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November Issue: Nurse Vaccine Hesitancy, the Staffing Crisis, Palliative Care, More
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November Issue: Nurse Vaccine Hesitancy, the Staffing Crisis, Palliative Care, More

Nursing

November Issue: Nurse Vaccine Hesitancy, the Staffing Crisis, Palliative Care, More

“As nurses, we must push back on public health misinformation where and when we can, so that we don’t return to the days when viruses such as polio thrived and spread, and human health needlessly suffered.”—AJN editor-in-chief Carl Kirton in this month’s editorial

The November issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses

This study aimed to elucidate the characteristics of vaccine-hesitant nurses at two large medical centers where rates of COVID-19 vaccination were lower than expected, and to understand the reasons for such hesitancy.

Viewpoint: Reframing Hospital Nursing as a Specialty to Address the Staffing Crisis

In light of the current shortage of hospital nurses, the authors propose recasting the role as a specialty—instead of as an entry-level position—and call for an overhaul of nursing education, particularly clinical experiences.

CE: What COVID-19 Can Teach Nurses About Liability Risks

This article explores key nursing liability issues associated with the pandemic, including immunity, documentation, crisis standards of care, delegation and assignment, scope of practice, floating, travel nursing, telehealth, and misinformation and social media.

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Diane Szulecki, editor2022-10-21T08:14:54-04:00October 21st, 2022|Nursing|0 Comments

The ‘Clog Kick’: In Trying Times, Adapting to the Loss of a Palliative Care Team’s Essential Rituals
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The ‘Clog Kick’: In Trying Times, Adapting to the Loss of a Palliative Care Team’s Essential Rituals

COVID-19, Nursing

The ‘Clog Kick’: In Trying Times, Adapting to the Loss of a Palliative Care Team’s Essential Rituals

Palliative care, under optimal circumstances.

I work as a palliative care NP on an inpatient consult team at an academic medical center in Massachusetts. In the best of times, palliative care teams are exemplars of interdisciplinary functioning. According to nationally accepted consensus reports, since palliative care is holistic in nature, it must be administered by a team that can address the multidimensional elements of suffering for both patients and families in the setting of serious or life-limiting illness.

In my experiences on two interdisciplinary palliative care teams, we were damn strong together. We met each morning to divvy up the workload; around the crowded table were NPs, physicians, chaplains, social workers, sometimes a pharmacist or a librarian, and a bevy of rotating students of all disciplines. On the table was often food: from someone’s garden, our own kitchens, or the grocery store bakery.

A ‘thread of lightheartedness’ amidst the heaviness.

The work was seemingly endless (as many people as there were around the table, there were scores more patient consults), and the situations were heavy and complex. We took our work seriously because the situations we waded into day after day were often worst-case scenarios for our patients and their families.

But there was also a thread of lightheartedness that ran through the days and weeks. We prioritized team and clinician wellness, and often laughter was the centerpiece of the table. We strategized together, cried and fretted about our patients, roared or seared in frustration, and yes, we watched funny cat videos to keep the […]

Guest Author2021-02-23T17:02:36-05:00February 18th, 2021|COVID-19, Nursing|0 Comments

Caring with Intention: Palliative Care and the Human Family
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Caring with Intention: Palliative Care and the Human Family

Nursing, Patients

Caring with Intention: Palliative Care and the Human Family

Vivian Dee, APRN-BC, RN, lives in Texas. She works on a bone marrow transplant unit and is and a doctoral student in the DNP program at Walden University.

In 2008, our organization created a new palliative care wing. No one was certified yet or knew much about caring for palliative care patients. The leadership scrambled to put together learning instructions in the form of PowerPoints and seminars.

In the midst of this flux, our unit admitted a homeless man as one of our first patients. Larry was an alcoholic who’d been out on the streets for many years. His health had deteriorated, and he’d developed liver cirrhosis. Since he couldn’t afford medical care, he’d opted for palliative care.

Larry was unpretentious and polite, and he soon became one of my favorite patients. I met him at the initial team meeting, where we established goals of care. As the days passed, I got to know Larry and his wishes, dreams, and desires. He would talk about his family, his cousins, and his mother. How he longed to see them one more time. To ask forgiveness and to say goodbye.

