Nurses spend more time with patients than most other types of providers and have unique insight into patient care and the the healthcare system.

Year-End Take: A Hopeful Trend in U.S. Health Care?

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s […]

2016-11-21T13:11:06-05:00December 27th, 2011|health care policy, nursing perspective|3 Comments
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Reading Between the Whiteboard Lines in the ICU

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

My hospital uses dry-erase whiteboards as a tool to communicate with patients and family members. Mounted to the walls in the patients’ rooms, the boards are prominent and concise.  Aside from a lot of basic information, notes get added to the board when diagnostic tests are completed, when complementary therapies have been implemented, and when housekeeping staff visit. The “meat” of the board, however, is the section that addresses plans and goals for the day. The plans and goals are updated and modified continuously by nursing staff. They’re specific to each patient, yet, despite their personalization, the goals for ICU patients tend to fall into distinct categories.

The first category includes goals which are often set by the patients themselves. They tend to require a certain amount of collaboration and active participation. These types of goals, which include things like “maximize incentive spirometer use,” “ambulate,” and “advance diet,” imply a relatively healthy state and tend to predict transfer orders.

The next type of goal is aimed at restoring health and stability. These goals don’t necessarily require patient participation and often focus on pathophysiologic processes. On the whiteboards of these rooms, the listed goals are likely to include things like “wean ventilator,” “control agitation,” “control fever,” or “increase level […]

2016-11-21T13:11:09-05:00December 15th, 2011|nursing perspective, Patients|3 Comments
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Sarcopenia and Me – Or Why Exercise Really Matters as We Age

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Recently I started an exercise program with a personal trainer. I’ve been a runner for 25 years, even ran five marathons. I’ve never had a problem being disciplined about running four or five days a week, no matter what the weather. But I’ve never been able to stick to any other exercise program for more than a week or so. Working with weights, yoga, step classes, just doing push-ups in my living room when I get back from a run—never stuck with any of them.

Getting older isn’t kind to those who don’t exercise. Years ago my lack of upper-body fitness was hardly noticeable. Shoveling snow, raking leaves, playing racquetball, carrying my kids around, all of it kept me in good enough shape. That’s not the case now that I’m in my fifties. Lifting my grandson above my head—not happening. Hanging a new shower curtain – three clips – rest – three clips – rest…

When I found I couldn’t blow-dry my very short hair without lowering my arm repeatedly because of muscle fatigue, it was time to do something about it.  That’s when I decided to invest in a personal trainer. It was expensive—but I figured I would just do it long enough to make exercise, other than running, […]

2016-11-21T13:11:13-05:00December 7th, 2011|nursing perspective, personal health practices|3 Comments
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World AIDS Day, 30 Years On from That Fateful MMWR

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.”

So began the MMWR of June 5, 1981—the first herald of what became known as AIDS. Reading that report now, knowing the devastation that would follow, is chilling.

Today is World AIDS Day. It has been 30 years.

In some ways, we need this day more than ever, to remind us of the devastating potential of this condition—the Centers for Disease Control and Prevention (CDC) reports that only 28% of people in the U.S. infected with HIV get the treatment they need to suppress the virus. We need it to remind us of the millions who continue to suffer and die from it, mostly in Africa where two thirds of the AIDS cases occur.

We should also take time today to celebrate the victories. We’ve come far in the last 30 years. Effective treatments have been developed. Civil rights protections have been put in place. People with HIV can now […]

2016-11-21T13:11:16-05:00December 1st, 2011|nursing perspective|15 Comments
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Addressing Traumatic Injury in Older Adults

By Sylvia Foley, AJN senior editor

Frank Jones, age 83, arrives at a local trauma center after falling down a flight of stairs in his home. Initially diagnosed with two fractured ribs, a fractured ulna, and a fractured tibia, he’s admitted to the ICU.  At first, things seem to go well—his electrolytes and bloodwork appear to be within normal limits, and his vital signs are stable. But the next day he becomes increasingly unstable. What’s going on?

Trauma is currently the seventh leading cause of death in older adults—and older adults are more likely to suffer complications and die than are younger ones. But as author Christine Cutugno points out in this month’s CE, “The ‘Graying’ of Trauma Care: Addressing Traumatic Injury in Older Adults,” advanced age isn’t a predictor of trauma outcome. Many trauma-related complications are preventable.

What guides current care? While standards of care for geriatric patients and for trauma patients exist, as yet none have been specifically developed for and tested in geriatric trauma patients. Until that happens, Cutugno writes, “nurses will need to be guided by measures known to prevent iatrogenic complications in other patient populations.”

To that end, Cutugno first reviews common mechanisms of traumatic injury in older adults and discusses the effects of aging and comorbidities. She points […]

2016-11-21T13:11:24-05:00November 18th, 2011|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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