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

Taking Charge Seriously

By Christine Moffa, MS, RN clinical editor      

Most hospitals have charge nurses, although how they’re selected and what they do varies not only between hospitals but often between units in the same hospital. For instance, the first time I was in the role of charge nurse it was because none of the usual suspects were working that day! And my manager’s parting words were, “Looks like you’re getting baptized with fire. Good luck.” Thanks to the work of a quality improvement team, the nurses at New York-Presbyterian/Weill Cornell Medical Center in New York City won’t have to go through what I did.

This month’s Cultivating Quality column, An Evidence-Based Approach to  Taking Charge, “describes the planning, implementation, and evaluation of a charge nurse initiative in a large academic medical center.” After reviewing the literature and identifying issues through the use of focus groups, members signed up for different quality improvement teams to develop solutions and action plans.

            The following are some of the changes implemented by the teams:

  • The development of charge nurse core competencies and a definition of the role to be used hospital wide.
  • A standardized hand-off report to be used between charge nurses going off and on shift.
  • An orientation workshop using interactive case scenarios.

See the full article for a list of the charge nurse core competencies as well as an example of a case study used during the interactive workshop. Here’s a breakdown of the charge nurse role and its responsibilities:

Startling Findings about Men’s Awareness of Male Breast Cancer . . .

and a look at the benefits of dragon boat racing for breast cancer survivors of either sex.

By Sylvia Foley, AJN senior editor

Although breast cancer is far less common in men than in women, being a man doesn’t make one immune to the disease. Yet misconceptions about male breast cancer abound. In this month’s CE feature, Men’s Awareness and Knowledge of Male Breast Cancer, nurse researcher Eileen Thomas reports on a qualitative study of 28 men at higher risk (all had at least one maternal relative who had been diagnosed with breast cancer). The goals were twofold:  to learn more about men’s understanding and perceptions of this life-threatening illness, and to elicit information that might guide clinical practice and the development of sex-specific educational interventions.

The study findings are rather startling. Nearly 80% of the participants had no idea that men could develop breast cancer. Fully 100% of the participants reported that none of their primary care providers had discussed the disease with them. Asked how they thought male breast cancer was detected, most participants could name only one symptom  (“a lump”); one said, “They find it on the autopsy table.” And 43% reported that being diagnosed with breast cancer might cause them to question their masculinity. One participant stated, “I would feel like my manhood was taken away.” […]

Entering the Mainstream? Nursing Research at 25 Years

Logo of the United States National Institute o...

By Shawn Kennedy, AJN interim editor-in-chief

Last Thursday the National Institute of Nursing Research (NINR) held its kick-off event to celebrate its 25th anniversary—and what could be more appropriate than holding a research symposium at the National Institutes of Health (NIH)? Scientists and researchers (nurses as well as others) whose work is supported by the NINR presented highlights of their research. (See here for synopses.)

Why it matters to all nurses. All nurses, researchers or not, should celebrate the growth and accomplishments of the NINR—its establishment provided tangible recognition of the value of the substantial body of research conducted by and/or about the nursing profession. As practitioners, where would we be without research to provide the evidence underlying care interventions or the processes of delivering that care? With the October issue, AJN highlights the NINR’s silver anniversary: on the cover, with a guest editorial by NINR director Patricia Grady, and with a timeline highlighting key milestones and landmark research supported by the NINR (click through to the PDF version to read this article). To give you an idea why nursing research matters, here’s just one entry on the timeline, from 1998:

Nancy Bergstrom, PhD, RN, FAAN, in a multisite study, tests the Braden Scale for Predicting Pressure Sore Risk and finds its predictive capability accurate. The scale is now widely used in nursing homes […]

In Her Own Words: Pakistani Flood Victim Focuses on Providing Essential Medical Help to Others

I was in the process of taking my third-year nursing exams when the floods hit and destroyed the area where I live. That day, I was on my way to the city to take exams when I saw water was fast approaching on the motorway. As the bus driver backtracked, I saw all the bee boxes from the nearby farms, floating in the water. I suddenly forgot about my exams and started to worry about my home.

Why Didn’t Physicians Know What Nurses Know?

By Shawn Kennedy, AJN interim editor-in-chief

A recent post on our blog highlighted the experience of AJN’s associate editor Amy Collins in trying to get someone to diagnose the underlying reason for acute confusion in her grandmother. Over a two-week period, Amy’s grandmother was seen by various private and ED physicians, none of whom seemed to have an adequate diagnosis or a suggestion for treatment. Finally, nurses suggested that a urinary tract infection (UTI), fecal impaction, or some other infection might be a factor. It was a fecal impaction and yet none of the five physicians who previously evaluated Amy’s grandmother had thought about or assessed for it.

What the nurses said. Amy’s post generated many comments, both on the blog and on our Facebook page. What was interesting to me was how many nurses knew to first check for a UTI, electrolyte disturbance, or fecal impaction as a reason for confusion. Here are a few samples:

“Though not conclusive, in every case I have seen a change in cognition or behavior it was either a UTI or fecal impaction. I work in home health as a CNA and I am a nursing student.”

“The first thing I think to check is infection (UTI) with elderly, confused patients.”

“I’m a senior nursing student…and this material is on our exam that we are taking Friday. With acute confusion, always check for UTI and constipation.”

“Possible UTI. Possible dehydration &/or  constipation. Poor nutrition. All can (and do) manifest as “altered mental status.” Think I’d start with […]

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