Days soon turned into weeks, weeks into months. Larry became weaker. Soon it was apparent that it would only be days before Larry took his last breath. Knowing […]

Guest Author2018-03-22T08:25:34-04:00March 22nd, 2018|Nursing, Patients|0 Comments

Palliative Care: Often Overlooked in the ‘Acute’ Setting
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Palliative Care: Often Overlooked in the ‘Acute’ Setting

Nursing

Palliative Care: Often Overlooked in the ‘Acute’ Setting

Does this description of a patient sound familiar to you?

“… a 91-year-old man diagnosed with moderate Alzheimer’s disease, hypertension, and benign prostatic hypertrophy whose change in mental status has prompted hospitalization from a long-term care facility…. This is his third admission in five months with similar symptoms; each time he was given IV fluids and sent back to the long term care facility within a few days.”

Figure. Photo © Photofusion Picture Library / Alamy Stock Photo.

With minor adjustments in age, gender, and the exact illnesses involved, this paragraph describes patients that I cared for on a regular basis in a large medical center. I always found such patients frustrating, and sad. I was frustrated because it seemed all we could do was “patch them up,” send them back to the nursing home, and wait for their inevitable return; and sad because there seemed so little quality of life to reach for.

In AJN’s September issue (“Palliative Care […]

Betsy Todd, MPH, RN2017-10-02T08:33:17-04:00October 2nd, 2017|Nursing|1 Comment

AJN News: Better Palliative Care Training, Reducing Antibiotic Use, More

AJN’s monthly news section covers timely and important research and policy stories that are relevant to the nursing world. Here’s a preview of the stories you’ll find in our current issue (news articles in AJN are free access):

16802[1] Two culture plates growing bacteria in the presence of antibiotics. Photo by Melissa Dankel / James Gathany / CDC. Reducing Inappropriate Antibiotic Prescriptions

On-the-job behavioral interventions that involved social components—accountable justification (an EHR-based prompt requiring a prescriber to document an explanation for the choice of medication) and peer comparison—resulted in lower rates of inappropriate antibiotic prescribing by primary care physicians, according to a recent study.

Increase in Colorectal Cancer Occurring Before Age 50

Diagnoses of colorectal cancer in younger people are on the rise: between 1998 and 2011, one in seven patients diagnosed with colon cancer was younger than 50. This summary provides some useful context to help readers understand the implications of such numbers.

AACN Recommends Increased Palliative Care Training in Undergraduate Nursing Education

Undergraduate nursing school curricula should devote greater attention to palliative care training to reflect updated understanding and practice in the field, according to new recommendations from the American Association of Colleges of Nursing (AACN).

Diane Szulecki, editor2016-11-21T13:01:12-05:00May 18th, 2016|Nursing|0 Comments

Throwing a Rope Down The Hole of Despair: Early Referral to Palliative Care
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Throwing a Rope Down The Hole of Despair: Early Referral to Palliative Care

Nursing, Patients

Throwing a Rope Down The Hole of Despair: Early Referral to Palliative Care

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author: River, Mountain, Sky – detail of Polar Bear’s Last Song. Watercolor, inkjet collage, 2016.

Nervously, I adjust the Bluetooth earpiece I’m wearing before dialing the phone number. I’ve rehearsed my greeting. On the other end, the patient answers, “Hello?”

I tell her it’s her nurse navigator and I’ve called to find out how she’s doing. Her oncologist recently informed her the cancer has returned—further treatment will only ease symptoms, not cure the cancer.

“I haven’t left the house since I got the news,” she tells me. “Sometimes I just sit on the sofa all day. I don’t know what to do.”

It’s a common response from patients in similar circumstances. The realization they will not survive can become emotionally paralyzing, rendering a person unable to find purpose or a reason to keep going. Pain, fatigue from surgery, chemotherapy, and radiation therapy, contribute to feelings of hopelessness, hampering the ability to consider their choices.

“Did your doctor mention a palliative care referral?”

Many health care […]

Julianna Paradisi, RN, OCN2016-11-21T13:01:14-05:00May 2nd, 2016|Nursing, Patients|2 Comments

A Nursing Perspective on a Recent NEJM Palliative Care Article

By Pam Malloy, RN, MN, FPCN, director and co-investigator of the ELNEC Project, American Association of Colleges of Nursing (AACN), Washington, DC.

