Posts Tagged ‘Nursing’

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AJN EIC Talks Priorities With Leaders of Critical Care Nurses Organization

May 26, 2015
Karen McQuillan and Teri Lynn Kiss

AACN president-elect Karen McQuillan (left) and president Teri Lynn Kiss

By Shawn Kennedy, AJN editor-in-chief

Last week at the American Association of Critical-Care Nurses (AACN) annual meeting (see this post), I interviewed the association’s president, Teri Lynn Kiss, or “TK,” and the current president-elect, Karen McQuillan, who will officially take office after this month. After days of rushing from session to session (and there must be 300+ sessions to choose from) and wandering through exhibits, I always enjoy sitting down with leaders of this organization and hearing what they think is important in critical care nursing.

Teri Lynn Kiss, MS, MSSW, RN, CNML, CMSRN, director of Medical Unit-2South and case management services at Alaska-based Fairbanks Memorial Hospital, has led this growing organization of over 104,000 members for the last year. I asked her what she felt she’d accomplished. She said that one of the most valuable things the association had done in the past year was to provide clear and credible information about Ebola to its members, the health care community, and to policy makers in Washington. She also believes the association’s work on creating healthy work environments is important not just for nurses but will translate to better care for patients. Her presidency, she said, enabled her to fulfill her own personal mission of service to others—one she will continue with the association in different capacities.

Karen McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, a clinical nurse specialist at R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, announced that her theme would be “Courageous Care.” As she noted in her keynote address, “For us as nurses, courageous care means doing what is necessary to provide the best possible care for our patients and their families. Period.”

But you can listen to them speak for themselves in this podcast recording of our conversation.

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AJN Collections of Note: From Women’s Health Issues to Assessment Tools for Older Adults

May 18, 2015

By Jacob Molyneux, senior editor

'Nuff Said by ElektraCute / Elektra Noelani Fisher, via Flickr.

Elektra Noelani Fisher/ Flickr

It’s easy to miss, but there’s a tab at the top of the AJN home page that will take you to our collections page. There you can delve more deeply into a wide range of topics—and find many options for obtaining continuing education credits in the process.

For example, you’ll find a collection of recent continuing education (CE) feature articles devoted to women’s health issues, such as menopausal hormone therapy, cardiovascular disease prevention for women, and issues faced by young women who are BRCA positive.

The patient population in the U.S. continues to age. To gain confidence in meeting the needs of these patients, nurses can consult our practical collection of articles and videos devoted to the use of evidence-based geriatric assessment tools and best practices.

For the more creative side of nursing, we have a collection of 20 visual works and poems from our Art of Nursing column.

For those concerned with potential legal issues, it’s a good idea to have a look at the three CE articles from our Legal Clinic column on protecting your nursing license.

For would-be authors and those interested in applying knowledge to practice more effectively, there are step-by-step series on conducting a systematic review and on how nurses can implement evidence-based practice at their institutions. Read the rest of this entry ?

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Florence Nightingale: The Crucial Skill We Forget to Mention

May 13, 2015

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements that benefited the health of populations globally. She was our first nursing theorist, defining an environmental model of health care still used today.

But you are probably aware of all of this. Florence’s contributions to nursing and health are well known. What often gets left out though, and is of great importance to the history of nursing and how we practice today, is that Florence Nightingale was a writer.

In fact, Florence was a prolific writer. She published hundreds of articles and books, along with letters and editorials, pamphlets and briefs. If she lived today, I’m sure we’d be reading her regularly on the op-ed pages of the New York Times.

Suppose Florence hadn’t been a writer? Think about it . . . what would we know of her theories without Notes on Nursing? What would have been lost if she hadn’t written about her work in epidemiology, her research on hospital design, her efforts to improve sanitation and lower rates of infection? It’s incalculable.

But all this wasn’t lost—because, along with all her other wisdom, she was wise enough to understand the importance of communicating through writing what nurses do.

