What if Our Antibiotic Prescribing Practices are Wrong?

How often have you emphasized to patients, family, and friends that they must finish their prescribed antibiotics, even if they feel better? A provocative new analysis in BMJ takes a close look at why standard antibiotic protocols may promote, rather than prevent, antibiotic resistance.

The authors’ arguments center around two key points:

  • The length of a course of antibiotic therapy is not evidence based, but rather “set by precedent [and] driven by fear of undertreatment.”
  • Typical, prolonged courses of these drugs cause endogenous or colonizing bacteria to become antibiotic resistant. It is these “collateral” organisms, they argue, and not the organism that has actually caused the infection, that drive the spread of antibiotic resistance.

Individualized antibiotic courses.

The BMJ authors present a strong argument for more individualized courses of antibiotic treatment. Unfortunately, when the news media picked up this story, much of what was written and broadcast erroneously suggested that everyone should simply stop their antibiotics when they feel better. […]

A Crucial Public Health Lesson: Let the Women Speak

” . . . people have their own hope and power which they need to discover.”

Illustration by Gingermoth for AJN.

Do some public health projects fail to live up to their ambitions because they were conceived in a conference room rather than in dialogue with those they are trying to help? It seems possible. Terms like client or community “buy-in” are now fashionable, but maybe what’s really meant by such terms is that people are given a chance to state their needs and their concerns ahead of time. And that someone is listening.

In this month’s Reflections essay by nurse practitioner Mark Darby, he remembers a valuable lesson once imparted to him through example by a Dominican priest. “Shut Up and Let the Women Speak” doesn’t flatter the younger version of the author who once visited the Dominican Republic on a medical mission. […]

2017-12-11T08:37:50+00:00 December 11th, 2017|Nursing, nursing stories, Public health|0 Comments

Integrating Strong Emotions as a Developing Nurse

Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse in Southern California and blogs at http://heartofnursing.blog.

Most people, I would venture to say, start off in their profession with a fair degree of idealism, and this certainly holds true for nurses. When I talk with nursing students or new grad nurses and ask their story about why they chose nursing, the most common response runs along the lines of wanting to help others in meaningful ways.

Preparing new nurse grads for nursing realities.

In fact, I will meet with such a group of students this afternoon as I speak on a panel in the ethics class at my nursing alma mater. I, and other colleagues on this panel, want to encourage and inspire. But we will also be telling the students about the challenges we have encountered in situations involving moral distress, ethical dilemmas, and personal burnout. We will present situations when we felt that what we were doing at the bedside was not meaningful because we were only prolonging suffering—or, in other cases, so full of emotion and significance that it felt overwhelming to process.

We want to present the reality of nursing to these students, not to shatter their idealism, but to push them towards meaningful self-awareness from […]

2017-12-08T10:16:46+00:00 December 8th, 2017|Nursing|2 Comments

A Nurse, a Purple Heart Medal, and the Pearl Harbor Attack

USS Arizona burning after Pearl Harbor attack

Tomorrow is National Pearl Harbor Remembrance Day, when we honor the more than 2,400 Americans who were killed in the attack on December 7, 1941, that led the United States to enter World War II. Many nurses were there that day, caring for the wounded and showing civilians how to be of assistance—just as they have been during wartime dating back to the American Revolution. They have served in the U.S. military since Congress authorized the Army Nurse Corps and Navy Nurse Corps in the first decade of the 1900s, and before that provided battlefield care as civilians.

A nurse honored for service during the Pearl Harbor Attack.

Some of these nurses are spotlighted by exhibits and web pages of the National Women’s History Museum, an online museum that aims to “show the full scope of women’s contributions to history” and thus highlights the histories of female-majority professions such as nursing. “The Bravery of Army Nurse Annie G. Fox at Pearl Harbor” tells the story of the first U.S. servicewoman to receive the Purple Heart medal. First Lieutenant Fox was the head nurse at Station Hospital at Hickam Field, on the naval base at Pearl Harbor, when the attack occurred. Nearly a year later, when she […]

2017-12-06T10:48:59+00:00 December 6th, 2017|Nursing, nursing history|0 Comments

Family Caregivers: Nurses by Default

Caregiver guides family member using safe stair-climbing technique. Photo courtesy of AARP Public Policy Institute.

We all know how compressed hospital stays are. Patients are frequently admitted and discharged within a few days, even for what used to be “big” surgeries. We dutifully send them home with discharge instructions—sometimes, pages of them—and often have only a few minutes to go over them with whoever is taking the patient home. And in many cases, that person is not even the one who will be caring for the patient, so instructions for medications and treatments are given second-hand. And we wonder why there are so many readmissions within 30 days!

Forty million plus unpaid caregivers in the United States.

As I note in this month’s editorial, there are over 40 million unpaid caregivers in this country who are administering complex medical and nursing interventions such as ostomy and wound care,  tube feedings, injections, and tracheostomy care, in addition to taking on bathing, toileting, and other necessary care. Many of these caregivers do so without any real training. Aside from the real danger that they may cause harm to the patient or to themselves, they often live in fear that they are not providing what […]