Posts Tagged ‘Nursing’


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 ?


Tragic Plane Crash, Truvada Concerns, Changing Infection Rates: AIDS/HIV Issues in the News

July 21, 2014

Truvada / via Wikimedia Commons

By Jacob Molyneux, AJN senior editor

There have been a number of recent high-profile news stories as well as some notable new research related to HIV/AIDS and its treatment and prevention.

First, AJN would like to add its voice to those expressing heartfelt regret at the deaths of a number of prominent and widely respected HIV advocates and researchers in the Malaysia Airlines jet that appears to have been shot down over Ukraine last week.

The Truvada controversy. Those who who died on the plane had been heading to an international conference in Melbourne, Australia, where one of the hot topics under discussion would be the pros and cons of the continuing expansion of the use of the antiretroviral drug Truvada beyond the treatment of existing HIV infection to long-term prophylactic use by the uninfected.

The topic is particularly timely here in New York where Governor Cuomo last week announced that New York State would make Truvada a centerpiece of its HIV-prevention strategy. The drug, taken every day, is more than 90% effective in preventing infection, but, as an NPR story recently described, a number of experts have raised concerns about widespread long-term use of Truvada for HIV prevention, noting

  • serious potential side effects of Truvada.
  • the $1,300/a month cost of the drug.
  • the reduction in the use of condoms by some of those taking Truvada, which could lead to higher rates of other sexually transmitted diseases.

Read the rest of this entry ?


The Ethics of a Nurse’s Refusal to Force-Feed Guantanamo Hunger-Strikers

July 18, 2014

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

The Miami Herald reported this week that a U.S. Navy nurse and officer refused to take part in force-feeding hunger-striking detainees at Guantanamo Bay.

There’s much we still don’t know about this story, but the force-feeding of prisoners at Guantanamo has been a contentious issue for some time. The practice has been compared by some to torture, and ethicists in the medical literature have urged the physicians involved to refuse to participate, while the U.S. government and President Barack Obama defend the practice on humanitarian grounds of preventing the deaths of the detainees.

Whether or not one feels that nurse participation in the force-feeding is justified, this officer, whose identity has not been released, appears to deserve the profession’s praise for taking a moral stand in an extraordinarily difficult circumstance. All nurses have the right of conscientious objection, of refusing to participate in practices that they find morally objectionable—assisting in abortions is another practice that some nurses have opted out of on moral grounds—and officers in the U.S. armed services are bound to consider the legality and morality of orders they carry out.

Much is at stake for this nurse. Not only do officers risk their careers when refusing an order on moral grounds, but they must breach a sacred principle of effective military operation: obedience to the chain of command except by an officer in extraordinary circumstances.

Further, the officer deciding to refuse an order must make this determination alone and accept severe consequences if the further consideration of the higher chain of command, the courts, or history does not support her or his assessment. Read the rest of this entry ?


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 ?


A Child’s Story, or Why She Became a Nurse

June 30, 2014
Illustration by Anne Horst. All rights reserved.

Illustration by Anne Horst. All rights reserved.

Day in and day out, a child lives in fear. Her stomach often twists in knots of pain for hours before the pain fades away. The doctors can find no medical reason for the pain. Her mother angrily accuses her of faking it, of being more trouble than she’s worth. The child is often told how stupid she is. Though her father sometimes protects her, at times his medication doesn’t work and he transforms from a caring protective father into a crazed abusive one. Even when the child is unharmed, she stays in a constant state of panic as soon as she walks in her front door.

That’s the opening paragraph of this month’s Reflections essay. “A Child’s Story” is a tough read. It’s about child abuse, helplessness, the will to endure, about those who help and those who don’t. In the end, it’s a hopeful story, despite everything. The story is also a reminder of just how much the decision to become a nurse means to some people. Here’s a brief excerpt, but we hope you’ll read the entire short essay (click on the article title above).—Jacob Molyneux, senior editor


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Providing Culturally Sensitive Care: It Takes More Than Knowledge

June 25, 2014

By Karen Roush, AJN clinical managing editor. Photos by the author.

DSC_0136One Saturday a few weeks ago I grabbed my camera and headed out to spend the afternoon taking photographs around the city. I ended up wandering around the streets of Chinatown, photographing the street life—the rows of fresh fish on piles of ice, the colorful patterns of vegetables in crates outside shops, old women in variations of plaid and flowered housedresses lined up on a bench, children scattering clusters of pigeons.

Eventually I happened upon a vigorous and highly skilled game of handball in a park. The competitors were predominately young Asian men, though there were a few Hispanic men playing too. Standing next to me, a young man was telling his friend about a clever way a mutual friend had devised to get out of paying a parking ticket. If you live in New York, or almost any big city, you will earn yourself a parking ticket or two at some point. Intrigued by this man’s idea, I asked him if it actually worked and he assured me it did. Then he rolled his eyes and said, “Oh no, I shouldn’t have said anything. Once the white people know, that’s the end of it!” Read the rest of this entry ?


Life Drawing

June 11, 2014

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

by julianna paradisi - all rights reserved

by julianna paradisi – all rights reserved

With one double-gloved hand I pull the unblemished skin of her buttock laterally. Holding a syringe in the other, I pierce the large muscle with a needle, injecting acid-yellow methotrexate deep inside. Its purpose is to deplete the tiny, nonviable embryo inside her of folic acid, preventing its growth, a rupture, and potential harm to the woman.

Usually I administer chemotherapy to stop the life cycle of tumors, not the rapidly dividing cells of an embryo that missed its mark, mistakenly lodged in a fallopian tube instead of finding its way into her uterus where both of them could have been safe. Ectopic, it sacrificed viability, and threatens the life of its host.

