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

Road Trip: Rehab for the ICU Nurse

Courtesy of the author; all rights reserved.

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

I took care of Gloria when she was admitted to the ICU after being involved in a high-speed, head-on collision. Although her injuries were very serious, my initial instinct was that she’d recover. I had a good feeling about her; as it turned out, I’d made a mistake in underestimating her mortality.

But everyone did, I think.

For the first few days her plan of care was routine and she progressed as expected. After several surgeries she was being successfully weaned from the ventilator. There was a plan for extubation. Gloria was awake and cooperative with all aspects of treatment.

She had an engaging spirit, and although she was never able to communicate with us well, we became attached to her and quite protective; we often requested taking care of her as our shift assignment, and later become strained and snappish with one another as unexpected complications propelled her along a steep and steady decline. Rehabilitation was ultimately traded for an extended ICU stay; extubation plans were cancelled in lieu of a tracheostomy.

I work among a group of passionate people. We’re determined and diligent. Because of that, a patient’s death in the ICU sometimes feels like a failure. We’re […]

2016-11-21T13:09:40-05:00July 16th, 2012|nursing perspective|4 Comments
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Researchers Ask: How Do Nurses Perceive Their Use of Clinical Practice Guidelines?

By Sylvia Foley, AJN senior editor

You’ve probably heard about the “knowledge translation” gap that exists between the care that patients often receive and the evidence for best practice. Clinical practice guidelines, which can help clinicians close that gap, are often underused, and most of the existing research on guideline use has focused on physicians. Nurse researcher Kathleen A. Abrahamson and colleagues wanted to learn more about how nurses perceived their use of guidelines. Their findings are reported in this month’s original research CE, “Facilitators and Barriers to Clinical Practice Guideline Use Among Nurses.”

Abrahamson and colleagues examined free-text responses to two open-ended survey questions provided by 575 RNs at 134 Veterans Affairs medical centers: “What are the facilitators to CPG use?” and “What are the barriers to CPG use?” Conventional content analysis of the data allowed several thematic categories and subcategories of responses to emerge.

Among the findings were the following. […]

2012-07-13T09:15:48-04:00July 13th, 2012|nursing perspective, nursing research|0 Comments
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Transitional Care: How the Affordable Care Act Would Have Helped My Father

By Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. This post is also being published at the Robert Wood Johnson Foundation Human Capital blog.

When I heard that the Supreme Court had upheld the Affordable Care Act, I immediately thought of my father. He suffered mightily at the end of his life. Plagued with multiple chronic illnesses, he spent his last year in and out of hospitals. He received good hospital care, but his health deteriorated every time he left the hospital.

He simply couldn’t keep track of a growing list of prescriptions, tests, and doctor visits. He accidentally skipped antibiotics, which led to infections, which landed him back in the hospital. He accidentally skipped blood tests, which landed him back in the hospital. It seemed that every time he came home, he’d land back in the hospital. I lived thousands of miles away and couldn’t be the advocate that he needed.

What he needed was transitional care—he needed a nurse to meet with him during a hospitalization to devise a plan for managing chronic illnesses and then follow him into his home setting. He needed a nurse to identify reasons for his instability, design a care plan that addressed them, and coordinate various care providers and services. He needed a nurse to check up on […]

2016-11-21T13:09:41-05:00July 12th, 2012|nursing perspective|10 Comments
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Web Stuff: Meds and Heat, Noise Epidemic, Nurses and Smartphones at Work

 

Flickr/National Archives and Records Administration

Medicines and summer heat. Anyone with one or more prescription medicines might occasionally wonder whether there’s a better place to store them than a kitchen cabinet. This is especially true for meds mailed to you in three-month supplies rather than the one-month supply we used to get.

Here’s a brief article at the NPR Shots blog that notes a few meds that you particularly should be concerned about, emphasizes that areas of extreme heat or humidity are the worst location (so-called “medicine cabinets” in humid and hot bathrooms are not so great, nor are cabinets over stoves, in direct sun, or the like). While most medicines can tolerate a certain amount of abuse, the ideal environment for most of them (except those that need refrigeration) is room temperature, which doesn’t mean Fahrenheit temperatures reaching into the 80s or 90s. I’ve sometimes wondered why someone doesn’t just invent a type of medicine storage container that can be locked if need be, limits humidity, etc. Steal my idea—please! Are there any strategies you find effective for safely storing medications?

Smartphones at work: OK, in case you didn’t know it, most nurses are using smartphones at work:

In 2010, the U.S. Bureau of Labor Statistics estimated that 72 percent of physicians use smartphones. Nurses aren’t […]

2016-11-21T13:09:42-05:00July 11th, 2012|nursing perspective|0 Comments
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The Affordable Care Act Survives, At Least for Now

Shawn Kennedy, AJN editor-in-chief

Senate roll call, Affordable Care Act/by Kurykh, via Wikimedia Commons

It’s been a couple of weeks now since the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA), and there have been too many articles and analyses to count. The bottom line is that its fate won’t be settled until after the November elections. If the Republicans win the election, the ACA will become the first battleground, as its repeal has been promised by candidate Mitt Romney.

What is concerning is that a great many people pay attention to the rhetoric rather than finding out the facts (remember “death panels”?). This point was well made by political cartoonist Stuart Carlson in this cartoon. It’s hard not to be in favor of many of the provisions—like extending coverage under a parent’s plan for children up to 26 years of age, or barring insurance companies from denying coverage for preexisting conditions.

As nurses, we need to know the facts and go beyond the political rhetoric. We need to be informed for ourselves (anything that has an impact on health care delivery and funding will affect nursing) and for our patients, who will have questions. Get the facts—read the law at the link above, a summary of the law, or the articles we published summarizing how it will affect nursing (our original article, and a 2011 update, both open access until […]

2016-11-21T13:09:43-05:00July 9th, 2012|health care policy, nursing perspective|2 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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