Today nurses continue to do work that has a major impact on health care and patient outcomes. But how much of that is getting lost because nurses don’t think of themselves as writers, because they don’t see writing as a part of what nurses do?

I worked with a group of nurses at a medical center here in New York to help them write and publish articles about the quality improvement projects they had completed. I was amazed by the work they’d done—work that had changed patient outcomes, lowered readmission rates, and improved their own working conditions. Patients discharged from the transplant unit were now going home with more confidence and less fear. Patients with congestive heart failure were able to better self-manage their care, and thus stay home with their families instead of being readmitted to the hospital again and again. Fewer mothers were having C-sections because the OB staff were working as a more cohesive interprofessional team.

The issues they were addressing aren’t unusual. Transplant staff everywhere are struggling with how to prepare their patients for discharge when the hospital stay has grown so much shorter and their needs continue to be so great. I’m sure each of you have stories of poor teamwork that has negatively affected patient care. And there isn’t a hospital in the country that isn’t trying to get their readmission rates down—with efforts to do so placed on the already overburdened shoulders of its nurses. Read the rest of this entry ?

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A Found Poem For Nurses Week

May 11, 2015
Badruddeen, via Flickr

Badruddeen, via Flickr

The poem below, originally published in our May 2005 issue, is by Veneta Masson, MA, RN. It’s a “found poem,” a form of poetry in which the poet assembles phrases selected from a source or sources. The lines here come “from actual posts to an Internet bulletin board,” but they could as easily be comments on AJN‘s Facebook page! The author is a nurse and writer living in Washington, DC (more about her work can be found here).—Jacob Molyneux, senior editor

Nurses Week—What Did You Get?
Hi, everyone! Just curious to see what you received for Nurses Week.

Denim shirts with the company logo

Swiss Army–type knives with fourteen blades

Carnations in dollar-shop vases

One wilted rose

Soap on a rope

I think I’m worth more than this

A live band at the Holiday Inn

A potato bar luncheon

If you weren’t there, you got nada

Nothing

Not a thing

A PA announcement thanking the nurses

We dug out our caps & wore them all day
our VP of Nursing came to the unit and stayed for an hour
we sat with her & shared our stories of why we went into nursing

We got pizza one day (if you were there) and ice cream one day (if you were there)

Rolos, Skittles and M&Ms—give me the tools to do my job
instead of tote bags and candy

A drawing for some pretty cool prizes—movies, massages, a month off call

A bonus

We got to work overtime!

I presented my findings to the Executive Team and found out Tuesday
that they had approved another nurse . . . the best thing I   could have gotten

One of my patients agreed to an interview with a local paper
and our story made the front page

Read the rest of this entry ?

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The Borders of Loss: An Early First in One Nurse’s Career

May 8, 2015

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is hers.

Peds Ward (2008), charcoal, graphite, flash, and acrylic. By Julianna Paradisi

Peds Ward (2008)/charcoal, graphite, flash, and acrylic/by Julianna Paradisi

Working in oncology, the topic of whether it’s crossing a boundary for nurses to attend the funeral of their patients comes up. Sometimes, however, we’re carried across that boundary by our heartstrings. The first patient funeral I attended was that of my first patient.

During Jack’s short life, he was the first assignment of many a new nurse on the pediatric unit where I was hired as a newly graduated nurse. He had lived in the hospital his entire life.

Jack was nearly ten months old when we met. Born with a congenital illness requiring multiple surgeries, he failed to thrive. A nasogastric tube snaked through his nose into his stomach so he could conserve the calories burned eating from a bottle or spoon. As Jack’s nurse, I mastered the skill of nasogastric tube feedings.

Most parents bond with their chronically ill babies, but it takes a big commitment on their part. Babies like Jack do not look like the pictures of healthy babies in magazines. They are cloistered in an isolette and connected to machines by feedings tubes and IV pumps. Weeks go by before they can be held.

Jack’s mother had all but abandoned him, a phenomenon sometimes occurring when children begin life with extended hospital stays. Susceptible mothers simply stop coming to visit. Phones calls to Jack’s mother were rarely returned; if they were, she vaguely promised a date and time for visits, but rarely showed.

