Best Care at Lower Cost: New IOM Report Spotlights Crucial Role of Nurses

By Mary D. Naylor, PhD, FAAN, RN. Dr. Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. She is also the National Program Director for the Robert Wood Johnson Foundation program, Interdisciplinary Nursing Quality Research Initiative, aimed at generating, disseminating, and translating research to understand how nurses contribute to quality patient care. She was appointed to the Medicare Payment Advisory Commission in 2010. 

Building on the Future of Nursing report’s call for nurses to fully engage with fellow health care professionals, a new report from the Institute of Medicine, Best Care at Lower Cost, calls on nurses and others in the health care system to apply emerging tools, technologies, and approaches to yield lower costs and better health outcomes. I had the great fortune to serve as a member of the study committee.

The complexity problem. The report couldn’t be more timely or relevant, particularly for nurses and the patients they serve, given the complexity of the current health care system. Administrative and workflow inefficiencies limit hospital nurses from spending more than about 30% of their time on direct patient care. With increasing specialization, modern medicine now includes nurses in more than 50 specialties. To successfully coordinate a patient’s care, nurses need to communicate and collaborate with patients, family caregivers, physicians, pharmacists, social workers, and many other team members.

The complexity […]

2016-11-21T13:09:23-05:00September 6th, 2012|career, nursing perspective|1 Comment
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AJN’s September Issue: Bariatric Surgery, Biomarkers, Mobile Technology for Nurses, More

AJN’s September issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

It’s no surprise that obesity and overweight are on the rise in this country, and nurses will likely find themselves caring for patients who have undergone bariatric surgery at some point in their career. “Outcomes and Complications after Bariatric Surgery” reviews the five most common procedures, outcomes and complications of surgery, and pre- and postoperative patient care. This CE article is open access and can earn you 2.5 CE credits.

Nearly 40% of all surgeries in the United States are performed on adults ages 65 and older. A common complication of surgery in this population is postoperative delirium, which is associated with extended lengths of stay, higher patient care costs, increased morbidity, and greater risk of death. “Postoperative Delirium in Elderly Patients” evaluates risk factors for postoperative delirium in elderly patients and examines potential intervention strategies. This CE article is open access and can earn you 2.5 CE credits.

Smartphones, e-readers, and tablets are everywhere, including at the bedside. In “Tablet Technology for Nurses,” Megen Duffy provides a guided tour of the potential uses and pitfalls of mobile technology for nurses—plus a comparison of the iPad and Kindle Fire.

Whether to predict, diagnose, or monitor disease, biomarkers are useful in every step of patient care. “Biomarkers: […]

2016-11-21T13:09:24-05:00August 31st, 2012|Nursing|0 Comments
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Caring for Patients Who Have Bariatric Surgery

Roux-en-Y gastric bypass. Image courtesy of Ethicon Endo-Surgery, Inc.

By Sylvia Foley, AJN senior editor

People who are obese (BMI of 30 kg/m2 or greater) are prone to a laundry list of ills. They’re not only at greater risk for diseases such as type 2 diabetes, coronary heart disease, stroke, and osteoarthritis—they’re also more apt to experience discrimination and psychological abuse, and to suffer from anxiety and depression. Many have repeatedly tried to lose weight through diet, exercise, psychotherapy, and pharmacotherapy, to no avail. Until recently, there was little else providers could offer them.

But bariatric surgery, known to be an effective treatment for obesity and obesity-related comorbidities, is becoming an increasingly common option. In 1998, only about 13,000 bariatric procedures were performed in the United States; by 2007 that figure had jumped to 200,000, and it continues to rise. With prevalence rates for overweight and obesity also at record highs in this country, more nurses will likely find themselves caring for patients who have undergone such procedures.

In this month’s CE, “Outcomes and Complications after Bariatric Surgery,” authors Lauren Gagnon and Emily Karwacki Sheff explain the two main types of bariatric surgery and outline five of the most common procedures in the United States: 

2017-07-27T14:52:43-04:00August 30th, 2012|Nursing|1 Comment
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Domestic Violence Screening: Why the Rush to Dismiss It?

Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

All rights reserved. Photos by author.

A recent study reported in JAMA, “The Effect of Screening for Partner Violence on Women’s Quality of Life” (abstract only), is being touted in overly simplistic headlines across the Web (the word “debunks” has been getting a lot of use) as further evidence that domestic violence screening doesn’t improve outcomes for women.

Don’t believe it.

The problem doesn’t lie with the researchers or with JAMA; they accurately reported just what they found. The problem lies with how it is being interpreted by others as further proof of the overall ineffectiveness of screening for intimate partner violence (IPV).

What the study actually found was that there was no difference in health outcomes between women who received computerized screening and a resource list and women who just received the resource list or women who received neither.

This is how it worked:

Women in primary care settings who agreed to participate and who were randomized to the screening group were seated in front of a computer and responded to the three questions in the partner violence screening (for example, “have you ever been hit, kicked, punched or otherwise hurt by someone within the past year?”) on […]

2016-11-21T13:09:26-05:00August 24th, 2012|Nursing|1 Comment
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What’s New on the Nursing Blogs?

By Jacob Molyneux, AJN senior editor/blog editor

Matthew Bowden/Wikimedia Commons

So what’s new on the nursing blogs. I’ve been checking around today, and here are a few good things I’ve found so far. Please let me know if there are any really new and lively nursing blogs we should add to our nursing blogs page. We need some new voices, and I’m sure they’re out there.

Burnout. At Nursing in Hawaii (this blog changes its name periodically to reflect the current location of its peripatetic owner), we find a pretty interesting and roundabout kind of post, “Nurse Burnout, Reality Shock, Marlene Kramer,” that addresses the stages of nurse burnout in a really useful and practical way (after discussing an early seminal book on the topic, what this has to do with the development of the Magnet program, and a few other items). Here’s an excerpt, but I’d suggest reading the whole thing for a look at this seemingly universal issue for nurses.

the honeymoon. This is where the new nurse is still being oriented and everything is wonderful. The preceptor is so smart! The staff is amazing! The paycheck is HUGE! we all love to be around such a person and delight in the innocence of youth.

crash and burn. the onset of this is hard to predict, but usually about the six-month mark. Takes place when the nurse starts getting feedback from every direction, not […]

2016-11-21T13:09:27-05:00August 22nd, 2012|nursing perspective|2 Comments
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