We Haven’t Made You Better: Orthopedic Trauma and Emotional Healing

Learning that healing the body isn’t always enough.

For much of my career as a trauma ICU nurse and orthopedic trauma nurse practitioner, I focused on building my knowledge of pathophysiology and mastering the assessment and procedural skills required to care for trauma survivors. After a decade of practice, I felt like I had entered the “expert” phase of clinical competence described by Dr. Patricia Benner in AJN in 1982.

But I was completely ignorant of a giant hole in my practice. A trauma survivor pointed out this gap during a routine clinic visit. Ms. H was six months removed from an ankle fracture she’d suffered in a motor vehicle collision on her way to work one morning. On exam, she had regained full strength and range of motion, the fracture was healed on radiographs, and her pain was limited to a minor ache after extended activity. She’d healed remarkably.

I told her that she had done an excellent job with her recovery and could resume her life, including going to work. I’ve come to believe that Ms. H’s response to this assertion changed my entire perspective on patient care. “I can’t go back to work,” she said. “Since the accident, I can’t get in a car without having panic attacks.”

I […]

2022-09-16T11:39:37-04:00September 16th, 2022|Nursing, nursing research, Patients|0 Comments
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Time to Stop Proving Burnout Exists and Start Researching Real Solutions

“Put simply, we know burnout exists and we know it’s getting worse. Let’s leave it at that and move forward. Let’s focus on what we know might mitigate burnout…”

That’s from this month’s Viewpoint, “Burnout Research at a Crossroads,” by Tim Cunningham and Sharon Pappas. Some readers may find it a relief to have this stated so baldly: let’s move on to solutions, say the authors. Let’s put research dollars, time, and energy behind the search for clearer information about what works and what doesn’t.

A two-pronged approach.

The authors see a crucial and legitimate place for investigation of what works and what doesn’t in wellness initiatives to support “personal resilience” through self-care (an increasingly nebulous term in itself).

But they caution against shifting the responsibility onto nurses’ shoulders and ignoring real systemic issues.

With this in mind, they call for research that first of all examines systemic factors:

“It’s only commonsensical that burnout and work experience are intimately tied. It’s time to look more closely at staffing, work hours, team nursing, equitable pay, and other work environment factors that may decrease burnout.”

[…]

2022-04-29T15:08:45-04:00April 28th, 2022|Nursing, nursing research, safe staffing|1 Comment
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DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what that […]

2021-01-27T11:35:45-05:00January 27th, 2021|Nursing, nursing research|1 Comment
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How Research Starts: Choosing a Question That Passes the ‘So What’ Test

As an undergrad at the University of Michigan School of Nursing more than 40 years ago, I was among the few students who loved the required “research” course. I don’t know whether I looked forward to that class because I was an avid reader of Nancy Drew and saw research as detective work, or simply because nursing was so new to me that everything about it seemed exciting.

The main idea behind the course was that all nurses should be able to read and understand research reports. We didn’t get into the nuts and bolts of study design, complex statistics, or modeling, but we were expected to be able to analyze basic nursing research articles and to identify a study’s strengths and weaknesses.

This early experience didn’t lead me to pursue a career in research, but it left me with a respect for the research process and an interest in asking clinical questions.

Research basics explained.

Now, I have a chance to update my understanding of the field through AJN’s new series on research basics, Nursing Research, Step by Step. The first installment, “How Does Research Start?” is in the October issue of AJN. In this introduction to the subject, author Bernadette Capili makes it clear […]

2020-10-29T08:57:25-04:00October 29th, 2020|Nursing, nursing research, nursing students|0 Comments
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Patient Input on Obstacles to Sleep Helps Focus One Unit’s Improvement Efforts

Do you know anyone who’s ever had a good night’s sleep in the hospital? As nurses, we hear the complaints; as patients ourselves, or as family members of patients, we’ve been there.

Differing views on the source of a unit’s sleep problem.

After their hospital’s 20-bed telemetry unit received a low HCAHPS survey score on a quiet-at-night question, nurse practitioner Christian Karl Antonio and his colleagues at a northern California community hospital took on the challenge of improving patients’ sleep experience on the unit.

Before designing an intervention, they spoke with patients as well as staff, and were surprised to learn that the two groups see the problem differently.

“Patients perceived being awakened for vital signs, blood draws, and medication administration as the most frequently occurring factors that contributed to noise at night. On the other hand, staff members perceived that noise at night came from staff conversations, equipment with alarms, announcements on the paging system, and delivery carts, among other sources.”

[…]

2020-10-08T10:01:55-04:00October 8th, 2020|family experience, Nursing, nursing research, Patients|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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