CDC’s Frieden: Some States Lag Far Behind Others In Reducing Smoking

By Shawn Kennedy, MA, RN, editorial director

At the opening briefing at the conference of the Association of Health Care Journalists, Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), unveiled a new report on state-specific tobacco control measures. As health commissioner in New York City until he took his current post last June, Frieden gained a reputation for tackling chronic health issues. (We reported in 2007 on his controversial diabetes initiative.)

Frieden says that while there is a clear change in societal attitudes towards tobacco use (for example, he says, we’ve moved from “Would you like a cigarette?” to “Do you mind if I smoke?”), progress in reducing tobacco use has been stalled since 2004. He noted the significant success of graphic “counter-marketing” efforts (ads depicting individuals who have physical disabilities, amputations, and laryngectomies as a result of tobacco use) in reducing smoking rates (though at least one study reported by the BBC has suggested that such in-your-face ads may be more likely to keep people smoking than to make them quit). However, said Frieden, “Tobacco taxation is the single most effective tool, accounting for half or more of the reduction in tobacco use.” Among the findings Frieden highlighted: […]

2016-11-21T13:18:04-05:00April 23rd, 2010|Nursing|0 Comments
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Medication Adherence in the Mentally Ill, the Mixed State of Cancer Survivorship Care, When Good People Faint, More

We’ve already noted one or two of them here in recent weeks, but here are some excerpts and links to several other articles of note in the April issue of AJN, in case you missed them:

The percentage of prescribed medications that are actually taken by patients is estimated to be as low as 60%—and among patients with chronic conditions, it may be even less. Patients with mental disorders may have even lower rates of adherence than those with physical conditions. Suzanne Hardeman, an NP and licensed professional counselor, and Meera Narasimhan, a physician, have culled from the available literature a list of strategies that have been shown to improve adherence in patients with mood and psychotic disorders.

That’s from a sensible and useful article on improving medication adherence in patients with mental disorders.

For a report on the good and bad news about where we are with providing cancer survivorship programs and support, read “Building Cancer Survivorship Care,” which points out some excellent resources, but also notes that “few cancer patients have access to survivorship care.” Still!

Laura Dean faints after witnessing an elderly man collapse with an apparent heart attack. James Parsons passes out as an RN begins venipuncture for collection of a lab specimen. Nursing student Melanie Simms faints while observing her first surgical procedure.

“Recognizing and Treating Vasovagal Syncope” gives a nice overview of this common problem, who is most likely to be afflicted by it, how to prevent injuries when it happens, and how nurses can […]

2016-11-21T13:18:06-05:00April 22nd, 2010|nursing perspective, nursing research|0 Comments
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Turf Wars Aside, How Do NPs and MDs Really Differ?

By Christine Moffa, MS, RN, AJN clinical editor

There’s been a lot of talk lately about turf wars between NP’s and physicians, especially when it comes to the much discussed U.S. shortage of primary care providers. Before going back to school and getting a master’s in nursing education, I batted around the idea of becoming a nurse practitioner. It seemed like the ideal next step for someone who was happy being a clinician but wanted to take on an advanced role.

However, there was something that didn’t sit right with me about becoming an NP—namely, my fear of public perception. I’m not sure most people know exactly what the role of an NP is and how it differs from that of a physician, particularly in primary care. I’ve seen patients call their primary care NP “doctor [insert first name here],” which to me illustrates the confusion.

When people ask me the difference, I myself have a hard time articulating it. How do I respond when someone says something like this: “if entry to medical school and residency is typically more competitive than for advanced degree nursing programs, and if physicians spend a longer time attending tougher programs, how do you justify their doing the same work as NPs?” (For instance, when I was in school we, along with the NP candidates, were only required to take two semesters of pathophysiology!)

Now, I’ve been to an NP as a patient, and I was happy with the care I received. She certainly […]

2016-11-21T13:18:07-05:00April 20th, 2010|career, nursing perspective, students|6 Comments
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Are Nursing Strikes Ethical? New Research Raises the Stakes

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.

In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.

These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units […]

2016-11-21T13:18:09-05:00April 16th, 2010|career, Ethics, nursing perspective|5 Comments
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Nurses Doing Primary Care, Hospital-Acquired Infections, Questionable Celebrity Advice, and Tort Reform

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

That’s the start of an MSNBC story called “Doc Deficit? Nurses Role May Grow in 28 States.” Much of the article is about nurse practitioners (NPs)–and the different ways they are (or are not) allowed to practice in different states, as well as the ongoing efforts of physician groups to limit their practice (even as the health care overhaul increases the demand for primary care physicians and invests in nurse-managed clinics). We’ve posted on scope of practice issues here more than once—what’s your take as nurses, or patients?

HAIs persist. Also today, as described from a number of perspectives in a collection of articles on Kaiser Health News, the Department of Health and Human Services (HHS) released a report stating that the rate of hospital-acquired infections did not improve in 2009, despite ongoing attention to this issue in studies, IHI initiatives, nursing journals, and nearly everywhere else. What gives?

Does getting sick make you an expert? Elsewhere, at Covering Health (the blog of the Association of Health Care Journalists), Andrew Van Dam is critical of tennis star Martina Navratilova’s public advocacy for yearly mammograms for women over 40.

In February, Martina […]

2016-11-21T13:18:11-05:00April 14th, 2010|health care policy|0 Comments
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