About Jacob Molyneux, senior editor/blog editor

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

Recent Decline in U.S. Opioid Prescriptions: Good News But Some Concerns

by frankieleon/ via flickr by frankieleon/ via flickr

It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.

This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.

A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”

Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the […]

Psychiatric Nursing: The Seemingly Unreachable Patient

By Jennifer Rodgers for AJN. Illustration by Jennifer Rodgers for AJN

In many fields, we must keep doing the same thing over and over without any apparent results. Nurses, for example, may find that their efforts to make a patient safe, to reach a patient, to ease a patient’s suffering have little visible effect. This is just part of the work, but some patients will inevitably pose a greater personal challenge than others.

Five Words,” the Reflections essay in the May issue of AJN, written by former psychiatric nurse Tania Renee Zayid, is about one of those patients and the feelings of hope and disappointment his nurse experiences in his presence. In it, she writes:  […]

A New, Updated AJN Off the Charts Blog

by Saida, via Flickr by Saida, via Flickr

AJN Off the Charts has been moved and redesigned—nearly in time for the start of Nurses Week.

The address of the updated blog will remain the same as always: ajnoffthecharts.com.

Please forgive the recent blog downtime. If you encounter any technical issues, please let us know about them, via our new contact page.

As with the old blog, all blog followers and subscribers should continue to receive notifications of new posts. If you find that you are not receiving these, please let us know. […]

That Ordinary Nightmare Shift

Sandy Klever, RN, currently works in hospice care in Des Moines, Iowa. At the time of the events described here, she was working on a medical/surgical floor at a Veterans Administration hospital.

julie kertesz/ via flickr creative common julie kertesz/ via flickr creative common

“Can you work tomorrow evening?” sweet-talks my nurse manager. Even though I will miss handing out treats on Halloween, I say yes. “But what about all my candy?” I ask. “Just bring it with you!”

Halloween night should be an easy shift. Do not say the ‘Q’ word, I tell myself. As I’m drinking coffee in the staff room, I’m assigned to four familiar patients, one of whom is a discharge.

Then the door opens and a colleague hands me a notecard about a direct admit coming from the ER, tells me that he’s having a COPD exacerbation and is homeless.

Well, I can manage a COPDer. At least he’s not a challenging laryngectomy patient transferring from the ICU.

“Oh, and by the way,” my colleague adds, “he’s confused and bipolar.”

Off to the floor! Because his room is still being cleaned, I have plenty of time. Within minutes, I have performed a complete assessment on my first patient. Moving on to my second patient, I see a commotion in the hallway and realize my new admit is coming on a cart already. As we maneuver the […]

Alerting Nurses to Late Effects of Pediatric Hodgkin Lymphoma Treatment

“As of January 2010, there were an estimated 379,112 survivors of childhood and adolescent cancers, of whom 35,253 (9.3%) had been treated for Hodgkin lymphoma,” according the American Cancer Society—as summarized in Cardiotoxicity and Breast Cancer as Late Effects of Pediatric Hodgkin Lympoma (HL) Treatment,a CE feature in the April issue of AJN.

Author Joanne Lee Candela, an adult NP in the survivorship program at the Memorial Sloan Kettering Cancer Center in New York City, hopes to raise awareness among all nurses of “residual risks associated with the various HL treatments, thereby promoting appropriate screening and, as needed, referral for specialty care.” The below table, from the article, depicts selected potential late effects of Hodgkin lymphoma treatment. Click to enlarge.

Table1HLlateeffectsThe article points out that “two of the most prevalent and life-threatening late effects are female breast cancer, secondary to chest radiation as well as to any underlying genetic tendencies, and cardiotoxicity and its sequelae, which are related to chest radiation that encompasses the heart and to the anthracycline component of chemotherapy.” […]

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