High Opioid Overdose Numbers Spur State, City Initiatives

State 2015 overdose death rates compared with national rate. (CDC image)

As we report in an October news article, recent studies have shed light on the growing scale of the opioid crisis in the United States. Among the latest statistics:

  • 33,000 Americans died in 2015 from an opioid overdose, a high percentage from the use of synthetic opioids such as illegally manufactured fentanyl.
  • The diagnosis of “opioid use disorder” climbed 493% from 2010 to 2016 in Blue Cross Blue Shield claims.
  • Around 4.31% of Americans ages 12 or older use prescription pain relievers for nonmedical uses.

Increasing Naloxone availability.

The findings underscore the urgent need to take steps to combat the crisis—a need that has prompted states and cities to attack the issue using various methods. Baltimore’s health commissioner, for example, issued a standing order for naloxone to be available at all of the city’s pharmacies. Brown University and the Rhode Island School of Design collaborated to create NaloxBoxes—emergency naloxone boxes installed at city social service centers that enable any bystander to administer a rescue dose.

Speeding access to addiction treatment.

And, to minimize delays in patients’ receipt of medication-assisted opioid addiction treatments like methadone, New York State has reached agreements with two insurance companies to end their requirements for prior authorization for such treatments. […]

2017-10-23T08:50:26+00:00 October 23rd, 2017|Nursing, Public health|0 Comments

Learning New Skills of Supporting One Another as Nurses

Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse in Southern California and blogs at http://heartofnursing.blog. A direct link to her recent TEDx Pasadena Women 2017 talk should soon be available online.

I have had a couple of recent conversations with nurse coworkers who have been close witnesses to patient deaths that were particularly difficult. They told me how challenging it was to process the experiences with fellow nurses—even those whom they considered as good friends—in the hours and days immediately following the patient deaths.

Some conversations in the break room or in carpool rides would go into the medical details surrounding the deaths, but stayed away from discussing personal emotions beyond general statements such as “It was just really sad.”

Other conversations, they told me, were comprised of awkward silence—as opposed to a more intentional therapeutic silence, a deep listening. In both scenarios, my coworkers said they’d felt a lack of quality and depth in these encounters. While they hoped for an opportunity to talk with colleagues, who would surely understand the experience and details better than anyone else, ultimately they felt that they were left to sort out their thoughts and feelings alone.

Even in a unit where we constantly express gratitude for a strong sense of teamwork, my colleagues and […]

2017-10-20T09:00:54+00:00 October 20th, 2017|Nursing|0 Comments

Workarounds May Work, But They Perpetuate Dysfunction

Photo © Associated Press

A couple of months ago, we posted a query on Facebook asking visitors to the page if they had ever used workarounds—the improvised shortcuts that may not be the standard practice or the policy, but may allow for more efficient work processes. We were amazed at the uniformity of the responses. No one saw a problem with workarounds, and most responded along the lines of “I love my workarounds—couldn’t do my job without them” and “I’ll never tell—keep hands off my workarounds.”

Nothing new.

Workarounds have probably been around since Florence Nightingale’s day—I can imagine one of her nurses at Scutari hiding lamp oil so she’d have enough to make rounds at night. In my early nursing days, we hid sheets so we’d have some in case we needed an extra bed change for a patient. When I worked in the ER of a busy city hospital, we kept a pretty large supply of IV fluids and medications on hand in a closet. It became a well-known secret that the ER had its own stockpile—in fact, there were occasions when the pharmacy would come to us for meds!

Today, the workarounds I hear about tend to revolve around dealing with the electronic health record and scanning medication bar codes.

Some cautions.

In this month’s article, “Workarounds Are Routinely […]

The CAPABLE Program: Supporting Aging in Place

Determining what matters to homebound elders.

Sarah Szanton

This month, AJN profiles Sarah Szanton, who created a program known as CAPABLE—Community Aging in Place, Advancing Better Living for Elders—that helps low-income seniors to remain at home with the aid of a unique home care team.

Szanton, an NP who has provided care for homebound elders, notes that “[b]eing in someone’s home gives you the opportunity to see what matters to them.”

The “person–environment fit.”

Szanton’s keen interest in the “person–environment fit” of her frail elderly patients led her to a different perspective on managing illness—one focused less on the “medical model” and more on “function and being able to do what they would like to do.”

In 2008, after the NIH requested proposals for projects to help the newly unemployed, Szanton wondered whether people with home-building skills could be paired with elders to improve their independence and quality of life. And the idea for CAPABLE began to form.

A unique home care team: nurse, occupational therapist, handyman.

CAPABLE’s home care teams are made up of a nurse, an occupational therapist, and a handyman. The patient identifies functional goals such as “to be able to stand long enough to prepare a meal,” and the team devises a plan based on these goals. […]

Easy to Judge Patients for their Choices, Harder to See Them as Individuals

This month’s Reflections essay, “Someone’s Son,” is by Jami Carder, now an RN case manager at the Visiting Nurse Association of Cape Cod. In it, she looks back to a formative nursing experience.

I started my nursing career as a floor nurse. Our patients were complex, and though it seemed we never had enough time or staff, it was important to give them the care they needed and deserved…. [I]t was frustrating to feel that any time was being ‘wasted’…. I remember complaining, at such times, about not being able to take care of my other patients who were ‘really sick.’

By Eric Collins/ecol-art.com.

Who ‘deserves’ care?

Wasted here is meant as code for spending valuable patient care time on patients who are sick because of unhealthy behaviors: in this essay, substance abuse. But we might also then include smoking, overeating, lack of exercise, and so on.

The potential list of unhealthy behaviors is long. And the question of choice is slippery, to say the least. It’s always before us in our personal lives, moment to moment—and by extension, for nurses at the bedside, and in how we as a society think about health care and who ‘deserves’ it. […]

2017-10-11T12:17:07+00:00 October 11th, 2017|Nursing|0 Comments