AJN in November: Preeclampsia Management, Health Conditions Associated with Military Service, More

The November issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Preeclampsia: Current Approaches to Nursing Management

A clinical review of current practice related to preeclampsia risk assessment, prediction, and management, plus updated diagnostic criteria from the American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy.

CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD

Evidence shows that veterans who receive their health care from private sector employers are less likely to be screened for military service—and therefore may not be treated for service-related health conditions. Here, the authors explore whether rural Pennsylvania providers offer this screening to their patients.

Creating a Fair and Just Culture in Schools of Nursing

What strategies can nursing schools use to create a fair and just culture? The second part in a two-part series.

Perspectives on Palliative Nursing: Liberty and Justice for All 

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn?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.

There’s much more in our November issue, including:

2017-10-30T09:25:26-04:00October 30th, 2017|Nursing|0 Comments

Sepsis Perfusion Assessment: A Matter of Seeing and Touching

A heightened level of care.

Sepsis is estimated to strike up to 3.1 million people in the United States each year, and in 2014 resulted in over 182,000 deaths. Patients who develop sepsis are subjected to an onslaught of procedures and interventions, from cardiac monitoring and transfer to the ICU to frequent blood sampling and insertion of central lines and urinary catheters. It is a frightening experience and requires attention to the patient’s experience and interventions to mitigate stress.

According to a clinical feature article in our October issue, “Assessing Patients During Septic Shock Resuscitation,” the revised six-hour bundle from the Surviving Sepsis Campaign includes a recommendation that, after initial fluid resuscitation, patients’ perfusion and volume status should be reassessed.

Noninvasive bedside indicators of perfusion and volume status.

click image to expand

This article focuses on measuring capillary refill time (CRT) and the skin mottling score (SMS; see figure at right) and details the evidence underlying the correct way to perform these assessments and how to incorporate findings into the overall plan of care.

One of the key advantages of these two measurements is that they are noninvasive and require no equipment—just the eyes and touch of an astute nurse—yet they are highly valuable in the overall indication […]

Tips for Nurses to Counter Workplace Negativity

“Negativity is a lot like cigarette smoke. If it’s around, you know it.”

The 26th Annual Convention of the Academy of Medical-Surgical Nurses (AMSN) took place October 12-15 in Palm Springs, California. More than 1,100 nurses from across the country as well as Canada, Saudi Arabia, Puerto Rico, and the Bahamas came to network, attend educational sessions, and enjoy stimulating company.

Negativity as a default response to workplace stress.

The opening address by Sharon Cox, “Staying Positive While Working with Pearl and Grumpy,” set an enthusiastically constructive tone for the four-day conference. Cox, a former staff nurse, unit manager, and medical center administrator, shared practical suggestions for managing the “stress, drama, and trauma” of today’s health care workplace.

Cox pointed out how easy it is in the current environment to turn on each other, see ourselves as victims, and create negativity that affects our personal health and working relationships—and also affects patients and their families. Said Cox, “Negativity is a lot like cigarette smoke. If it’s around, you know it.”

Good habits are intentional.

Cox emphasized the value of cultivating our ability to remain positive in the midst of daily challenges. There are options in virtually every situation—and, she emphasized with a smile, we are not talking about options to change the behavior of others […]

2017-10-25T14:39:45-04:00October 25th, 2017|Nursing|0 Comments

High Opioid Overdose Numbers Spur State, City Initiatives

State 2015 overdose death rates compared with national rate. (CDC image)

As we report in an October news article, recent studies have shed light on the growing scale of the opioid crisis in the United States. Among the latest statistics:

  • 33,000 Americans died in 2015 from an opioid overdose, a high percentage from the use of synthetic opioids such as illegally manufactured fentanyl.
  • The diagnosis of “opioid use disorder” climbed 493% from 2010 to 2016 in Blue Cross Blue Shield claims.
  • Around 4.31% of Americans ages 12 or older use prescription pain relievers for nonmedical uses.

Increasing Naloxone availability.

The findings underscore the urgent need to take steps to combat the crisis—a need that has prompted states and cities to attack the issue using various methods. Baltimore’s health commissioner, for example, issued a standing order for naloxone to be available at all of the city’s pharmacies. Brown University and the Rhode Island School of Design collaborated to create NaloxBoxes—emergency naloxone boxes installed at city social service centers that enable any bystander to administer a rescue dose.

Speeding access to addiction treatment.

And, to minimize delays in patients’ receipt of medication-assisted opioid addiction treatments like methadone, New York State has reached agreements with two insurance companies to end their requirements […]

2017-10-23T08:50:26-04:00October 23rd, 2017|Nursing, Public health|1 Comment

Learning New Skills of Supporting One Another as Nurses

I have had a couple of recent conversations with nurse coworkers who have been close witnesses to patient deaths that were particularly difficult. They told me how challenging it was to process the experiences with fellow nurses—even those whom they considered as good friends—in the hours and days immediately following the patient deaths.

Some conversations in the break room or in carpool rides would go into the medical details surrounding the deaths, but stayed away from discussing personal emotions beyond general statements such as “It was just really sad.”

Other conversations, they told me, were comprised of awkward silence—as opposed to a more intentional therapeutic silence, a deep listening. In both scenarios, my coworkers said they’d felt a lack of quality and depth in these encounters. While they hoped for an opportunity to talk with colleagues, who would surely understand the experience and details better than anyone else, ultimately they felt that they were left to sort out their thoughts and feelings alone.

Even in a unit where we constantly express gratitude for a strong sense of teamwork, my colleagues and I still struggle to help each other through the deeper experiences of grief and trauma.

A missed opportunity?

And at times when I’m in the charge nurse role and staff members are responsible for end-of-life care, I […]

2018-01-18T10:02:53-05:00October 20th, 2017|Nursing|1 Comment
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