About Betsy Todd, MPH, RN

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

Is This Child in Pain?

When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical […]

2018-08-13T08:09:58-04:00August 13th, 2018|family caregiving, Nursing, Patients, pediatrics|0 Comments
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Multi-Drug-Resistant Organisms and Contact Precautions

When MRSA was new on the scene, strict isolation precautions were the norm.

Photo by Rick Sforza, Redlands Daily Facts / SCNG.

Years ago, when we first started to see patients with methicillin-resistant Staphylococcus aureus (MRSA) infections at the hospital where I worked, we kept them in what was then called “strict isolation.” These patients were kept on one unit and cohorted in two rooms at the end of the hall. Staff wore gowns, gloves, masks, and hair covering. How we hated having to put on all that gear!

The current challenge of MDROs.

Today, we understand more about transmission, and isolation precautions are better tailored to the epidemiology of each drug-resistant organism. Unfortunately, though, since that time antibiotic resistance has rapidly increased, and we now find ourselves not only with a lot more MRSA to contend with, but with patients whose infections are susceptible to only one or two antibiotics (and occasionally, to none).

Some of these multi-drug-resistant organisms (MDROs) seem to be persistent colonizers—that is, the organism “takes up residence” on or in the body without causing infection, and can still be transmitted to others. In some cases these patients will need to be on isolation precautions every time they […]

2018-08-06T09:07:11-04:00August 6th, 2018|infection control, Nursing, Public health|0 Comments
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Instructor Incivility Toward Nursing Students

“An anxious student is practicing Foley catheter insertion on a manikin in the nursing skills laboratory. The instructor rolls her eyes as the student nervously fumbles and breaks sterility.”

A less well known type of incivility.

Incivility and bullying in health care have been much discussed in recent years, as they should be. In this month’s issue, Linda Koharchik focuses on a less well known manifestation of this problem:  instructor incivility toward nursing students. This kind of vertical violence can be particularly distressing, given the fact that nursing instructors function as de facto gatekeepers for entry into practice. Student nurses can’t simply refuse to deal with them.

Eye rolling, reprimands within earshot of classmates, criticism of the student in front of the patient, and even frank bullying and intimidation are examples of instructor behaviors that some students have to cope with. It’s not hard to imagine what this kind of anxiety-provoking “guidance” can do to a student’s performance, leading to yet more abuse from the instructor.

Merely a rite of passage?

Koharchik notes that some authors have suggested that dealing with incivility is a “rite of passage” for students, one that will help them better cope with the challenges of their chosen work. But nursing students are already exposed to plenty of stress during their training, […]

2018-07-23T09:15:34-04:00July 23rd, 2018|Nursing|0 Comments
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A Nurse’s Open Letter to Parents Who Have Lost a Child

“You are never alone as you miss these children, as you laugh recalling moments with them. Don’t worry that the memory of them is fading—their presence is strong and lives even beyond you and your love for them. We remember them, too.”

Illustration by Barbara Hranilovich for AJN. All rights reserved.

In this month’s Reflections column, author Jessica L. Spruit has written an open letter to parents who have lost a child. Spruit, a pediatric NP in a hematology/oncology department, makes it clear that the children in her care are not forgotten and that their deaths are never routine, even on a hem/onc unit. Here, she shares memories of her patients from over the years, recalling the things that made them unique—as children, and not just as “patients.”

In her letter, Spruit describes something that is often hard to convey about our work. In spite of all of the stress and frustrations of nursing today, we still are able to engage deeply with other people. The courage and grace (and fun and joy, too) that we have the privilege to witness become part of who we are. When our patients are children, their gifts to us are particularly memorable.

“Please don’t ever think that we ‘do this all the time’ or that it is ‘just part of our job.’ Please don’t fear that you are the only ones who remember and miss your children.”

Read “We Remember Them, Too” in […]

2018-07-17T14:28:09-04:00July 17th, 2018|Nursing, pediatrics|0 Comments
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The Thin Flat Line Between Life and Death

Illustration by Jennifer Rodgers.

A patient has died. His nurse begins postmortem care.

“I tell myself the things I always do—it was his time, we did everything we could. I can hear someone crying outside the room.”

In this month’s Reflections essay, author Kassandra August-Marcucio shares her feelings as she performs the steps of this protocol after a failed resuscitation attempt. We are reminded of each task, of the feelings of guilt that can arise (“I was his nurse and he died!”), of the last contacts with the patient’s family.

“The exaggerated zip of the bag is final.”

Almost every nurse has cared for a patient after the patient dies. Sometimes the nurse and patient have barely met; sometimes the patient is well-known to the staff. Many nurses (most, I hope), whatever their religious or spiritual beliefs, approach postmortem care with some sense of the gravity of the moment of someone’s passing. The “routine” tasks involved take on a slightly different aura than the other tasks of our days. Still, it’s hard not to rush through postmortem care to attend to the pressing needs of other patients.

[…]

2018-06-28T10:04:41-04:00June 27th, 2018|narratives, Nursing|3 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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