Posts Tagged ‘Nursing’

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The Blame Game

April 7, 2014

By Jacob Molyneux, senior editor

TheBlameGameIllustrationThe Reflections essay in the April issue of AJN is called “The Blame Game.” It’s by a nurse who finds herself visiting a family member in the hospital during her shift break at the same hospital. In her distress, she gets little relief or reassurance from the harshly judgmental nurse she encounters.

The vividly told episode raises the question: can the act of casting judgment on another person diminish our ability to see these people as complete human beings, whatever their failings? And also this question: what is the proper attitude of nurses toward their patients?

Please give it a read and see what you think. Is this nurse’s attitude an exception, or more common than it should be, as the author suggests? Here’s a brief quote from near the end:

There seems to be a dangerous epidemic of clinicians blaming patients for their health issues. As a nursing student, I saw more and more of this attitude. The health care profession seems to have evolved a culture of accusation and attack against patients, a group we should be empowering and protecting.

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Working Out the Bugs: Old and Alone in the City

March 19, 2014

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is 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 tweets at @12hourRN.

Old Woman Dozing/Nicolas Maes

Old Woman Dozing/Nicolas Maes

At work the other day, after almost seven years as a nurse, I had an experience that completely floored me. While connecting a bag of cefepime to my tiny, elderly, blind patient’s IV, I spotted a cockroach making its way across her pillow. And then another on her lap. And then they were on the wall behind the bed, coming out of the closet where her belongings were stored. Another nurse had just handed her the pocketbook she’d requested, and the host of insects that apparently called it home were now scurrying quickly around the room, and around me.

I consider myself a fairly brave woman. I can kill a bug if I need to, I see rats quite frequently, and come on, I’m a nurse—there have been some pretty gory things to pass these eyeballs and touch these fingers. But this was different; it was not the hospital grossness that I am a seasoned veteran of. This was a glimpse into my patient’s dirty home. I ran like a little child.

When the situation had calmed down, I talked to my patient about her home, an apartment in Manhattan. How did she get around? How did she get food? She told me that her quest for survival had grown more challenging—that, with no family to care for her, she depends solely on Meals on Wheels, and that she might, after so many years, need to cave in to the pressure and move into an assisted living facility. Although, based on my assessment, she clearly qualified, no doctor had ever offered her a home health aide or visiting nurse.

Cockroaches aside, she is not the first elderly New Yorker I’ve cared for who has no web of support. Living precariously between the poles of health and complete collapse, many of them walk through the city streets for groceries, live on next to no money, and have very little reserve when sickness finally overturns their delicate homeostasis. Read the rest of this entry ?

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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic

CascadeofCare

The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?

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Acknowledging Nightingale’s Pervasive Influence on Medicine as We Know It

March 4, 2014

By Jacob Molyneux, senior editor

Florence Nightingale in Crimean War, from Wikipedia Commons

Florence Nightingale in Crimean War, from Wikipedia Commons

There’s a very good article about Florence Nightingale in the New York Times right now (“Florence Nightingale’s Wisdom”)—and it’s by a physician.

The author, Victoria Sweet, writes that Nightingale was the last person she wanted to know about or identify with when she was in medical school. Then she gradually began to realize Nightingale’s extraordinary influence on modern medicine as it’s now practiced. As Sweet point out,

So much of what she fought for we take for granted today — our beautiful hospitals, the honored nursing profession, data-driven research.

It’s a good piece, and though you may already know some of what it covers, it’s well worth reading. For those who want to learn more about Nightingale, let me point out a series of short posts we ran back in the summer of 2010 on this blog. In Florence’s Footsteps: Notes from a Journey, written by Susan Hassmiller, senior advisor for nursing at the Robert Wood Johnson Foundation, detailed the stages of a trip she took that summer as she retraced Nightingale’s steps through England and all the way to the Crimea, all the while contemplating her legacy.

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AJN’s March Issue: New Series on Systematic Reviews, HIV Update, C. Diff on the Rise, Sexual Assault, More

February 28, 2014

AJN0314.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Advances in HIV testing and treatment. The photo on our cover, showing members of  Sexy With A Goal (SWAG), a program provided for lesbian, gay, bisexual, and transgender individuals affected by HIV and AIDS by the AIDS Service Center of New York City’s Lower East Side Peer Outreach Center, reflects the changing face of the AIDs epidemic. Thirty years ago, a diagnosis of HIV was tantamount to a death sentence. But the young men on our cover prove that this is no longer the case. With advances in treatment and patient advocacy, education, and support, HIV is now a chronic, manageable disease. A CE feature, “Nursing in the Fourth Decade of the HIV Epidemic,” discusses HIV epidemiology and policy in the United States, the HIV care cascade, advances in HIV testing and treatment, and how nurses can continue to have a positive impact on the HIV epidemic.

If you’re reading AJN on your iPad, you can watch a video describing one author’s early experience with an HIV-infected patient by tapping on the podcast icon on the first page. The video is also available on our Web site. A

New option for victims of sexual assault. Until recently, survivors of sexual assault were not entitled to a free medical forensic examination unless they reported the assault to law enforcement. The authors of “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option,” March’s original research CE, studied the implementation of the new nonreport option, exploring its impact on survivors, the criminal justice system, and sexual assault nurse examiners. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New series on systematic reviews. Since the advent of evidence-based practice in health care, nurses and other clinicians have been expected to rely on research evidence to inform their decisions. But how does one uncover all the evidence relevant to a question? “Systematic Reviews, Step by Step: The Systematic Review: An Overview,” the first article in a new series from the Joanna Briggs Institute, provides a synopsis of the systematic review as a scientific exercise, and introduces nurses to the steps involved in conducting one. Read the rest of this entry ?

