AJN in November: Skin Tears, Veteran Women’s Mental Health, Supporting Family Caregivers, More

The November issue of AJN is now live. Here are some articles we’d like to bring to your attention.

ajn1116-cover-onlineCE Feature: Preventing, Assessing, and Managing Skin Tears: A Clinical Review

Although skin tears are common, particularly among older adults and neonates, they are often inadequately documented and poorly managed, resulting in complications, extended hospital stays, and negative patient outcomes. In this article, the first in a series on wound care in collaboration with the World Council of Enterostomal Therapists, the authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears.

CE Feature: “Veteran Women: Mental Health–Related Consequences of Military Service

The last two decades have seen increasing numbers of women entering all branches of the U.S. armed forces. Many are exposed to traumatic events that place them at higher risk for mental health conditions. It’s essential for all nurses to be knowledgeable about the mental health issues commonly seen in this population. The author of this article reviews research confirming that both active-duty and veteran women are at increased risk for postdeployment mental health problems, including posttraumatic stress disorder, military sexual trauma, and suicide—and also addresses the nursing practice implications, including screening.

Supporting Family Caregivers: “Managing Complex Medication Regimens

This first installment in a series published in collaboration with the AARP Foundation offers an overview of how nurses can provide medication management education to family caregivers of older adults.


October 28th, 2016|Nursing|0 Comments

The Speed of Patience: Notes On Navigating Hospital Hallways

The Speed of Nurses

'She Observes,' ink on paper, 2005 by Julianna Paradisi ‘She Observes,’ ink on paper, 2005 by Julianna Paradisi

A while ago, my stepfather had surgery at the hospital where I work. After spending a long day in the waiting room, my husband and I left the post-surgery unit. As we walked down the narrow hallway towards the main lobby, a young man, his girlfriend trailing behind by the hand, came around a corner from the opposite direction too quickly. They headed towards the elevator. We narrowly avoided collision. Had either my husband or I been disabled, someone might have been injured.

As he pulled the young woman into the elevator, he sniped at us sarcastically, “I’m not rude!” Rude or not, he was obviously unfamiliar with the traffic flow of hospital hallways.

Hospital hallways accommodate two types of travelers: staff and patients/visitors. These groups travel at speeds established by urgency and limited by ability.

For nurses, getting to a patient’s room fast may mean saving a life, or simply providing an emesis basin to preserve a patient’s dignity. Among nurses, a lack of urgency (the inability to act fast) is viewed as a character flaw.

Although I am no longer a bedside nurse, as a nurse navigator I often need to get to pre-surgery quickly to comfort an anxious patient before the OR team rolls them away, or meet a new patient before a physician consult or imaging scan.

The Speed of Patients

Being a nurse, however, has also deepened my respect for the dignity of the old and infirm, even if it means cooling my jets during the work day. All of us will join the ranks of the old and the infirm if we live long enough. And that’s what nurses do—we help people to live long enough.

I’m not alone in this sentiment. I watch colleagues slow down their busy pace to allow patients and visitors time to reach their destinations. We are busy, with responsibilities demanding our presence, but slowing down to the speed of patients is a part of nursing. […]

October 27th, 2016|Nursing|0 Comments

Information for Nurses on Voluntarily Stopping Eating and Drinking (VSED)

The New York Times recently published an article by Paula Span called “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission.” VSED stands for voluntarily stopping eating and drinking, an end-of-life option that is, on the surface, as simple as its name suggests. Span, who recently attended the first conference devoted to VSED, gives an overview of one mother’s choice to end her life using this method. She also does an excellent job enumerating the ethical, practical, and legal implications of choosing to stop eating and drinking.

screen-shot-2014-11-05-at-4-39-13-pmWhich types of patients is such a choice appropriate for? How much suffering does it involve? Are there legal pitfalls of involvement in the VSED process by nurses and physicians? We can expect that all of these questions and more will be receiving growing attention in the coming years.

Late in the article, Span quotes Judith Schwarz, PhD, RN, now clinical coordinator of End of Life Choices New York. In 2009, AJN published a CE article, “Stopping Eating and Drinking,” by Schwarz. This substantive article centers around a detailed case study. “Gertrude,” we learn, has lived a very full life. All the things that give her pleasure and a modicum of freedom are gradually being removed as her body’s functions decline. Here’s a brief excerpt from the article introduction:

Gertrude (not her real name; other identifying details have been changed) was 99 years old. Having survived the Holocaust and overcome many other challenges in her long life, she thought it ironic that she had to ask her children to help her die.


October 24th, 2016|Ethics, Nursing, patient experience|0 Comments

‘She’s Alive Because Of You’: A Nurse’s Advocacy Pays Off

Katie L. George, DNP, RN, AG-ACNP, CCRN. Photo courtesy of Katie L. George. Katie L. George, DNP, RN, AG-ACNP, CCRN

While attending this year’s American Association of Critical-Care Nurses National Teaching Institute meeting, AJN editor-in-chief Shawn Kennedy heard a story that she felt all nurses needed to hear as a reminder of the impact a nurse’s advocacy can have on a patient.

Critical care nurse Katie George, just a few years into her career when the events in the story took place, was caring for Ms. A., a young woman whose spinal cord had been nearly severed in a car accident.

Faced with a prognosis suggesting that Ms. A.’s quality of life would be poor and that she would have to remain on a ventilator, Ms. A.’s family made what they felt was the humane decision to have her removed from life support. But Ms. A.’s fiancé—and her nurse Katie George—were convinced that Ms. A., who seemed to be able to communicate by blinking in response to questions, should at least be given the chance to make the decision for herself.

Ms. A. was suffering from locked-in syndrome, a condition in which the patient is conscious and eye movement is functional despite full body paralysis. Giving her a chance to decide her own fate would require finding a way to legally validate Ms. A.’s mental capacity, although her physicians felt that this might not be possible. […]

October 20th, 2016|Nursing, nursing perspective, patient experience|0 Comments

The Primary Care Confessions of Traumatized Patients

drawing of patient in waiting room Illustration by Hana Cisarova. All rights reserved.

In this month’s Reflections essay, “The Traumatized Patient,” family nurse practitioner Margaret Adams delves with sympathy into what she calls the “primary care confessions” of a challenging subset of patients. Writes Adams:

I’ve come to recognize patients like you—sometimes by your disturbingly long and detailed allergy lists, but more often by the frequency with which you come in for the same constellation of symptoms: fatigue, headaches, dizziness, general malaise. Something happened to you— maybe years ago, maybe recently—and it left its mark on you in irredeemable ways, . . .

While symptoms often do have underlying physiological causes, Adams is likewise attuned to the emotional subtext behind certain seemingly fruitless patient encounters. And with many specific examples, she makes the case here that the life of trauma plays itself out over time in the body and mind. […]

October 18th, 2016|Nursing, nursing stories, patient engagement, Patients|0 Comments