Betsy Todd, MPH, RN, Author at Off the Charts

Long-Term Complications After Congenital Heart Defect Repair

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

Even those of us who don’t work in peds or cardiology are familiar with the amazing surgeries done to repair congenital heart defects (CHDs). After surgery, kids with CHDs are literally transformed, their glowing good health a reminder that medical miracles really can happen.

Sometimes, though, health problems develop many years after CHD surgery. These can be consequences of the original defect itself, or of the specific type of repair that was employed.

In this month’s CE feature, “Long-Term Outcomes after Repair of Congenital Heart Defects (part 1),” Marion McRae, an NP in the Guerin Family Congenital Heart Program at Cedars-Sinai Medical Center, Los Angeles, discusses the anatomy, physiology, and repair options related to six common CHDs: bicuspid aortic valve, atrial septal defect, ventricular septal defect, atrioventricular septal defect, coarctation of the aorta, and pulmonic stenosis. One of the types of congenital heart defects covered in the article is shown in the illustration.

Betsy Todd, MPH, RN2016-11-21T13:03:10-05:00January 19th, 2015|Nursing, Patients|2 Comments

‘Tables Turned’: When the Patient’s Family Member Is a Nurse

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

Nurses are not always comfortable when a patient’s family member is also a nurse. In AJN’s January Reflections essay, “The Tables Turned,” a critical care nurse describes her attempt to navigate the role change from nurse to family member when her sister is hospitalized with multiple injuries after a bike accident.

Her sister is in obvious pain, but pain management is complicated by a low blood pressure. The author asks her sister’s nurse about alternative analgesics. She writes:

“The nurse, perhaps caught off guard by my question, answered abruptly: ‘I don’t think so. We don’t do that here.’ There was a pause. ‘Don’t do what?’ I asked. ‘We don’t do IV Tylenol,’ she repeated. She did not offer an explanation, an alternative, or say she’d ask another provider… I felt helpless, both as a critical care nurse and as a sister.”

As if to reinforce that the patient’s sister is not welcome to participate in care discussions, the charge nurse soon comes by and suggests that the author “step out to get some rest.”

Of course we don’t know the nurse’s […]

Betsy Todd, MPH, RN2016-11-21T13:03:16-05:00January 7th, 2015|career, narratives, Nursing, nursing perspective, pain management, Patients|5 Comments

Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

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

Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work […]

Betsy Todd, MPH, RN2016-11-21T13:03:20-05:00December 17th, 2014|Nursing, nursing perspective, nursing research|9 Comments

Addressing Nurses’ Urgent Concerns About Ebola and Protective Equipment

By Betsy Todd, MPH, RN, CIC, AJN clinical editor. (See also her earlier post, “Ebola: A Nurse Epidemiologist Puts the Outbreak in Perspective.”)

This is not a time to panic. It is a time to get things right.—John Nichols, blogging for the Nation, 10/12/2014

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

For years, nurses have tolerated increasingly cheap, poorly made protective gear—one result of health care’s “race to the bottom” cost-cutting. Now the safety of personal protective equipment (PPE) is being hotly debated as the Ebola epidemic spills over into the U.S.

If all nurses had access to impermeable gowns that extended well below the knee (and could be securely closed in back, had real cuffs, and didn’t tear easily); faceguards that completely shielded; N95 respirator masks that could be properly molded to the face; and disposable leg and shoe covers, we might not be having the same conversation. Yet how much protection can we count on from the garb we now have available, especially considering the minimal donning and doffing training given to most nurses?

While there […]

Betsy Todd, MPH, RN2016-11-21T13:03:44-05:00October 15th, 2014|infectious diseases, Nursing, nursing perspective|17 Comments

How Do You Want to Be Cared For?

The patient in the next bed by mynameisharsha / Harsha K R, via Flickr

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

How do you want to be cared for?

Have you written your own personal nursing care plan? I’m not asking about your health care proxy or living will; most nurses have seen enough disastrous end-of-life scenarios to understand the need for formal advance directives. But if you become comatose or unable to communicate, what small pleasures would ease your suffering? What sights and sounds would promote healing for you, or ease your dying?

I’m often dismayed by the thoughtlessness of some staff regarding what their patients see and hear. Nurses will tune an unconscious patient’s television to the staff’s favorite soap opera, or blast the music of their own choice from the patient’s radio. I’ve witnessed staff talking on cell phones, and even arguing loudly with other staff, as though the person in the bed weren’t even there. When did we lose our attentiveness to patients as unique individuals? […]

Betsy Todd, MPH, RN2016-11-21T13:03:47-05:00October 8th, 2014|Nursing, nursing perspective, Patients|2 Comments

About Betsy Todd, MPH, RN

Long-Term Complications After Congenital Heart Defect Repair

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‘Tables Turned’: When the Patient’s Family Member Is a Nurse

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Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

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Addressing Nurses’ Urgent Concerns About Ebola and Protective Equipment

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How Do You Want to Be Cared For?

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