“I often feel anxious and nervous when I care for a dying patient . . .”

As a nursing student, I often feel anxious and nervous when I care for a dying patient. My classroom lectures have been similar to those given in medical school—death is an enemy to be conquered. We focus on treating the disease process and give very little attention to death and dying.

That’s from a letter to the editor now online in our February issue. The article the letter writer was responding to was “Stopping Eating and Drinking,” which we published back in September. The article is about an end-of-life option that is a choice available to patients who aren’t “actively dying” but who have experienced a radical diminution in their quality of life. It’s also about what a nurse legally and ethically should and should not discuss with a patient.

The notion of a nurse advising a patient on stopping eating and drinking is a potentially controversial one, but the responses we received were surprisingly unalarmed that we would publish such an article. Here’s another letter we got in response. We love to hear from our readers, whether in the old print format or here on the blog.


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2016-11-21T13:19:37-05:00February 3rd, 2010|Nursing|0 Comments

Normal Blood Pressure — in 1914

That’s an excerpt from an October 1914 article about blood pressure that was published in AJN (our older articles only exist in PDF versions, so click the PDF link in the upper right corner of the article landing page).

Maybe, though, in the absence of the many medications we now have to treat hypertension, these really were “normal” (that is, realistic) blood pressure levels for adults as they aged! It’s funny how, in so many areas, we keep on redefining the meaning of this oft-used phrase: “normal changes related to aging.”

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2016-11-21T13:19:39-05:00February 3rd, 2010|Nursing|1 Comment

Is the Florence Nightingale Pledge in Need of a Makeover?

By Christine Moffa, who was AJN clinical editor at the time it was written in 2010.

Authors and publishers frequently send nursing– and health care–related books to AJN in hopes we will review them. I love it, so keep on sending them. My latest read is Mystery at Marian Manor: The Adventures of Nora Brady, Student Nursea book for young adults. I guess you could call it a Cherry Ames for the new millennium.

At the beginning of the book is the Florence Nightingale Pledge, something I haven’t read since my graduation in 1995. I have to say it made me cringe. It’s almost as bad as when I visit my parents and see the nursing school graduation photo of me in that silly nursing cap I wore under protest. (If the men didn’t have to wear it, why did I?) If you’ve forgotten the pledge, here goes:

I solemnly pledge myself before God and presence of this assembly;
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession
and will hold in confidence all […]

Emergency—Bleeding Esophageal Varices: What Nurses Need to Know

By Sylvia Foley, AJN senior editor

This month’s  CE feature opens with a patient with alcoholic cirrhosis who suddenly vomits large amounts of blood. She’s experiencing variceal hemorrhage from esophageal varices, an often deadly complication of alcoholic liver disease, as author Melissa M. Smith explains. Esophageal varices occur in roughly half of all people with alcoholic cirrhosis; about one-third of these will experience variceal hemorrhage.

Smith describes the etiology of esophageal varices, then discusses the risk factors for variceal hemorrhage, noting that risk for initial hemorrhage increases with:

  • larger variceal size
  • presence of red spots or wales on the varices
  • more severe portal hypertension
  • more severe cirrhosis, with or without ascites

And the above factors as well as the following increase risk for recurrent hemorrhage:

  • severity of initial bleed
  • age over 60 years
  • bacterial infection
  • renal failure
  • active alcoholism

Smith discusses emergent treatment and outlines further treatment options, which include endoscopic variceal ligation, endoscopic injection sclerotherapy, balloon tamponade, and transjugular intrahepatic portosystemic shunt (TIPS) placement. The patient case vividly illustrates what can happen when bleeds recur.

Have you cared for patients with variceal hemorrhage? We invite you to share your experiences with us in the comments.

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2016-11-21T13:19:42-05:00February 1st, 2010|nursing perspective|2 Comments
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