Occasionally, a caseworker would locate her, and explain that Jack would be put into foster care for abandonment. This would prompt a string of visits. She’d bring a toy, and talk about taking Jack home. She learned to feed him by holding a 60 cc syringe skyward as formula trickled through the tube taped to the side of her baby’s face, and into his stomach. I wonder if she wished she could simply hold Jack as he bottle-fed, the two of them gazing into each other’s eyes, the way mothers expect to do?

But she was young; it was too much for her. After a few visits, she’d disappear again. In her defense, no other family visited in her absence—a clue to her lack of social support.

In this manner, Jack became the “child” of the pediatric nurses, raised by a tribe of women. We took turns caring for him. Day shift nurses bathed him, dressed him in clothing they bought, and stimulated Jack’s mind with brightly colored toys that rattled or squeaked. Night shift nurses bathed him again, dressed him in footed fleece pajamas we bought, and read bedtime stories while rocking Jack to sleep. He loved music and singsong rhymes. His dark eyes fought to stay open in his pale face until defeated by sleep.

Attempts at feeding Jack met with resistance. The effect of long-term use of an NG tube was Jack’s aversion to putting anything in his mouth, including food. To maintain nutrition, his doctors were forced to surgically insert a gastric tube into his belly. Bolus feedings caused Jack to vomit, so they were converted to continuous drip. Clamped to an IV pole, a feeding pump followed Jack wherever he went, down the pediatric unit halls.

Jack never gained enough muscle strength to learn to walk. At the nurses’ station he watched us work, seated in a walker on wheels he was never strong enough to move on his own. Often, he was sick.

At Christmas, Jack’s room was a kaleidoscope of gifts. Every pediatric nurse with young children brought them to visit, bearing gifts they’d wrapped themselves: “For baby Jack, spending Christmas in the hospital.” For many, it was their first opportunity for empathy.

Time went by, and no one claimed Jack. His condition stabilized, he began to gain weight, and discussions about his discharge began. None of us could bear the thought of Jack living with strangers in a home for medically fragile children, away from us, his family.

Not surprisingly, a nurse stepped up. She decided to become Jack’s foster mother. She began the rigorous process required by the state. She decorated a room for Jack. Read the rest of this entry ?

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Cochrane Reviews: An Oft-Overlooked Evidence Source for Nurses at the Bedside

May 1, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

“Research holding the torch of knowledge” (1896) by Olin Levi Warner. Library of Congress, Thomas Jefferson Building, Washington, D.C./Photo by Carol Highsmith, via Wikipedia

Long ago, in an ICU far away, I picked up the habit of saying, during rounds, “Well, you know, research suggests the practice…” I have trouble remembering who taught me this tactic, but it has always been a highly effective way of advocating for my patients.

The eyes of doctors, never ones to be silenced by a nurse who reads research, usually light up at the challenge.

I’ll admit that, for a while, many of my conversational citations came from ‘clinical pearls’ or tidbits I read from certifying organizations via social media. While my knowledge was based on credible sources, my analysis was topical, at best.

Then I started graduate school. Although my program isn’t a clinical one, the need to seek out evidence for class assignments intensified my practice of trying to apply research evidence at the bedside.

It’s tricky to find and discuss credible research as a bedside nurse. Services like Lexicomp and UpToDate, which most hospitals hold subscriptions to, compile current research for clinician use and provide comprehensive information that’s far more credible than Wikipedia. But they’re exhaustive and often require a pretty hefty chunk of time to really analyze and understand. Printing out a 37-page document to hand to an attending on rounds isn’t a practice I’d recommend.

So how do we get reliable, evidence-based information efficiently when it’s needed? It wasn’t until deep into grad school that I started to realize that Cochrane Reviews were sometimes the best bedside research translator out there. The Cochrane Collaboration is an international, nonprofit organization that performs systematic reviews on peer-reviewed journal articles. The reviews are considered, by my professors at least, often the best form of evidence. Short summaries and abstracts are free to all users and are easy to find via PubMed and print. (Full access is subscription based, at least in the U.S.)

