The Checklist – Taking Finger-Pointing Out of the Equation

By Peggy McDaniel, BSN, RN

Ok, I will admit right off that I am a huge fan of Atul Gawande’s writing. I have read his books Better and Complications, and I think much of his work should be required reading for all health care students. I haven’t read his newest book, The Checklist Manifesto: How to Get Things Right. I plan to soon, but it’s the 3rd book down in the pile on my bedside stand.

That confession aside, there has been some recent news around the use of checklists that bears some attention. Dr. Gawande helped develop a two-minute checklist that is to be done prior to surgery. 

Dr. Peter Pronovost was involved in the development of a similar checklist related to the insertion of central lines. 

Airlines and airplane manufacturers, such as Boeing, use checklists constantly to ensure consistent, high quality outcomes. 

I did a quick Google search for “checklists and nursing” and found various references to skills and competency checklists. As a nurse, my skills have been observed and validated with checklists over the years. I have also been party to filling out checklists on myself and my peers. Come to think of it, much of our charting has been done by filling out checklists. 

I guess I am a bit surprised that the use of checklists to validate competencies and keep track of […]

2016-11-21T13:19:34-05:00February 5th, 2010|nursing perspective|3 Comments
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Déjà Vu All Over Again: Internal Uterine Contraction Monitoring Another Case of Practice Without Evidence

By Shawn Kennedy, MA, RN, interim editor-in-chief

Last week, the New England Journal of Medicine (NEJM) reported (abstract available here) on a Dutch multi-center randomized trial comparing internal versus external monitoring of uterine contractions during induced labor on rate of cesarean or instrument delivery. Among secondary outcomes they examined were use of analgesia, oxytocin and antibiotics, adverse neonatal effects, and complications from the intrauterine catheter (hemorrhage, sepsis, among others).

What caught my eye was the first sentence of the paper, which read, “The monitoring of uterine contractions by means of internal tocodynamometry during induction or augmentation of labor is advocated by professional societies in obstetrics and gynecology.” Yet, as this study points out, there has been little data to support the societies’ recommendation for internal monitoring. And, lo and behold, the results of this trial “do not support the routine use of internal tocodynamometry for monitoring  contractions in women with induced or augmented labor.”

This reminds me very much of electronic fetal monitoring. […]

2016-11-21T13:19:36-05:00February 4th, 2010|nursing perspective|1 Comment
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“I often feel anxious and nervous when I care for a dying patient . . .”

As a nursing student, I often feel anxious and nervous when I care for a dying patient. My classroom lectures have been similar to those given in medical school—death is an enemy to be conquered. We focus on treating the disease process and give very little attention to death and dying.

That’s from a letter to the editor now online in our February issue. The article the letter writer was responding to was “Stopping Eating and Drinking,” which we published back in September. The article is about an end-of-life option that is a choice available to patients who aren’t “actively dying” but who have experienced a radical diminution in their quality of life. It’s also about what a nurse legally and ethically should and should not discuss with a patient.

The notion of a nurse advising a patient on stopping eating and drinking is a potentially controversial one, but the responses we received were surprisingly unalarmed that we would publish such an article. Here’s another letter we got in response. We love to hear from our readers, whether in the old print format or here on the blog.


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2016-11-21T13:19:37-05:00February 3rd, 2010|Nursing|0 Comments
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Normal Blood Pressure — in 1914

That’s an excerpt from an October 1914 article about blood pressure that was published in AJN (our older articles only exist in PDF versions, so click the PDF link in the upper right corner of the article landing page).

Maybe, though, in the absence of the many medications we now have to treat hypertension, these really were “normal” (that is, realistic) blood pressure levels for adults as they aged! It’s funny how, in so many areas, we keep on redefining the meaning of this oft-used phrase: “normal changes related to aging.”

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2016-11-21T13:19:39-05:00February 3rd, 2010|Nursing|1 Comment
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Is the Florence Nightingale Pledge in Need of a Makeover?

By Christine Moffa, who was AJN clinical editor at the time it was written in 2010.

Authors and publishers frequently send nursing– and health care–related books to AJN in hopes we will review them. I love it, so keep on sending them. My latest read is Mystery at Marian Manor: The Adventures of Nora Brady, Student Nurse, a book for young adults. I guess you could call it a Cherry Ames for the new millennium.

At the beginning of the book is the Florence Nightingale Pledge, something I haven’t read since my graduation in 1995. I have to say it made me cringe. It’s almost as bad as when I visit my parents and see the nursing school graduation photo of me in that silly nursing cap I wore under protest. (If the men didn’t have to wear it, why did I?) If you’ve forgotten the pledge, here goes:

I solemnly pledge myself before God and presence of this assembly;
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession
and will hold in confidence all personal […]

2016-11-21T13:19:41-05:00February 2nd, 2010|career, nursing history, nursing perspective, students|26 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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