I just read a New England Journal of Medicine article by Drs. Craig D. Blinderman and the late J. Andrew Billings that came out on Christmas Eve, 2015. “Comfort Care for Patients Dying in the Hospital” was a thoughtful, informative article and I am grateful that it appeared in a journal that wasn’t focused solely on hospice/palliative care.

While the information in the article is essential for all health care professionals, I would like to take this opportunity to remind my nursing colleagues that we have a tremendous opportunity and privilege to plan, provide, and orchestrate the care that was described in this article—and we have been doing so for some time.

Nurses spend more time at the bedside and out in the community assessing and managing patients with serious, complex illness than any other health care professional. Our interdisciplinary colleagues depend on our assessments and we play a major role in developing plans of care with our diverse team. We are there having difficult conversations with patients—many times in the middle of the night when they cannot […]

Guest Author2016-11-21T13:01:34-05:00January 8th, 2016|Nursing, nursing perspective, pain management, patient experience|2 Comments

How Do RNs View Palliative Care for Hospitalized Older Adults? What a Study Reveals

By Sylvia Foley, AJN senior editor

“I think [palliative care is] also for that portion of the population that falls in the crack, in terms of, they’re not quite ready for the hospice thing but they’re not really ready for new aggressive chemo or anything else. … They’re in that vague no man’s land of where they fit in terms of services.”—study participant

Timely referral to palliative care could potentially benefit many seriously ill, hospitalized older adults. Such care not only offers relief from disease symptoms, but also helps patients and families to reach personal goals, reconcile conflicts, and extract meaning from their varied experiences. Yet those who might benefit are less likely to receive such care if their providers are unclear about the concept and how it differs from hospice care.

Table 5. Five Main Thematic Categories with Associated Subcategories

To learn more about how staff nurses understand and manage palliative care, nurse researcher Maureen O’Shea decided to conduct an exploratory study. She reports on the findings in this month’s CE–Original Research feature, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults.”

Here’s a quick overview. […]

Guest Author2017-07-27T14:44:09-04:00November 17th, 2014|nursing perspective, nursing research|0 Comments

AJN in November: Palliative Care, Mild TBI, the Ethics of Force-Feeding Prisoners, More

AJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

Palliative care versus hospice. For many seriously ill, hospitalized older adults, early implementation of palliative care is critical. These patients often require medically and ethically complex treatment decisions. This month’s original research article, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults,” found that staff nurses often confuse palliative and hospice care, a fact that suggests a need for increased understanding and knowledge in this area. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Mild traumatic brain injury (TBI) can have profoundly negative effects on quality of life and can negatively affect relationships with family and caretakers. This issue’s other CE feature, “Mild Traumatic Brain Injury,” reviews the most commonly reported signs and symptoms of mild TBI, explores the condition’s effects on both patient and family, and provides direction for developing nursing interventions that promote patient and family adjustment. Earn 2 CE credits by taking the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, in our iPad app, by tapping the icon on the first […]

Amy M. Collins, managing editor2016-11-21T13:03:37-05:00October 31st, 2014|career, Nursing, nursing perspective|0 Comments

Maybe Palliative Care SHOULD Go to the Dogs

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

Last week, we took Sam, our ailing 14-year-old Labrador Retriever, on what became his last trip to the vet. Sam had been diagnosed with bone cancer in February after we noticed the right half of his head enlarging. Because of where the tumor was, it was inoperable. We felt that at his age chemotherapy wasn’t a realistic option, and we didn’t want the last few months of his life to be bad ones.

His veterinarian, who’d treated Sam since his puppy days, supported the decision, saying she would make the same choice for her dog. And so we spent the last few months adjusting doses of steroids and pain meds to enable him to live as normally as possible. For Sam, “normal” was being able to greet all comers to our door, to be the leader on his walks, to be smack in the middle of where his family was. (If people were in the basement and on the second floor, he would lie equidistant from where everyone in the house was. If we were in the same room, he sat, front legs crossed in his “elegant dog” pose, where he could see us all.)

So last month, when we saw that he would no longer get up to greet visitors or his family; was reluctant to go on walks (he did, but with a great sigh and lots of panting after even the shortest […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:15:45-05:00September 13th, 2010|Nursing|6 Comments

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Palliative care, under optimal circumstances.

A ‘thread of lightheartedness’ amidst the heaviness.

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“Did your doctor mention a palliative care referral?”

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