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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Morphine in Hospice Care: Why Family Members May Resist Its Use

Underlying his concerns was a strong sense of moral responsibility. He was his mother’s protector. He was her voice. He had a duty to keep her safe…

Morphine’s essential place in hospice care.

When I began work in a hospice, I quickly came to see morphine as a wonder drug. It was used so much more effectively in palliative care than with the med-surg patients I had cared for in the hospital!

Morphine can be given via multiple routes, it’s easy to titrate, its side effects are well-known and therefore easy to manage, and it can bring dramatic pain relief as well as markedly improved breathing.

It was common for us to admit patients to hospice whose pain had never been controlled, and they were often dumbfounded at how easily their pain could be managed. The proper medical use of morphine was literally life changing for them.

Addressing family members’ concerns.

As a result of my hospice experience, I’ve always been a big believer in patient and family education to debunk myths and highlight the optimal uses of this drug. And yet education alone isn’t always what family members need when morphine is prescribed for their loved ones. Especially when the patient is at home and it’s a family member, not a nurse, managing […]

2019-11-12T15:36:45-05:00August 21st, 2019|family experience, patient experience|3 Comments
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May I Hug You? Supporting Personal Boundaries in the Health Care Setting

Touch as affirmation.

Illustration by Julianna Paradisi

“May I hug you?”

My patient and I had just finished a rather lengthy conversation, the kind of authentic communication that reaffirms the humanity connecting us all—the number one reason I love being a nurse. Sitting in a chair across from me, she reached out her hand for me to shake. I sensed she felt the same connection I did, but was too shy to ask for more.

“May I hug you?” I asked.

Tears formed in her eyes as she stood and we hugged. The circle was complete.

Not everyone is comfortable being touched.

I’m a hugger. I connect easily with patients and throughout my career have given and received more spontaneous hugs than I can hope to count. Lately though, for a variety of reasons, I’ve begun to ask permission before hugging a patient.

Foremost, I’ve developed a stronger advocacy towards the right to personal boundaries. I am not you is a good thing to remember when meeting anyone for the first time, whether they are a patient, coworker, or a child. Not everyone is comfortable being touched.

‘Handshake free zones.’

A while ago, I met a new resident while visiting a patient in her hospital room. After introducing ourselves, […]

2019-07-15T10:44:45-04:00July 15th, 2019|Nursing, Patients|1 Comment
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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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