Night Watch

Editor’s note: In this tightly observed guest post, a nurse visiting a sick family member experiences the hospital as a kind of foreign country.

Eileen McGorry, MSN, RN, worked as a registered nurse in community mental health for over 30 years. She currently lives in Olympia, Washington, with her husband Ron.

The walkway is hard, the concrete cold, and I am immersed in darkness. Then there is the swish of the hospital doors and whispery stillness. The light over the reception desk shines on a lone head, bent over a book. A clipboard is pushed toward me. The paper on it is lined with names, some boldly printed, others scribbled, the letters unrecognizable. The spacious lobby is filled with individual groups of soft stuffed chairs and love seats. All of it quiet and empty. Over the chairs and sofas, the black of the midnight hour is changed into twilight.

I remember the bustle of the area at midday. Families gathered together, eyes searching the crowd for the green scrubs of surgeons. “She will live,” they say to some, and to others, “We will wait and see.” The frenzy of the day over, the empty chairs wait for tomorrow.

I sign my name in script. I use the old Catholic school script. The script preached by my mother, who is upstairs recovering from heart surgery. I walk past the chairs along walls so white […]

Should Adults Experiencing In-Hospital Cardiac Arrest Be Intubated?

Photo by A.J. Heightman / Journal of Emergency Medical Service / PennWell Corp.

Although it’s commonly practiced, results from a large new study call into question the effectiveness of intubating adults who experience in-hospital cardiac arrest.

As we report in a May news article, researchers analyzed data for 108,079 adult patients who experienced cardiac arrest in the hospital between 2000 and 2014—and found that patients who were intubated within the first 15 minutes of arresting were less likely to survive than patients who were not.

Among other findings, intubated patients were less likely to experience a return of spontaneous circulation and had a lower rate of good functional outcome (defined as either mild or no neurological deficit, or only moderate cerebral disability).

The researchers concluded that the study results do not support early intubation for adults who experience cardiac arrest. However, they noted that their analysis was unable to eliminate potential confounders like the skills and experience of health care professionals, the underlying cause of the cardiac arrest, and the quality of chest compressions. Additional clinical trials are needed to yield useful results and to better understand the influence of confounding factors. […]

2017-05-15T09:13:26-04:00May 15th, 2017|Nursing|2 Comments

Establishing the Evidence for Clinical Ladder Programs

Nursing Advancement Before the Clinical Ladder

When I took my first job as a hospital staff nurse, pretty much the only path to advancement in the clinical setting was moving into an administrative position. Nurses moved up by becoming nurse managers, then supervisors, and eventually nursing directors. It was considered unusual for someone to stay at the bedside for many years.

Benner’s Novice-to-Expert Model

Then along came the clinical ladder—a way for nurses to advance clinically. Patricia Benner’s landmark work on identifying the hallmarks of novice-to-expert practice laid the foundation for identifying the different stages of acquisition of skills (see her article on the topic published in AJN in 1982; free until May 22).

Evolving Competencies Require New Paths to Advancement

But while the competencies nurses need to practice effectively are vastly different today, many hospitals haven’t updated their clinical advancement programs to reflect the knowledge, skills, and attitudes (KSAs) that nurses need to practice effectively in today’s complex health systems. Moreover, there’s been little research to provide the evidence for identifying the various competencies and the associated KSAs. Our original research article in the May issue provides that evidence.

Creating an Evidence-Based Progression

The authors of “Creating an Evidence-Based Progression for Clinical Advancement […]

The Nurse Who Saw Me: Easing the Strain of a Mother’s Vigil

Illustration by Barbara Hranilovich. All rights reserved.

“The Nurse Who Saw Me,” the Reflections essay in the May issue of AJN, is by JR Fenn, a writer and lecturer in upstate New York. The author, who is not a nurse, describes a night of uncertainty she spent in an isolation room on a pediatric unit with her sick daughter.

This is the kind of writing that helps a reader understand the perspective of a scared parent in a disorienting and uncomfortable environment. The care is efficient, and the clinicians she encounters all seem to be doing the right things for her baby. But reassurance is not immediately forthcoming, as we see in this passage from near the beginning:

The attending looks at us over her white mask when I ask if my daughter is going to be OK. ‘There isn’t the research for babies this young,’ she says, her eyes so huge I can see my terrified face reflected in them. I can’t ask any more questions because my throat has swelled closed as I fight tears.

[…]

The Essence of Nursing Care: A Powerful Tribute for Nurses Week

“Frontline nurses, as the health professionals who spend the most time with patients and their families, are central to ensuring that the patient experience is a positive and dignified one.”

Susan Hassmiller

This sentence from “The Essence of Nursing Care,” a guest editorial in the May issue of AJN, isn’t just rhetoric. It’s based on a recent and unforgettable personal experience of the power nurses have to recognize and sometimes ease a family member’s suffering at the very worst of times.

In this moving editorial, Susan Hassmiller, the senior advisor for nursing at the Robert Wood Johnson Foundation, writes about the nurses who helped her in the terrible days following her husband Bob’s tragic bicycle accident last fall. Writes Hassmiller:

“My life changed forever on Sunday, September 25, 2016, at 11:09 am. . . .That’s when I learned that Bob, my best friend and husband of 37 years, lay paralyzed in the trauma unit of a nearby hospital . . . .During those 10 brutal days, I learned anew the crucial role that nurses play in caregiving and compassion. Three nurses stood out in particular.”

I won’t attempt to summarize the rest of this guest editorial. It’s as eloquent a tribute as nurses are likely to get this year on Nurses Week. The article is free, so […]

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