Posts Tagged ‘Nursing’

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A Lasting Gift for a Nurse’s Holiday Shifts and Lost Family Time

December 19, 2014
Illustration by Lisa Dietrich for AJN.

Illustration by Lisa Dietrich for AJN.

As we know, gifts come in many forms, and often are as valuable to the giver as to the receiver. The best ones come at times when we least expect them. Readers will find that the start of AJN‘s December Reflections essay, “A Change of Heart,” describes a frustration that may be familiar to many nurses. In this case, it’s Christmas Day, and a nurse is kept by the urgent demands of her job from spending time with family. She writes:

I’ve been a nurse for more than half of my life . . . I love my career and consider myself blessed to have found my calling. But we all experience times when our long hours and the rigorous demands of this job make us feel that we sacrifice too much of our personal and family time to care for strangers.

The author had planned to be home for Christmas dinner. But, she tells us, “we had four back-to-back emergency CABGs starting at 8 am and stretching long past my scheduled 3 pm end of shift.” The essay develops from there as the hours pass. And then we meet a patient with everything at stake. The author is not the only one in danger of missing Christmas with family, and not just this year but for all the years to come.

We are reminded again and again that nursing has its truly redeeming moments of connection, those reminders that the work you do can be the difference between life and death for a patient. So it happens in this short, engaging essay. We encourage you to click the article title above and give it a read. It’s free, and it might put the various challenges of the holidays into perspective.—Jacob Molyneux, senior editor/blog editor 

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Too Tired to Nurse

December 8, 2014

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr

by patchy patch, via flickr

Just about every nurse I know has been “asked” (or “guilted” or “mandated”) to work an additional shift on top of a grueling one. The worst such experience I ever had was having to work from midnight to 8 am after working a straight week of 4 pm to midnight shifts. I was exhausted, but someone had called in sick, leaving only two RNs and one aide for the 11-bed ED trauma unit.

I was so tired that at one point I found myself falling asleep while I was standing by a patient’s bed charting vital signs. I couldn’t remember the blood pressure reading I had obtained just moments before. It was good luck that I didn’t make an error—and had the good sense to have a colleague double-check medications I was readying (these were the old days, before unit dosing). Read the rest of this entry ?

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Always a Nurse

November 19, 2014

By Janice M. Scully. The author worked in psychiatric nursing for four years before becoming a physician. After 20 years as a physician, she retired to pursue a career as a writer. For more information, click here.

The author's parents

The author’s parents

Nurses have to be resilient and resourceful—Florence Nightingale,  of course, is the template. My mother, Betty, was a smart and practical woman, the oldest of three siblings. She attended nurses’ training in the 1940s while the Second World War raged overseas. I have a photo of her as a young woman just out of high school, dressed in her starched uniform, standing by Binghampton (NY) City Hospital, her alma mater.

According to her, the lives of young nurses back then were not unlike the lives of nuns. After lights out in the dorm, the dorm mother would walk through and shine a light on each bed, as a night nurse on a medical ward at 2 AM might do. But instead of observing for signs of life, dorm mothers were checking to be sure the young female nurses were in their beds. Sometimes they weren’t.

Although the students might not be allowed out at night, they had a great deal of responsibility during the day. Nurses did everything for the sick, even the hospital laundry. They gave bed baths and back rubs in the course of comforting the sick.

During the war, even the most inexperienced nurses had grave responsibilities. When my mother was a new graduate, with few nurses and physicians on the home front, she was placed in charge of a woman’s surgical unit, admitting the fresh post-ops almost single-handedly, taking orders, hanging blood transfusions, managing wounds. A new medication, called penicillin, was available in the hospital, but so expensive that any nurse dropping a vial accidentally, as my mother did, would get severely reprimanded.

My mother had stories. One day a woman admitted for a surgical disorder became suicidal and jumped out of a hospital window, only to return to women’s surgical in a body cast. To my mother, this was a particularly horrifying case.

Her hospital nursing career was short, as were many women’s careers in the aftermath of the war. Though she quit hospital nursing in 1946 when my father returned from the navy—feeding customers in the family restaurant they built together—in a sense, she always took care of people.

Mom ran the kitchen, Dad the bar. Salesmen would follow her around with their clipboard—and I would follow, too, listening to her ordering cans of string beans and pickle slices, cases of chicken.

She had five children within seven years. Our family lived upstairs over the restaurant and my mom balanced both worlds. It wasn’t easy, which is something I appreciate now more than I could when I was a child.

But it seems she never forgot she was a nurse. During my frequent bouts of strep throat, in soft whispers she would confer with the family doctor by phone and, before I knew it, I could hear the glass syringe and needle boiling on the stove in a little metal pan. Then she’d draw up the penicillin from a vial she kept in the refrigerator. I would cringe in my room, waiting for the shot that was sure to come in my backside. But it always made me well, ridding me of my fever and throat pain.

Mom would also give neighbors their prescribed shots of this or that, such as vitamin B12, as if running a sort of mini-clinic in the restaurant kitchen. She volunteered to help a neighbor administer a daily exercise routine prescribed for her infant with Down syndrome. My mother was always, in a sense, a public
health nurse. Read the rest of this entry ?

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A Nurse’s Legal Duty to Discern Potential Harm and Protect Patients

November 7, 2014
Illustration by Janet Hamlin for AJN.

Illustration by Janet Hamlin for AJN.

