Defending Against Moral Distress

A collaborative initiative offers recommendations to build moral resilience.

All nurses have at some point been faced with situations that challenge their values. Whether dealing with families or patients or the actions of colleagues, we may be faced with acting (or not acting) in accordance with our professional or personal values. I can easily recall several situations (which I detail in my February editorial) that involved unnecessary invasive procedures and surgery or removing life support.

Such situations take a toll on the individual and the care team and ultimately have a negative effect on patient care quality. Moral distress is not something that can be entirely eliminated—there will always be situations that provoke angst. But individuals can build moral resilience if they learn to recognize it when it occurs and if their organizations support them in finding ways to manage ethically challenging situations. […]

2017-02-06T09:15:27-05:00February 3rd, 2017|Ethics, Nursing|0 Comments
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Culture as a Key to Health

By Beth Toner, MJ, RN, senior communications officer, Robert Wood Johnson Foundation

(Video caption: The Dakota are a horse tribe, and Charley, a retired reservation policeman, takes care of abandoned horses, connecting them to the tribe’s youth to help the young redefine themselves in relation to tribal history. Video used by permission; produced by Purple States LLC with support from the Robert Wood Johnson Foundation.)

I consider myself, and have been told by others that I am, an extraordinarily patient person—except behind the wheel of a car.

I commute 80 miles each way to work (that’s how much I love my job), so I spend a lot of time in the car. That, in turn, means I get annoyed—unreasonably so—by folks who are driving in such a way that forces me to spend a minute longer than I need to in that car. Now, it never leads to dangerous or aggressive driving, but it does lead to a lot of windows-up ranting while I’m on the road. One day, while I was in mid-rant, my 21-year-old daughter finally said, “Mom, you need to imagine other people complexly.”

I think of that conversation often as I listen to the polarizing dialogue that continues across our nation. What if, across the nation, we each imagined other people complexly, not just as their culture, their gender, their political party, their favorite television show? People, with all their joys and sorrows, their best qualities and their deepest flaws—uniquely themselves, yet with so much […]

2017-02-02T10:33:44-05:00February 1st, 2017|Nursing, Public health|1 Comment
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AJN in February: Improving CKD Outcomes, Nurses and Patient Safety, Moral Distress, More

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

CE Feature: “Improving Outcomes for Patients with Chronic Kidney Disease: Part 1”

The burden of chronic kidney disease (CKD) is rising both in this country and worldwide. An estimated 10% to 15% of U.S. adults are currently living with CKD. The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. This month, part 1 offers an overview of the disease, describes identification and etiology, and discusses ways to slow disease progression. Part 2, which will appear next month, addresses disease complications and treatment of kidney failure.

CE Feature: “Nursing’s Evolving Role in Patient Safety”

In its 1999 report To Err Is Human: Building a Safer Health System, the Institute of Medicine suggested that between 44,000 and 98,000 Americans die annually as a result of medical errors. The report urged health care institutions to break the silence surrounding such errors and to implement changes that […]

2017-01-30T10:39:50-05:00January 30th, 2017|Nursing|0 Comments
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A Public Health Nurse at the Intersection of Birth and Death

by Lisa Dietrich for AJN/ all rights reserved

The January Reflections essay in AJN is called “Touching Death, Touching Life.” The author, Yaffa Vinikoor, is a public health nurse who describes a patient she refers to as Sidney. Over time, she’s come to know the worn furniture of Sidney’s small apartment and the details of his life, such as Arnold, his paid caretaker, and Sidney’s younger wife, who lives separately. Sid has dementia and several other conditions and is in decline. “Sid,” she writes “usually lay slanted, like he’d been haphazardly dropped onto the enormous mattress, hair askew and face contorted.”

The essay explores what it’s like to be pregnant while doing such work. Vinikoor’s situation that summer puts her in relation to two very different currents:

I continued to do my work in the city as a public health nurse with the chronically ill homebound up until the day I went into labor. . . . I continued to walk miles per day, the nursing supplies in my backpack bowing my back and the baby in my belly guiding me forward . . . . As I cared for those whose lives were in steady decline, I thought about what giving birth to new life would be […]

2017-01-27T10:31:16-05:00January 27th, 2017|Nursing, nursing stories, Public health|2 Comments
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School Recess as a Matter of Public Health

A friend who teaches first grade finds her principal’s recess policy maddening. The children are allowed almost no recess, and some teachers have resorted to “sneaking” their classes outside when the principal is off-site. “The children have no rights,” my friend says. She adds that when they haven’t been able to run and play, “teaching is a waste” because the kids can’t focus.

The U.S. Department of Health and Human Services recommends a minimum of 60 minutes of daily physical activity for children and adolescents, and the American Academy of Pediatrics describes recess as “crucial.” Yet many schools continue to prioritize academics over physical health. In this month’s AJN Reports, author Carol Potera explores the connection between the decline in physical activity in schools and the increase in childhood obesity and describes the ways in which some schools are trying to reverse these trends. […]

2017-01-24T15:55:08-05:00January 25th, 2017|Nursing, Public health|3 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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