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

The Challenge of Caring for a Graying Prison Population

Photo by Ackerman + Gruber An elderly prisoner in hospice care. Photo by Ackerman + Gruber

Inmates 54 or older are the fastest growing age demographic in U.S. prisons. According to the U.S. Bureau of Justice Statistics, the percentage of inmates who are 54 or older jumped from 3% to 8% in two decades (1991–2011). Criminal justice experts say the increase is probably an effect of the longer sentences of 1980s antidrug laws.

A 2014 report by the Vera Institute of Justice asserts that “prisons and jails are generally ill-equipped to meet the needs of elderly patients who may require intensive services” for their medical conditions. Correctional staff often lack training for treating age-related illnesses and prisons typically don’t have the ability to monitor chronic health issues or employ preventative measures. Inmates are often sent off-site for medical treatment beyond what prisons can provide.

Older adults with physical disabilities or cognitive impairments are also more vulnerable to injury, abuse, and psychological decompensation in the prison setting. “ [T]he prison environment is, by design, an extremely poor place to house and care for people as they age or become increasingly ill or disabled,” said a 2013 American Civil Liberties Union report. Even reliance on devices like wheelchairs, walkers, or breathing aids can present logistical hardships for inmates in facilities that were designed […]

2016-11-21T13:01:23-05:00March 15th, 2016|Nursing, nursing perspective|0 Comments
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‘Circadian Assaults’: Daylight Saving Time May Hasten Strokes, MIs in Those At Risk

By AJN clinical editor Betsy Todd, MPH, RN, CIC

“Nurses and other shift workers may be particularly vulnerable to the problems that can result from sleep deprivation.”

Philippe Boulet/flickr creative commons Philippe Boulet/flickr creative commons

I don’t like daylight saving time (DST). Twice a year, when we begin and end this transition, I’m tired and cranky for a week. These sudden leaps forward and backward in time disrupt our bodies’ natural relationship to what should be gradual changes of season.

Not surprisingly, some studies suggest that these assaults on our circadian rhythms may affect our cardiovascular health. Swedish studies (here and here) based on national myocardial infarction (MI) data found small but significant increases in MI rates in the first few days to a week after the change to DST.

A Michigan study of more than 42,000 MI patients treated with angioplasty found a significant increase in MIs on the Monday after the start of DST. Their data, however, indicated that the overall incidence rate of MIs in need of angioplasty did not change, and the researchers suggested that DST may simply “accelerate” the incidence of cardiovascular events in at-risk patients, pulling them forward in time.

Researchers in Finland recently reported an increase in strokes at the start of DST, and like the Michigan researchers, concluded from their […]

2016-11-21T13:01:24-05:00March 11th, 2016|Nursing, nursing perspective|1 Comment
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The Balancing Act: A Dying Patient and a Spouse Who Can’t Let Go

Illustration by McClain Moore Illustration by McClain Moore

The Reflections essay in the March issue of AJN is called “The Balancing Act.” The author describes a situation she faced as an ICU nurse in which her efforts to keep a dying patient comfortable were complicated by a spouse’s reluctance to accept the inevitable. It’s often hard to advocate for a patient while honoring the emotional struggle of a close family member. Here’s the start of the essay.

I have just arrived to work in the ICU and am assigned a patient in respiratory distress. Her name is Darlene and her husband Tom is pacing the room. Within 10 minutes, he drinks three cups of coffee, ignoring the cot provided by the previous nurse so he could sleep next to Darlene. His wife has more than one cancer and both are growing. She left the hospital a week ago for hospice care, but has been readmitted after a decision by her husband to reattempt curative treatment.

[…]

2016-11-21T13:01:24-05:00March 9th, 2016|Nursing, nursing perspective, Patients|2 Comments
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‘Less Codes, Less Death’: A Study Explores Nurses’ Perceptions of the Benefits of Rapid Response Teams

By Sylvia Foley, AJN senior editor

For any given health care program, staff perceptions about how well it works will affect its use and maintenance. This is the case with regard to rapid response teams (RRTs). Nurse leaders’ perceptions of the benefits of RRT teams will influence their sup­port for these teams; and the perceptions of RRT members and end users similarly will influence use. Yet little is known regarding such perceptions.

Semistructured Interview GuideNurse researcher Deonni Stolldorf recently conducted a study to learn more. She reports on her findings in one of this month’s Original Research features, “The Benefits of Rapid Response Teams: Exploring Perceptions of Nurse Leaders, Team Members, and End Users.” Here’s a brief summary:

Objective: This study sought to explore and compare the perceptions of nurse leaders, RRT members, and RRT users regarding the benefits of RRTs.
Methods: A qualitative, multiple-case study design was used. Semistructured interviews were con­ducted with nurse leaders, RRT members, and RRT users at four community hospitals, as part of a larger mixed-methods study examining RRT sustainability.
Results: All participants reported perceiving various ways that RRTs benefit the organization, staff mem­bers, and patients. Variations in the benefits perceived were observed between the three participant groups. Nurse leaders’ perceptions tended to focus on macro-level benefits. RRT members emphasized the teaching and learning opportunities that RRTs offer. RRT […]

2016-11-21T13:01:24-05:00March 4th, 2016|Nursing, nursing perspective, nursing research|3 Comments
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Just Breathe: A Nurse’s Tough Love Proves Crucial During One Mother’s Labor

Photo by chintermeyer, via Flickr. Photo by chintermeyer, via Flickr.

By Amy Collins, AJN managing editor

The pain jolted me from my sleep. It was 1:30 in the morning. The sensation was stronger than anything I’d ever felt, and I grabbed my phone to start my contraction timer. I had read loads on labor and childbirth, and everything suggested I was in for the long haul. But my timer was showing the contractions were already only five minutes apart. I spoke with the hospital’s on-call physician, who told me to relax and spend as much time as possible at home so I could be more comfortable.

But within minutes, the pain had increased to a level where it was difficult to talk. The contractions were now three minutes apart and my water had broken. My husband and I decided to go to the hospital.

I’d like to say I was strong and handled the pain of labor well, but I was quickly losing control and succumbing to anxiety. By the time we got to the maternity unit, I was sobbing. The labor nurse assigned to me introduced herself as Jean. She was older and seemed seasoned, with a stern, no-nonsense attitude. She brought me to a delivery room and gave me a gown. Before labor started, my plan had been to see […]

2016-11-21T13:01:25-05:00March 2nd, 2016|nursing perspective, patient engagement, patient experience|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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