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The Fraught Journeys of Those Fleeing Hurricanes

AJN received this guest post last week, when the effects of Hurricane Irma were still in the headlines, from Kathryn Jackman-Murphy, EdD, MSN, RN, professor of nursing at Naugatuck Valley Community College in Connecticut. The challenges she describes here are not specific to Hurricane Irma—they are faced again and again by those forced from their homes and communities by storms and other natural disasters, and they often happen out of sight of the media.

by patchy patch, via flickr

Right after Hurricane Irma began to hit Florida, I checked in with one of my son’s adult friends. He was searching for a safe landing site for himself and his elderly parents, as his initial plans to stay had been compromised by the hurricane. He was now in Tennessee, with no idea of where they would be able to stay until it was safe to return home. The dad is a Vietnam-era veteran with PTSD, hypertension, and diabetes. The mom also has diabetes and some limitations with mobility related to arthritis and walks with a cane.

How can nurses help?

Watching the devastation in Florida and Texas, I was searching for something to do to help. That’s what nurses do—we help. Being so far away in the Northeast, I felt not only helpless but acutely aware that […]

2017-09-20T13:33:35-04:00September 20th, 2017|climate change, environmental health, Nursing, Public health|0 Comments
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Nursing Considerations for Post-Hurricane Hazards

NASA satellite image of Hurricane Irma at peak intensity, Sept. 6, over Virgin Islands

On Sunday, September 10, many of the residents of coastal towns around the state of Florida sought shelter from Hurricane Irma in shelters, and in their homes when shelters reached capacity. Hurricane Harvey relief efforts were still fresh in the minds of the public—and in fact still underway—even as Florida prepared for a projected direct hit of Hurricane Irma and Georgia and South Carolina braced for storm surges and tropical storms.

By Tuesday, the weather system had dissipated and flood waters covered the areas hit by Hurricane Irma, creating environments that present many hazards, some known and others unknown. As other parts of the Southeast feel relief, with restored electricity and Internet and cell phone service restored, some towns that didn’t fare so well are still recovering from the devastation. Recovery may be hampered as we receive news of additional severe storms developing in the Atlantic.

For Florida residents in certain areas, the storm is far from over. Those most vulnerable for health problems in this post-hurricane period include persons with chronic conditions, children, older adults, those living in poverty and those newly impoverished by the hurricane, relief workers and first responders, undocumented immigrants, […]

2017-09-18T07:50:13-04:00September 18th, 2017|Nursing, Public health|0 Comments
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Please Nurse: Needing to Feel Human Again in the ICU  

Ruby Vogel circa 1970. Courtesy of Shannon Perry.

The patient perspective below was written by Ruby Vogel in 1976, shortly after she was discharged from the hospital following a cholecystectomy and colon surgery. Her daughter Shannon Perry, PhD, RN, FAAN, professor emerita at San Francisco State University, recently received the document from her sister, also a nurse and former nursing educator, to whom their mother had originally given it.

According to Perry’s sister, who found the document while cleaning out some files, Vogel had thought her daughter could use the information to help her students understand the experiences of patients in the ICU. Some things were different back then—for example, says Perry, a cholecystectomy and colon surgery were major surgeries with several days in the hospital for recovery. But some things stay the same, and this vivid account highlights how patient-centered care—a touch, a hand on the brow—can make the difference. Ruby Vogel died in 1985.

Intensive care put me in a different world—of noises, silly ideas, and feelings. I seemed apart from people. They came and went but I wasn’t people, just that big sore place. I could hear and I could see. People didn’t seem to speak to me nor stay around long enough for my eyes to focus or my lips to form words. In and out. Checking! Checking! Checking! I could see and hear. Family, nurses came in, took a look and left. I was still there.

That awful machine next […]

2017-09-11T10:45:55-04:00September 11th, 2017|patient experience, Patients|0 Comments
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A Nurse Takes a Stand—and Gets Arrested

image via Wikimedia Commons / Jacklee

Douglas P. Olsen, PhD, RN, associate professor, College of Nursing, Michigan State University, writes about ethical issues for AJN.

On July 26, Alex Wubbels, charge nurse at the University of Utah Hospital burn unit in Salt Lake City, showed extraordinary ethical courage that will serve as an example for my students for a long time to come. She refused a police detective access to an unconscious patient so he could draw a blood sample, citing clear violation of hospital regulations, which require patient consent, a court warrant, or that the patient is under arrest. After a short, tense discussion, she was roughly handcuffed and put in a police vehicle by the detective. I recommend watching the video of the incident, although parts of it are quite disturbing. According to various analyses reported in the media, the hospital and Wubbels were legally correct and the detective’s view of her legal obligations was wrong.

All treatment, even the most minimally invasive, can be refused by a patient and therefore requires the patient’s informed consent. There are limited exceptions under which treatment can be provided without patient consent. These include:

2017-09-02T09:55:06-04:00September 2nd, 2017|Ethics, Nursing|11 Comments
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PTSD and Falls: For the Elderly, a Lost Sense of Safety and Control

Jack lowers his head and presses his temples with his thumbs. He whispers, “Am I going crazy?”

In the weeks after his fall and trip to the emergency department, something has gone painfully awry. He’s been having episodes of anxiety when transferring from bed to chair as well as difficulty sleeping. His once unflappable optimism has been blunted by intrusive memories and ruminations about the fall and a sense of foreboding about the future.

Psychological Aftereffects of a Fall

Though he sustained no serious injury and had been quickly returned to the assisted living facility where he lives, the fall has left him with symptoms of posttraumatic stress disorder (PTSD). Most health care professionals are unaware that falls in the elderly can cause posttraumatic stress symptomatology, acute stress disorder, even PTSD. Indeed, in some settings falls occur frequently enough to insulate nurses and other medical staff from the awareness of how terrifying such an event can be or how it can undermine one’s sense of safety and control, particularly when it results in injury and/or invasive medical treatment.

Although Jack was under hospice care at the time of his fall, the facility sent him to the hospital because of its policy on ruling out head injury. Most hospices and facilities have protocols governing their response to falls. These typically include […]

2017-07-19T07:34:30-04:00July 19th, 2017|Nursing|2 Comments
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