About Betsy Todd, MPH, RN

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

Unexplained Deathbed Phenomena: Honoring Patient and Family Experience

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by luke andrew scowen/flickr creative commons luke andrew scowen/flickr creative commons

When my dad died, a special little travel clock that he’d given me years before stopped working. It restarted a week after his death, and continued running for years. I have no explanation for this sudden lapse in timekeeping, but it made me feel closer to my dad.

I’ve heard many other stories of unusual events surrounding the death of a loved one. I was therefore delighted to read this month’s Viewpoint column, “Letting Patients and Families Interpret Deathbed Phenomena for Themselves.” In this short essay, Scott Janssen presents some intriguing research findings and a compassionate argument for speaking openly about these occurrences. He writes:

“It’s an open secret among those of us working with the dying – there’s a lot of strange stuff going on for patients, as well as for the clinicians and family members who care for them, that rarely if ever gets talked about: near-death experiences, synchronistic coincidences (stopped clocks at time of death, for example), out-of-body experiences, and visitations from deceased loved ones.”

Janssen, a former hospice social worker and now a psychotherapist, sees such phenomena as part of “the normal continuum of experiences at the end of life.” He calls upon clinicians to create safe contexts in which patients and families can share these experiences without fear that they will be judged, ridiculed, or dismissed by caregivers.

It’s food for […]

2016-11-21T13:01:59-05:00September 21st, 2015|Nursing, nursing perspective, patient experience, Patients|0 Comments
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Are the Benefits of Nutrition for Cardiovascular Health Being Undersold ?

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

By Eric Hunt/via Wikimedia Commons By Eric Hunt/via Wikimedia Commons

A nutrition conference at which physicians and medical students outnumber either nurses or dietitians is a rare event. This was the case at last month’s International Conference on Nutrition in Medicine: Cardiovascular Disease in Washington, DC, cosponsored by the Physicians Committee for Responsible Medicine (PCRM) and George Washington University.

The speakers, shared a wealth of data on the influence of different types of diets on weight, blood pressure, lipids, serum inflammatory markers, hemoglobin A1c levels, and diseased coronary arteries. More than one pointed out that we too often overestimate the benefits of drugs and medical procedures and discount the effectiveness of diet and lifestyle changes. Some highlights:

Does heart disease begin in utero? Children who are large for gestational age (> 95th percentile) and those born to overweight mothers are at increased risk for cardiovascular disease (CVD). Vascular physiologist Michael Skilton, PhD, associate professor at the University of Sydney in Australia, has also identified microscopic lesions in aortic endothelium of babies born small for gestational age (< 10th percentile). He suggests that their diets include the American Heart Association’s recommendations for omega-3 fatty acid intake beginning in childhood (breast milk, flax seeds, walnuts, or child-friendly omega 3 supplements can be used in lieu of fish-derived omega 3s when mercury is a concern).

Children […]

2017-03-15T16:58:14-04:00September 14th, 2015|Nursing, personal health practices|1 Comment
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How Should We Measure Temperature in Young Children?

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Photo courtesy of Exergen Corporation. Photo courtesy of Exergen Corporation.

Do you dread taking rectal temperatures in pediatric patients, knowing that your action will leave you with a screaming, distrustful child as well as a distressed parent? Rectal temperature measurements have long been considered the “gold standard” for accuracy. But are they essential in very young children, especially when infection is not suspected?

“Improving Pediatric Temperature Measurement in the ED” in our September issue relates how a group of ED nurses explored possible alternatives to routine rectal temperature measurements during triage. Their ED protocol had been to use this method in all children under the age of five. However, this practice extended the time needed for triage, was often upsetting to parents, and seemed potentially unnecessary when the reason for the ED visit did not suggest infection (where there would be a need for more careful fever assessment).

An existing emergency services committee made up of ED staff nurses from the hospital’s two campuses set out to explore their options. The committee’s first move was to clearly define the practice problem:

Using PICOT format (Patient population, Intervention of interest, Comparison intervention, Outcome, Time frame), the committee initially formulated the following clinical question: For pediatric patients younger than five years of age (P) who require […]

2016-11-21T13:02:01-05:00September 10th, 2015|Nursing, Patients|0 Comments
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Legionnaires’ Outbreak in New York City: Some Basics for Nurses

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

11148_loresIn the largest U.S. outbreak of Legionella infection since 1976, when there were 221 cases and 34 related deaths in an outbreak at a Philadelphia American Legion convention, more than 113 cases of the disease have been diagnosed in New York City since mid-July. Twelve people have died.

Legionnaires’ disease is neither rare nor exotic; it is a type of community-acquired pneumonia (it can also be hospital acquired). Symptoms include fever, cough, and progressive respiratory distress. Legionella can also cause a milder, flulike illness known as Pontiac fever that generally resolves without treatment. Because many cases of Legionnaires’ disease are never actually diagnosed, mortality rates are difficult to determine, but the rate currently is estimated at 5% to 30%.

The CDC estimates that 8,000 to 18,000 people are hospitalized with Legionnaires’ disease each year in the U.S., yet only about 3,000 cases are diagnosed and reported. Most cases of Legionnaires’ disease are sporadic, unlinked to any outbreak. The infections often are not recognized as Legionnaires’ disease, for several reasons.

2016-11-21T13:02:09-05:00August 12th, 2015|infectious diseases, Nursing|1 Comment
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Evidence-Based Practice and the Curiosity of Nurses

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

karen eliot/flickr by karen eliot/via flickr

In a series of articles in AJN, evidence-based practice (EBP) is defined as problem solving that “integrates the best evidence from well-designed studies and patient care data, and combines it with patient preferences and values and nurse expertise.”

We recently asked AJN’s Facebook fans to weigh in on the meaning of EBP for them. Some skeptics regarded it as simply the latest buzzword in health care, discussed “only when Joint Commission is in the building.” One comment noted that “evidence” can be misused to justify overtreatment and generate more profits. Another lamented that EBP serves to highlight the disconnect between education and practice—that is, between what we’re taught (usually, based on evidence) and what we do (often the result of limited resources).

There’s probably some truth in these observations. But at baseline, isn’t EBP simply about doing our best for patients by basing our clinical practice on the best evidence we can find? AJN has published some great examples of staff nurses who asked questions, set out to answer them, and ended up changing practice.

2017-05-27T10:24:27-04:00July 27th, 2015|career, Nursing, nursing perspective, nursing research|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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