nursing perspective Archives - Page 103 of 158

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 […]

Guest Author2016-11-21T13:11:24-05:00November 18th, 2011|nursing perspective|1 Comment

Autumn Leaves and Colorful Lives

By Julianna Paradisi, who normally blogs at JParadisi RN and has written for this blog before. Her artwork appeared on the cover of the October 2009 issue of AJN, and her essay, “The Wisdom of Nursery Rhymes,” was published in the February issue.

: by oedipusphinx—theJWDban via Flickr

The autumn leaves are particularly beautiful in Oregon this year. An arborist interviewed on the evening news attributed the extraordinary orange and gold to an unusually cold, wet spring, which lasted until July, followed by the intense heat and warm evenings of a brief Indian summer. According to the arborist, the combination caused a greater than normal amount of sugar in the leaves, resulting in the brilliant colors. I think about this on my morning run, as my feet scatter fallen leaves along the sidewalk.

The Season of Eating is, however, not the only messenger of the approaching holidays in a nursing unit. There is something about the holiday season that signals Death to harvest a higher than normal number of the patients we have grown to love through the course of their illnesses. Some of the deaths are expected, but not all of them. I don’t know why more people seem to lose their battles with illness around the holidays than at other times of year.

When I first began working in outpatient oncology, it took me by surprise that my coworkers […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:26-05:00November 14th, 2011|nursing perspective|2 Comments

Nurse Practitioners Are Not ‘Physician Extenders’

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

“Physician extender.” It’s way past time to kill that term.

A study published in the October issue of Surgery found that adding an NP to the surgical team decreased the number of unnecessary ED visits by 50% and increased the use of visiting nurse, physical therapy, and occupational therapy services. A Medscape article (registration required) on the study explained the importance of the findings in this way: “According to the researchers, physician ‘extenders,’ such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week. . . .”

Sure enough, the stated purpose of the study was to determine if “integrating this physician extender into the surgery team” would improve outcomes and resource allocation. Ouch.

Experts in our own right. Nurse practitioners are not physician extenders. We are highly skilled and educated nurses who provide evidence-based care grounded in the nursing model. We are not “extensions” of anyone. We are colleagues and collaborators, independent clinicians and experts in our own right. Our purpose is to provide comprehensive care, promote health, educate, and advocate. It is not to relieve interns, supplement physician education, or be the low-cost alternative when physicians have to “do more with less,” as Medscape quoted one […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:27-05:00November 11th, 2011|career, nursing perspective, nursing research|6 Comments

On Protocols, Shortcuts, and the Unforgettable Smell of Ether

By Linda Johanson, EdD, RN, associate professor of nursing at Appalachian State University, Boone, NC

In nursing school my professors warned us of the dangers of taking shortcuts when performing procedures. They cautioned that deviations from protocols could lead to serious error. I had to learn this lesson the hard way, and although it’s been about 30 years since I made this mistake, I still remember the occasion like it happened yesterday.

The patient was in ICU bed #10, a glassed-in isolation room across from the nursing station. He was in his mid-60s, but he was mentally handicapped, so he appeared and acted younger. He was in the unit recovering from a respiratory arrest, and on the day I was caring for him he was still intubated, but breathing spontaneously.

I was completing an assessment on him when the charge nurse called to me from the nursing station, and I stuck my head out the door to see what she wanted. She told me there was a new order to remove the patient’s indwelling urinary catheter. I checked my pockets for a 10 mL syringe to perform the procedure but didn’t find one.

When I complained about having to go all the way to the supply room to collect one, the charge nurse queried, “Well, […]

Guest Author2016-11-29T13:29:41-05:00November 9th, 2011|nursing perspective|9 Comments

Realizations of a New Nurse #1: I Am Now the Educator

: image via Wikipedia

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA.

In nursing school, there is a growing push to educate future nurses on the amazing breadth of roles within the nursing profession. As a student, you are in some way exposed to the role of nurse as leader, advocate, healer, educator, team player, and researcher. Even this list is not exhaustive. These roles are certainly vital and important and worth teaching about in school.

As a brand new nurse, I haven’t personally encountered all of these roles yet, but there is one in particular that I encounter—and embody—every day: that of educator.

One of the most humbling realizations I’ve had since recently becoming a nurse is that I am now the educator. I’m glad to know that there are other nurses around me, as well as many resources from which to glean knowledge, but I am daily faced with the fact that people now look to me for answers. There are times when I feel outside myself, for while I give correct answers, hearing myself giving them is a little surreal. I’m sure these feelings subside with time, but I hope that I always remain somewhat in awe of the amount of trust my title elicits.