Prone on the stretcher after the twin injections, she cries quietly. I hand her a box of tissues. She blows her nose. I try to think of something comforting to say, something that lets her know this is sad for me too. Resources are limited, so the powers that be decided that the safety provided by a chemotherapy-certified nurse outweighs the education, skill, and emotional support provided by an obstetrics nurse. Most likely they’re right, but I feel badly that I know more about the mechanism of methotrexate than about resources for a woman in this circumstance—a reminder that being a nurse takes more than the ability to give an injection.

Later that evening, the patient discharged home, my shift ended, I carry tools of my other trade (charcoal, paper, and pencils) to a life drawing studio. I’m seeking a few hours of quiet meditation in the gestural rhythms of transferring life to paper. Read the rest of this entry ?


Preventing the Next Elliot Rodger: A Call to Push for Solutions, Despite the Obstacles

June 6, 2014

Donna Sabella, PhD, MSN, PMHNP-BC, is a mental health nurse and assistant clinical professor and director of global studies at the Drexel University College of Nursing and Health Professions in Philadelphia. She also coordinates the AJN column Mental Health Matters.

screen capture Elliot RodgerWho’s next? On May 23rd, we were once again forced to witness a scene of senseless violence. Elliot Rodger  stabbed to death three men in his apartment, after which he gunned down two women and a man. Aside from the six murders, he injured 13 people, shooting some of them and hitting others with his car, before apparently shooting himself in his car.

All of this carnage from one lonely, angry, troubled 22-year-old raised in a world of relative privilege—we feel for the victims and their families, and we feel for the Rodger family as well, who appear to have done everything they could to help their son find help for his mental instability and prevent this latest tragedy from unfolding.

While perhaps comforting to family and friends of the slain, our grief and prayers for all involved and our dismay at the other horrific events preceding this one mean little when it comes to preventing the attacks of the next Elliot Rodger.

But I believe we are wrong if we think our outrage and sadness are all we have to offer. As we wring our hands and wonder what could have been done to prevent this, some answers seem clear. Elliot Rodger, like many of those on the list that he now joins, did not suddenly become what he was on the day he carried out his plans. Read the rest of this entry ?


AJN June Issue: Genomic Advances in CF, LGBT Care Disparities, Denying Smokers Jobs, More

May 29, 2014

AJN0614.Cover.OnlineAJN’s June issue is now available on our Web site. Here’s a selection of what not to miss.

The newborn featured on our cover this month is wrapped in a blanket decorated with a string of letters—better known as genetic code. Today, all newborns in the United States are screened for various inherited and congenital conditions, but the use of genomic sequencing at birth could provide information beyond what current screen­ing already provides—health information to go in their medical records for use in detecting and managing disease.

Cystic fibrosis (CF) is one disorder that has been affected by recent developments in the field of genetics. The discovery of the CF gene in 1989, along with advances in molecular genet­ics, made it possible to screen for CF through DNA testing. Early diagnosis and prompt treat­ment of CF has been shown to improve patients’ overall health and survival. Genetic advances have also led to the development of promising drugs to treat CF. For more on the impact of genomic advances on diagnosis and treatment, and implications for nursing practice, read, Genomic Breakthroughs in the Diagnosis and Treatment of Cystic Fibrosis,” and  earn 2.3 CE credits by taking the test that follows the article.

LGBT health care disparities. The health care disparities that affect people who are lesbian, gay, bisexual, or transgender (LGBT) are closely tied to sexual and social stigma that linger to this day. Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: An Overview of Best Practices,” explores LGBT health issues and health care disparities, and offers recommendations for best practices based on current evidence and standards of care. This CE feature offers 2.6 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with one of the authors (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

New installment on systematic reviews. Last month, our new series from the Joanna Briggs Institute on writing a systematic review provided details how to develop a comprehensive search strategy. Now, the fourth installment of the series, Study Selection and Critical Appraisal (abstract only; log-in required), focuses on these crucial steps in the process of conducting a systematic review. Read the rest of this entry ?


Critical Care Nurses: Heading Home to ‘Focus the Flame’

May 27, 2014

By Shawn Kennedy, AJN editor-in-chief

AACN president-elect Teri Lynn Kiss

AACN president-elect Teri Lynn Kiss

The American Association of Critical-Care Nurses (AACN) National Teaching Institute ended last Thursday, just in time to get folks home for Memorial Day weekend. Last week, my post was about the opening session and awards. Here are some more highlights from the rest of the week:

Concurrent sessions were plentiful—too many to choose from. My top two favorites were one on transfusing blood and blood products and another on managing pain, agitation, and delirium. New this year were sessions related to health care financing, a nod to the fact that all nurses need to be cognizant of the cost of care. My other “must attends” were the poster sessions—these are largely by up-and-coming researchers and teams doing innovative projects.

current AACN president Vicki Good

current AACN president Vicki Good

Handling conflicts with colleagues. A “super session” by Christine Cashen, a professional speaker, had everyone on their feet in a standing ovation. Extremely funny and with a clear message about handling conflict with colleagues (a very big issue in nursing, as we know), Cashen was a huge hit. Several attendees sitting near me kept a running tally of coworkers who fit Cashen’s descriptions of people who communicate in a dysfunctional way. While the content was not necessarily new, her framing of it was refreshing and hit home for many. A few of her messages that resonated particularly well:

• We need to ‘BOOGIE’ more in the workplace, with BOOGIE being an acronym for “Be Outstanding Or Get Involved Elsewhere”—a message for those who drag others down with their lack of commitment and energy to the team effort.
• Communicate clearly to the correct person. “Say what you mean. Mean what you say. Don’t be mean when you say it.”

Read the rest of this entry ?


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