Throwing a Rope Down The Hole of Despair: Early Referral to Palliative Care

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author: River, Mountain, Sky – detail of Polar Bear’s Last Song. Watercolor, inkjet collage, 2016.

River, Mountain, Sky - detail of Polar Bear's Last Song. Watercolor, inkjet collage, 2016 by Julianna ParadisiNervously, I adjust the Bluetooth earpiece I’m wearing before dialing the phone number. I’ve rehearsed my greeting. On the other end, the patient answers, “Hello?”

I tell her it’s her nurse navigator and I’ve called to find out how she’s doing. Her oncologist recently informed her the cancer has returned—further treatment will only ease symptoms, not cure the cancer.

“I haven’t left the house since I got the news,” she tells me. “Sometimes I just sit on the sofa all day. I don’t know what to do.”

It’s a common response from patients in similar circumstances. The realization they will not survive can become emotionally paralyzing, rendering a person unable to find purpose or a reason to keep going. Pain, fatigue from surgery, chemotherapy, and radiation therapy, contribute to feelings of hopelessness, hampering the ability to consider their choices.

“Did your doctor mention a palliative care referral?”

Many health care providers […]

2016-11-21T13:01:14-05:00May 2nd, 2016|Nursing, Patients|2 Comments
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AJN in May: Night-Shift Naps, Intrathecal Cancer Pain Relief, Teaching Nurses to Write, More

On this month’s cover is A Maid Asleep (1656–57) by the Dutch master Johannes Vermeer. We chose this painting to call attention to the issue of sleepiness in nurses who work the night shift, which is explored in this month’s Original Research article.

On-the-job sleepiness among nurses can increase the risk of patient care errors, job-related injuries, and long-term health problems.

For night-shift nurses, one potential solution is being allowed to take brief naps during a shift, which the American Nurses Association recommends as an evidence-based countermeasure to fatigue. But nurses may face barriers to doing so, including a lack of formal breaks on the unit and concerns about impeding the quality of nursing care. To learn about a project that explored those barriers and attempted to implement night-shift naps, read “Napping on the Night Shift: A Two-Hospital Implementation Project.”

Some other articles of note in the May issue:

CE Feature: “Intrathecal Pumps for Managing Cancer Pain.” Among patients with cancer, moderate to severe pain is prevalent and can be refractory even with the use of systemic opioids, which may cause adverse effects that are difficult to manage at the doses required to control pain. When delivered intrathecally, however, opioids and adjuvant analgesics may provide greater pain relief at dramatically lower doses and with fewer adverse effects. This article provides an overview of intrathecal pump therapy, including its benefits and potential risks and complications; the medications that can be delivered intrathecally; and the nursing […]

2016-11-21T13:01:16-05:00April 29th, 2016|Nursing, nursing perspective, nursing research|0 Comments
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Nurses, Exercise, Time: Hitting a Nerve

Flickr creative commons/ Richard Masoner Flickr creative commons/ Richard Masoner

Hitting a Nerve. I received several recent emails about an editorial I wrote in the April issue of AJN, in which I discussed nurses’ health practices, including exercise, in conjunction with one of our feature articles, “Original Research: An Investigation into the Health-Promoting Lifestyle Practices of RNs.”

The authors found that, for study participants,

“physical activity and stress management scores were low for the entire group of RNs.”

Drawing a connection between these findings and recent research by Letvak and colleagues suggesting an association between nurses’ health and job performance, I wrote, “If the nurse caring for you or your loved one is suffering from fatigue and stress, she or he may be more apt to make an error or to sustain a workplace injury.”

Judging from the emails I received, I hit a chord. The writers stressed the difficulty of working full time and, in many cases, caring for a family as well. Often, they said, they had little energy left over for themselves. One writer, though, did say that my editorial was the ‘kick’ she needed to get back to walking! […]

2017-06-28T14:34:26-04:00April 28th, 2016|Nursing, nursing perspective, personal health practices|1 Comment
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That Ordinary Nightmare Shift

Sandy Klever, RN, currently works in hospice care in Des Moines, Iowa. At the time of the events described here, she was working on a medical/surgical floor at a Veterans Administration hospital.

julie kertesz/ via flickr creative common julie kertesz/ via flickr creative common

“Can you work tomorrow evening?” sweet-talks my nurse manager. Even though I will miss handing out treats on Halloween, I say yes. “But what about all my candy?” I ask. “Just bring it with you!”

Halloween night should be an easy shift. Do not say the ‘Q’ word, I tell myself. As I’m drinking coffee in the staff room, I’m assigned to four familiar patients, one of whom is a discharge.

Then the door opens and a colleague hands me a notecard about a direct admit coming from the ER, tells me that he’s having a COPD exacerbation and is homeless.

Well, I can manage a COPDer. At least he’s not a challenging laryngectomy patient transferring from the ICU.

“Oh, and by the way,” my colleague adds, “he’s confused and bipolar.”

Off to the floor! Because his room is still being cleaned, I have plenty of time. Within minutes, I have performed a complete assessment on my first patient. Moving on to my second patient, I see a commotion in the hallway and realize my new admit is coming on a cart already. As we maneuver the patient […]

2016-11-21T13:01:17-05:00April 25th, 2016|Nursing, nursing perspective, nursing stories|3 Comments
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Earth Day 2016: A Call for Less Toxic Homes, Safer Health Care Facilities

By Barbara Polivka, PhD, RN, professor and Shirley B. Powers Endowed Chair of Nursing Research, University of Louisville, Kentucky

EarthNASAAs we celebrate the 46th Earth Day, it’s good to look back.

  • Earth Day was founded by U.S. senator Gaylord Nelson and started as a national environmental teach-in on April 22, 1970. An estimated 20 million Americans gathered that day at sites across the nation.
  • An important result of the enormous public response to the first Earth Day celebration was the subsequent creation of the U.S. Environmental Protection Agency and the Clean Air Act.
  • Earth Day became an international celebration in 1971 when the UN Secretary General talked about it at a Peace Bell Ceremony in New York City.

Earth Day is a time to think about how we affect the environment and how we are affected by the environment.

Health Care Without Harm is an international organization promoting environmental health and justice. If you aren’t familiar with Health Care Without Harm I urge you to go to their web site to see how health care organizations are decreasing their environmental impact. Health care facilities are taking the following steps:

2016-11-21T13:01:17-05:00April 22nd, 2016|Ethics, Nursing|0 Comments
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