About Betsy Todd, MPH, RN, CIC

Clinical editor, American Journal of Nursing (AJN), and epidemiologist

The Role of Prevention and Standardized Care in Improving CKD Outcomes

Slowing Chronic Kidney Disease Progression

Most nurses have worked with patients with chronic kidney disease (CKD). Their condition may have been related to diabetes, high blood pressure, an acute infection, or other assaults on the kidney. I’ve tended to see a diagnosis of CKD as the beginning of an inevitable decline. Certainly, “prevention” didn’t seem a relevant concept at this point; my role was to assess and monitor, teach and support, and hope for the best.

Fig. 1. The Nephron. Blood flows into the nephron through the glomerulus. Filtrate from the glomerulus flows into Bowman’s capsule, then through the proximal tubule, the loop of Henle, and the distal tubule, a series of tubules that modifies the filtrate primarily by reabsorbing water and needed electrolytes into the bloodstream. The modified filtrate (urine) then flows into the collecting duct and eventually drains into the renal pelvis. Courtesy of National Kidney Disease Education Program and the NIDDK.

However, the authors of the February CE feature, “Improving Outcomes for Patients with Chronic Kidney Disease,” make it clear that many of us (nurses as well as physicians) aren’t up to date about what we can do to slow the progression of CKD. As authors Norton et al. note:

“The greatest opportunities to reduce the impact of CKD […]

February 15th, 2017|Nursing, Public health|0 Comments

School Recess as a Matter of Public Health

A friend who teaches first grade finds her principal’s recess policy maddening. The children are allowed almost no recess, and some teachers have resorted to “sneaking” their classes outside when the principal is off-site. “The children have no rights,” my friend says. She adds that when they haven’t been able to run and play, “teaching is a waste” because the kids can’t focus.

The U.S. Department of Health and Human Services recommends a minimum of 60 minutes of daily physical activity for children and adolescents, and the American Academy of Pediatrics describes recess as “crucial.” Yet many schools continue to prioritize academics over physical health. In this month’s AJN Reports, author Carol Potera explores the connection between the decline in physical activity in schools and the increase in childhood obesity and describes the ways in which some schools are trying to reverse these trends. […]

January 25th, 2017|Nursing, Public health|2 Comments

Metabolic Syndrome: Lifestyle Factors and Prevention

Metabolic syndrome: one-third of U.S. adults.

Cycling Mother and Daughter, Netherlands/via Wikimedia CommonsConversations about health—whether between neighbors or between clinicians and patients—often revolve around weight problems, blood pressure, blood sugar, and cholesterol levels. Taken together, these are the cardiovascular risk factors referred to as metabolic syndrome.

In the United States, more than one-third of all adults have metabolic syndrome. This is an astonishing figure, especially because these risk factors can be modified.

What keeps some who are obese or overweight ‘metabolically healthy’?

In recent years, researchers have learned that some people who are overweight or obese do not demonstrate the other risk factors that are part of metabolic syndrome, and therefore these people have a lower-than-expected risk of cardiovascular disease. In a study reported in this month’s AJN (“Examining the Links Between Lifestyle Factors and Metabolic Syndrome“), a group of Taiwanese nurse researchers set out to learn whether there might be lifestyle factors that keep this subgroup of people “metabolically healthy,” protecting them from the other cardiovascular risk factors that usually come with extra weight.

Lifestyle factors associated with prevention.

Dr. Shu-Hung Chang and colleagues performed community-based physical exams on more than 700 people in northern Taiwan and questioned them about lifestyle factors including smoking, drinking, exercise, and the foods they ate. The researchers found that overweight and obese people who quit smoking, exercised, […]

Helping New Nurses Find Their Way: The Art of Saying Yes

A Preceptor’s Example

Photo by Ed Eckstein Photo by Ed Eckstein

AJN’s Transition to Practice column is designed to help new nurses in their first year at the bedside. In this month’s column, “The Art of Saying Yes,” Amanda Anderson explains how as a new nurse she learned the benefits (to herself and her patients) of going the extra mile at work. She describes the surprising personal and professional benefits that come from “the times you choose to say yes when you might just as easily have deferred.”

Anderson paints a vivid picture of her first days on the job as a nurse: The fear of making mistakes, the feeling of being a useless novice, the shame of not always being able to keep up with seasoned staff. She was fortunate, though, to have an expert mentor in those early days. Her preceptor was an experienced nurse who modeled the art of saying yes—an art that might be described as a willingness to leap in to help when not required to do so: to take on a housekeeping task, for example, or pitch in unasked to help another nurse whose day is spinning out of control.

“There is no term for this concept in the literature,” writes […]

November 18th, 2016|career, Nursing|3 Comments

Taking Skin Tear Prevention and Management Seriously

In the Past, Approaches to Skin Tears Were Inadequate

Many years ago, when I worked in a skilled nursing facility, it seemed my patients were always experiencing skin tears. We didn’t have wound care specialists then. My approach to these injuries, which I didn’t see as serious, was to cleanse them with saline and awkwardly attempt to reposition the detached flap. In retrospect, the nursing care I provided didn’t amount to much more than “a lick and a promise.”

Greater Awareness of Risks, Dangers of Skin Tears

screen-shot-2016-11-14-at-6-09-55-pmToday, we know that skin tears can evolve into serious, complex wounds. Available data indicate that in long-term care settings, these injuries affect up to 22% of residents. Wound care specialists have developed a classification system for skin tears—as for pressure injuries, specific recommendations from wound care specialists guide our nursing care.

In this month’s AJN, author Sharon Baranoski and colleagues from the International Skin Tear Advisory Panel detail the assessment and management of skin tears in “Preventing, Assessing, and Managing Skin Tears: A Clinical Review.” While the authors emphasize the need to involve wound care nurses in the management of these injuries, many readers may find the product selection guide in this article to be especially useful. […]

November 14th, 2016|Nursing|3 Comments