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

Precarious Hope: A Hospice Nurse Balances Truth and Kindness

This couple might be your elderly neighbors: he helps his wife into the house as she moves slowly, step by unsteady step, in time with her four-point cane; at the same time, you know that he is recovering from recent chemotherapy treatments. Or they may be your aging parents: your mother’s role as primary caregiver hampered by her right leg weakness from a stroke and advancing heart disease, while your father needs more care from day to day as his renal failure approaches the decision to begin dialysis or not. They support and care for each other.

PrecariousHopeIllustrationThe December Reflections column in AJN, “Precarious Hope,” is by an RN case manager at a hospice. She describes a couple in which one partner has dementia and the other has cancer, their mutual dependency, and the challenge of knowing how best to care for them:

In hospice, I’m often confronted with the difficulty of balancing honesty with kindness. I love a quote often attributed to the Buddha: “When words are both true and kind, they can change our world.” It follows that sometimes what is true is not kind, and that truth must be cloaked in kindness—as in this instance, as I sit at the table listening to George, whose hopeful, unrealistic comments confirm that he simply can’t hear the truth.

It’s a sensitive portrait of love, the fine line between self-delusion and perseverance, and the way that sometimes simply bearing witness is the […]

2016-11-21T13:08:44-05:00December 14th, 2012|nursing perspective|1 Comment
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ECRI Conference Notes: Creating and Replicating ‘Systemness’ within Health Care Delivery

By Joyce Pulcini, PhD, RN, FAAN, Policy and Politics contributing editor, AJN

The ECRI Institute’s 19th annual conference (November 28–29) looked at system-level innovation and quality in the health care system. It brought together experts from many fields, including medicine, nursing, hospital or health system administration, informatics, health care quality, policy makers, journalists, and academics. ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care. The goals of the conference were to address the following:

  1. What is “systemness”?
  2. Which elements within mature health care systems result in the best clinical outcomes?
  3. Are approaches taken by long-established systems transferable to smaller, newer, or less integrated systems?
  4. Are financial incentives enough to drive change?
  5. How can electronic health records (EHRs) help improve “systemness”?
  6. Do transformation units within health care systems produce results?

The conference essentially tried to attack in a creative way the issues around the creation of systems that function optimally. Truly changing culture and providing optimal care delivery should always result in putting the patient at the center of care. The conversation was open and the conference succeeded in fostering important dialogue among the speakers and the audience.  A major focus was on creating systems, looking at technological or financial solutions, and measuring outcomes.

The session on team care (“Creating teams to improve inter- and intra-health care systems: Does evidence show a benefit?”)  highlighted the vexing issues around how to truly foster optimal teams. Lisa Schilling, RN, MPH, VP National HC Performance Improvement, Director, Center for […]

2016-11-21T13:08:48-05:00December 5th, 2012|digital health, health care policy, nursing perspective|0 Comments
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A Crucial Distinction: Missing Incidents vs. Wandering in People With Dementia

At every stage of dementia, people with the condition are at risk for both missing incidents, in which they are unattended and unable to navigate a safe return to their caregiver, and “wandering,” a term often used to describe repetitive locomotion with patterns such as lapping or pacing. By understanding the differences between these two phenomena, nurses can teach caregivers how to anticipate and prevent missing incidents, which are not necessarily related to wandering. The authors differentiate missing incidents from wandering, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents.

When someone’s behavior is consistently outside the norm, our tendency is to stop paying close attention to observable differences in that behavior. This may be particularly true when we are responsible for the care and safety of a person with dementia. As described by the overview above, one of the CE articles in the December issue of AJN, “Missing Incidents in Community-Dwelling People with Dementia,” focuses on a crucial distinction between two types of behavior in people with dementia, one that is expected and manageable and even at time beneficial (for exercise, self-calming, etc.), and one that can be far more dangerous. Here’s a useful table that spells out some of the key differences to keep in mind between missing incidents and wandering. But for a more detailed look at the topic, please click the link above and read the entire article.—Jacob Molyneux, senior editor

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2016-11-21T13:08:49-05:00December 3rd, 2012|nursing perspective|0 Comments
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More Evidence: Should We Get Rid of 12-Hour Nursing Shifts, Despite Their Popularity?

By Shawn Kennedy, AJN editor-in-chief

A new study in Health Affairs provides yet more support that reliance on 12-hour nursing shifts (or longer—we all know that shifts often extend a bit longer than scheduled) should be reconsidered. The study supports previous findings of increased burnout among nurses who work shifts longer than eight hours, but finds as well that longer shifts (13 hours or more) are associated with increased levels of patient dissatisfaction.

Despite these negatives for both nurses and patients, 80% of nurses surveyed across four states said they were happy with their hospitals’ scheduling practices.

I imagine that, with all the recent emphasis on patient satisfaction scores, this study will make nurse executives and hospital administrators take notice—especially as consumers become more aware of the research through coverage like this story at the U.S News & World Report site.

We’ve had evidence for a while that the 12-hour shift is not a best practice. For example, in 2004, Anne Rogers and colleagues also published research in Health Affairs. In their national survey of over 1,000 nurses, they found that most nurses generally worked longer than their actual shifts; nearly 40% of shifts were longer than 12 hours, and 14% of respondents had worked “16 or more consecutive hours at least once during the four-week period.” More importantly, they found that “the likelihood of making an error increased with longer work hours and was three times higher when nurses worked […]

2016-11-21T13:08:51-05:00November 27th, 2012|nursing perspective|19 Comments
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Post-Sandy Emotional Self-Care for Nurses and Others

Hurricane Sandy, from International Space Station at 16:55:32 GMT on Oct. 29, 2012 / NASA

By Donna Sabella, MEd, MSN, PhD, RN, mental health nurse, AJN contributing editor, and coordinator of the monthly Mental Health Matters column

With the recent devastation caused by Sandy in the mid-Atlantic and New England areas we need to be mindful that the harm done in such events goes beyond property and the physical domains. Many exposed to Sandy’s wrath may be suffering from varying degrees of stress and psychological trauma. It is important to remember that, along with taking care of our physical needs, in the process of getting back to normal we also need to be mindful of our emotional needs and reach out for help as necessary.

As health care providers we nurses pride ourselves on being able to handle anything that comes our way as we strive to give patients the best care possible, but it is important for us to be aware of our own emotional needs during times of crisis and disaster. Sandy is considered a disaster—for those affected by the storm, either directly or indirectly, the experience can lead to thoughts, feelings, and behaviors that are outside our usual range, and which may indicate it’s time to seek help. Below, I offer some information that provides tips on how to take psychological care of ourselves after Sandy :

2016-11-21T13:08:52-05:00November 19th, 2012|nursing perspective|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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