About Jacob Molyneux, senior editor/blog editor

Senior editor, American Journal of Nursing; editor of AJN Off the Charts.

Some Observations In Response to the NY Times Article on Palliative Sedation

By Judy Schwarz, PhD, RN*  


The NY Times article of 12/26/09 that described use of palliative sedation in hospice institutional settings provided helpful and clinically accurate informative—for the most part. These few notes are meant to address those issues raised by the article that may unduly alarm dying patients, their families, and their clinical caregivers.


1) There is a consensus among palliative care clinicians that “palliative sedation to unconsciousness” (a descriptive term that eliminates some of the visceral reaction elicited by use of the term “terminal sedation”) is an intervention used only when other therapies that do not compromise patient consciousness have failed and the patient continues to experience intolerable and intractable suffering that cannot otherwise be relieved.

2) Use of palliative sedation to unconsciousness has NOT been shown to cause a hastened death. Research showing that patients at the very end of life who receive palliative sedation do not die more quickly than patients who are not sedated has been published in such peer-reviewed journals as Annals of Oncology, Journal of Palliative Medicine, Journal of Pain and Symptom Management, Archives of Internal Medicine, and Palliative Medicine. (In response to the Times article, the National Hospice and Palliative Care Organization has made available a bibliography of these articles.)

This intervention is generally only provided when patients are “imminently” dying (a condition the recognition of which requires experience and clinical judgment) and is distinct from “respite sedation,” which is used when clinicians plan to awaken a patient from the unconscious state to […]

2016-11-21T13:20:16-05:00January 7th, 2010|Nursing|1 Comment
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Nurses Express Concerns About Colleagues’ Commitment, Training

Back in November AJN clinical editor Christine Moffa posted a short anecdote. She told how she’d been at a training to give H1N1 vaccinations and encountered another nurse with apparent contempt for learning the basic facts about the virus. While it’s obvious that you can’t generalize about the state of an entire profession based on one stranger’s off-the-cuff comment, the responses to this post do indicate that the anecdote touched a nerve in some readers and that other nurses have also had similar experiences with their colleagues. Here are some brief excerpts from longer comments:

From Naomi: “If I fail a class by 1 point and go to the director of my nursing program demonstrating my professionalism, critical thinking, and self responsibility i would get a pat on the back and a registrar’s form in the hopes that I could repeat the class if there are enough seats. My 3.8 GPA allowed me gain admission into my nursing program not my professionalism, critical thinking, and self-responsibility even though those are key qualities for a good nurse.”

From Nursevon: “I am a faculty member in an undergraduate BSN program at a university in the midwest. I have become increasingly discouraged in my job as an educator. The focus of students is very short-sighted: typically on points and grades. As hard as I try to instill professionalism, critical thinking, and self-responsibility for one’s own learning, I frequently come away profoundly discouraged.”

From Richard Crosby: “Hearing a new nurse explain a drug or […]

2016-11-21T13:20:18-05:00January 6th, 2010|career, students|1 Comment
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Home Care Nursing Isn’t for the Faint of Heart


The convalescent-home referral said that Loretta was 71 years old with the usual health problems related to stroke and diabetes. It also said that her husband had a gun and “wasn’t afraid to use it.” Fiercely protective of his wife, he’d had many disputes with the nursing staff about her care. The discharge planner who’d referred her to our home care agency insisted that two nurses make the initial home visit.

Read the rest of “The Dirtiest House in Town,” the Reflections essay in the January issue of AJN, here. And let us know your own experiences in home care nursing.

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2016-11-21T13:20:19-05:00January 5th, 2010|nursing perspective|2 Comments
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Lab Coats vs. Scrubs: Do the Clothes Make the Nurse?

By Jay Swanson, BSN, RN, OCN

Within a nurse’s career there are many opportunities for advancement, new jobs, or a change in shift. Most startling is the move from “working the floor” to “desk job.” When I left the floor to work in a job more focused on patient education, I was treated differently. I had worked on the same unit for five years; I was an informal leader on the floor and the chairperson of the floor management council, an elected position. I am not saying that I was well liked, but I was at least trusted.

During the first few months in the new job I felt that the coworkers I had known and worked alongside wouldn’t talk to me or look at me. Had I sold out? Was I less of a nurse?

It’s true, I no longer work 12-hour shifts, or weekends or holidays. I spend most of my time gathering resources and providing educational support for our oncology patients, and I get to leave work more or less when I want (usually after 5 pm).

Yes, all that’s true . . . but what I really blame is the lab coat. I believe the lab coat suddenly put me in a different category from those who wore scrubs. How do I know? When I did wear scrubs to work one day, I was treated differently, as if all of a sudden I was “one of them” again.

So what is it about the coat? Too close to physicians or other […]

2016-11-21T13:20:21-05:00January 4th, 2010|career, nursing perspective|9 Comments
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2010: The Year of the Nurse

By Shawn Kennedy, interim editor-in-chief

Tomorrow when we ring in the New Year we’ll also be ringing in the International Year of the Nurse. No kidding. The designation honors the centennial of the death of Florence Nightingale (she died on August 13, 1910). It launches at noon everywhere on January 1 with the Million Nurse Global Caring Field Project, a “global meditation” led by noted nursing theorist Jean Watson, and events will continue throughout the year.

Most of you were probably aware that the United Nations had developed eight Millenium Development Goals (MDGs) that nations should achieve to end poverty and improve the health, education, and quality of life of their peoples. Three of the eight goals are specifically focused on health, but the others all have an impact on health one way or another.

The target date for achieving the goals is 2015, but as countries have implemented programs to achieve these goals they’ve become acutely aware that, without nurses in sufficient supply, they will fall short. For example, how do you reduce the maternal death rate during childbirth if there are few skilled health professionals to provide prenatal care or assist at births? How do you treat TB and HIV when there are no health workers to dispense and monitor drug therapy? […]

2016-11-21T13:20:23-05:00December 31st, 2009|nursing perspective|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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