AJN’s Recent Awards: As Always, It Depends on Strong Writers and Editors

Because AJN‘s reputation depends on the conscientious work of numerous authors and editors, we’d like to note here the awards AJN has been awarded in 2017 so far, both for content published in the journal and on this blog, AJN Off the Charts. We are grateful to be recognized by the following organizations:

Winning journal articles, entire issues, and covers:

2017-07-21T08:59:42+00:00 July 21st, 2017|Nursing|0 Comments

PTSD and Falls: For the Elderly, a Lost Sense of Safety and Control

Jack lowers his head and presses his temples with his thumbs. He whispers, “Am I going crazy?”

In the weeks after his fall and trip to the emergency department, something has gone painfully awry. He’s been having episodes of anxiety when transferring from bed to chair as well as difficulty sleeping. His once unflappable optimism has been blunted by intrusive memories and ruminations about the fall and a sense of foreboding about the future.

Psychological Aftereffects of a Fall

Though he sustained no serious injury and had been quickly returned to the assisted living facility where he lives, the fall has left him with symptoms of posttraumatic stress disorder (PTSD). Most health care professionals are unaware that falls in the elderly can cause posttraumatic stress symptomatology, acute stress disorder, even PTSD. Indeed, in some settings falls occur frequently enough to insulate nurses and other medical staff from the awareness of how terrifying such an event can be or how it can undermine one’s sense of safety and control, particularly when it results in injury and/or invasive medical treatment.

Although Jack was under hospice care at the time of his fall, the facility sent him to the hospital because of its policy on ruling out head injury. Most hospices and facilities have protocols governing their response to falls. These typically include timely response times, […]

2017-07-19T07:34:30+00:00 July 19th, 2017|Nursing|1 Comment

Connecting Emotional Intelligence, Team Communication, and Patient Safety

An Early-Career Nursing Memory

Photo by Barry Diomede/Albany Stock Photo.

Many years ago, fresh out of nursing school, I was in charge one night, with no other RNs on the unit. We had an “active GI bleeder” who needed hourly boluses of either ice water or iced milk through an NG tube. (Yes, the standard treatment at that time was gruesomely uncomfortable for the patient, and in later years determined to be counterproductive.) I had more than a dozen other patients to care for, but everyone got their meds and, miraculously, the bleeding man made it through the night.

When my supervisor made rounds at the end of the shift, I reported that all was well and that my critical patient had survived. Her only response: “Mrs. Todd! There is blood on your shoes!”

This senior nurse, standing there in her starched whites and impeccable shoes, didn’t recognize that I had feared I would be inadequate to the task, or even acknowledge my pride as a brand-new nurse in actually saving someone’s life. In retrospect, I can’t help wondering if her choice to focus on a superficial fact, irrelevant to the crisis, could be interpreted as an indication that she lacked a certain acuteness of emotional […]

2017-07-17T16:49:20+00:00 July 17th, 2017|Nursing, patient safety|1 Comment

The Inner Stretch of Nursing

Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse at Children’s Hospital Los Angeles. Her Reflections essay, “Intimate Strangers,” will be published in AJN’s August issue; her own blog is at http://heartofnursing.blog.

There is a level of discomfort nurses are pushed to that goes beyond tight staffing, busy 12-hour shifts, and mental tracking of our patient’s disease process. It is the inner stretch of our emotional, relational, and spiritual muscles. We are pushed to wrestle with questions and issues beyond what we find comfortable, and then we must learn to live with a certain unresolved level of discomfort. We can’t go back to a perhaps safe naïveté about life as we knew it before we saw how indiscriminate some forms of suffering and death could be. Our own theological wonderings come to light, and our capacity for vulnerability and intimacy is tested when certain patients find a way past the self-protective walls we put up. Sometimes, all the big questions of life loom over us in the course of one 12-hour shift.

We are stretched in how we think about quality of life.

My everyday thoughts about quality of life usually revolve around the quality of my relationships, how much free time I had to enjoy my hobbies, what delicious food or special coffee […]

2017-07-17T11:16:06+00:00 July 14th, 2017|Nursing|4 Comments

Nursing Protocol for Stroke Increases Survival, Reduces Disability

image via Flickr / Vormingplus Gent-Eeklo vzw

As we report in a July news article, a new study showed that a nursing care plan for stroke, implemented in the first 72 hours after admission, reduced deaths and disability compared with standard stroke care. The protocolwhich was implemented on 19 acute stroke care units in New South Wales, Australiatreated fever, hyperglycemia, and dysphagia using the following interventions:

  • Fever: Temperature monitoring every four hours; administration of paracetamol to lower temperature when needed
  • Hyperglycemia management: Blood glucose monitoring and saline or insulin infusion if indicated
  • Dysphagia detection: Nurses were trained by speech pathologists and assessed to test competency in screening for swallowing problems.

The study included 1,076 patients and confirmed the protocol’s positive outcomes four years later. (The same research group had conducted an earlier study showing the benefits after 90 days.) The authors hypothesized that rigorous implementation of the protocol in an organized stroke services setting helped preserve key tissue. […]

2017-07-12T10:20:34+00:00 July 12th, 2017|Nursing|0 Comments