About Jacob Molyneux, senior editor/blog editor

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

‘Patient Activation’: Real Paradigm Shift or Updated Jargon?

By Jacob Molyneux, AJN senior editor

I attended a Health Affairs briefing yesterday in Washington, DC. Based on the February issue of the journal, it was called “A New Era of Patient Engagement.” A lot of research money appears to have been flowing to this area in recent years.

Our January article on "Navigating the PSA Screening Dilemma" includes a discussion of 'shared decision making' Our January article on “Navigating the PSA Screening Dilemma” includes a discussion of ‘shared decision making’

The basic idea isn’t entirely new to anyone who’s been hearing the term “patient-centered care” for a long time: as Susan Dentzer writes in “Rx for the ‘Blockbuster Drug’ of Patient Engagement,” a useful article summarizing the main ideas raised in the Health Affairs issue: “Wherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t.”

One might add to these projected benefits: better experiences as patients.

Something’s got to change, so why not this? If many nurses feel they’ve heard all this before, the sense of a health care system […]

2016-11-21T13:08:20-05:00February 7th, 2013|nursing perspective, patient engagement, Patients, personal health practices|1 Comment
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School Nurses: We Don’t Just Need Them for the Obvious Cases

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

Sitting in the dark movie theatre, I hear a familiar high–pitched “beep, beep, beep.” The sound brings me to full attention, away from the action on the big screen and back to my “date,” a blond and very handsome five-year-old boy sitting beside me. I see him mouth the words, “I can’t breathe,” but he makes no sound.

Children at playground, Brisbane, Australia, 1939/Wikimedia Commons Children at playground, Brisbane, Australia, 1939/Wikimedia Commons

He’s not trying to be quiet for fellow moviegoers—he’s getting no air from his ventilator, as the alarm has indicated. Though his eyes are open wide and his nostrils flared with an oxygen-starved expression, his eyes still hold trust. He knows I can help him breathe, now—quickly, the Ambu bag is in my hand, squeezing breath into his immobile body, as I feel around in the dark for a disconnected vent circuit. (Of course, I had already silenced the alarm as quickly as possible, for the other kids and their parents in the theater during the lightly attended matinee.)

Such adventures out of the children’s hospital were a monthly occurrence. A child life therapist and a nurse would take medically fragile kids out into the community, usually with parents in attendance. These afternoons of fun gave the parents and kids hands-on experience before discharge.

And something […]

2016-11-21T13:08:27-05:00January 31st, 2013|Nursing|0 Comments
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Some Recent Notable Posts from Nursing Blogs

Some posts of interest from the nursing blogs (those that are currently active; a fair number of familiar bloggers seem to be taking breaks, having kids, starting new jobs):

“Certified Medical Assistants Calling Themselves Nurses” can be found at The Nurse Practitioner’s Place. It’s not just inaccurate to do so, says the author. It’s often illegal.

Photo from otisarchives4, via Flickr. Photo from otisarchives4, via Flickr.

At My Strong Medicine, a short post about men, women, USPSTF guidelines, becoming an NP, and reaching a certain age, called “Heard While Studying: Everything Falls Apart at Age 40.”

One blogger, among others, who has been pretty quiet for some months (and who used to organize a regular “blog carnival” that helped create a community among nurse bloggers) is Kim McCallister at Emergiblog. She popped back up several weeks ago with a post called “The Voice,” which is about exactly that—how a nurse blogger lost the sense of freedom she started with as a staff nurse jotting down experiences, and instead internalized a “Sister Superego” that cautioned her to be “prim and proper,” rapping her knuckles until she just fell silent instead. Frustration with computerized charting and the general state of health care seems to be part of it as well. We hope the spirit moves her to write more soon.

Lastly, there’s a nice post by Megen Duffy (who often writes AJN‘s iNurse column, and who […]

2016-11-21T13:08:29-05:00January 25th, 2013|healthcare social media, nursing perspective|0 Comments
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Shared Decision Making and PSA Screening

PSA article screenshot“Should men get PSA tests to screen for prostate cancer?”

The Wall Street Journal posed the question in an informal, online poll last September. An accompanying article featured a debate between Richard Ablin, who’d discovered the prostate-specific antigen (PSA) in 1970, and an oncologist, Oliver Sartor. Ablin argued that the PSA test should be used only to screen men with a family history or active symptoms. For all other men, he said, a coin toss would be as effective. Sartor countered that the test finds cancers that can be treated early, acknowledging that for most men surveillance instead of active treatment is appropriate. Ablin retorted, “If we really could determine which cancers need treatment and which don’t, we wouldn’t be having this debate.”

The passage above is from this month’s AJN Reports by Joy Jacobson, “Navigating the PSA Screening Dilemma.”

The article gives a great overview of one of the big screening debates of the moment. Many of these debates are driven by changes in guidelines along with a dawning awareness in the medical community that certain tests we’ve assumed to be wholly beneficial, wholly necessary for most patients, may in fact be more harmful than not for many patients, leading to unnecessary treatment, anxiety, and waste of valuable resources.

The article also incorporates a discussion of the role being envisioned for “shared decision making” in helping patients make informed choices that are right for them. Let us know […]

2016-11-21T13:08:30-05:00January 23rd, 2013|Nursing|0 Comments
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Original Research: Perioperative Medication Withholding in Patients With Parkinson’s Disease

Drawing of the face of a Parkinson's disease patient showing characteristic symptoms: mainly hypomimia, a expression-less mask-like face. Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux / publiée sous la direction du professeur Charcot,... ; par Paul Richer,... Gilles de la Tourette,... Albert Londe,.... - 1888. Chapter "Habitude exterieure et facies dans la paralyse agitante". Plate XL1V 1888 drawing of face of a Parkinson’s patient revealing “characteristic symptoms: mainly hypomimia, a expression-less mask-like face.” Appeared in Nouvelle iconographie de la Salpétrière [Tome 1] : clinique des maladies du système nerveux./Wikimedia Here’s the abstract of our January original research CE article, “Original Research: Perioperative Medication Withholding in Patients with Parkinson’s Disease: A Retrospective Electronic Health Records Review.”

Abstract

Background: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson’s disease, has a short half-life of one to two hours. When patients with Parkinson’s disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson’s disease symptoms. Clear guidelines regarding perioperative symptom management are lacking.

Objectives: The goals of this study were threefold: to measure the perioperative duration of the withholding of carbidopa-levodopa in patients with Parkinson’s disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson’s disease symptoms.

Methods: We conducted a retrospective review of patient electronic health records at a […]

2016-11-21T13:08:31-05:00January 18th, 2013|nursing research|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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