End-of-Life Conversations at the 11th Hour

Illustration by Gingermoth

A problem all too familiar to nurses.

How often have we nurses talked to friends, family members, or each other about the importance of making end-of-life decisions well before that decision becomes critical? We see so many deaths that come only after extended and often avoidable suffering, it’s all many of us can do to keep from grabbing a family member’s hand and whispering, “Let her go!” At home, our families are used to hearing us say again and again, “Do not let me die like that!”

If we work in a hospital, chances are that we are confronted over and over again with trying to help families make “11th hour” decisions that will affect how their loved ones die. How do we broach the subject, when time is so short?

Trust prepares the ground.

This month’s Reflections article, “Difficult Conversations,” isn’t a primer to walk us through these conversations, but it offers an example of how we can take our cue from events or changes in the patient’s condition to raise the topic of the inevitable. Author Vanessa Arroyo illustrates how, after we’ve developed a relationship with patient and family and earned their trust, it may become possible to ask the […]

2019-08-19T09:59:07-04:00August 19th, 2019|Nursing, nursing stories|1 Comment
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Health Technology Hazards, 2015: Alarm Issues Still Lead ECRI Top 10

hazard/jasleen kaur, via Flickr hazard/jasleen kaur, via Flickr

It’s a new year, and the ECRI Institute has released its Top 10 Health Technology Hazards for 2015 report, highlighting new health technology hazards (and some older, persistent ones) for health care facilities and nurses to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the fourth year running. But this year, the report focused on different solutions. Often, according to the report, strategies for reducing alarm hazards focus on alarm fatigue—a hazard nurses have long battled. Now, the report recommends that health care facilities examine alarm configuration policies and practices for completeness and clinical relevance. These practices include:

  • determining which alarms should be enabled.
  • selecting alarm limits to use.
  • establishing the default alarm priority level.
  • setting alarm volumes.

Repeat hazards that made the list included inadequate reprocessing of endoscopes and surgical instruments (#4), robotic surgery complications due to insufficient training (#8), and, in at #2, data integrity issues such as incorrect or missing data in electronic health records and other health IT systems. For an overview of these hazards, see our posts on ECRI top 10 health technology hazards from 2013 and 2014.

And here’s an overview of new hazards that made the cut, along with some of the report’s […]

2016-11-21T13:03:15-05:00January 12th, 2015|digital health, Nursing, Technology|1 Comment
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School Nurses: We Don’t Just Need Them for the Obvious Cases

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

Sitting in the dark movie theatre, I hear a familiar high–pitched “beep, beep, beep.” The sound brings me to full attention, away from the action on the big screen and back to my “date,” a blond and very handsome five-year-old boy sitting beside me. I see him mouth the words, “I can’t breathe,” but he makes no sound.

Children at playground, Brisbane, Australia, 1939/Wikimedia Commons Children at playground, Brisbane, Australia, 1939/Wikimedia Commons

He’s not trying to be quiet for fellow moviegoers—he’s getting no air from his ventilator, as the alarm has indicated. Though his eyes are open wide and his nostrils flared with an oxygen-starved expression, his eyes still hold trust. He knows I can help him breathe, now—quickly, the Ambu bag is in my hand, squeezing breath into his immobile body, as I feel around in the dark for a disconnected vent circuit. (Of course, I had already silenced the alarm as quickly as possible, for the other kids and their parents in the theater during the lightly attended matinee.)

Such adventures out of the children’s hospital were a monthly occurrence. A child life therapist and a nurse would take medically fragile kids out into the community, usually with parents in attendance. These afternoons of fun gave the parents and kids hands-on experience before discharge.

And something […]

2016-11-21T13:08:27-05:00January 31st, 2013|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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