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

Editor-in-chief, (emerita), AJN

Managing Your Patients’ Pain: It’s Not Just about the Opioids

Before Pain Assessment Was the Norm

Some of the most difficult times I experienced as a nurse involved patients in pain. This was before the days of patient-controlled analgesia, when patients in acute pain were mostly managed with “Demerol IM q4h.”

I recall many incidents of paging and telephoning and beeping physicians and residents to get orders for pain medications and trying whatever non-pharma methods I could think of to allay pain. It was awful to see patients suffer needlessly.

Progress, But with a Cost

Then pain became a key part of assessment, as well as of patient satisfaction scoring, and clinicians heeded the need for managing pain. However, there has been too much reliance on the quick fix of strong opioids. A friend who recently had surgery was asked by a nurse to rate his pain. When he replied “eight,” she asked him if he wanted one or two oxycodone pills. His reply, “Well, what do people usually take?”

Revising the Approach to Pain Management

Thankfully, pain management is being revisited, and along with a renewed focus on not prescribing by the numbers (a patient’s pain rating should only be one factor in deciding the intervention), there is a greater understanding of pain and how it can become chronic, and there are more modalities at our disposal to manage […]

2017-04-05T10:34:01-04:00April 5th, 2017|Nursing, pain management|0 Comments
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The Buzz at Nursing Conferences about Quality and Healthy Work Environments

“I was struck by the preponderance of sessions dealing specifically with incivility and bullying (in both academia and practice settings).”

Recent back-to-back nursing meetings gave me a lot of food for thought. After attending conferences, I like to find the overall theme—not just from the scheduled topics, but from the posters and the exhibits and the general “buzz” from conversations. Here’s my take on the two meetings I attended this month.

ANA’s 2017 Translating Quality into Practice Conference

This conference started with an opening session focused on quality from a consumer point of view. Keynote speaker Harry Greenspun asserted that today “it’s the patient or family’s responsibility that the right thing happens at the right time by the right person.” Nurses, he said, are the group that needs to engage and empower consumers (who, he said, should only be called patients when they are receiving care) in improving care.

ANA president Pam Cipriano added that “nurses are the ones doing the work on quality—all the projects and quality improvement is being done on the backs of nurses.”

While some sessions focused on specific clinical practices (reducing hospital-acquired infections or falls, for example), many focused on broader aspects of quality improvement—how systems can support QI change and integrate new technology (mobile apps, simulation).

There was also discussion relating to staffing strategies and teams (though the cynic in me feels that much of the […]

2017-03-29T13:31:16-04:00March 29th, 2017|Nursing|0 Comments
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Women’s History and Nursing’s History

This year’s theme of Women’s History Month, which we celebrate each March, is focused on women’s achievements in business and the labor force, but we don’t need this reason to take time out to remember the strong women who have shaped nursing. We certainly have many of them.

As I wrote in an editorial marking women’s history month in 2015:

Most people still don’t understand all that nurses have done—and continue to do—to improve health care. Most would likely recognize the name of Florence Nightingale. But I wonder if any other nurses would come to mind. I wonder how many nonnurses know that Lillian Wald developed the community health system (she founded New York City’s Henry Street Settlement), pioneered public health and school nursing, and helped establish the National Association for the Advancement of Colored People; or that Florence Wald (no relation to Lillian) brought hospice care to the United States; or that it was Kathryn Barnard’s research that established the beneficial effects of rocking and heartbeat sounds on premature infants, which is why most neonatal ICUs and newborn nurseries contain rocking chairs.

Lillian Wald and other notable nurse pioneers, 1923 March 2015 cover showing Lillian Wald and others at Henry Street Visiting Nurse Service, 1923.

Despite gains in professionalism and education, nurses still are not well […]

2017-03-29T11:15:38-04:00March 16th, 2017|Nursing, nursing history|0 Comments
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Why You Need to Know about the Proposed Health Care Plan

Rep. Paul Ryan, Wisconsin/Flickr/Gage Skidmore

AHCA Release Ignites Concerns from Right and Left

The administration’s plan to replace the Affordable Care Act (ACA) was released earlier this week and has ignited a firestorm among Republicans and Democrats alike.

Democrats claim the American Health Care Act (AHCA) will create havoc and hardship for millions of the most vulnerable.

Many Republicans are worried about the plan’s effect on their constituents, while more conservative members of the GOP feel it doesn’t go far enough in repealing the ACA.

While there is a stated push by the new administration to “sell” the plan and implement it quickly to keep campaign promises, legislators in both parties are calling for time to examine the plan and analyze the cost of the plan, which has yet to be determined.

As almost everyone knows, finding a way to provide affordable health care in this country is very complicated and requires a delicate balance of funding by the federal government and states. It’s likely that there will be several changes before a final plan is in place.

What seems to be clear is that the changes coming down the road will have a direct impact on nurses, patients, and the institutions in which we work. Will […]

2017-03-09T14:15:23-05:00March 9th, 2017|health care policy, Nursing, nursing perspective, Public health|1 Comment
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ANA’s Cipriano, AARP’s Reinhard Comment on ACA’s Undoing

President Obama signing the ACA in 2010/via Wikimedia Commons

Nurses and the Undoing of the ACA

Many in the nursing community supported the Affordable Care Act (ACA) when it was first introduced. This is understandable, given our firsthand experience of patients who didn’t seek care until they were gravely ill because they lacked health insurance. We know how disease management can change outcomes for those with chronic illness and how preventive care can make the difference between having a treatable cancer or a metastasis.

In the years since, as both supporters and detractors continued to argue over the law and its need to be improved (or scrapped, depending on your viewpoint), over 20 million people gained health insurance and access to care.

Now as Congress moves to repeal and replace the ACA with a yet-to-be-determined plan, many are concerned that major gains will be lost and once again it will be the poor and vulnerable who will suffer. (I touched on some of the concerns in my March editorial.)

To get a little more insight, I spoke with two very policy-smart nurses about what might happen and what they feel should happen.

What ANA president Pam Cipriano said:

I asked ANA president Pam Cipriano what she thought was the most critical aspect of the […]

2017-03-01T10:17:14-05:00March 1st, 2017|health care policy, Nursing, nursing perspective|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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