By Jacob Molyneux, AJN senior editor

The November installment of AJN’s Legal Clinic column by nurse and attorney Edie Brous, “Lessons Learned from Litigation: The Nurse’s Duty to Protect,” describes a case in which nurses were held responsible for not adequately protecting a sedated patient from a sexually predatory physician. The case description begins this way:

NX was a young woman who underwent a laser ablation of genital warts at Cabrini Medical Center in New York City. While still under the effects of general anesthesia, she was transferred to a small, four-bed section of the recovery room. Shortly after her admission to the recovery room, the nurses admitted another patient to a bed two feet away from NX. The curtains were not drawn and there were no patients in the other two beds.

A male surgical resident, Andrea Favara, entered the recovery room wearing Cabrini scrubs and Cabrini identification. Residents were not directly assigned to the recovery room and were seldom called there. The nurses knew all of NX’s physicians but did not know Favara; he wasn’t one of NX’s physicians . . .

The details that follow are disturbing. After describing the case and the failure of nurses to confront this unknown physician or actively monitor his interactions with the patient, Brous sketches the ensuing legal machinations, as well as the ultimate decision of an appeals court. Some of the main take-home points for nurses are as follows: Read the rest of this entry ?

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Presence, Improvisation, Dark Humor: Crucial Skills of a Hospice Nurse

November 3, 2014
Illustration by Pat Kinsella for AJN.

Illustration by Pat Kinsella for AJN.

Here’s the start of “Molly,” the Reflections essay in the November issue of AJN, written by hospice nurse Thom Schwarz.

Late evening, early spring, the peepers not yet trilling. I am in my car, rain streaking the windshield, reading a New Yorker essay about war writing, an ironic distraction from my visiting hospice nursing work.

This is a piece that doesn’t offer any easy answers for the facts of suffering and death. But it does posit a certain consolation in staying present, undaunted, engaged, and resourceful when faced with the power and mystery of each patient’s encounter with impending death.

All Reflections essays are free, so give it a look.—Jacob Molyneux, senior editor 

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At the Intersection of Hospice and Obstetrics, a True Test of Patient-Centered Care

October 22, 2014

By Jacob Molyneux, senior editor

Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks.

Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks.

We’d like to draw attention to a particularly frank and thought-provoking article in the October issue of AJN. “A Transformational Journey Through Life and Death,” written by a perinatal nurse specialist who is also a bioethicist, describes a hospital’s experience in meeting the needs of a patient with two very different, potentially conflicting, medical conditions.

It was a sunny afternoon in mid-October when I first met Renee Noble. I had already heard about her from staff who had given Renee and Heidi Ricks, her friend and doula, a tour of the neonatal ICU and were taken aback when they asked to see the Hospice Inn as well. The nurses knew that Renee had been diagnosed with ovarian cancer, but no one had said anything about it being terminal. Heidi had insisted that after Renee delivered she would need hospice inpatient care. Alarmed, the staff had called me, the perinatal clinical nurse specialist, after Renee and Heidi left.

In addition, this is a patient with strong preferences about her own care, preferences that may be at odds with the more conventional approaches to treatment held by many nurses and physicians. Read the rest of this entry ?

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As Sepsis Awareness Increases and Guidelines Change, Timing Remains Crucial

October 6, 2014

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

stopwatch/wikimedia commons

stopwatch/wikimedia commons

September was Sepsis Awareness Month, but the urgency of the issue didn’t disappear when the month ended. I still remember my first day in the medical intensive care unit (MICU) I’d soon call home. I was shadowing the charge nurse, and an admission had just come in from the ED.

“Here, we need a CVP setup.” A crinkly bag of normal saline and a matching package containing something evidently important were shoved into my hands—a medical football passed to the only open player.

Very quickly, I would learn what a CVP, or central venous pressure, was and to monitor it. I would learn all about sepsis, and septic shock, and the treatment of its devastating process. Multiple organ dysfunction syndrome (MODS) was a primer for my care in this unit, and on my first day off of orientation, I was entrusted with one of its full-blown victims: Septic shock from pneumonia, causing respiratory, renal, and heart failure. Learning to spike a bag of saline for a CVP transducer was just my first step into the vast and complicated land of sepsis management.

This was 2007. Sometimes, as in all hospitals, care was delayed and septic patients sat without timely treatment for hours. Back then, we tubed people, snowed people, and flooded people. Now, after two updates to the Surviving Sepsis Campaign’s guidelines, we sometimes tube them, and sometimes we don’t. We use a lot less sedation, and a lot less fluid.

If you’re not familiar with them, it’s a good time to review the updated guidelines. The Surviving Sepsis Campaign Web site offers everything from exhaustive articles to handy cheat-sheets on how to handle patients from the ED who have sepsis in a manner that complies with updated guidelines. Timely sepsis recognition doesn’t just depend on ED nurses or those in the ICU; every nurse needs to know what to look for, as demonstrated by the case in this AJN article, “Recognizing Sepsis in the Adult Patient” (free until November 1).

Timing remains crucial. In the new guidelines, you’ll find a lot of the same treatment goals and procedures, but a lot more stress on rapid recognition and on doing things quickly and in the right order. Timing is so central that the campaign bundled its guidelines into time segments: 3-hour bundle and 6-hour bundle.

For example, within the first three hours, practitioners must draw blood cultures, determine lactate level, hang broad-spectrum antibiotics, and begin fluid resuscitation with a crystalloid. By the time six hours have passed, 30ml/kg of normal saline must be completed, and if the patient’s mean arterial pressure and urine output don’t meet certain parameters, vasopressor infusion (norepinephrine first, please!) must be started.

Close attention to the effectiveness of these basic measures—diagnosis, antibiotics, resuscitation, and stabilization—is key. Other more complex treatment measures such as mechanical ventilation and renal replacement therapy are addressed, but the focus remains on timing and simplicity in care.

 

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