About Betsy Todd, MPH, RN

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

The Complex Working Relationships Between National and Expatriate RNs on Humanitarian Missions

Photo via Flickr / Andrew Smith

Each summer, many nurses and nursing students join humanitarian aid missions, traveling to countries where health resources are scarce in order to work in medical clinics, on surgical teams, or as part of a public health brigade to serve impoverished communities. They work alongside local health workers, often under crisis conditions. We tend to take for granted that there are no downsides to these efforts. But how do local nurses feel about working with (and usually under the supervision of) nurses from other countries?

In 2014, nurse Debbie Wilson worked in an Ebola treatment unit in Liberia. It wasn’t her first overseas medical mission. But under the particularly intense conditions of the deadly Ebola outbreak, she worked very closely with the Liberian nurses in the unit—nurses whose own family members, friends, and coworkers had died of the disease. (Read about Wilson’s experience here.) Over time, these nurses shared with Wilson their stories of positive and negative experiences working with other expatriate nurses in the center.

Since that deployment, Wilson has teamed up with her Liberian colleague Darlington S. Jallah to formally explore the working relationship between expats and local nurses. They share their findings in Exploring Working Relationships Between National and Expatriate RNs on Humanitarian Aid Missions: The Perspectives of Liberian Nurses in the June issue of AJN.

Wilson and Jallah led focus groups with Liberian […]

2019-06-19T10:54:55-04:00June 19th, 2019|Nursing|2 Comments
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‘Worth Its Weight in Gold’: The Small, Unexpected Triumphs of Nursing

“Nursing is a job that sometimes finds you investing emotionally in things you never expected to care about.”

How many times have you waxed enthusiastic at work about something that people who aren’t nurses would find weird, or even downright gross? Eyeing a patient’s Foley bag and exclaiming about how great her urine looks…praising a young man for coughing up gobs of sticky sputum….

Illustration by Pat Kinsella for AJN.

The challenge of obtaining a specimen.

In this month’s Reflections column, “Worth its Weight in Gold” (free until July 7), visiting nurse Jonathan Robb describes his efforts to obtain a urine sample for culture from an elderly woman who has minimal bladder control.

Most of us are familiar with the balancing act of obtaining a specimen under conditions that cause discomfort or embarrassment to a patient. We cajole and gently press for whatever has to be done, trying to maintain a relaxed atmosphere while hiding any urgency about completing the task that we might feel. This delicate pas de deux has the potential to be very stressful for both parties.

Robb’s sometimes comical descriptions of the contortions necessary to meet his particular challenge will ring true to nurses.

“…despite the […]

2019-06-17T10:16:20-04:00June 17th, 2019|Nursing, nursing stories, patient engagement|0 Comments
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Sickle Cell Disease: Complications and Nursing Interventions

Our cover photo this month features three-year-old twins Ava and Olivia. Both have sickle cell disease. In this tender shot, one twin is comforting her sister during treatment at Akron Children’s Hospital in Akron, Ohio.

How much do you know about sickle cell disease (SCD)?

Did you know:

  • that children with SCD can experience “silent strokes” that become clinically evident only as progressive neurocognitive deficits?
  • that renal complications account for 16%-18% of overall mortality?
  • or that SCD-induced priapism in boys and men is not only excruciatingly embarrassing and often painful but may require emergency treatment?

Recognizing common complications.

“Two of the greatest challenges faced by clinicians caring for patients with SCD are the lack of evidence-based guidelines…and the underuse of the few recognized disease-modifying therapies.”

In “Understanding the Complications of Sickle Cell Disease,” a CE feature in this month’s AJN, Paula Tanabe and colleagues provide us with readable and practical information about the complications of SCD.

If, like me, you are not an expert in SCD, this article is an excellent primer on how to recognize the most common complications of the disease, what treatments that are available, and where […]

2019-06-03T08:22:06-04:00June 3rd, 2019|family caregiving, Nursing, patient experience|0 Comments
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Mild Cognitive Decline or Physical Limitations: What’s a Nurse to Do?

Noticing small changes in what’s possible.

I worked for many years in infection prevention and control, and loved it. Still do. But I loved bedside work too, and it was always in the back of my mind that I might one day return to staff work. That is, until I took care of a family member during the last year of his life.

While I think I provided him with reasonably good care—let’s not get into the emotional connection that made me a less objective caregiver than were his fantastic CNAs—there was no fooling myself any longer. After years away from the bedside, my assessment skills have slipped. I’m not used to working while wearing glasses (without which I can’t read labels or check for reddened skin or cloudy urine). And arthritis in my wrists meant that those bed-to-walker transfers were not optimally safe.

What about multitasking, 12-hour shifts?

My difficulty in providing physical care made me wonder whether my cognitive skills, too, might not be up to managing the pace and pressure of floor work today. I may still be good at supporting and teaching, but can I multitask through 12 hours of nonstop problem-solving and decision-making?

In “When Is It Time to Leave Nursing?” in this month’s AJN, nurse Janet Blake […]

2019-05-21T12:18:44-04:00May 21st, 2019|career, Nursing|0 Comments
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Can You ‘Stop the Bleed’?

Reconsidering tourniquets.

Bystanders apply pressure to woman’s leg to stop bleeding after explosion at 117th Boston Marathon. Photo by John Tlumacki / Boston Globe via Getty Images.

Have you ever used a windlass tourniquet? I had never even heard of one until recently. The only tourniquets I knew were fashioned from belts, scarves, or neckties, and we were always admonished to use these sparingly, because it was thought that they could cause severe damage to a limb.

In “Leading the Effort to Promote Bleeding Control in Our Communities” in this month’s AJN, James Reed and Margaret Carman dispel myths about tourniquets and share the growing evidence for their safety.

They also introduce us to the Stop the Bleed campaign. Hemorrhage is the second-leading cause of death (head injury, the first) after a traumatic injury, and when an extremity is the source of bleeding, rapid tourniquet application saves lives.

“More than 50,000 casualties sustained in the wars in Central and Southwest Asia have provided evidence that recognizing hemorrhage and controlling it should be the highest priority in caring for […]

2019-05-16T12:15:52-04:00May 16th, 2019|Nursing, Public 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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