About Betsy Todd, MPH, RN

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

If We Know How to Prevent Falls, Why Are Our Patients Still Falling?

Falls: at least ‘theoretically preventable.’

Sometimes it can feel as though managing fall risk takes up a big part of the day. You do your regular risk assessments, put safety measures into place, and still—patients fall.

Considering the frailty of some patients, the many meds that contribute to falls, and the fact that even mild cognitive impairment can be made worse by a hospitalization, it’s a tribute to good nursing care that there aren’t more falls.

But because falls sometimes cause serious injury and are, at least theoretically, preventable, it always feels like we’ve failed when a patient ends up on the floor.

A checklist for high-risk patients.

Nurses at one hospital decided that they needed a new way to approach fall safety. In “Using a Fall Prevention Checklist to Reduce Hospital Falls,” authors Madeline Johnston and Morris Magnan describe their use of a 14-item change-of-shift checklist based on the hospital’s existing fall prevention protocol. For a patient known to be at high risk for falls, oncoming staff went through the checklist to be sure that all prevention interventions were in place before taking responsibility for the patient. […]

2019-03-01T11:40:56-05:00March 1st, 2019|Nursing, patient safety|2 Comments
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Protocol to Reduce Hospital-Acquired Pneumonia Improves Outcomes, Lowers Costs

Costs. Length of stay. Patient mortality. We know that the care we provide is central to good outcomes of every kind. But how often do we get to clearly demonstrate this for hospital administration? In “A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia” (free until March 1) in this month’s issue, authors Chastity Warren and colleagues describe a QI project that showcased how a simple nursing intervention decreased morbidity, mortality, and costs at their hospital.

A standardized oral care protocol.

Aware of the connection between poor oral care and hospital-acquired pneumonia, a group of nurses at their large Midwest hospital set out to devise a standardized oral care protocol for all adult patients. Patients were categorized as either ventilated, at-risk (for example, someone with a trach or with swallowing difficulties), or short-term care. The care kit and the frequency of oral care were different for each group.

Once the intervention was in place, the nurses tracked not only the incidence of hospital-acquired pneumonia in both ventilated and non-ventilated patients, but also (by creatively “triangulating” several sources of data) the adherence of staff on each unit to the protocols.

Protocol adherence.

Regarding protocol adherence—always a challenge with new protocols when multiple units and staff are involved—the authors noted that there’s still work to […]

2019-02-06T09:10:07-05:00February 6th, 2019|Nursing, nursing research|0 Comments
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Even in an Unimaginable Crisis, Nature Heals

“Eleven-year-old Olivia’s parents were ‘done,’ had reached their limit of bad news, and refused to enter the conference room. They didn’t want more information or what they perceived as pressure to withdraw life support.”

The hardest decision.

by Janet Hamlin for AJN

These words in the opening paragraph of this month’s Reflections column,”Little Sparrow,” describe a situation that will be instantly recognizable to many nurses, especially those who regularly work with people who have suffered severe head injuries or other central nervous system trauma. These two short sentences encapsulate the terrible crisis that develops when a tragic outcome seems inevitable to staff—while family members, in shock, struggle to absorb information and make decisions.

A healing garden.

In the essay, which will be free until February 20, Elaine Meyer, PhD, RN, describes her approach to one such family. While the parents of the seriously injured young girl pray for a miracle, staff are distressed because they feel they are inflicting unnecessary suffering on the child. […]

2019-02-05T08:19:55-05:00February 5th, 2019|family, Nursing, nursing stories|1 Comment
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Self-Disclosure in the Nurse-Patient Relationship

“How much of ourselves should we share with our patients?”

Illustration by Jennifer Rodgers for AJN

The ‘therapeutic use of self.’

Early nursing theorists wrote about how the “therapeutic use of self” helps us to forge close working relationships with our patients. Today we talk about authenticity, and it’s been noted that “the essence of nursing care comes from bringing our authentic selves to the nurse-patient relationship.”

We each develop a nursing “style,” weaving our own identities into the way we relate to patients and families. But where do the parts of ourselves that are very much “us” but not immediately evident to others come into the picture?

“Would a single mother hesitate to share her story of adopting a child without
a male partner? Would a widower refrain from correcting the assumption that
his spouse is still alive?. . . . I am compelled by the belief that sharing truth in either
scenario would enhance the authenticity of the relationship. Nevertheless, I remain
reluctant to correct my patients’ misperceptions of my family life.”

To disclose or not to disclose?

In this month’s Reflections column, “A Lie by Omission?“, nurse practitioner Charles Yingling takes a thoughtful look at what we choose to share with our patients, and what […]

2019-01-18T09:31:02-05:00January 18th, 2019|Nursing, nursing stories, patient engagement|0 Comments
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Hidden in Plain Sight: What Nurses Need to Know About Food Insecurity

Are any of the people you see in your office or clinic “food insecure?” How about the college friends of your children? Or perhaps your own coworker?

Food insecurity is all around us.

The United States Department of Agriculture describes food insecurity as the lack of “consistent, dependable access to adequate food for active, healthy living.” Recent data indicate that food insecurity affects about 13% of U.S. households. In some states, the rate approaches 20%. Certain populations are particularly vulnerable: 27% of veterans who served in Iraq or Afghanistan and as many as 37% of college students are food insecure.

Twice monthly, the Muslim Food Pantry in Flint, MI, distributes free food to anyone who needs it. The pantry is run by volunteers and offers food, bottled water, and hygiene products to those with limited or no food or clean water—the latter a result of the Flint […]

2019-01-14T11:45:33-05:00January 14th, 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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