Nursing Archives - Page 125 of 406

The Thin Flat Line Between Life and Death

Illustration by Jennifer Rodgers.

A patient has died. His nurse begins postmortem care.

“I tell myself the things I always do—it was his time, we did everything we could. I can hear someone crying outside the room.”

In this month’s Reflections essay, author Kassandra August-Marcucio shares her feelings as she performs the steps of this protocol after a failed resuscitation attempt. We are reminded of each task, of the feelings of guilt that can arise (“I was his nurse and he died!”), of the last contacts with the patient’s family.

“The exaggerated zip of the bag is final.”

Almost every nurse has cared for a patient after the patient dies. Sometimes the nurse and patient have barely met; sometimes the patient is well-known to the staff. Many nurses (most, I hope), whatever their religious or spiritual beliefs, approach postmortem care with some sense of the gravity of the moment of someone’s passing. The “routine” tasks involved take on a slightly different aura than the other tasks of our days. Still, it’s hard not to rush through postmortem care to attend to the pressing needs of other patients.

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Betsy Todd, MPH, RN2018-06-28T10:04:41-04:00June 27th, 2018|narratives, Nursing|3 Comments

Not Until Cairo: A Flight Nursing Tale

Worsening signs.

The author’s flight path circled the globe

The cabin of the Learjet is dark, the heart monitor a metronome over the drone of the engines and pulse of the mechanical ventilator. I’ve been watching my patient’s cardiac rhythm, with ominous hackles rising on the back of my neck while my partner naps. Over the course of the journey the man’s inherent tachycardia has slowly shifted into a sinus rhythm that might seem like normalization on a paper medical report, but feels wrong. After all, this patient is dying. He is returning to Egypt to die amongst family after last-ditch cancer treatments in America have failed.

“Not on this flight,” I think to myself. “Not until Cairo.”

The plane banks as it descends into the Newfoundland night. The cabin vibrates with turbulence; St. John’s may be the most easterly North American fuel stop, but its position on the Atlantic all but guarantees unpredictable weather. The lights of the town sparkle below as my partner rouses, pops his ears, and stretches.

“Look at his heart rate,” I say, quietly. “Pressure’s okay, though.”

“Yeah,” he says. There’s an unspoken accordance between us. We’ve flown together enough—been trapped in small planes for countless hours, evaluating and collaborating—that we easily […]

Marcy Phipps, BSN, RN, CCRN, CFRN2018-06-21T10:11:27-04:00June 21st, 2018|Nursing, nursing stories|4 Comments

Distracted Nursing: On Personal Cell Phone Use at Work

A new societal norm.

Kathleen Bartholomew

Most of us have seen the cars on the highway that suddenly slow down in the passing lane, blocking other cars while weaving dangerously across the dividing lines between lanes. We know the signs of distracted driving well enough by now. It resembles drunk driving. Or we’ve had to dodge the people staring down at their cell phones as they blindly approach us on the sidewalk.

Divided attention in the nursing workplace.

The examples of distraction because of cell phone use are endless; in fact, especially in certain places and age groups, this form of preoccupation has become the norm. The behavior carries over into many workplaces, and nursing is not exempt. The following excerpt is from this month’s Viewpoint essay by nurse educator and consultant Kathleen Bartholomew, “Not So Smart: Cell Phone Use Hurts Our Patients and Profession.”

It is 6:45 in the morning, and as I pass a patient in the ED, I see a nursing assistant watching a movie on her phone. She is supposed to be monitoring the 1:1 suicide risk, yet she appears so intrigued with the movie that I wonder if the patient is safe—or perhaps wants to talk.

Earlier that same day, a nurse tells me a story of calling the […]

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Jacob Molyneux, senior editor/blog editor2018-06-19T11:40:33-04:00June 19th, 2018|Nursing|7 Comments

In Colorado EDs, ‘Alternative to Opioids’ Pilot Project Exceeds Goals

Ashley Copeland talks to her mother in the Swedish Medical Center ED. Copeland was treated for a severe headache with a nerve-blocking anesthetic, but no opioids. (John Daley/CPR News)

Last year, in an effort to address the state’s acute opioid abuse problem, several Colorado health care organizations—including the Colorado Emergency Nurses Association—worked together on an intervention to target patients admitted to the ED with pain. The plan? Implement a pain management program to promote alternative strategies, with a goal of decreasing opioid usage by 15% in the participating EDs.

As discussed in a June news article, the program, which was piloted in 10 hospitals and involved heavy involvement from nurses, surpassed its goal: opioid usage during the intervention period (as measured in morphine equivalent units) was 36% less than in the previous year.

The pilot project […]

Diane Szulecki, editor2018-06-14T09:29:35-04:00June 14th, 2018|Nursing, patient experience|1 Comment

Who’s Listening to Hospitalized Patients with Hearing Impairment?

In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of his intact hearing […]

Betsy Todd, MPH, RN2018-06-12T12:53:06-04:00June 12th, 2018|Nursing, nursing research, patient experience|1 Comment