Milk and Molasses Enemas – A Tradition to Keep

By Maureen Shawn Kennedy, AJN editor-in-chief

I recall giving an “M&M” enema when I worked as a nurse’s aide in high school. The small community hospital medication room had a jar of molasses in the cabinet, and I watched the nurse mix ½ a cup of the thick syrup with ½ cup of milk and put it in an enema bag. She then handed it to me and said, “C’mon, it’s easy, I’ll show you how.” And it was, and it worked pretty quickly. Older nurses and physicians swore by it.

By the time I was out of nursing school and working in clinical practice, commercial preparations seemed to be the standard. But as the song goes, “everything that’s old is new again.” This month in AJN, Jackline Wangui-Verry and colleagues’ paper, “Are Milk and Molasses Enemas Safe for Hospitalized Adults? A Retrospective Electronic Health Record Review,” describes their investigation of this long-time and oft-used intervention for constipation.

Examining the safety of a long-established, ‘last resort’ practice.

The authors “wanted to learn whether this approach is actually safe and effective or more of a ‘sacred cow’ . . . .”

This study focused on safety and a follow-up study will include efficacy. They evaluated the hospital records of 196 hospitalized adults who received an M&M enema after laxatives or stool softeners failed to produce a bowel movement. No serious complications—“allergic reactions, bacteremia, bowel […]

2019-09-11T10:41:01-04:00September 11th, 2019|Nursing, nursing research|3 Comments
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Revisiting Evidence-Based Practice, and ‘Making Change Stick’

Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes.

That’s the beginning of the first article in our first “step by step” series, Evidence-Based Practice, Step by Step, launched in November 2009. It won the Nursing Print Media Award for Nursing Excellence from Sigma Theta Tau International; the 12 articles in the series continue to be among the most highly viewed of any AJN articles online.

Nurses know about EBP, but changing practice is another thing.

The continued popularity of the articles made us wonder if the tenets of EBP were still not adequately known by nurses. So we asked the experts, and the result is our new series, EBP 2.0: Implementing and Sustaining Change.

Sharon Tucker, PhD, RN, FAAN, and Lynn Gallagher-Ford, PhD, RN, NE-BC, DPFNAP, FAAN, both  at the Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at the Ohio State University College […]

2019-04-17T08:43:00-04:00April 17th, 2019|Nursing, nursing research|1 Comment
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Are Your PCA Pumps Accurate, and Working?

Device malfunction happens.

After orthopedic surgery several years ago, I awoke in the PACU to find nurses working frantically on one side of my stretcher. Simultaneously, I realized that my leg hurt. A lot. And with another moment’s awareness—awake enough now for my nurse’s brain to begin to kick in—I understood that all of the activity concerned my PCA pump.

neeta lind/flickr creative commons

One of the nurses noticed that I was stirring. “Your pump has malfunctioned. We can’t get the replacement to work. A third pump is on the way. I’m so sorry!”

The scramble for a replacement, and then another, probably lasted less than five minutes, but it was a pretty wild ride. My deep breathing in an attempt to control the pain gave me something to focus on, but it was a pretty weak effort up against bone pain in the immediate post-op period. I’m grateful that my nurses—there were at least three involved at that point—regarded the pump failure as an emergency.

But operator errors are more common.

Needless to say, then, I was particularly interested in a new study that appears in this month’s AJN. In “Errors in Postoperative Administration of Intravenous Patient-Controlled Analgesia: A Retrospective Study,” Yoonyoung Lee and colleagues examined […]

2019-04-10T09:29:43-04:00April 10th, 2019|Nursing, nursing research, patient experience, Patients|0 Comments
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‘We Request Your Quiescent Contribution’: Predatory Publishers Are Absurd, But Not Funny

Multiple daily solicitations.

The screenshot below shows an excerpt from an email our editor-in-chief recently received. Editors at AJN receive multiple emails daily from mysterious publishers soliciting them for article submissions, important roles on editorial boards, or as conference speakers. If it weren’t alarming, it would be flattering. We’re not scholars and experts in sub-specialties of botany or engineering, in fossil fuel geology, neurosurgery, or, for that matter, microbiology. Our advice on such topics might well be dangerous, or at least irrelevant and wrong.

Some open access journals are highly respected in their fields; the journal that sent this letter also bills itself as open access, but if it contains legitimate articles on microbiology, and I’m not saying it doesn’t, they may find themselves with strange bedfellows.

Despite obvious warning signs, some authors are not deterred.

It’s impossible to keep ahead of the flood of such emails, most of which are characterized by typographical oddities and peculiar juxtapositions of tone. There are many other tell-tale signs of predatory publishers, most of which have little or no oversight from real content experts and no editing or filtering of content (one must simply pay a fee to be published or attend a conference).

But what’s most worrisome about this trend is that their strategy of casting a […]

2019-02-28T11:46:34-05:00February 28th, 2019|Nursing, nursing research, writing|0 Comments
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Protocol to Reduce Hospital-Acquired Pneumonia Improves Outcomes, Lowers Costs

Costs. Length of stay. Patient mortality. We know that the care we provide is central to good outcomes of every kind. But how often do we get to clearly demonstrate this for hospital administration? In “A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia” (free until March 1) in this month’s issue, authors Chastity Warren and colleagues describe a QI project that showcased how a simple nursing intervention decreased morbidity, mortality, and costs at their hospital.

A standardized oral care protocol.

Aware of the connection between poor oral care and hospital-acquired pneumonia, a group of nurses at their large Midwest hospital set out to devise a standardized oral care protocol for all adult patients. Patients were categorized as either ventilated, at-risk (for example, someone with a trach or with swallowing difficulties), or short-term care. The care kit and the frequency of oral care were different for each group.

Once the intervention was in place, the nurses tracked not only the incidence of hospital-acquired pneumonia in both ventilated and non-ventilated patients, but also (by creatively “triangulating” several sources of data) the adherence of staff on each unit to the protocols.

Protocol adherence.

Regarding protocol adherence—always a challenge with new protocols when multiple units and staff are involved—the authors noted that there’s still work to be […]

2019-02-06T09:10:07-05:00February 6th, 2019|Nursing, nursing research|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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