February Issue: Contraception Options Update, Polypharmacy’s Dangers, Managing Urinary Incontinence, More

“Yes, we need to be fiscally responsible, but nurses’ main priority shouldn’t be patient throughput or implementing changes that save money while compromising care and patient outcomes. Nurses must be enabled to nurse.”—editor-in-chief Shawn Kennedy in her editorial, “Who Will Be Left to Care?”

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

CE: An Evidence-Based Update on Contraception

A comprehensive review of the major characteristics of nonpermanent contraceptive methods, including combined hormonal contraceptives, progestin-only methods, nonhormonal methods, and recent innovations in contraception.

CE: Mitigating the Dangers of Polypharmacy in Community-Dwelling Older Adults

The author explores the factors that contribute to polypharmacy in
older adults, examines its negative physiological and economic effects, and outlines strategies to promote safe and appropriate medication prescribing.
[…]

2020-01-27T09:45:06-05:00January 27th, 2020|Nursing|0 Comments
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As Another Coronavirus Begins to Spread, Follow Reasonable Precautions and Avoid Fear-Mongering

(Editor’s note: Published January 24. The situation has considerably changed in the intervening weeks, during which the virus has rapidly spread across the globe. We obviously now know a great deal more about the dangers it presents.)

Emerging infections are part of our world—more evident these days because we have the tools and global communication networks to quickly identify them. This month, we’ve begun another crash course in the initial management of a new pathogen.

Short timeline from first cases to screening test availability.

Rumors of a concerning cluster of undiagnosed pneumonia in Wuhan, China, surfaced on social media on December 31. The patients weren’t responding to antibiotic therapy, but tests were negative for the usual viral suspects. World Health Organization staff quickly connected with Chinese health officials and testing and epidemiological investigations kicked into high gear.

Many of the infected patients had worked at a fish and live animal market in Wuhan, suggesting that the illnesses might be zoonotic (passing from animals to human) in origin. On January 7, the pathogen was identified as a new coronavirus, related (though not closely) to the coronaviruses that cause SARS and MERS. The viral genome was quickly sequenced, and on January 12, China shared the genetic sequence with the global scientific community. By January […]

2020-03-19T17:12:45-04:00January 24th, 2020|infection control, infectious diseases, Nursing, Public health|1 Comment
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Putting Down Her Burden: A Patient’s Final Choice

‘goodbye, inhaler!’

Chronic illness as a Sisyphean bargain.

Sisyphus was a legendary king of ancient Greece who was condemned by the gods to eternally roll a rock up a hill, only to have it roll down again each time as it neared the top.

Many people with chronic illness today may be able to relate. Chronic illness can mean years or even decades of worsening symptoms and ever more complex medication and treatment regimens, side effects of treatments, treatments for side effects, monetary pressures, activity limitations, a sense of separateness from the legions of the merely ‘walking worried’ around us, and the subtle pervasive tension and vigilance of never quite knowing what might come next.

The ironies of advanced medicine.

The assumption, of course, is that all the effort is worth it. And it is: many of us benefit from, or know people who benefit from, drugs that keep them alive when 50 or 100 years ago they would have died long ago, or keep them able to walk, or breathe without a struggle, or sleep without excruciating nerve pain or the itching of terrible skin sores, and so on. Life has always been about compromise; these are simply new refinements of a universal equation.

2020-01-23T10:03:01-05:00January 23rd, 2020|Nursing, nursing stories, patient experience|1 Comment
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Hypertonic vs. Hypotonic, Osmolality, and Other Fun Nursing Concepts

We hang fluids with varying concentrations of electrolytes in response to specific lab results, but how much do we actually remember what is going to happen physiologically?

Revisiting the fundamentals of fluid and electrolyte balance.

I remember first learning about fluids and electrolytes in undergraduate physiology, and then again all throughout medical-surgical nursing courses. When I was in orientation for my first position as an ED nurse, it was included in the critical care course. Sounds like that should have been enough—but it wasn’t.

Understanding the underlying science matters.

The basic concepts underlying the body’s mechanisms for keeping systems functioning are complex processes involving the ebb and flow of fluid and molecules controlled by several systems. It’s a delicate balance and one that we all learn in basic nursing education, but then usually recall little of it when we practice.

We hang fluids with varying concentrations of electrolytes in response to specific lab results, but how much do we actually remember what is going to happen physiologically? We know the protocol of what to infuse when, but we’re hard-pressed to explain the science underlying our practice. This is a concern because nurses are usually the first ones to review laboratory results and need to understand the implications of abnormal results and what might be an urgent concern […]

2020-01-21T12:02:37-05:00January 21st, 2020|Nursing|0 Comments
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A Sense of Meaninglessness and Disconnectedness: Addressing Spiritual Distress Among Cancer Survivors

“I lost a critical year of my life, and now I can’t move forward. I feel stuck. My life is passing me by, and I don’t know what I’m supposed to do anymore.”

This quote is from a composite case example that focuses on the spiritual distress experienced by some cancer survivors. Treatment may be over with, and the prognosis may be excellent. All signs may point to the probability of a cancer-free future. But after confronting a potentially life-threatening diagnosis, many survivors struggle with a sense of meaninglessness or disconnectedness.

In “Assessing and Managing Spiritual Distress in Cancer Survivorship” in the January issue of AJN, Timiya Nolan and colleagues explore the concept of spiritual distress and its impact on a person’s quality of life.

A topic that often goes unaddressed.

The authors emphasize the need for clinicians to actively screen for this problem and learn how to initiate conversations with patients. Clinicians are often reluctant to raise the issue of spiritual well-being, and thus wait for survivors to voice any spiritual concerns. While this approach is effective in some cases, if the conversation never occurs, the survivor’s spiritual needs may be unmet. […]

2020-01-16T10:15:37-05:00January 16th, 2020|Nursing, patient experience, Patients|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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