About Betsy Todd, MPH, RN

Former clinical editor, American Journal of Nursing (AJN), and nurse epidemiologist

Bone Marrow Aspiration: A Nursing Procedure?

Too much to do already?

A few months ago, we asked on our Facebook page whether nurses would ever be interested in adding a new “medical” skill, such as lumbar puncture, to their practice.

Common responses to this question were along the lines of “Are you crazy? I have too much to do already!” But what if you used a new set of skills as part of a small team of nurse “proceduralists” in a nurse-led clinic, and received excellent training and ongoing support?

One team’s expertise.

In “Bone Marrow Aspiration and Biopsy Performed by RNs: A Review of Clinical Practice” in the September issue of AJN, Eryn Draganski and colleagues share the details of their hospital’s longtime success in using a team of specially trained nurses to perform bone marrow aspiration and biopsies. In addition to reducing costs and allowing for more timely scheduling, this practice has also provided patients with a team of nurses whose extensive experience in the procedure ensured excellent outcomes and patient support.

“…using a small team of nursing proceduralists… provides a unique opportunity to improve consistency in practice, which may result in better quality control and, ultimately, boost patient safety.”

Nursing scope of practice.

Nurse practice acts in many states don’t specifically address whether or […]

2019-09-13T11:42:36-04:00September 13th, 2019|Nursing|1 Comment
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‘An Epidemic Transformed’: Where Are We With HIV Today?

“I wasn’t supposed to be here,” [the patient said] to the nurse as he watched the last few drops of his chemotherapy drug infuse into the port implanted in his chest… The nurse caring for him smiled while preparing to disconnect his IV tubing and flush the port….   What distinguished [this patient] from the nurse’s other patients was that he had been living with HIV for 32 years.”

At the very beginning of the HIV epidemic, a friend of mine worked on one of the first HIV units in New York City. The nursing staff followed Standard Precautions in their work with these patients, as we do today. They weren’t particularly concerned about risk to themselves, because it was already clear that this disease—as little as we knew about it then—was not easily transmitted to caregivers.

Remembering fear.

Yet many who worked in other parts of the hospital were not convinced of this. One of my friend’s stories always stayed with me: She relayed how dietary staff would take the elevator to the HIV unit, shove the meal cart out of the elevators into the elevator lobby, and quickly step back into the elevator and close the doors. Many times […]

2019-09-03T10:06:59-04:00September 3rd, 2019|infectious diseases, Nursing, Public health|0 Comments
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Morphine in Hospice Care: Why Family Members May Resist Its Use

Underlying his concerns was a strong sense of moral responsibility. He was his mother’s protector. He was her voice. He had a duty to keep her safe…

Morphine’s essential place in hospice care.

When I began work in a hospice, I quickly came to see morphine as a wonder drug. It was used so much more effectively in palliative care than with the med-surg patients I had cared for in the hospital!

Morphine can be given via multiple routes, it’s easy to titrate, its side effects are well-known and therefore easy to manage, and it can bring dramatic pain relief as well as markedly improved breathing.

It was common for us to admit patients to hospice whose pain had never been controlled, and they were often dumbfounded at how easily their pain could be managed. The proper medical use of morphine was literally life changing for them.

Addressing family members’ concerns.

As a result of my hospice experience, I’ve always been a big believer in patient and family education to debunk myths and highlight the optimal uses of this drug. And yet education alone isn’t always what family members need when morphine is prescribed for their loved ones. Especially when the patient is at home and it’s a family member, not a […]

2019-11-12T15:36:45-05:00August 21st, 2019|family experience, patient experience|3 Comments
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End-of-Life Conversations at the 11th Hour

Illustration by Gingermoth

A problem all too familiar to nurses.

How often have we nurses talked to friends, family members, or each other about the importance of making end-of-life decisions well before that decision becomes critical? We see so many deaths that come only after extended and often avoidable suffering, it’s all many of us can do to keep from grabbing a family member’s hand and whispering, “Let her go!” At home, our families are used to hearing us say again and again, “Do not let me die like that!”

If we work in a hospital, chances are that we are confronted over and over again with trying to help families make “11th hour” decisions that will affect how their loved ones die. How do we broach the subject, when time is so short?

Trust prepares the ground.

This month’s Reflections article, “Difficult Conversations,” isn’t a primer to walk us through these conversations, but it offers an example of how we can take our cue from events or changes in the patient’s condition to raise the topic of the inevitable. Author Vanessa Arroyo illustrates how, after we’ve developed a relationship with patient and family and earned their trust, it may become possible to ask […]

2019-08-19T09:59:07-04:00August 19th, 2019|Nursing, nursing stories|1 Comment
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A Roundup of Women’s Health Issues

Is it Women’s Health Month? Not according to the calendar. But as you browse through this month’s issue of AJN, you may indeed get the impression that we decided to focus on women’s health for the month of August.

This month’s Viewpoint, by Julie Michelle Haracz, “Making OTC Oral Contraceptives Available for All Women,” reminds us that “No woman should have to wait months for an appointment to see a physician, travel long distances, or pay more than she can afford to prevent an unintended pregnancy.” Haracz notes that oral contraceptives already are available over the counter in more than 100 other countries.

In the news: quick takes and closer looks.

Our August news section is filled with stories of particular importance to women. Our reporters cover the flurry of recent state laws that would significantly limit a women’s ability to obtain an abortion (all facing court challenges), an interesting UK study showing that a single dose of antibiotic after forceps-assisted or vacuum-assisted births reduced the incidence of infection, and sobering new CDC statistics suggesting that 60% of U.S. pregnancy-related deaths are preventable.

Did you know that suicide is the second-leading cause of death among young people in the U.S.? Sadly, the rate of suicide among girls ages 10 to 14 is rising, narrowing the gap between rates rates for boys and girls.

Some positives.

2019-08-12T10:32:32-04:00August 12th, 2019|Nursing, Public health, women's health|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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