‘Sedation vacations': yes, no, maybe? A topic I’ve always loved to use my research line on is the practice of ‘sedation vacations.’ When patients are deathly ill and ventilated, their lives depend on the use of sedatives. However, studies have linked lengthy use of sedative agents to serious complications—drug bioaccumulation, postextubation delirium, decreased quality of life, and adverse events, to name a few. Hence, the daily sedation vacation was born.

Most ICUs these days require a daily sedation vacation for intubated, sedated patients. There’s little doubt that patients are often oversedated, and the practice of pausing the sedation to see if they wake up and then readjusting their sedation according to policy can cut excess use. Some units allow nurses to perform the practice without input from an attending physician. Others rely on a case-by-case method. I’ve worked in both, and in both have said the words, “You know, research calls for daily sedation vacations, and this patient meets the criteria. Should I move forward?”

In most such instances, a sedation vacation was authorized for the patient, and sometimes a discussion of current practices was stimulated by my reference to research. I’d always thought that sedation vacations were a validated, proven, evidence-based practice, and had always advocated for them when my patients met clinical criteria. Read the rest of this entry ?

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A Nurse Ethicist’s Analysis of a Recent Nursing Home Sexual Consent Case

April 21, 2015

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scales of justice/by waferboard, via Flickr

scales of justice/by waferboard, via Flickr

An 78-year-old retired state legislator and farmer in Iowa is currently on trial for having sex with his wife, who has severe Alzheimer’s disease, in her shared room in a nursing home. He has been charged with rape.

The case highlights two ethical questions or conflicts:

  • When is protection needed and when is it intrusive and harmful?
  • What are the mental abilities required to consent to sex?

Consenting to sex is not the same as informed consent for treatment. In treatment, a clinician obtains consent to act on (treat) the patient in a way that will benefit the patient. By contrast, proper consent for sex is mutual and both parties benefit.

To extend the comparison: a patient’s decision to consent to treatment is generally made by balancing the benefits, harms, and risks to the individual patient. The decision to engage in sex often involves consideration of another’s satisfaction—it is not unknown for one spouse to agree to sex to please the other, even though he or she would not otherwise want sexual contact.

Another complicating factor in the question of sexual consent is that gender matters. While the social ideal is to consider sex consensual, societal understanding often tilts toward considering the male as the aggressor and the female as the gatekeeper. In addition, we often assume that power, especially physical power, is not equal in sexual relations.

Decision-making capacity. A patient must have decision-making capacity to give valid consent for treatment. Such capacity is not considered a blanket characteristic, but is assessed in relation to the risks, benefits, and complexity of the specific treatment decision.

The assessment of capacity in relation to the specific decision can also be applied to consent for sex. Unfortunately, a proper level of mental ability needed to confer capacity for sex is not clearly established and can vary in relation to circumstances. The woman in this case had severe mental impairment, but that does not necessarily mean that she lacked the capacity to consent to sex with her husband. Differences of opinion regarding the level needed for her valid consent are illustrated in the following summary of an exchange from the trial included in a recent New York Times article:

Mr. Yunek [the defense attorney] asked Dr. Brady [the center’s physician] if “Donna is happy to see Henry — hugs, smiles, they hold hands, they talk — would that indicate that she is in fact capable at that point of understanding the affection with Henry?” Dr. Brady said no, calling that a “primal response” not indicative of the ability to make informed decisions.

The defense attorney is implying that her actions indicate desire and willingness and that this is a sufficient level of mental ability for valid consent; the physician, on the other hand, suggests that such “primal responses” are not sufficient to indicate a level of mental ability. This is not a disagreement about what her ability is, but about what is the proper degree and type of ability needed to consent. It’s not so much a disagreement about facts as about values.

One approach to establishing whether sexual contact between these two older adults was appropriate is to examine each relevant factor. These include the following: Read the rest of this entry ?

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