About Betsy Todd, MPH, RN

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

Who’s Listening to Hospitalized Patients with Hearing Impairment?

In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of […]

The Risks and Benefits of Transfusion Therapy

Potential complications of transfusions.

Photo © GARO / PHANIE / agefotostock

If your patient develops mild jaundice or thrombocytopenia two weeks after a blood transfusion, would you consider their transfusion history an important part of your assessment?

When I think of monitoring a patient who is receiving a blood transfusion, I think primarily about watching for a hemolytic transfusion reaction or circulatory overload. To me, that means keeping a close watch during the transfusion and for about 24 hours afterwards. Yet “classic” hemolytic reactions and volume overload are not the only potential complications of blood therapy. Delayed reactions can occur days or even weeks after you’ve run through your saline flush and disposed of the blood bag.

Update of current transfusion practices.

In this month’s AJN, Margaret Carman and colleagues provide readers with an update of current practices in transfusion therapy. In “A Review of Current Practice in Transfusion Therapy,” the authors survey the benefits and risks of fresh whole blood (used today primarily in military or disaster settings) and blood components—red blood cells, plasma, cryoprecipitate, and platelets. […]

2018-05-29T11:19:05-04:00May 29th, 2018|Nursing, patient safety, Patients|0 Comments

Sleepless Nurses

“If I couldn’t even figure out what goes into my lunch box, how could I possibly have multitasked . . . on a busy unit?”

Awake for 40 hours.

Photo by Jeff Greenberg. The ImageWorks.

I recently had the disorienting experience of being awake for 40 hours. This had to do with a family member’s interminable emergency department visit, a 3 a.m. car breakdown, and a post-ED MRI and medical visit.

I’ve never been up for 40 hours in my life. I didn’t pull “all-nighters” in school before exams, and never worked longer than a double eighthour shift. Partying the night away wasn’t in my DNA. So this experience was strange and new, and something I pondered over for days afterward.

An ‘otherworldly’ state.

By the time I’d been up for 24 hours straight, I was operating at a level about two beats behind everyone around me. Physically, I felt a little off-balance, as though I might fall if I didn’t step carefully. My brain seemed mired in muck, and I found myself trying to recall what I knew about depleting bodily stores of ATP. Preparing to return to work around hour 26, I stared into my lunch box. I couldn’t remember what food I […]

2018-05-21T08:29:35-04:00May 21st, 2018|Nursing|4 Comments

Counting on Colleagues (and Former Students) When a Family Member is Hospitalized

Rarely do we consider what it might be like to see [a former student’s] face across the bed of a desperately ill loved one.   

Illustration by Janet Hamlin. All rights reserved.

That’s from AJN‘s May Reflections essay by nursing professor Amy Kenefick Moore, who shares her family’s experience over the hectic days that follow a terrible accident in which her stepson sustains critical injuries.

When her stepson is admitted to a hospital affiliated with her school of nursing, Moore reaches out on her university LISTSERV to ask the nurses working at that hospital to watch out for her family member. “Responses flew back,” with alumni working on the trauma service promising to take good care of Moore’s stepson.

Nurses as family members.

Whatever our nursing experience, when we’re on the scene as family members, we usually understand the basics of the clinical situation and its possibilities. Our knowledge of nursing and medicine and of our family member’s medical history, functional baseline, and beliefs about health and illness can be a great asset to those caring for our loved one. […]

2018-05-09T13:10:44-04:00May 7th, 2018|Nursing, nursing stories|0 Comments

Recognizing Delirium in Hospitalized Children

A hospital can be a scary place for any of us, but the experience is likely to be especially upsetting for children. An unfamiliar environment, possibly painful procedures, immobility, food that’s not from home (or no food), and disturbed sleep are hard on most people. A child’s particularly vivid imagination may exacerbate an already-frightening experience. It’s not surprising that delirium can occur in hospitalized children.

Characteristics of pediatric delirium.

Delirium in children has not been explored to the extent that it has been in adults, but research suggests its manifestations in either group can include five characteristics: agitation, disorientation, hallucinations, inattention, and sleep–wake cycle disturbances. Some evidence also suggests that children with delirium may have a more labile affect than adults, and more severe perceptual disturbances. […]

2018-04-25T10:05:56-04:00April 25th, 2018|Nursing, pediatrics|0 Comments
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