About Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)

Editor-in-chief, (emerita), AJN

Who Is Doing Advance Care Planning in Nursing Homes?

When I was an ED nurse in a city hospital years ago, we often received patient transfers from area nursing homes. Usually these patients were very elderly, appeared cachectic, and were largely unresponsive (as I recall, many were post-stroke or had dementia). Diagnoses were usually very similar: dehydration, hypotension, UTI, pneumonia; many had contractures. The usual care was rehydration with IV fluids, an NG tube, antibiotics, and often a Foley catheter. Sometimes they were septic and then they were intubated, placed on ventilators, and sent to the ICU, where just about everyone died after a short stay.

What’s the point of this care?

I often wondered, as did many of my colleagues, what was the point of this. It seemed futile, and injurious to the patient. Sometimes, if we could reach family members before nasogastric or endotracheal tubes were placed, we were able to secure an order to dispense with all but comfort measures. Otherwise, all measures were initiated and then things became complicated—legal issues arose about discontinuing futile care and families often couldn’t bring themselves to discontinue life support measures.

Today, a greater focus on advance care planning.

Advance care planning (ACP) was hit or miss in those days—mostly miss—and our patients suffered because of this. It’s only recently that emphasis has been placed […]

2018-12-10T11:07:41-05:00December 10th, 2018|Nursing|0 Comments
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40 Million and Counting: These Days, Every Month Is Family Caregiver Month

Family caregivers, unpaid and unsung.

Photo courtesy of AARP Public Policy Institute.

November is, among other things, the month designated as family caregiver month. These are the 40 million or so people who provide care to loved ones at home, often by themselves. This can range from the basic tasks of daily living that a loved one can no longer perform by themselves, like bathing, dressing, and eating, as well as complex nursing care involving injections, wound and ostomy care, and more.

Helping nurses help the helpers.

In this season of short days and family holidays, it seems like a good time to remind you of the free resources AJN has for nurses and for the caregivers whom you work with. We’ve developed these articles and teaching videos in a decade-long partnership with the AARP Public Policy Institute directed by Susan Reinhard, and with the Betty Irene Moore School of Nursing at the University of California-Davis.

Teaching videos and tip sheets to share with caregivers.

Each article covers the evidence behind what and how you should teach a caregiver on a particular topic and is associated with a video demonstrating techniques and procedures for the caregiver to follow. […]

2018-11-30T10:14:08-05:00November 30th, 2018|family caregiving, Nursing|1 Comment
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As Patient Handling Injury Rates Remain High, Schools Teach Outdated Methods

The old-fashioned way to reposition patients.

I haven’t seen draw sheets in hospitals for years now. “Back in my day,” those narrow sheets we placed across the middle of the bed were considered essential to patient care. Draw sheets were easier to change than the full sheet and they kept the bed neat. They always seemed to be hard to come by—probably because most nurses had stashed their own supply of them in patients’ rooms.

But more importantly, they were what we used to reposition patients. We used to work in pairs on turning rounds—one of us on each side of the bed, rolling the draw sheet tightly to get a grip, then sliding the patient up in bed or turning them on their sides. It was hard work, and no form of “good body mechanics” saved your back or shoulders and neck from strain when you needed to stretch across a bed—or, many times, climb on top of it—to move an unconscious patient. It’s no wonder that nurses and nursing assistants had such high rates of serious musculoskeletal injuries.

The institution of ‘No-Lift’ policies.

Then came electric beds, overhead lifts and transfer stretchers, and “No Lift” policies, which were based on data from the Occupational Safety and Health Administration (OSHA) on the frequency of injuries and supported by nursing organizations. Many hospitals and nursing homes implemented safe patient handling and mobility […]

2018-11-16T07:25:15-05:00November 16th, 2018|Nursing, nursing career, wellness|5 Comments
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Violence Against Health Care Workers: Time for a Zero Tolerance Approach

“Staff should know implicitly that they don’t have to work in an unsafe environment . . . “

The October issue of AJN has two articles that focus on workplace violence. We’ve shared them through social media—and sadly, the response and comments indicate that this information is sorely needed.

One, described in last week’s blog post by clinical editor Betsy Todd, is an article from a health system reporting on how they developed an innovative program to train their employees to deal with violent situations.

‘Staggering numbers.’

The second article (free until Nov. 8) is from nurse and attorney Edie Brous, our contributing editor and coordinator of our legal column, and covers what staff should expect from management in striving for safe workplaces. The numbers of workplace injuries and violent episodes are staggering—the CDC, Bureau of Labor Statistics, and other government agencies dealing with health and safety all show significant increases in the last five to ten years. Brous cites many of these data and notes, “The health care industry experiences almost as many violent injuries as all other industries combined.”

Organizations must be proactive . . . and held accountable.

What responsibility do health care organizations have? Brous writes:

“Organizations must be proactive in protecting their workforce and held accountable […]

2018-10-25T10:18:03-04:00October 25th, 2018|Nursing|0 Comments
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Why Do Journalists Ignore Nurses?

And what are we going to do about it?

We’ve all seen the stories in print or watched the video clips:

  • In a story about a hospital’s response to a disaster, the hospital administrator and/or a physician describe the actions of the staff, while behind them one can see nurses rushing about.
  • In a story about patient survival after a harrowing event, it’s the physician alone who is interviewed about the patient’s care and recovery.

Nurses—and nursing’s role—are made invisible; our contributions are devalued, relegated to little more than a backdrop for most stories about health care or news involving delivery of services. And yet we all know that nurses were intimately involved in the event and outcomes. In ignoring nurses’ experiences and perspectives, health care coverage perpetuates nursing’s invisibility and ignores nursing’s central role in health care.

A replication study reports little progress after 20 years.

In the October issue, Diana Mason and colleagues present their report of a study they conducted as an adjunct to their recent replication of the 1997 Woodhull Study on Nursing and the Media. In the replication study,

” . . . nurses were identified as sources in only 2% of health news stories in the same print publications investigated in the earlier study, showing no improvement in […]

2018-10-08T10:41:16-04:00October 8th, 2018|Nursing, nursing perspective|2 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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