‘Worth Its Weight in Gold’: The Small, Unexpected Triumphs of Nursing

“Nursing is a job that sometimes finds you investing emotionally in things you never expected to care about.”

How many times have you waxed enthusiastic at work about something that people who aren’t nurses would find weird, or even downright gross? Eyeing a patient’s Foley bag and exclaiming about how great her urine looks…praising a young man for coughing up gobs of sticky sputum….

Illustration by Pat Kinsella for AJN.

The challenge of obtaining a specimen.

In this month’s Reflections column, “Worth its Weight in Gold” (free until July 7), visiting nurse Jonathan Robb describes his efforts to obtain a urine sample for culture from an elderly woman who has minimal bladder control.

Most of us are familiar with the balancing act of obtaining a specimen under conditions that cause discomfort or embarrassment to a patient. We cajole and gently press for whatever has to be done, trying to maintain a relaxed atmosphere while hiding any urgency about completing the task that we might feel. This delicate pas de deux has the potential to be very stressful for both parties.

Robb’s sometimes comical descriptions of the contortions necessary to meet his particular challenge will ring true to nurses.

“…despite […]

When Family Caregivers Are Unsure

Those who care for ailing family members are often faced with new symptoms or with changes in a loved one’s condition. They have to decide if it’s a natural progression of the disease and “just” another thing to manage, or if it signals a serious problem like a urinary tract infection, pneumonia, or a COPD exacerbation that needs to be addressed. Often, they end up in the ER, in some cases needlessly.

The authors of the original research CE article in this month’s issue, “New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?,” write:

“If caregivers have a clear understanding and awareness of their loved ones’ existing symptoms, they’ll be better prepared to recognize changes and new symptoms. Early recognition makes it more likely that the patient can be treated in place and trips to the ED can be avoided.”

Are caregivers being adequately prepared?

As I write in the March editorial, with over 43.5 million adults providing care to family members, we need to ensure they are prepared to do so by the time their loved one is discharged from the hospital

These caregivers provide complex care—from injections and ostomy care to managing ventilators and tube feedings—and according to surveys conducted by AARP, they […]

Why Didn’t Physicians Know What Nurses Know?

By Shawn Kennedy, AJN interim editor-in-chief

A recent post on our blog highlighted the experience of AJN’s associate editor Amy Collins in trying to get someone to diagnose the underlying reason for acute confusion in her grandmother. Over a two-week period, Amy’s grandmother was seen by various private and ED physicians, none of whom seemed to have an adequate diagnosis or a suggestion for treatment. Finally, nurses suggested that a urinary tract infection (UTI), fecal impaction, or some other infection might be a factor. It was a fecal impaction and yet none of the five physicians who previously evaluated Amy’s grandmother had thought about or assessed for it.

What the nurses said. Amy’s post generated many comments, both on the blog and on our Facebook page. What was interesting to me was how many nurses knew to first check for a UTI, electrolyte disturbance, or fecal impaction as a reason for confusion. Here are a few samples:

“Though not conclusive, in every case I have seen a change in cognition or behavior it was either a UTI or fecal impaction. I work in home health as a CNA and I am a nursing student.”

“The first thing I think to check is infection (UTI) with elderly, confused patients.”

“I’m a senior nursing student…and this material is on our exam that we are taking Friday. With acute confusion, always check for UTI and constipation.”

“Possible UTI. Possible dehydration &/or  constipation. Poor nutrition. All can (and do) manifest as “altered mental status.” Think I’d start with […]

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