Defining Death

My first encounter with brain death was back in the early 1970s. I was a new RN in a shock-trauma unit. We admitted a 17-year-old young woman who had attempted suicide by jumping out of a fifth-floor window. If it wasn’t awful enough, I remember it was Thanksgiving weekend and she had been home from college.

Angiograms of normal blood flow in an active brain (at left) and lack of blood flow indicating
brain death. Photos © Fusionspark Media Inc.

As one might imagine, she sustained massive injuries, including severe head trauma. She had been intubated at the scene and was on a mechanical ventilator. Her pupils were fixed and dilated, and she had no spontaneous respirations and virtually no brain activity, according to electroencephalography (EEG) studies.

A gradual refinement of criteria.

I recall that there had to be three consecutive EEGs done before we could remove the ventilator. There was no ethics committee or formal meetings with hospital attorneys or administrators—just the physician, the family, and the pastor. And then the patient’s siblings and grandparents came to say goodbye. It was heart-wrenching.

Things have gotten more defined […]

2020-03-05T08:21:37-05:00March 5th, 2020|Nursing|0 Comments
Read More

The Sound of Silence: Racism in Nursing

“In the end, we will remember not the words of our enemies, but the silence of our friends.”   -Dr. Martin Luther King

One of the conundrums I face when writing stories from my nursing career is the question “whose story is it?” For instance, does observing an act of racism give the observer the right to tell the story of what happened to another person? Does telling the story with the intent of exposing the ugliness of racism make it okay?

by julianna paradisi

It’s February, Black History Month. How can a white woman, a registered nurse, discuss race issues in a profession in which only 7.8% of the workforce is black without sounding ignorant, or worse, racist herself? Once or twice in the past I’ve made well-intended comments that revealed my own blind spots when talking about race. Fortunately, these were brought to my attention by friends who understood my good intentions, however misguided. I’m grateful for their support, and compassion. Like learning a new language, using the right words when talking about race requires commitment, practice, and a little bit of courage.

‘Here’s the chart. Answer the man’s questions.’

Years ago, I encountered a surgeon I’d never met before who repeatedly asked me for updates […]

2020-02-26T09:39:39-05:00February 26th, 2020|Nursing|3 Comments
Read More

March Issue: Brain Death Criteria Update, Inadequate Physical Activity in Female Cancer Survivors, More

“. . . there is no underestimating the power of meaning to bolster individuals and the power of meaninglessness to sap them of the will to go on.”—Henry Bair, author of the March Reflections column, “Waiting for Jerry”

The March issue of AJN is now live! Here are the highlights:

Original Research: Arthritis-Related Functional Limitations and Inadequate Physical Activity Among Female Adult Cancer Survivors

This study uses data from the U.S. National Health and Nutrition Examination Survey to examine the extent to which functional limitations due to arthritis are predictive of low physical activity levels in female cancer survivors.

CE: Brain Death: History, Updates, and Implications for Nurses

The authors review the development of brain death criteria, describe recent controversies and criteria updates, and discuss considerations for nurses who care for patients declared dead by neurologic criteria. […]

2020-02-24T09:40:14-05:00February 24th, 2020|Nursing|0 Comments
Read More

Will your ‘RN’ Name Tag Protect You from Violence?

When I stepped into the entryway, I was met by a group of men, crouched on the floor over a game of craps and shouting excitedly. One of them stood up when he saw me come through the door . . . He dropped the dice, pulled a gun from his waist, and pointed it at my face.

Workplace violence prevention training has become the latest mandatory education module in many hospitals. But what about nurses who work in non-hospital settings? In this month’s Viewpoint, “Workplace Violence Outside the Hospital Setting,” NP and visiting nurse Joanne Schmidt describes the terrifying situation she walked into one day at the start of her morning home visits.

In many community settings, no cameras or security staff.

Schmidt points out that nurses who work in home care, mobile medical vans, school clinics, and other community-based settings may be considerably less safe every single day than those of us who work in relatively protected hospital environments. At least in acute care there are cameras and security staff! […]

2020-02-20T10:55:11-05:00February 20th, 2020|Nursing, nursing stories|1 Comment
Read More

Can We Ever Overcome Burnout in Nursing?

Reality shock redux.

Flickr / Harshit Sekhon

It seems to me that we’ve been talking about burnout about as long as I’ve been in nursing, and that’s over 40 years. In 1974, Marlene Kramer’s book Reality Shock: Why Nurses Leave Nursing reported on how nurses’ dissatisfaction with their inability to practice as they were taught was a major factor in their leaving the profession. (Here’s AJN’s 1975 review of the book.) In the 1980s, it was the downsizing of staff that caused many to leave (see the February editorial for my own experience). In the last decade, as health system changes and staffing (again) engendered moral distress and burnout among members, nursing organizations sought ways to mitigate distress among nurses.

Burnout’s persistence as an issue.

But the issue persists and arguably has gotten worse, with increasingly alarming reports of high levels of burnout—between 34% and 54% physicians and nurses report symptoms—and suicides.

To address the problem, the National Academies of Science, Engineering, and Medicine (NAM) established a 17-member committee to review the research on the […]

2020-02-18T11:56:44-05:00February 18th, 2020|Nursing|1 Comment
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top