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Posttonsillectomy Pain in Children: Safer, More Effective Treatment Strategies

February 26, 2014

By Shawn Kennedy, editor-in-chief

Capture

One of the CE articles in the February issue is “Posttonsillectomy Pain in Children.” It might seem like a no-brainer—ice-collar, cold fluids, and acetaminophen with codeine, right? WRONG. As the article indicates, there’s a lot more to managing this stubborn, sometimes severe pain.

For one thing, there’s been a big reversal in choice of pain medication. Acetaminophen with codeine, long a mainstay in managing children’s pain, is no longer recommended—in fact, the FDA issued a black box warning last year saying that codeine should not be used because its metabolism rate in one subset of children can cause excessive sedation. Reports of three deaths and a case of nonfatal respiratory depression in children who received appropriate doses prompted the warning. Read the rest of this entry ?

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Nursing Blog Links, Late Winter Edition: Emotions in Primary Colors

February 18, 2014

By Jacob Molyneux, senior editor/blog editor

by doortoriver, via Flickr

by doortoriver, via Flickr

Nurses seem to have hope on their minds as the daylight grows longer and stronger and the winter ever so slowly winds down. There’s a good post at According to Kateri about hope and letting go of the past.

Which reminds me: sort of along these lines, we recently had a good post here at Off the Charts about hope and patient prognosis.

Theresa Brown’s latest at Opinionator, a New York Times blog, is about the communication gap between clinician and patients and the need to find ways to bridge this, for everyone’s sake.

There’s a post at Not Nurse Ratched about another of the more basic emotions: anger. Or, more specifically, anger related to workplace issues that are slowly driving you nuts. Not that any nurses can relate to that . . .

If you’re up for it, here’s a pretty profound post from Hospice Diary about someone who is very articulate about the meaning of his own dying process.

And here’s a kind of funny one at Nursing Notes of Discord about the questions a new nurse asks in the course of a day.

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Not Compatible With Nursing

February 5, 2014

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

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Photo by the author

“His family knows this is not a survivable injury, right?”

This question, posed to me in the doorway of my patient’s room by a trauma surgeon I regard as brilliant, caught me off guard.

“No,” I said. “They don’t know that.”

He frowned at me, mumbled something about false hopes, then moved away to continue his rounds.

This wasn’t the only physician who’d expressed a strong opinion regarding my patient’s mortality—a consultant had deemed his injuries “not compatible with life.” But I’d been caring for this man, as a 1:1 assignment because of his high acuity, for every shift for weeks. It seemed obvious to me that my patient’s continued presence in the ICU—and his relative stability on that particular day—directly opposed the dire predictions. The man’s family did not see his situation as hopeless, and neither did I.

And yet days after the surgeon uttered those words, my patient suffered a complication and became so unstable that for hours he teetered between life and death. The resuscitation effort was massive—and no one mentioned survivability. No one behaved like there was even a shred of futility in bringing to bear the full force of medical interventions. I never left his bedside, determined that, if my patient were to die, it would not be for a lack of vigilance and intervention on the part of his nurse. Read the rest of this entry ?

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Voice of Dissension: When Nurse Teamwork and Patient Safety Diverge

January 29, 2014
ParadisiIllustrationDissension

Dissension (from the series Pareidolia), charcoal & graphite on paper, 12″ x 9,”
2012 by Julianna Paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology. The illustration of this post is by the author.

The term “voice” gets thrown around a lot these days, usually in reference to creative content. Visual artists, writers, musicians, and actors rise to their unique place in the art world on the originality of their voice, not merely for mastery and talent.

In nursing, voice is important too. Hospitals spend a small fortune in paid staff hours for team-building meetings or retreats for nurses to smooth the rough edges of staff members, reducing friction among unit nurses with the ultimate goals of nurse retention and improved patient care. While these are admirable goals, I’m beginning to wonder if too much emphasis on team building may also diminish a nurse’s unique voice, thereby inadvertently interfering with patient safety? A team is only as strong as its individual members. Read the rest of this entry ?

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Chronic, Common, Hidden: Helping Patients With Urinary or Fecal Incontinence

January 13, 2014
Article illustration by Gingermoth. All rights reserved.

Article illustration by Gingermoth. All rights reserved.

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Urinary and fecal incontinence are not the kinds of health topics widely discussed—people may compare notes about knee or hip replacements or their cholesterol levels, but you’ll find few people talking about leaking urine or feces. Even at medical and nursing conferences—unless one happens to be at a conference specifically dealing with those issues—you might be hard-pressed to find the topic on a program agenda.

But these are common problems—a 1995 report in the CDC’s MMWR estimated that 15%–30% of adults over age 60 suffer from urinary incontinence. (And that was 10 years ago. No doubt that number is higher by now, given the higher numbers of people who are over 60.) Fecal incontinence occurs in about one in 12 adults—in a 2009 report, that was 18 million people.

It’s the kind of problem that can drastically change the quality of life for those who have it, due to their fear of having an “accident” in public. Think about it: no extended excursions unless there are facilities all along the way (this can rule out many outdoor activities like golf, trips to the beach, or hiking); timed meals and beverages to reduce the chance of leaking, or even foregoing them altogether. It isolates people unnecessarily, and may contribute to further decline.

Our CE article this month, “Self-Management of Urinary and Fecal Incontinence,” examines self-management concepts and provides strategies to enable nurses to to help people self-manage their incontinence. Here’s the article overview:

Widely used by patients to control symptoms of chronic conditions such as diabetes, asthma, and arthritis, self-management can also help patients with urinary or fecal incontinence. The authors discuss the principles of self-management, the behaviors and skills self-managing patients need to acquire, and the nurse’s role in reinforcing their use. They then describe strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence. Read the rest of this entry ?

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