The Hardest Decision: A Military Husband Returns to Tragedy at Home

FebruaryReflectionsIllustrationOur February Reflections essay, “The Hardest Decision,” is by a Amanda Richmond, a nurse based in Arkansas. It’s about a husband facing a drastically changed world upon return from deployment overseas—and a nurse who bears witness. Here’s the opening paragragh. Reflections essays can always be read without a subscription to AJN.—JM, senior editor

That she was still beautiful made her situation all the more tragic. She had little visible damage. An EVD tube snaked out from under her hair and deposited its contents into a drip chamber. Her chest rose and fell at a preselected rate of 14 breaths per minute. iv lines disappeared under her gown and terminated into a central line. On the monitor, her vital signs were flawless.

2016-11-21T13:08:19-05:00February 12th, 2013|nursing perspective|3 Comments
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‘Patient Activation’: Real Paradigm Shift or Updated Jargon?

By Jacob Molyneux, AJN senior editor

I attended a Health Affairs briefing yesterday in Washington, DC. Based on the February issue of the journal, it was called “A New Era of Patient Engagement.” A lot of research money appears to have been flowing to this area in recent years.

Our January article on "Navigating the PSA Screening Dilemma" includes a discussion of 'shared decision making' Our January article on “Navigating the PSA Screening Dilemma” includes a discussion of ‘shared decision making’

The basic idea isn’t entirely new to anyone who’s been hearing the term “patient-centered care” for a long time: as Susan Dentzer writes in “Rx for the ‘Blockbuster Drug’ of Patient Engagement,” a useful article summarizing the main ideas raised in the Health Affairs issue: “Wherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t.”

One might add to these projected benefits: better experiences as patients.

Something’s got to change, so why not this? If many nurses feel they’ve heard all this before, the sense of a health care system in necessary flux […]

2016-11-21T13:08:20-05:00February 7th, 2013|nursing perspective, patient engagement, Patients, personal health practices|1 Comment
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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained […]

2017-07-27T14:51:56-04:00February 4th, 2013|nursing research|1 Comment
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AJN’s February Issue: COPD, Fungal Meningitis Outbreak, SIDs, Nursing Leadership

AJN0213 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Last month, we published findings from a quantitative study exploring antiparkinson medication–withholding times during hospitalization and symptom management. This month you can catch part two of this series, which reports on findings from a qualitative study on the perioperative hospitaliza­tion experiences of patients with Parkinson’s disease. Participants’ comments in this study made it clear that the actions of nurses could affect the perioperative experience for better or worse. The article is open access and can earn you 2.1 continuing education (CE) credits.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the U.S. Our CE feature “COPD Exacerbations” outlines current guidelines and evidence-based recommendations for identifying, assessing, and managing COPD exacerbations. The article is open access and can earn you 2.6 CE credits.

This month we introduce our new series, Perspectives on Leadership, which is coordinated by the American Organization of Nurse Executives. This first article, “Partnering for Change,” describes how one hospital’s nurse leaders and staff worked together to change the way nurses conduct shift report.

Matthews_BillboardEach year in the U.S., more than 4,500 infants die suddenly and unexpectedly. February’s In Our Community article, “Babies Are Still Dying of SIDS,” describes how a nurse’s advocacy and activism resulted in safe-sleep legislation. A podcast […]

2016-11-21T13:08:26-05:00February 1st, 2013|Nursing|0 Comments
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School Nurses: We Don’t Just Need Them for the Obvious Cases

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

Sitting in the dark movie theatre, I hear a familiar high–pitched “beep, beep, beep.” The sound brings me to full attention, away from the action on the big screen and back to my “date,” a blond and very handsome five-year-old boy sitting beside me. I see him mouth the words, “I can’t breathe,” but he makes no sound.

Children at playground, Brisbane, Australia, 1939/Wikimedia Commons Children at playground, Brisbane, Australia, 1939/Wikimedia Commons

He’s not trying to be quiet for fellow moviegoers—he’s getting no air from his ventilator, as the alarm has indicated. Though his eyes are open wide and his nostrils flared with an oxygen-starved expression, his eyes still hold trust. He knows I can help him breathe, now—quickly, the Ambu bag is in my hand, squeezing breath into his immobile body, as I feel around in the dark for a disconnected vent circuit. (Of course, I had already silenced the alarm as quickly as possible, for the other kids and their parents in the theater during the lightly attended matinee.)

Such adventures out of the children’s hospital were a monthly occurrence. A child life therapist and a nurse would take medically fragile kids out into the community, usually with parents in attendance. These afternoons of fun gave the parents and kids hands-on experience before discharge.

And something […]

2016-11-21T13:08:27-05:00January 31st, 2013|Nursing|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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