‘Right Under Our Noses’: Nightmarish Nursing Home Conditions During the Pandemic

As vaccinations increase and COVID-19 infection rates in nursing homes plummet, it’s easy to forget just how bad things got in many of them and how ill-equipped many were in the the early months of the pandemic to provide humane and effective care.

The following excerpt is from our March Reflections essay, “Right Under Our Noses: Nursing Homes and COVID-19,” which was written by a California nursing professor who volunteered to join a California Medical Assistance Team. The mission of her team was to bring aid to a skilled nursing facility where the coronavirus was rapidly infecting both patients and staff, a facility with little PPE available and many staff members refusing to come to work out of fear of infection.

The conditions I saw were shocking, even to an experienced nurse. I saw soggy diapers on the floor at the heads of many beds on most mornings. One day a bedbound patient needed the bedpan. I searched every closet and drawer but there were no supplies. I filled a basin with warm water and cut up a PPE gown to make washcloths to clean the patient. On the second day of my deployment I realized that many of […]

2021-03-18T12:10:25-04:00March 18th, 2021|COVID-19, Ethics, infectious diseases, Nursing, nursing perspective, safe staffing|1 Comment
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Moral Courage in a Pandemic: a 14th Century Physician and Health Care Workers Today

What does it mean to be human? What values should we live by? How should we respond to those in need during a time of crisis? What would I do?

A physician during the Black Death.

Guy de Chauliac

As a hospice social worker who loves the humanities, I find that historical figures often come to mind when there’s a parallel with things that are happening with patients and their families. Amidst the COVID-19 pandemic, I’ve been thinking a lot about a 14th century French physician named Guy de Chauliac.

Although little known today, in his time he was one of Europe’s most respected medical practitioners. In fact, his text Chirurgia Magna was a standard part of medical education for 200 years.

I came across de Chauliac’s story years ago while researching the ‘Black Death,’ the plague that decimated Europe in the 1340s, killing up to a third of its population.

Those who have read Giovanni Boccaccio’s contemporary account of this plague in his work Decameron are often left with a cynical impression that, as Boccaccio puts […]

2020-03-27T12:15:38-04:00March 27th, 2020|Ethics, infection control, Nursing, nursing perspective, Public health|0 Comments
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Got Ethics?

Photo © Getty Images

We’ve published articles on all sorts of champion programs developed for various hospital initiatives. Central to these creative models (which address problems in areas like pain, mobility, elder care, and skin care, for example) is enlisting nurses to become knowledgeable about a key subject so that each patient care unit can have its own readily available resource, or “champion.”

Ethics champions programs at three hospitals.

In our July issue, we present “Ethics Champion Programs” (free to access until August 1), which describes how three pediatric hospitals—Children’s Mercy Kansas City, Children’s Hospital Colorado, and Children’s Healthcare of Atlanta—have implemented such programs to ensure that nurses have access to resources to address ethical issues. These resources include ethics rounds, monthly forums, education sessions, and unit-based and family consultations. While each program has unique components, the common goals of all three are to create a safe space for discussing ethical issues, to address moral distress, and to cultivate a climate of ethical practice.

To me, there seems to be no more important issue than ensuring ethical practice. As nurses, we face many instances in which we may question our interventions or find ourselves at odds with colleagues over treatment decisions, or in the midst of family angst over such decisions. These […]

2018-07-26T14:17:54-04:00July 25th, 2018|Ethics|0 Comments
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When Clinical Nursing Students Are Bullied by Staff Nurses

A disillusioning experience.

In this month’s Viewpoint column, clinical nurse instructor John Burkley describes a disturbing incident in which his clinical nursing students were treated with dismissiveness and rudeness by a nurse on a unit to which they’d been assigned. The students ultimately left this early encounter with hospital nursing—which took place at a teaching hospital—with varying degrees of disillusionment.

Nurses may need to develop a certain inner resilience to handle the physical, emotional, moral, intellectual, and organizational challenges of their profession. But bullying won’t help them develop it.

Alienating future nurses does lasting harm. What can be done?

As Burkley notes, negative clinical experiences can have a formative influence on aspiring nurses—they “are alienating, contribute negatively to learning, and should not be tolerated.”

Unfortunately, while many nurses are welcoming and supportive of clinical students, such incidents of subtle or overt bullying appear to be common. Drawing on his own experience as well as current literature, Burkley offers a few possible ways nursing schools and teaching hospitals can address this issue. […]

2018-04-30T08:23:05-04:00April 30th, 2018|Ethics, Nursing, nursing career, nursing students|4 Comments
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On Ethical Short-Term Medical Missions: An Argument from Experience

“In the absence of clearly articulated intentions and approaches, how can we be sure that short-term medical missions won’t have unintended long- or short-term consequences?”

Garrett Matlick

That’s the central question posed by Garrett Matlick’s Viewpoint essay, “Short-Term Medical Missions: Toward an Ethical Approach,” in the April issue of AJN. Matlick, currently enrolled in the Family Nurse Practitioner/Master of Public Health Program at Johns Hopkins University School of Nursing, Baltimore, had an opportunity to observe short-term medical missions (STMMs) that succeeded as well as some that failed.

What works and what doesn’t?

Having considered the current paucity of quality research on STMMs and their effects, Matlick both calls for more rigorous future research and offers a few basic considerations that he believes should be applied to all STMMs that offer direct care to local communities. His case is immensely strengthened by the use of multiple real world examples he observed or participated in while in Cambodia.

AJN sometimes receives Reflections essay submissions from nursing students and others about their experiences in STMMs in various countries. (Unlike the Viewpoint column discussed in this post, Reflections essays tend to focus more on personal reflections and story than on making an argument.) Some submissions reflect a nuanced awareness of limitations and benefits […]

2018-04-11T11:53:31-04:00April 11th, 2018|Ethics, nursing students, Public health|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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