Honoring the Personhood of Brain-Dead Patients: A Delicate Approach

A dandelion alone in a field suggests the fragility of life. Photo by RIDVAN AYRIK/ Pexels

In the past month, we had a couple of patients in our pediatric ICU who had suffered tragic neurological injuries and were declared medically brain-dead. In the state of California as in most states, a pronouncement of brain death is equal to a legal pronouncement of death, and the medical team then possesses legal permission to remove mechanical support from the physical body that has remained under intensive care.

In both of these cases in our ICU, the parents struggled to accept the terminal implications of brain death and pushed back to varying degrees for more time to see if their children might still somehow find a way to recover. In these types of cases, the actual moment-by-moment practice of bedside nursing care becomes complicated. How do we honor the personhood of the patient as we provide intensive care for the body prior to removing mechanical support, and at the same time gently help the parents accept that their child has medically died?

The potential for misunderstanding nursing care

The interactions nurses have with family members as we care for their brain-dead child present many opportunities […]

2023-06-21T13:06:54-04:00June 21st, 2023|end of life, Ethics, family experience, Nursing|1 Comment
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Resources for Staying Safe as Wildfires and Poor Air Quality Events Increase

Orange sky from wildfire smoke in San Francisco Photo by Tegan Miele/Unsplash

Find out what you need to know about the health risks of wildfire smoke and the best ways to keep you and your family or patients informed and safe—whether through use of a smartphone app, limiting outdoor activities, buying an air filtration device, or other means.

As we enter summer, wildfire season is upon us and will extend into the early fall. Wildfires in the United States have increased in frequency and severity over the past several decades. The states with the most wildfires are California, Georgia, Texas, North Carolina, Florida, Arizona, and Oklahoma. This year, as the season ramps up, Canada has experienced record-setting wildfires, with smoke causing air quality alerts and evacuations in Canada, the northeastern United States, and Europe.

The health risks of wildfire smoke.

With these fires comes poor air quality, with the main culprit being a pollutant known as particulate matter (PM) 2.5. These tiny particles or droplets in the air are 2.5 microns or less in width and are able to travel deep into the respiratory tract. Exposure to fine particles can cause short-term health effects such as eye, nose, throat and lung irritation, coughing, sneezing, runny nose, and shortness of breath. It […]

2023-06-16T08:03:16-04:00June 16th, 2023|climate change, environmental health, environmental health, Nursing, Public health|0 Comments
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QR Codes for Rapid Responses: Improved Clinical Operations and DEI Insight

Improving data collection of RRTs for quality improvement

The method we use to track rapid response team (RRT) data has evolved on our health campus at Mount Sinai Queens. Just a few years ago we were using paper logs; now we use electronic logs accessed by a QR code. The goal initially has been to become paperless and collect data to analyze our rapid responses for clinical insight. The greater data collection with the QR code process has in turn allowed for analysis, including a closer examination of diversity, equity, and inclusion (DEI) variables. 

About our rapid response team

Our RRT consists of the ICU charge nurse, ICU attending, respiratory therapist, and the nurse manager or the evening/night nursing administrator. They are called upon when there is a significant change in a patient’s condition that requires critical care expertise at the bedside. After hearing the overhead call for a rapid response, the responding ICU RN scans the RRT QR code using a smart phone. The QR code is displayed within the ICU nurses station for easy access. Depending on the type of rapid response, the responding RN can enter data into the RRT electronic log as care progresses and/or at the conclusion of the response.

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2023-06-14T17:12:55-04:00June 14th, 2023|equity, Nursing, Quality improvement, Technology|0 Comments
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Crumbled Walls: A Transformative Caregiving Journey

Confronting fragility: a perfectionist father’s illness.

“Nurses make horrible patients,” my dad’s words echoed in my mind as I stood beside his hospital bed. Confined to this cold and sterile room, he, once a seasoned nurse, now teetered between worlds, fighting to maintain control of his crumbling body and the walls that had always surrounded him.

My father took pride in his immaculate exterior wall. He kept a well-manicured lawn and showcased three exemplary children and a life partner we referred to as our “uncle” when outside the wall. The inside structure was sharp and less forgiving. Within the confines of his perfectly controlled life, I was subjected to restrictive diets and forced to starve myself, all in pursuit of fitting his external vision of a perfect 16-year-old girl. I didn’t match his mural, but at least I had “a pretty face.”

In this hospital bed, my father’s wall became brittle and translucent. Machines whirred, extending their tentacles, both charging him with life and subtly stealing it away. Weakened by the long-term use of prednisone, his body bore the weight of cancer’s progression, leaving him moon-faced and unrecognizable. His once unblemished mural, now in ruins, left him dependent and vulnerable, requiring nursing assistance for basic tasks like toileting and bathing.

In his time of greatest […]

2023-06-13T07:28:49-04:00June 6th, 2023|end of life, Nursing, nursing career|4 Comments
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The Hidden Crisis: Unveiling the Mental Health Struggles of Teen Boys

In today’s world, teenage boys are facing a crisis that often goes unnoticed: their mental health. Anxiety, depression, despair, and even suicidal thoughts plague young boys and young men alike. Shockingly, teenage boys and young men in the United States are more than twice as likely, and sometimes up to four times as likely, to die by suicide compared to their female counterparts. They are also at a higher risk of gun violence and drug overdoses. It’s time to shed light on this crucial issue that often remains overlooked by both the public and health care professionals.

The increase in youth mental health issues has garnered considerable attention in recent times, with the U.S. surgeon general calling it “the defining public health crisis of our time.” But a lot of this has focused on the struggles of adolescent girls and LGBTQ+ teens.

Undoubtedly, these issues deserve our utmost attention and support. However, it is a mistake to assume that teenage boys and young men are faring well. As someone who writes and speaks about boys and has personal experience raising four sons, I understand that male depression and anxiety often manifest as irritability, rage, or anger. Many young males turn to alcohol or drugs as a […]

2023-06-01T07:53:32-04:00June 1st, 2023|mental illness, Nursing|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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