Brain Injury. Undocumented Patient. Who Decides About Treatment?

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.

© Photolibrary Wales/ Albany Stock Photo.

Imagine that someone you love—a young person—suddenly collapses and is rushed to the hospital. Her heart is restarted, but it soon becomes apparent that there has been extensive anoxic brain injury. In a vegetative state, on a ventilator, no ability to follow commands, spastic extremities, an EEG showing continuous seizure activity. . . . and this person is an undocumented immigrant. And uninsured.

In this month’s AJN, Kimberly Radtke and Marianne Matzo present a fictional case (based on their real-life experience in palliative care) to illustrate the ways in which this kind of scenario might play out. The parents are overwhelmed, trying to make decisions while they are still in shock. Physicians soon express their concerns about prolonging “medically inappropriate care.” And who will pay for it?

In addition, hospitalization due to critical illness increases an unauthorized immigrant’s risk of repatriation without their consent. What must the family be feeling as they struggle to understand their daughter’s future?

The role of the ethics committee.

Radtke and Matzo discuss the […]

2017-11-17T15:19:22-05:00November 13th, 2017|Ethics, Nursing|0 Comments
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Are There Veterans Among Your Patients?

When vets get non-VHA health care, some issues may be missed.

Most U.S. veterans—and in 2014, there were approximately 19.3 million—do not get their health care from the Veterans Health Administration (VHA). Overburdened facilities with long waiting times and the fact that many veterans live considerable distance from a VHA facility mean that many get their health care from local and private organizations.

And while this may mean more convenient and timely care, it also might mean that health issues related to their military service might be missed by providers who do not have experience providing care to service members and veterans.

This Saturday, November 11, marks another Veterans Day. It’s been our tradition to include content related to health care for veterans or active duty military in November. This year, we have an original research CE article, “Primary Care Providers and Screening for Military Service and PTSD.”

Few providers screen for military service.

The authors of this article sought to examine whether non-VHA primary care providers were screening patients for military service and PTSD. Based on their survey of providers in western Pennsylvania, they found that most did not ask patients about a history of military service—and of those providers who did, few screened patients for PTSD. […]

2017-11-10T10:21:53-05:00November 10th, 2017|Nursing, nursing research|0 Comments
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‘An Urgent Public Health Challenge’ – APHA Meeting Emphasizes Climate Change

APHA climate change/health infographic. Click to enlarge.

The theme of this year’s American Public Health Association (APHA) meeting in Atlanta is “Creating the Healthiest Nation: Climate Changes Health.” The meeting is estimated to have drawn 12,000 attendees. Below are highlights so far.

Threats and opportunities.

Monday night, Howard Frumkin, DrPH, MPH, MD, of the University of Washington, called climate change “one of the most pressing public health issues we face.” In discussing the recently released Lancet Countdown on Health and Climate Change 2017 Report: U.S. Briefing, a joint publication of the Lancet and APHA that highlights the threats and opportunities climate change poses to Americans, Frumkin identified some key findings:

  • Exposure to dangerous heat and severe weather events is increasing.
  • Exposure to disease and allergies is changing (one example: allergy seasons are often prolonged).
  • The carbon intensity of U.S. energy use is decreasing, but this process must be accelerated to reduce climate-related health risks.

Nurse voices in environmental health.

During a session called “Public Health Nursing Research—Climate, Health, and Vulnerable Populations,” Linda A. McCauley, PhD, RN, FAAN, of Emory University, highlighted the vital role nurses play both in producing research findings about environmental hazards and human health and in translating these into practice.

“Nurses can go to the science and take it back to the community. That’s what we’re so good at.”

But when it comes to speaking out about environmental issues and […]

2017-11-08T10:31:59-05:00November 8th, 2017|environmental health, Nursing|0 Comments
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Update on Preeclampsia: What Nurses Need to Know

Illustration by Sara Jarret.

Preeclampsia is the most common hypertensive disorder of pregnancy, yet there is still much we don’t know about why it develops and how to prevent it. It can present in different ways, from hard-to-ignore symptoms such as constant headache or severe right upper quadrant pain, to no symptoms at all before elevated blood pressure or urine protein is detected at a routine prenatal visit.

Did you know that:

  • despite a long list of known risk factors, most cases of preeclampsia are diagnosed in healthy nulliparous women?
  • both moms diagnosed with preeclampsia and infants exposed to it in utero are at greater risk for cardiovascular disease?

Update your knowledge by reading “Preeclampsia:  Current Approaches to Nursing Management” in the November issue of AJN. This CE article provides a helpful clinical update, including the pathogenesis of preeclampsia, diagnostic criteria, screening tests on the horizon, 2017 recommendations for pharmacologic management, optimal timing of delivery, and nursing management.

2017-11-06T09:49:41-05:00November 6th, 2017|Nursing, patient safety|0 Comments
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Through Song, a Nurse’s Renewed Connection to An Ailing Mother

Illustration by Barbara Hranilovich for AJN.

Millions of Americans are now acting in some capacity as caregivers for an ailing parent. This month’s Reflections column is by a nurse who describes a moment in time as she helps to care for her home-bound and dying mother. Her mother remains, on occasion, as judgmental and offputting as the mother of her childhood.

But in such cases, there’s little to gain by dwelling on old disappointments and hurts—and in this instance, there are good memories as well.

The common language of song.

These good memories are primarily associated with her mother’s love of and talent for singing. “Moon River and Mom” describes this nurse’s experience of tending her mother’s leg wound as the Meals on Wheels man visits, and what happens afterward when the author prompts her mother to sing. […]

2017-11-03T07:50:46-04:00November 3rd, 2017|family experience, Nursing, nursing stories|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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