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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 was […]

2022-09-16T11:39:37-04:00September 16th, 2022|Nursing, nursing research, Patients|0 Comments
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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
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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 exercise […]

2022-08-18T11:39:58-04:00August 18th, 2022|climate change, environmental health, Nursing, nursing perspective, Public health|0 Comments
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The 12-Hour Nursing Shift: Preferred by Staff, but Good for Patients?

A new study finds reduced communication skills after consecutive shifts but no clinical deficits.

Twelve-hour shifts have been a mainstay of nursing schedules since they began as a staffing strategy in the 1970s, but debate continues about their effect on nurses’ health and ability to safely care for patients.

Studies have examined both aspects of the issue. Regarding staffing, researchers have found that a majority of nurses and hospital administrators prefer 12-hour shifts as a means to achieve continuity of care, ease of scheduling, and for nurses, work–life balance. Regarding patient care quality, research has shown an association between longer consecutive shifts and more clinical errors.

The latest findings. 

A recent study from Washington State University aimed to test the latter. The research team recruited 94 RNs working consecutive 12-hour shifts to examine the cumulative effect of shift work–related changes on sustained attention, cognitive effectiveness, and subjective sleepiness. Participants were evaluated in two 20-minute simulated care situations by other RNs trained to assess performance. Nurses working day and night shifts were randomized across fatigued and rested conditions, defined respectively as having worked three consecutive 12-hour shifts or having three consecutive days off.

[…]

2022-07-15T10:14:05-04:00July 14th, 2022|Nursing|0 Comments
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Looking Beyond Nursing Education Offerings Can Open Doors

In a world where time efficiency is supreme, nurses often seek educational opportunities only within their area of nursing expertise. After all, further expertise in my specialty area will directly apply to work, right? It may seem counterintuitive to look for learning opportunities outside nursing, but the results may surprise you.

I am a nursing PhD student, and the PhD program contains only one “independent study” elective course. One chance for me to choose my own topic. Most students choose to research background literature for their dissertation, but I chose . . . to audit a law course. My future research project involves children with special needs, and I discovered a local special education law course. School education is vitally important for families with special needs children, but the rules surrounding education are poorly understood by parents—and nurses.

Since I don’t have a law degree, I wasn’t certain how much I would understand or use the material covered in the class, but auditing the class turned out to be the best decision I could have made, yielding immediate benefits and opening doors of future opportunity.

Outside the educational comfort zone.

Initially, I felt excitement tinged with trepidation and self-consciousness. To audit a course, I needed to obtain permission from […]

2022-07-08T13:00:07-04:00July 8th, 2022|career, Nursing|1 Comment
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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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