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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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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We Can Do More to Prevent Patient Self-Harm in the Hospital

“Phone cords, plasticware, and pens – all items found on a typical hospital unit and all seemingly benign.  Yet unchecked, each can be used by a patient to cause self-harm.”

As our health care system jettisons more and more psychiatric inpatient beds, it seems that the old “medical psych” units are becoming a thing of the past. These were the units where a person with significant mental health problems stayed after surgery, or after a medical event. The fact that these patients had at least two serious health challenges—one mental, the other physical—was routinely acknowledged, and medical psych units were staffed with nurses expert in both types of care.

Self-harm on nonpsychiatric units: a closer look at who and how.

Today, patients with serious mental illness are routinely “housed” on medical or surgical inpatient units. Some of these patients have a history of self-harm, and nonpsychiatric hospital units are not designed to keep them safe.

In “Preventing Self-Harm in the Nonpsychiatric Health Care Setting” in this month’s AJN (free until December 10), Kim Liberatore from the Pennsylvania Patient Safety Authority shares some of her organization’s data on patient self-harm events in nonpsychiatric settings. […]

2019-11-22T09:47:57-05:00November 22nd, 2019|mental illness, Nursing|1 Comment
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Caregivers Home Alone-And Needing Our Support

Family caregivers performing complex care.

When my mother needed care at home in her final days, she was fortunate in that two of her daughters were nurses who were familiar and comfortable in providing her care. We were fortunate in that she did not require complex care like tube feedings or IVs or ostomy care or wound care or dialysis. But many people do, and must rely on family members to do these complex tasks.

I remember how I felt as a nursing student when I had to administer one of these complicated interventions. I remember being anxious, my hands sweating as I desperately tried to recall the list of instructions I had looked up the night before.

And yet I had an instructor with me to walk me through it. Family caregivers have no such support and often don’t even get adequate instruction beforehand.

Family caregivers need more than recognition.

November is National Family Caregivers month and I can’t think of a group more in need of recognition. But while naming a month in their honor is nice to increase awareness of the more than 40 million family caregivers in this country, they need much more than that. Specifically, they need more in the […]

2019-11-18T11:16:45-05:00November 18th, 2019|family caregiving, family caregiving, Nursing, Patients|1 Comment
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Thoughts on Preventing Delirium During an ICU Stay

It’s well known that an ICU stay presents several risks to patients, whatever their reason for needing critical care.

  • Various infections are more likely to develop than in other care units.
  • Intense drug therapy can result in adverse drug interactions.
  • The excess stimulation and (often) windowless rooms increase the risk for delirium and its consequences.

Would you do anything to protect your own health if you knew that after surgery you would be spending time in an ICU?

In this month’s Viewpoint column, author Patricia Gavin describes how she coped with her own ICU stay, which she knew in advance would be part of her post-op care:

“…when I realized I would be there for a few days, I decided to create
my own ‘care plan’ to stave off delirium and its adverse outcomes.”

Does it help if the patient knows her own risk factors?

She goes on to explain what she knew about her own risk factors for delirium, and the things she could do to stave off the complication during this stressful time.

And she notes how one nurse made a particular difference in helping her to get through her stay without cognitive complications. Gavin reminds us of the practical strategies that nurses can employ, beginning with, “Extend […]

2019-09-26T10:31:05-04:00September 26th, 2019|Nursing, patient safety|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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