Nursing Archives - Page 123 of 407

Is This Child in Pain?

When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical complexity remains challenging, […]

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Betsy Todd, MPH, RN2018-08-13T08:09:58-04:00August 13th, 2018|family caregiving, Nursing, Patients, pediatrics|0 Comments

Nurses Retiring from Nursing–or Not

Many of my nursing school classmates are retiring. A few said they were “done” with nursing and health care and with working, and stopped as soon as they were able to afford not working. They keep busy traveling, babysitting grandchildren, or just taking it easy. Some are trying their hand at something totally different—becoming a docent in a museum, for example, or taking courses to be a travel agent.

Keeping a connection to nursing.

Retired nurse Diane McCarthy volunteers in the neonatal ICU at OhioHealth Riverside Methodist Hospital in Columbus. Millennial nurses such as Erin Bergmann (left) say they benefit from having more experienced nurses like McCarthy on the unit. Photo by Kyle Robertson.

Most people I know, however, still want to keep a connection with nursing and have transitioned into part-time or consulting roles. After fulfilling and demanding careers, many older nurses still have a lot to offer and are not ready to completely retire from nursing. As one colleague has aptly termed it, “preferment”—doing what you prefer, when you prefer, and with […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2018-08-09T11:10:56-04:00August 9th, 2018|Nursing, nursing career|2 Comments

Multi-Drug-Resistant Organisms and Contact Precautions

When MRSA was new on the scene, strict isolation precautions were the norm.

Photo by Rick Sforza, Redlands Daily Facts / SCNG.

Years ago, when we first started to see patients with methicillin-resistant Staphylococcus aureus (MRSA) infections at the hospital where I worked, we kept them in what was then called “strict isolation.” These patients were kept on one unit and cohorted in two rooms at the end of the hall. Staff wore gowns, gloves, masks, and hair covering. How we hated having to put on all that gear!

The current challenge of MDROs.

Today, we understand more about transmission, and isolation precautions are better tailored to the epidemiology of each drug-resistant organism. Unfortunately, though, since that time antibiotic resistance has rapidly increased, and we now find ourselves not only with a lot more MRSA to contend with, but with patients whose infections are susceptible to only one or two antibiotics (and occasionally, to none).

Some of these multi-drug-resistant organisms (MDROs) seem to be persistent colonizers—that is, the organism “takes up residence” on or in the body without causing infection, and can still be transmitted to others. In some cases these patients will need to be on isolation precautions every time they are admitted to […]

Betsy Todd, MPH, RN2018-08-06T09:07:11-04:00August 6th, 2018|infection control, Nursing, Public health|0 Comments

How a Patient’s Family Heals a Nurse in this Era of Medicine

“This family’s brave, selfless, and clear-minded approach to their daughter’s last days showed me that it is still possible for me and my colleagues to heal in the ways we want to heal, hurt in the ways we accept we will hurt, and not harm in ways we never, ever intended to harm.”

A painful contradiction of pediatric ICU nursing.

One of the things that feels most unfair about pediatric ICU nursing is that with critically ill children, you don’t get the comfort of being able to look back and say, “At least they lived a long and happy life.” You ache that a baby, a toddler, a school-age child, a teenager was supposed to have their whole life ahead. But instead, much of their short life was marked by illness, prods and pokes, lines and tubes, sedation rather than play, a sterile environment full of strangers at all hours rather than a home full of time with friends and family.

The deep desire in both the parents as well as the health care providers to do anything possible to give them a shot at a future is in and of itself right and good. Yet the decision about how much to push both medicine, and the child as the obligatory recipient, in the fight for a future that is neither guaranteed in quantity nor quality can often be wrought with controversy and ethical distress. Clinicians do not necessarily find peace with their work just because a life was physically saved; sometimes quite […]

Hui-wen Sato, MSN, MPH, RN, CCRN2018-08-01T10:47:19-04:00August 1st, 2018|Nursing|0 Comments

The 2018 ANA Membership Assembly: Making True Dialogue a Reality

By Katheren Koehn, MA, RN, FAAN, executive director of the Minnesota Organization of Registered Nurses (MNORN) and a member of AJN‘s editorial board.

I have been a member of the American Nurses Association (ANA) for over 40 years, an active member for about 35 years. I “grew up” in the association as a delegate to the House of Delegates. I learned to “edit on the fly” by debating perhaps hundreds of resolutions introduced by state nurses associations at the annual, then biannual meetings of the highest level of governance of ANA.

Debating resolutions.

Resolutions had a formal structure of “whereas” and “be it resolved.” Whereases contained the facts; the be-it-resolved contained the actions delegates wanted the ANA to enact. Whereases could not be edited or debated; be-it-resolveds could be edited and debated for hours, or until someone remembered to use the Robert’s Rule “Call the Question.” Debate over resolutions had more to do with proving your point than listening to another’s point of view. It was great theater, but I don’t know how often those resolutions moved our profession forward. I’m sure some of them did, but I remember the debate more than the resolution.