nursing perspective Archives - Page 83 of 158

The Nuts and Bolts of Fluid Therapy in Critically Ill Patients

By Maureen Shawn Kennedy, AJN editor-in-chief

Back in the day when I was a bedside nurse, hemodynamic monitoring was just coming into play, and then only in coronary care. In the ER, we relied on a combination of vital signs (pulse and BP), urine output, and central venous pressure (CVP) to guide fluid administration. Later, patients in need of close monitoring received arterial lines to monitor pulmonary arterial pressures; monitors and stopcocks were everywhere (and soon after, infections, but that’s another story . . . ).

But things are changing again, and the trend is toward less-invasive monitoring. In our May issue, we’re pleased to bring you a comprehensive CE article (worth 2.6 contact hours), “Using Functional Hemodynamic Indicators to Guide Fluid Therapy.” The author is Elizabeth Bridges, PhD, RN, CCNS, an associate professor in biobehavioral nursing and health systems at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center in Seattle. Many critical care nurses will know her from her “standing room only” research sessions at the American Association of Critical Care Nurses National Teaching Institute (this year it will be in Boston, May 20–23), in my view one of the best annual national nursing meetings.

Here’s the article abstract:

Hemodynamic monitoring has traditionally relied on such static pressure measurements as pulmonary artery occlusion pressure and central venous pressure to guide fluid therapy. Over the past 15 years, however, there’s been a shift toward less invasive or noninvasive monitoring methods, which […]

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Jacob Molyneux, senior editor/blog editor2013-05-01T09:38:12-04:00May 1st, 2013|nursing perspective|0 Comments

Misplacing Our Focus on Quality Improvement

By Maureen Shawn Kennedy, AJN editor-in-chief

I welcome manuscripts written by nurses in clinical practice, especially comprehensive updates on managing a clinical syndrome or a common problem that readers would find informative and interesting. I call these the “meat and potato” papers—the ones that provide substantial content, the need-to-know information that will help nurses provide quality, evidence-based care. The best ones discuss the physiology and pathology underlying clinical symptoms, practice implications for ongoing monitoring and management, and patient and family teaching and concerns.

The other papers I value are those that describe quality improvement initiatives or processes that improve outcomes and, by following the SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines, are sufficiently detailed so that others can replicate them. (For information on what we seek to publish, see a recent blog post.)

Lately, though, I’m seeing more and more submissions that are not so much focused on how to use best practices to improve care, but rather on ways to improve scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The authors typically describe the impetus for the improvement as low scores, get administrative support to set benchmarks for improving scores, and define success as improved scores. Often the changes are clinically insignificant but scores increase, so everyone is happy.

While the HCAHPS is a national measure that has been adopted as a measure of quality, it’s important to keep in mind that it measures […]

Amy M. Collins, managing editor2016-11-21T13:07:44-05:00April 24th, 2013|nursing perspective|1 Comment

Good Medicine

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:07:48-05:00April 22nd, 2013|nursing perspective|5 Comments

Friday Nursing Blogs Roundup, More or Less

By Jacob Molyneux, AJN senior editor/blog editor

Another Friday in New York, and it’s time to do a quick tour of the nursing blogosphere after a grueling week in which the city I will always think of as home, Boston, took a major hit on a holiday that always marks the end of a long winter, the first stirrings of spring, the Red Sox playing in the morning, no one at work, glimpses of marathoners passing in the distance up still salt-stained avenues under barely budding trees, usually in bright sun and a gusty breeze with an underside of chill.

I have noted ad nauseam in the past that blogs have life cycles, wax and wane, flourish or fade out. And that’s okay. Though maybe blogs should go to a blog graveyard at some point, or be given a proper burial, or demolished like old buildings in a great controlled cinematic whoosh of collapsing pixels and pixel-dust. Or, in some cases, put in a museum to mark a moment in Web history or preserve particularly lively voices and experiences for posterity.

Enough throat clearing. There isn’t much out there to report this week. We try to collect links to sane, more or less active blogs on our nursing blogs page. A few nurse bloggers are perennially engaging and active, and a couple of these excellent bloggers even write occasional posts for this blog, so for once I won’t draw attention to them. […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:07:49-05:00April 19th, 2013|healthcare social media, nursing perspective|1 Comment

The Hands of Strangers

By Karen Roush, AJN clinical managing editor

A marathon is a triumph of spirit and endurance. It is a solitary endeavor carried along by a hundred thousand strangers. Anyone who has run a marathon knows that the spectators are not merely spectators. They are participants—they give their energy, their encouragement, their voices; they become part of your will, your perseverance; they carry you forward. Some part of every voice, every hand touched, crosses that finish line with you.

A marathon takes place in a particular city but it belongs to the world. For months, even years, someone in Sydney, in Kampala, in Seoul, in Cedar Rapids, in Damascus, in some small unknown village and in every great city, prepared for those same 26.2 miles ending yesterday at Boylston Street in Boston.

When I think about the marathons I’ve run, it is not crossing the finish line that I remember. What I took away, and what stays with me to this day, is a powerful and joyful sense of our shared humanity. That is what the bomber tried to shatter yesterday.

I have no doubt that in time investigators will find answers to who did this and why. But the greater questions will remain. How do we live with the certainty of our vulnerability? How do we come together freely and joyfully, knowing the threat that walks in our midst? How do we stay open enough to reach our hands out to strangers?

As we grieve the […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:07:50-05:00April 16th, 2013|nursing perspective|1 Comment