiving “fragmented care and services, long wait times, and unaccepted [sic] delays,” according to that agency’s Website.

To be fair, it was widely reported this past week that long wait times have become “the norm” across the American health care system. Still, thousands of veterans are likely to have suffered, even in some cases died, because of the protracted wait times at Veterans Health Administration facilities.  Read the rest of this entry ?

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