Posts Tagged ‘Nursing’


Imagery: A Safe, Simple Practice Available to All Nurses

November 23, 2015

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

by Ramon Peco/via Flickr

by Ramon Peco/via Flickr

“In our quest to keep up with the latest medical advances, we often forget that the healing art of imagery is available to each of us,” writes nurse practitioner Laurie Kubes in this month’s AJN. In “Imagery for Self-Healing and Integrative Nursing Practice,” Kubes explores some of the evidence supporting this technique and illustrates how it can enhance both patient care and our own self-care.

Imagery builds upon the quiet reassurance and support that we routinely provide to patients in our efforts to make them comfortable and relaxed. The more deliberate practice of imagery engages the power of imagination for deeper relaxation and a potentially more healing experience. And all we need in order to do this, as Kubes notes, is an open mind, a basic knowledge of the practice, and time to dedicate to it.
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Recognizing and Managing Late or Long-Term Complications in Adult Allo-HSCT Survivors

November 17, 2015

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

Everybody, myself included, thought he was going to die. Another nurse on another floor had administered his stem cell transplant a few weeks prior, but as his primary nurse I was now in charge of managing its aftereffects.

Ben (not his real name, and some details have been changed) was one of the many young patients I’d cared for who suffered from a violent course of complications following allogeneic hematopoietic stem cell transplant (allo-HSCT). Intractable diarrhea and skin sloughing led to graft-versus-host-disease’s usual sequelae: wounds, drug-resistant infections, looming sepsis. The walls of his bladder, scarred and irritated by the myriad of toxic drugs he’d been given, bled. One day, while I slept at home between night shifts, he lost so much blood that they rushed him to the OR. The treatment—never before performed—stopped the bleeding. But it left him in excruciating, around-the-clock pain.

Between regular doses of Dilaudid and PCA pump pushes, he cried out to me, “I can’t do this. I don’t want this anymore.” I couldn’t blame him—his cancer fight raged on endlessly. Watching his boyishly handsome face grimace with so much pain, I remembered other young allo-HSCT patients’ faces, some of them peaceful only in the postmortem.

As it turned out, Ben survived his ICU stay. I heard about his discharge to the bone marrow transplant unit after I returned from a vacation. I lost touch with him, in the way that most ICU nurses lose touch with their patients (as though the unit is earth and the floors are outer planets, foreign and unknown, impossible to visit). I hope he’s home now, though, and a part of me believes he is—living, joining the growing population of allo-HSCT survivors.

As I read Kara Mosesso’s November CE article in AJN,Adverse Late and Long-Term Treatment Effects in Adult Allogeneic Hematopoietic Stem Cell Transplant Survivors (the first of several articles from Memorial Sloan Kettering Cancer Center about cancer survivorship care), I thought of Ben and was glad to be reminded that people like him do survive. While the current population of allo-HSCT survivors is fairly small, it’s growing, and by 2020 may reach around half a million worldwide.

It seems that all nurses—whether caring for allo-HSCT patients in the acute phase, like me, or in the chronic phase in an outpatient setting, must become familiar with the multifaceted long-term care of this population of patients. The table below, from the article, lists various late and long-term allo-HSCT treatment effects and their risk factors. Visit the article link above for more context, sources, and more.

Late and Long-Term Allo-HSCT Effects

(click to enlarge)

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Check my Conduct: Committing to a Better Way to Act with Colleagues

November 10, 2015

Christina Purpora, PhD, RN, is an assistant professor at the University of San Francisco School of Nursing and Health Professions. She has 30 years of hospital nursing experience.

Kindness quotation. Photo by Steve Robbins/Flickr

by Steve Robbins/Flickr Creative Commons

I wonder whether any of my nurse colleagues can recall having said or done something less than kind to a peer at work. Looking back over 30 years of nursing, I am aware of times that I could have been kinder. Not too long ago, the way that Emily—a less experienced nurse who was new to our unit—conducted herself in response to my reaction to her request for help taught me that I ought to consider a better way to act.

Request for Help
I was walking out of a patient’s room when Emily greeted me by name, then said, “Ms. S has one of the new IV pumps and the alarm keeps going off. I can’t figure out what’s wrong. Can you please help me?”

I felt annoyed at her for making one more demand on my time when I could barely keep up with my current assignment. Rolling my eyes, I curtly replied, “Emily, I think you can handle it. You had the in-service like everybody else.”

Seemingly unrattled by my terse retort, Emily stood her ground. “Yes,” she told me, “I used the troubleshooting tips I learned. But there’s still a problem. I’m concerned about Ms. S. and I’m uncomfortable that I’ve missed something. I think this is a safety issue.”

I recognized Emily’s use of the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS “CUS” words: Concern, Uncomfortable, and Safety, a tool designed to clearly communicate that a patient is at risk for harm when a first attempt to get a safety threat across to a member of the health care team doesn’t work. The initial irritation I’d felt turned to embarrassment, and I answered Emily’s explanation with, “Okay, let’s go see Ms. S.”

I followed Emily to her patient’s room where, together, we figured out the problem. Ms. S. was unharmed. Outside of the patient’s room, Emily thanked me and asked what she could do for me in exchange for the time I’d spent helping her. When nothing came to mind, she reiterated, “Please let me know if something comes up, because I’d happy to help you.”

My embarrassment grew in the presence of Emily’s team approach. With the potential safety threat averted, we carried on with our respective patient care responsibilities.

