About Betsy Todd, MPH, RN, clinical editor

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

Simple Intervention Decreases Oral Mucositis from Head and Neck Cancer Treatment

A painful effect of cancer treatment.

Nurse Cindy Dawson provides patient education on oral care kit used in a nurse-led intervention to reduce oral mucositis severity in adults treated for head and neck cancer. Photo courtesy of Kay Klein.

Years ago, when I worked with patients being treated for head and neck cancer who had been admitted for one reason or another, I felt helpless in the face of their extremely uncomfortable oral mucositis. None of our topical concoctions seemed to bring much relief to these patients, who had often endured disfiguring surgery as well.

While there is as yet no perfect solution to this uncomfortable side effect from the radiation or chemotherapy used to treat head and neck cancers, a group of oncology staff nurses and their colleagues have demonstrated that a consistent, standardized approach to oral care for these patients may significantly alleviate the pain of this almost universal treatment effect.

Consistent, standardized oral care.

After reviewing the literature on oral care, Cullen and colleagues enhanced their usual patient teaching with oncology radiation center outpatients, worked with staff in all disciplines to ensure that their oral care messages were consistent, and assembled a specific oral care kit (containing such items as non-irritating toothpaste, lip salve, […]

What if Our Antibiotic Prescribing Practices are Wrong?

How often have you emphasized to patients, family, and friends that they must finish their prescribed antibiotics, even if they feel better? A provocative new analysis in BMJ takes a close look at why standard antibiotic protocols may promote, rather than prevent, antibiotic resistance.

The authors’ arguments center around two key points:

  • The length of a course of antibiotic therapy is not evidence based, but rather “set by precedent [and] driven by fear of undertreatment.”
  • Typical, prolonged courses of these drugs cause endogenous or colonizing bacteria to become antibiotic resistant. It is these “collateral” organisms, they argue, and not the organism that has actually caused the infection, that drive the spread of antibiotic resistance.

Individualized antibiotic courses.

The BMJ authors present a strong argument for more individualized courses of antibiotic treatment. Unfortunately, when the news media picked up this story, much of what was written and broadcast erroneously suggested that everyone should simply stop their antibiotics when they feel better. […]

Promoting Nursing Students’ Ethical Development in the Clinical Setting

Ethics professor discusses high-fidelity patient simulation exercise with student. Photo courtesy of Linda Koharchik.

I once spent an hour in an ambulatory surgery PACU when interviewing for work at the place. A few minutes into my visit, one of the patients awoke in tears. The PACU RN proceeded to slap the woman across the face. An open-handed, full-face slap. “No crying here!” she snapped.

I was floored, and reported the incident to the clinic’s medical director. This nurse not only assaulted a patient, she did so in full view of a visitor (me). I suspect that if, instead, I had been an instructor from their medical center with students in tow, she would not have behaved differently. And would I have responded differently if students were present? Would I have confronted the nurse while other patients were watching, to make clear to the students that willfully harming a patient can never be tolerated?

Approaches to ethical instruction.

In “Promoting Nursing Students’ Ethical Development in the Clinical Setting” (free until December 13) in the November issue of AJN, Linda Koharchik and colleagues discuss the ways in which we can further students’ understanding of ethical practice—not only in the classroom, but also when we are with them on the clinical units. […]

2017-11-29T15:45:34+00:00 November 29th, 2017|Nursing|2 Comments

‘Micro’ and ‘Macro’ Strategies for Nursing to Thrive as a Profession

At last month’s annual convention of the Academy of Medical-Surgical Nurses (AMSN), nurse and health care economist Peter Buerhaus received the Anthony J. Jannetti Award “for extraordinary contributions to health care.” Buerhaus, a professor of nursing at Montana State University College of Nursing, is widely known across health care disciplines for his research on health care costs and value, especially in regard to nurses and nursing. In his keynote talk, Buerhaus shared some of his recent research findings and offered some “micro” and “macro” nursing strategies for thriving amid today’s health care challenges.

Nurses maintain status as highly trusted professionals.

Click to expand. Most trusted professions, Gallup 2017 poll.

He began by reminding the group of some of the reasons that nurses are respected and trusted in America. People believe that nurses ensure quality of care, protect patients and maintain safety standards, and provide advice on personal health issues.

Studies show that we maintain this trusted status even when the media reports on the mistakes of individual nurses. And after good media attention, as when Alex Wubbels protected her patient or when nurses play key roles in disaster relief efforts, our approval ratings soar.

Accomplishments of NPs have reinforced good reputation of nurses.

Brain Injury. Undocumented Patient. Who Decides About Treatment?

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.

© Photolibrary Wales/ Albany Stock Photo.

Imagine that someone you love—a young person—suddenly collapses and is rushed to the hospital. Her heart is restarted, but it soon becomes apparent that there has been extensive anoxic brain injury. In a vegetative state, on a ventilator, no ability to follow commands, spastic extremities, an EEG showing continuous seizure activity. . . . and this person is an undocumented immigrant. And uninsured.

In this month’s AJN, Kimberly Radtke and Marianne Matzo present a fictional case (based on their real-life experience in palliative care) to illustrate the ways in which this kind of scenario might play out. The parents are overwhelmed, trying to make decisions while they are still in shock. Physicians soon express their concerns about prolonging “medically inappropriate care.” And who will pay for it?

In addition, hospitalization due to critical illness increases an unauthorized immigrant’s risk of repatriation without their consent. What must the family be feeling as they struggle to understand their daughter’s future?

The role of the ethics committee.

Radtke and Matzo discuss the many ethical dilemmas that are raised […]

2017-11-17T15:19:22+00:00 November 13th, 2017|Ethics, Nursing|0 Comments