About Jacob Molyneux

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

When a Patient Turns Scary, a Nurse’s Options Aren’t Always Clear

I was leaning over my patient, listening to his lung sounds, when his hand tightened around my wrist. “Why don’t you get in the bed with me?” he said.

Illustration by McClain Moore

That’s the arresting opening of “The Squeeze,” the Reflections essay by nurse Danielle Allen in the September issue of AJN. Such scary experiences happen, as many nurses can attest. What behaviors cross the line? Who decides? After all, nurses put up with lots of challenging behavior. What’s unacceptable, and what constitutes a real safety issue?

Complicating these questions may be the responsibility a nurse feels to not let down their equally burdened nursing colleagues. No one, as Allen writes, wants “to be that nurse. You know, the complainer, overly sensitive, not-a-team-player nurse.”

Allen vividly evokes her encounter with the patient, the varied responses of nursing colleagues later, the emotional aftereffects of the event, and the larger question she finds herself asking about what can be done to keep nurses and other health care workers safe. […]

2017-08-28T08:37:02+00:00 August 28th, 2017|Nursing, nursing stories|1 Comment

Intimate Strangers: A Pediatric Intensive Care Nurse Reflects

By Lisa Dietrich for AJN.

“How do I talk about these things with a stranger unless I know how to be intimate?” asks pediatric intensive care nurse Hui-wen (Alina) Sato, the author of “Intimate Strangers,” the Reflections essay in AJN’s August issue.

Sato writes about “walking intimately . . . through the most devastating hours of her life” with a woman she’s only just met—even as her role as a nurse involves ending the life-sustaining treatments of this mother’s child.

Nurses will tell you such experiences can be common in their profession. But essays like this remind us that such experiences are also remarkable. Sato is the type of nurse who ponders her role, who stops after the fact to wonder what it means to be a participant at such moments in others’ lives. […]

2017-08-04T10:51:54+00:00 August 4th, 2017|Nursing, nursing stories, patient engagement|0 Comments

Nurse-Author Theresa Brown Reflects on Recent Book About Doctor-Patient Communication

Nurse and frequent contributor to the New York Times Theresa Brown writes a column for AJN called What I’m Reading, in which she reflects on a recent book about an aspect of health care. This month she examines What Patients Say, What Doctors Hear (Beacon Press, 2017), by physician Danielle Ofri.

The book is about communication with patients, about real listening and the kinds of listening that often substitute for it, sometimes to the real harm of patients. Brown also considers some differences between the ways physicans and nurses tend to talk to patients. Here’s a brief excerpt, but we recommend that you read the short article, which is currently free:

Can any of us, nurses or physicians, say that we always listen as well as we should, giving each patient’s story our full attention? Like physicians, nurses feel the unrelenting pressure of time constraints. Although I try very hard to listen well, I’m sure there are times when I fail. Ofri’s book reminds us that it is clinically important to listen to what our patients say. Ironically, such listening can save time in the long run. But the main reason for doing so is simple: in order to give patients the best care possible, we need to hear what they’re actually trying to tell us.

Brown’s column is not a book review; while she draws readers’ attention to books that are well worth reading, the column goes beyond this purpose, […]

2017-07-31T09:33:35+00:00 July 31st, 2017|Nursing|0 Comments

A Nurse Takes a Fall, and Loses More than Her Mobility

The Reflections essay in the July issue of AJN, “An Inconsolable Loss,” tells the story of a traumatic event that interrupts and forever changes a retired nursing professor’s relationship with her mother, “whose gentle touch and approving smile” she had always craved. Writes author Brenda Kelley Burke:

For a number of years, I’d made daily trips after work to a nursing home to visit my mother . . . .The roles of child and mother were now reversed because of her dementia. I felt acutely aware of the mother–child bond and how it transcends time and circumstance. How could I measure up to this wise and loving woman, who so many years ago would kiss my small feet before she put on my socks and whisper, ‘God, guide them to the safe places’?

But one bitterly cold and snowy night, writes Burke, “like the famous nursery rhyme character, I too had a great fall that left me broken.” Sometimes the seemingly fixed patterns of our lives depend on the most fragile of balances—one change can lead to many others, and suddenly nothing seems the same. […]

2017-07-05T11:03:05+00:00 July 5th, 2017|narratives, nursing stories|1 Comment

Antipsychotics: Understanding These Increasingly Prescribed Medications

As AJN‘s June issue CE article on antipsychotic medications makes clear, the history of the treatment of mental illness provides many cautionary tales:

Theories about the causes of mental illness have included the belief that a person is possessed by spirits, demons, or the devil; that she or he has a weakness of character; or that the person had a “refrigerator” mother, someone whose coldness led to the child developing insanity. Those with mental health issues were treated with . . . therapies that are now considered to be questionable and inhumane: being chained . . . in institutions . . . and put into insulin-induced comas; having a lobotomy; being subjected to malarial therapy, exorcism, and prayer; being placed into ice water baths . . .

Images courtesy of the estate of Bryan Charnley. Full image caption below.

In the past century, as our understanding of various aspects of mental illness has increased (there’s still a long way to go), so has the range of available treatments, from psychotherapy to a constantly expanding arsenal of first- and later-generation drugs, many with substantial adverse effect profiles. The use of psychotropic medications continues to increase in the United States:

“It’s been […]

2017-07-27T11:30:53+00:00 June 5th, 2017|Nursing|0 Comments