About Betsy Todd, MPH, RN

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

Mental Health Nursing: Transcending the Limitations of Words

When I met Dorothy, she was always counting. Her chapped lips moved nonstop as she chanted random numbers. She’d increase the speed, as if that would help her to reach the end quickly—but since the numbers didn’t appear to be in any sensible order, this loomed before her like an impossible task…

The challenge of mental health nursing.

Illustration by Pat Kinsella. All rights reserved.

This month’s Reflections column, “Dimensions of Dorothy,” begins with this harrowing look at a woman in the grip of a mental health crisis. Author Maureen Bonatch goes on to poignantly describe how this illness can “steal someone’s identity and overwhelm their self-control.”

As a new nurse at the state psychiatric hospital, Bonatch definitely had a “new normal” to adjust to at work. As she observed the manifestations of severe mental illness, she also developed insight into why some had so few visitors: “It had to be difficult,” she writes, “to helplessly observe as an illness crept in to hold the person you knew and loved hostage.”

An inadequately valued area […]

2018-11-20T10:07:55-05:00November 20th, 2018|mental illness, narratives, Nursing|0 Comments
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Acute Flaccid Myelitis: The Investigation Continues

The headlines of the past several weeks about kids with a polio-like illness have been pretty scary. The idea that a healthy child could suddenly be sidelined with extreme muscle weakness is a nightmare scenario for the parents of young children. While frustratingly little is known about acute flaccid myelitis (AFM), the good news is that it remains quite rare, affecting less than one in a million people in the U.S. each year.

According to the CDC, there have been a total of 404 confirmed cases of AFM in the U.S. since 2014, with a median age of eight years. The epidemiologic curve of cases indicates that the illness is seasonal, peaking in late summer and early fall. Oddly, the number of cases spiked in 2014, 2016, and 2018, while there were fewer cases during 2015 and 2017.

Signs and symptoms of AFM.

AFM often follows a respiratory illness or fever. Limb weakness (often unilateral) then occurs suddenly, progressing rapidly within hours or a few days. There may be facial muscle weakness, problems with eye movement, or speech or swallowing difficulties, but mental status generally is not affected. One death has been reported.

No clear cause.

Poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus are known to (rarely) […]

2018-11-12T08:25:04-05:00November 12th, 2018|infectious diseases, Public health|0 Comments
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In Pediatrics, What’s the Best Way to Assess for Pressure Injury Risk?

The evolution of a scale.

In children, most hospital-acquired pressure injuries are related to medical devices rather than immobility. A device that can’t be repositioned, such as this cast, presents additional risk. Photo by Rafael Ben-Ari/Alamy Stock Photo.

Pressure injury prevention has always been a top nursing priority. Do you know about the latest tool for early identification of pediatric patients at risk for pressure injury?

The well-known Braden Scale, developed in 1987, was followed in 1996 by the Braden Q Scale for use in kids. Both were developed by nurses and are widely used around the world. However, the Braden Q Scale focused on immobility as a risk factor and wasn’t designed to address device-related pressure injuries, risks to children younger than three weeks of age or older than eight years, or children with congenital heart disease.

An update to include device-related risk in children.

So Sandy Quigley and Martha Curley, the nurses who modified Braden and Bergstrom’s original Braden Scale, set out to validate an updated version of their pediatric tool in order to address medical device use, a broader age range, and children born with heart disease. In “How to Predict Pediatric Pressure Injury Risk with the Braden QD Scale” in this month’s AJN, they explore the use of their Braden QD Scale (the D is for device related).

Quigley, Curley, and colleagues emphasize that while immobility-related pressure injuries in children have decreased significantly, “[in pediatrics] most hospital-acquired pressure injuries are associated […]

2018-11-07T10:32:44-05:00November 7th, 2018|Nursing|0 Comments
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Managing Acute Pain in People with Opioid Use Disorder

Photo © IStock.

Have you ever used the Clinical Opiate Withdrawal Scale (COWS) to ascertain whether your patient might be experiencing opioid withdrawal?

Considering the current prevalence of opioid misuse, it’s not unlikely that a patient admitted for a non-drug-related cause could be a person who uses opioids—someone who may or may not have shared that information with you.

The Clinical Opiate Withdrawal Scale is one of many helpful points of assessment and management discussed in this month’s CE article, “Acute Pain Management for People with Opioid Use Disorder.”

Compassionate, informed, nonjudgmental care.

This article, not specifically about unrevealed opioid intake, focuses on the management of acute pain in a person who is known to use opioids because they are currently on medication-assisted treatment (MAT)—that is, someone receiving methadone, buprenorphine, or naltrexone for opioid use disorder who is also experiencing acute pain from (for example) cancer, or after surgery or trauma.

[…]

2018-10-29T08:03:46-04:00October 29th, 2018|Nursing|0 Comments
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Workplace Violence Training: Beyond Tabletop Exercises 

Breaking the rules of ordinary nurse behavior.

Have you ever thrown a fire extinguisher at a hospital visitor?

In this issue, “Workplace Violence Training Using Simulation” describes how one Ohio health system employs classroom learning, hands-on defense techniques, and simulated violence scenarios to prepare staff for potentially violent situations, including the presence of an active shooter.

Part of this training involves learning how to break the rules of ordinary behavior. This is hard for nurses, because it’s so ingrained in us to protect and never to harm. Grabbing a fire extinguisher to throw at someone, even if that person is holding a gun, is not the initial reaction most of us would have in this situation.

“People often freeze or panic in response to acts of aggression, assault, or other violence, including shots fired,” note authors Robin Brown and colleagues. The remarkable workplace violence training that they have developed at their hospital aims to empower staff to respond effectively in dangerous situations. Key points of discussion include learning to

  • recognize the potential for violence in a patient or visitor,
  • identify our own behaviors that may trigger a person who already is upset,
  • and perhaps most importantly, overcome our panic and take action.

[…]

2018-10-12T10:25:56-04:00October 12th, 2018|Nursing, nursing research|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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