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

Editor-in-chief, (emerita), AJN

Thinking About Las Vegas

This latest mass shooting, in which 59 people were killed and 500 wounded in Las Vegas, is distressing—and it won’t be the last. Again we find it incredible that this can be allowed to happen.

And again we are reminded of the unique position of the United States compared to most other countries, our astronomically higher numbers of gunshot deaths and the financial and emotional costs they exact. As I wrote in my February 2016 editorial on gun violence, “firearms accounted for 417,583 deaths—253,638 suicides and 163,945 homicides between 2003–2013.”

There’s more information about gun violence and the dismaying number of injuries and deaths among children in our report in the September issue. And a study just published in Health Affairs puts the annual cost of emergency and inpatient care for firearm injuries at $2.8 billion.

The numbers of deaths and injuries we can measure. The sense of helplessness and frustration, and the creeping sense of anxiety we experience as we go into public spaces, are more invidious. […]

2017-10-07T08:35:43-04:00October 6th, 2017|Nursing, Public health|3 Comments
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Student Errors in the Clinical Setting: Time for Transparency

Mistakes happen.

When I was working as an ED nurse, we often had nursing students assigned to the area. One day we had an elderly man with asthma in one of the treatment rooms. The physician ordered aminophylline suppositories. After reviewing the “5 rights”—right patient, right medication, right dose, right time, right route—I directed the student to administer the suppositories. All seemed well.

Imagine my surprise when the student proceeded to insert the suppository into the man’s nose! She explained that since it was a breathing problem, she naturally thought they would be inserted nasally. It never occurred to her that these were rectal suppositories and it never occurred to me to ask if she knew what to do with them. We all had a good laugh and that was that.

Undocumented errors.

Another day, another patient, another faux pas: a physician said to “cut the IV,” which everyone knew (that is, we assumed everyone knew) meant to discontinue the patient’s IV. One of my colleagues intervened when she saw a determined-looking student, with bandage scissors in hand, approach the patient’s room, ready to “cut the IV.” We again marveled at the student’s interpretation of the phrasing, and that was that.

And that’s the problem—that was that. There was no documentation of these as “near-miss” errors, […]

2017-10-04T09:57:24-04:00October 4th, 2017|Nursing, nursing students, patient safety|2 Comments
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Safety vs. Independence: When Is a Person Too Old to Drive?

I’d venture that many of us have had family discussions about whether it’s safe for a grandparent or elderly aunt or uncle to be driving. Driving is often the last vestige of independence and one that is fiercely held onto.

I had an aunt and uncle who worked out a unique and very shaky scheme so they could still get around independently: he couldn’t drive because of severely diminished eyesight, but he would direct his wife, my aunt, who had early Alzheimer’s, as she drove. Between the two of them, they could get to grocery stores, church, medical appointments, and bingo.

And one colleague, to prevent her father from driving after multiple accidents, told him she needed the car to get to work; in reality, she just drove it a few blocks from the house and parked it.

While author Loren Staplin and his colleagues note in ”Can Your Older Patients Drive Safely?” that “decline in driving abilities is related to functional status, not chronological age,” they also observe that the “greater risk associated with driving at age 75 and older is . . . evident in these drivers’ greater level of involvement in fatal motor vehicle accidents relative to their representation in the licensed driver population.” […]

2017-09-13T09:26:54-04:00September 13th, 2017|Public health|1 Comment
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Designing Nurses: Make Your Ideas Reality

“At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher…”

Earlier this month, the New York Times published an article, “Design Thinking for Doctors and Nurses.” In it, the author describes a simple solution designed by a nurse to identify who was in charge of a resuscitation team: whoever was wearing the orange vest was the leader.

As a former ED nurse who participated in many codes and trauma emergencies, I could easily picture the chaotic scene that led to this innovative solution. In a large urban teaching hospital, cardiac arrests and trauma calls draw many physicians and medical students, respiratory therapists, and of course, at least two to three nurses. It wasn’t unusual to have conflicting orders shouted out by physicians, residents chiming in with questions and suggestions, and the medication nurse making the decision as to which order she/he would process. At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher—only the physician in charge and resuscitation team were allowed inside the box. All other onlookers (mostly medical students and residents) had to stay outside the box and be silent. It did wonders for instilling a quiet, organized atmosphere into a highly charged event.

Left out of a wide range of decisions critical to […]

2017-08-16T09:22:11-04:00August 16th, 2017|Nursing, nursing perspective|0 Comments
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The Reality of Depression Following Stroke

Photo by David A. Grossman.

This month’s CE article, “Early Intervention in Patients with Poststroke Depression,” hit home for me. It brought back memories of my Aunt Rita’s decline from a once-vibrant and independent career woman. As authors Gwendolyn Hamid and Meredith MacKenzie note, poststroke depression “often goes unrecognized and untreated because the physical and cognitive repercussions of stroke make it difficult to identify.”

Aunt Rita lived alone in an old Victorian house in Massachusetts. She was fun-loving and lively and enjoyed going to the theater and dinner in Manhattan, shopping, and sipping a beer and rooting for the Red Sox and Boston Bruins—especially when she was with her New York nieces and nephews. When she had cardiac bypass surgery in her 70s, however, things changed drastically. She didn’t bounce back from surgery. Aunt Rita was slow and tentative in moving about and became quiet and withdrawn. A niece came to live with her as a caregiver, but Aunt Rita didn’t seem to want to eat, drink, or even bathe. Her physician diagnosed organic brain disease secondary to the effects of a stroke.

About three months later, I drove up from […]

2017-07-10T09:31:27-04:00July 10th, 2017|Nursing|0 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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