nursing perspective Archives - Page 135 of 158

Déjà Vu All Over Again: Internal Uterine Contraction Monitoring Another Case of Practice Without Evidence

By Shawn Kennedy, MA, RN, interim editor-in-chief

Last week, the New England Journal of Medicine (NEJM) reported (abstract available here) on a Dutch multi-center randomized trial comparing internal versus external monitoring of uterine contractions during induced labor on rate of cesarean or instrument delivery. Among secondary outcomes they examined were use of analgesia, oxytocin and antibiotics, adverse neonatal effects, and complications from the intrauterine catheter (hemorrhage, sepsis, among others).

What caught my eye was the first sentence of the paper, which read, “The monitoring of uterine contractions by means of internal tocodynamometry during induction or augmentation of labor is advocated by professional societies in obstetrics and gynecology.” Yet, as this study points out, there has been little data to support the societies’ recommendation for internal monitoring. And, lo and behold, the results of this trial “do not support the routine use of internal tocodynamometry for monitoring contractions in women with induced or augmented labor.”

This reminds me very much of electronic fetal monitoring. […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:19:36-05:00February 4th, 2010|nursing perspective|1 Comment

Is the Florence Nightingale Pledge in Need of a Makeover?

By Christine Moffa, who was AJN clinical editor at the time it was written in 2010.

Authors and publishers frequently send nursing– and health care–related books to AJN in hopes we will review them. I love it, so keep on sending them. My latest read is Mystery at Marian Manor: The Adventures of Nora Brady, Student Nurse, a book for young adults. I guess you could call it a Cherry Ames for the new millennium.

At the beginning of the book is the Florence Nightingale Pledge, something I haven’t read since my graduation in 1995. I have to say it made me cringe. It’s almost as bad as when I visit my parents and see the nursing school graduation photo of me in that silly nursing cap I wore under protest. (If the men didn’t have to wear it, why did I?) If you’ve forgotten the pledge, here goes:

I solemnly pledge myself before God and presence of this assembly;
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession
and will hold in confidence […]

Guest Author2016-11-21T13:19:41-05:00February 2nd, 2010|career, nursing history, nursing perspective, students|26 Comments

Emergency—Bleeding Esophageal Varices: What Nurses Need to Know

By Sylvia Foley, AJN senior editor

This month’s CE feature opens with a patient with alcoholic cirrhosis who suddenly vomits large amounts of blood. She’s experiencing variceal hemorrhage from esophageal varices, an often deadly complication of alcoholic liver disease, as author Melissa M. Smith explains. Esophageal varices occur in roughly half of all people with alcoholic cirrhosis; about one-third of these will experience variceal hemorrhage.

Smith describes the etiology of esophageal varices, then discusses the risk factors for variceal hemorrhage, noting that risk for initial hemorrhage increases with:

larger variceal size
presence of red spots or wales on the varices
more severe portal hypertension
more severe cirrhosis, with or without ascites

And the above factors as well as the following increase risk for recurrent hemorrhage:

severity of initial bleed
age over 60 years
bacterial infection
renal failure
active alcoholism

Smith discusses emergent treatment and outlines further treatment options, which include endoscopic variceal ligation, endoscopic injection sclerotherapy, balloon tamponade, and transjugular intrahepatic portosystemic shunt (TIPS) placement. The patient case vividly illustrates what can happen when bleeds recur.

Have you cared for patients with variceal hemorrhage? We invite you to share your experiences with us in the comments.

Guest Author2016-11-21T13:19:42-05:00February 1st, 2010|nursing perspective|2 Comments

Oh for a Thimbleful of Gratitude!

By Christine Moffa, AJN clinical editor

I had surgery 12/28 and spent four days on med-surg afterwards. I literally spent 3/4 of my time sleeping (bliss! oh rapture unforseen!), but *every single time* anyone came into my room for any reason (meds, IV change, turn off the freaking IV alarm, phlebotomist, housekeeping, whatever), I said “thank you.” I got the feeling I was abnormal. . . . So. How often do your pts say thank you, and does it come as a surprise when they do?

It’s been a few years since I’ve worked directly with patients, but in the past when I had a particularly tough day I would tell people that “nursing is a thankless job.” I’m talking about the kind of day when you barely had time to use the bathroom, never mind eat something, and the only feedback you heard from patients and administration was about what you didn’t get done. So when I saw a post (excerpted above) called “How often do your pts thank you?” at Allnurses.com, it hit a nerve.

The responses to the post were mixed, with some saying it’s common to be thanked by patients and others arguing the opposite. Maybe it’s regional—I’ve only worked on the East Coast, and in my experience complaints seem to get more air time than gratitude. Or maybe it’s just the times we’re living in. Either way, I’m sure most nurses would say they didn’t choose this career in the hope […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:19:44-05:00January 29th, 2010|nursing perspective, patient engagement|7 Comments

If Health Care Reform Were an ICU Patient . . .

The idea that the Health Care Reform bill is on life support is disappointing, but not surprising. It was admitted in a weakened state of health. It appears suspiciously a victim of domestic violence by special interest groups. The bruises on its body resemble the outline of handprints of the insurance companies it was created to protect our citizens from.

So writes nurse-artist-blogger JParadisi RN in a recent post, which (whatever your beliefs about whether we should do something major soon about the increasing numbers of uninsured Americans and the skyrocketing costs of health care) has particular resonance as President Obama prepares to address the nation tonight about this and other issues.

(Full disclosure: Paradisi’s artwork appeared on the October 2009 cover of AJN.)