About Guest Author

This author has not yet filled in any details.
So far Guest Author has created 460 blog entries.

In the Nick of Time: Advance Care Planning in the ICU

Marian Grant, palliative care NP

I’m a health policy consultant for national palliative care organizations and often advocate for advance care planning, a process that helps people with serious illness prepare for future decision-making. I also work as a palliative care nurse practitioner (NP) in an academic medical center where I see the real-life aspects of advance care planning.

I recently saw a patient whose case typifies how advance care planning and policies to support it can work. A middle-aged woman with metastatic breast cancer at our cancer center had been seen the day before by the palliative care NP there. The NP was called to help assess the patient’s new-onset dizziness. While seeing the patient, she also spoke to her about her cancer status and suggested completing an advance directive. According to the NP’s note, the patient’s son, who was there with her, seemed surprised that things were not going as well for his mother as they had hoped.

The ‘Five Wishes’ advance directive.

Later in that same visit, the patient became profoundly hypotensive and was sent to the emergency department and then admitted to the medical ICU. The team there put in a request for a palliative care consult for metastatic cancer. I first saw the patient the next […]

2022-09-22T10:08:13-04:00September 22nd, 2022|end of life, Nursing, Palliative care|1 Comment
Read More

PPE’s Contribution to the Plastic Pandemic

“It’s estimated that it could take 450 years to completely decompose a surgical mask.”

Personal protective equipment (PPE) is critically important for health care workers; however, use of PPE is also contributing to environmental disaster. The COVID-19 pandemic and the monkeypox outbreak underscore how crucial protecting frontline workers is for their health and for public health at large. What is yet unclear are the environmental implications of our extensive PPE use during the pandemic. Nurses must have prominent voices at the table when discussing the future of PPE and how to deal with waste.

In the United Kingdom alone it was reported that over a period of just 53 days, 748 million PPE items were used in hospitals. In 2020, over 6.76 billion PPE items were distributed in England, three times the usual amount. Several countries reported over a 350% increase in medical waste during the height of the pandemic. During two years of the pandemic, it’s estimated that over 900 million tons of plastic waste was generated.

This ‘plastic pandemic,’ which is now a global threat that has been exacerbated by the COVID-19 pandemic, began in the 1850s when early forms of plastic began replacing natural materials. Despite recycling efforts, over 60% of plastics are estimated to remain […]

2022-09-20T09:37:57-04:00September 20th, 2022|environmental health, environmental health, Public health|0 Comments
Read More

We Haven’t Made You Better: Orthopedic Trauma and Emotional Healing

Learning that healing the body isn’t always enough.

For much of my career as a trauma ICU nurse and orthopedic trauma nurse practitioner, I focused on building my knowledge of pathophysiology and mastering the assessment and procedural skills required to care for trauma survivors. After a decade of practice, I felt like I had entered the “expert” phase of clinical competence described by Dr. Patricia Benner in AJN in 1982.

But I was completely ignorant of a giant hole in my practice. A trauma survivor pointed out this gap during a routine clinic visit. Ms. H was six months removed from an ankle fracture she’d suffered in a motor vehicle collision on her way to work one morning. On exam, she had regained full strength and range of motion, the fracture was healed on radiographs, and her pain was limited to a minor ache after extended activity. She’d healed remarkably.

I told her that she had done an excellent job with her recovery and could resume her life, including going to work. I’ve come to believe that Ms. H’s response to this assertion changed my entire perspective on patient care. “I can’t go back to work,” she said. “Since the accident, I can’t get in a car without having panic attacks.”

I […]

2022-09-16T11:39:37-04:00September 16th, 2022|Nursing, nursing research, Patients|0 Comments
Read More

Message from a Concerned School Nurse

Robin Cogan

In case you have not seen the new Centers for Disease Control and Prevention (CDC) guidelines for schools, published on August 11, 2022, here they are: Operational Guidance for K-12 Schools and Early Care and Education Programs to Support Safe In-Person Learning.

Key changes in CDC guidance for schools.

The CDC has chosen the path of least resistance as schools are about to reopen or are in their first few weeks of the new school year. Although the word “prevention” is included in the CDC’s name, this central goal seems to have been removed from these guidelines, including crucial pieces of the mitigation strategies that in the past prevented the school-level spread of the virus:

2022-08-25T09:13:06-04:00August 25th, 2022|infectious diseases, Nursing, nursing perspective, Public health, school nurses|2 Comments
Read More

Heat Illnesses: Nursing Essentials from a NYC Emergency Department

As complex as health care may be in an emergency department (ED) setting, the weather and seasonality have added additional variables to that complexity. It is critical that registered nurses in the ED understand the health care trends associated with the weather and seasons. As in many other places, the summer here in New York City is a time when people are more active, spending time outdoors and traveling. This summer we have experienced several stretches with temperature in the high 90 degrees. July recently had a seven-day stretch with temperatures nearing and exceeding 100 degrees in New York. These heat waves can become physiologically unbearable.

Jonathan Nover, MBA, RN

Who is most vulnerable to heat illness?

During these heat waves, it is important to recognize the pockets of vulnerability among us. Older adults are often the most vulnerable because of decreased capacity to thermoregulate in response to changes in temperature. It is also important to consider the effects of heat on the homeless community and people without access to air-conditioned environments. Children are more susceptible to heat illness than adults. Some medications, such as diuretics, and consumption of alcohol and illicit drugs can increase a person’s risk of heat exhaustion. Additionally, individuals who perform strenuous […]

2022-08-18T11:39:58-04:00August 18th, 2022|climate change, environmental health, Nursing, nursing perspective, Public health|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top