Reflect and Amend
For the rest of the shift, I couldn’t stop thinking about my outburst, which stood in glaring contrast to Emily’s professionalism. When I realized that a patient could have been harmed while I was resisting my peer’s call for help, I was horrified. I wanted to apologize to Emily. Read the rest of this entry ?


Final Connection: An ICU Nurse Revises Her Feelings About Cell Phones

November 2, 2015
Illustration by Denny Bond. All rights reserved.

Illustration by Denny Bond. All rights reserved.

Many of us have a love-hate relationship to smartphones, and each person (and generation) draws the line in the sand between invasiveness and usefulness in a different place. Cynthia Stock, the critical care nurse who wrote the Reflections essay in the November issue of AJN, “Final Connection,” starts her brief and moving story with honesty about such matters:

On Monday, if you had asked me how I feel about cell phones, I would have come up with this: I hate to listen to the drone of conversation coming from the person next to me on the treadmill at the gym. I don’t care about trouble with the HOA. I don’t care about a son who can’t decide on a career as a director or an actor. I work out to smooth the kinks in my soul from a job that requires me to navigate a relationship with life and death.

Today, ask me how I feel about cell phones. . . .

A good essay or story often centers around a reversal of some sort. What the protagonist believed may not be so true after all, or may be more complicated than first thought. As you can probably guess, in the course of the essay the author finds that she must revise her opinion of cell phones. Time and the pressures of geographical distance are sometimes felt more urgently in the ICU.

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Medical Marijuana: A Nurse’s Primer

October 27, 2015

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

Illustration by J Paradisi.

Illustration by J Paradisi.

Since I wrote “Marijuana Legalization and Potential Workplace Pitfalls for Nurses Who Partake” in July 2014, a few things have changed. For one, Measure 91 passed in Oregon, making it the third state to legalize recreational marijuana. Medical marijuana, however, has been legal since 1998 in Oregon, currently one of 23 states nationwide.

Also, when I wrote the earlier post, I was an infusion nurse—now, as an oncology nurse navigator, I’m asked about medical marijuana often, and I need to know the answers, as do all nurses practicing in states with legalized medical marijuana. Nurses working in oncology, emergency departments, pain management, infusion clinics, and pediatrics have high exposure to patients with medical marijuana cards.

By ‘knowledge,’ I don’t mean knowing everything, but knowing where to find what you need to know. In Oregon, for example, information about medical marijuana is found at the Oregon Medical Marijuana Program (OMMP). The Web site includes qualifying diagnoses, a downloadable handbook, an application packet with instructions, and a list of approved dispensaries. While retail issues surrounding recreational marijuana are still being sorted out, medical dispensaries in Oregon sell recreational marijuana to clients aged 21 and older.

Patients using medical marijuana are as diverse as the illnesses and side effects they use it to treat: PTSD, seizure disorders, chronic pain, inflammatory illness, and of course the adverse effects of chemotherapy, including nausea and vomiting, anxiety, sleeplessness, anorexia, and hot flashes associated with endocrine suppression therapy. Read the rest of this entry ?


Catheter Ablation of Atrial Fibrillation: Essentials for Nurses

October 23, 2015

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

A postablation case was a rarity for me, even as an experienced ICU nurse. While floating to the cardiac ICU one day, I received a patient from the cath lab who had just undergone the procedure for recurrent atrial fibrillation.

My colleagues, experienced in electrophysiology care, gave me a heads up—“Just watch her rhythm. That’s the most important thing.” But no one could provide a standard protocol for me to follow in her care. While I had the usual critical care protocol for monitoring patients, and the orders given to me for this patient, before she arrived I did a little online searching to determine how to tailor my care for her needs.

The catheter ablation procedure involves electrical ablation of tissue around the circumference of the pulmonary veins, the most common site for atrial fibrillation triggers (A). Lesions are created through the use of an irrigated radiofrequency ablation catheter (B). Illustration by Anne Rains.

The catheter ablation procedure involves electrical ablation of tissue around the circumference of the pulmonary veins, the most common site for atrial fibrillation triggers (A). Lesions are created through the use of an irrigated radiofrequency ablation catheter (B). Illustration by Anne Rains.

I set my patient’s alarms, and myself, on high alert for arrhythmias and treated my patient’s insertion site as I would a cardiac catheterization site—monitoring it for bleeding, signs of hematoma, or infection. But a protocol for care would have been welcome, as this cardiac electrophysiology procedure can often lead to unexpected complications that require immediate action—ones you might not originally think of, like a stroke or flash pulmonary edema.

The lack of standardized care guidelines for nurses after an atrial ablation is a good reason to read one of AJN‘s October CE articles, “Catheter Ablation of Atrial Fibrillation.” Coauthor Linda Hoke discusses what to expect, how to prepare, and complications to avoid when caring for patients having this procedure done. Read the rest of this entry ?


One Nurse’s Ode to Fragility

October 7, 2015
Illustration by Lisa Dietrich for AJN.

Illustration by Lisa Dietrich for AJN.

For nurses, the world outside work may from time to time seem as fragile and tenuous as the health of patients. Natural disasters threaten homes, illnesses afflict family members, the reminders of impermanence become too insistent. This month’s Reflections essay, “The Robin,” explores such emotional terrain with sensitivity and honesty.

Gentle warning: This is not an essay that neatly delivers a pearl of take-home wisdom at the end. But that’s what we liked about it. Sometimes the best we can do is hang in there and pay close attention. And, if we’re able and willing, write about it. Here are the opening few paragraphs of this short essay: Read the rest of this entry ?


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