A Health Care Proxy and an Act of Moral Imagination

“What would Joanna have wanted?” the ICU fellow (Dr. Smith) asked Sam, Joanna’s nephew and health care proxy, for the second time this week. Sam considered the question, furrowed his brow, and said, “I still don’t know, doc.”

The human costs of indecision.

Uncertainty can at times be better than false certainty. This may even be so, up to a point, when a loved one is on life-support and subject to invasive and painful procedures. It takes time to absorb the reality of a situation.

But any nurse can tell you that, at some point, indecision becomes a decision in itself, one that can lead to many unwished-for consequences.

Seemingly unanswerable questions.It

The quotation at the start of this post is from this month’s Reflections essay, “What Joanna Would Have Wanted” (free until July 15). The story, by nurse Jennifer Chicca, MS, RN, evokes the overwhelming sense of responsibility faced by a thoughtful young man in the role of health care proxy to a beloved aunt.

How is possible to be sure what someone would want, or not want, when their end-of-life wishes have not been clearly spelled out ahead of time? […]

2019-07-01T15:50:47-04:00July 1st, 2019|Nursing, nursing stories, patient experience|1 Comment
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Does Everything Happen for a Reason? One Oncology Nurse’s Perspective

Does Nature Argue Fate? The Acorn Contains The Tree/
charcoal, pastel, and ink on paper/ Julianna Paradisi 2019

The human need to find meaning.

“Everything happens for a reason” is a saying I hear a lot in my nursing practice, from patients and coworkers alike.

The need to find meaning in the events of our lives, good or bad, appears to be a distinctively human trait. Ancient Greeks believed Clotho, one of the Three Fates, spun the lives of humans. In medieval times, Anglo-Saxons may have believed in wyrd, a concept similar to fate in our modern language. Elsewhere, the idea of karma teaches a cause and effect perspective on this life, and on future lives. These are only a few examples.

Learning to ask ‘why’ as a pediatric ICU nurse.

I began questioning if everything happens for a reason as a pediatric intensive care nurse at the beginning of my career. Asking “why?” is a natural response to watching a child suffer. Why is a baby born without a functional left ventricle? Why does an infant contract leukemia or a brain tumor?

Certainly genetics or environmental factors cause some cases. Regardless, it’s difficult to […]

2019-06-27T09:53:05-04:00June 27th, 2019|Nursing, nursing stories, patient experience, Patients|1 Comment
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‘Worth Its Weight in Gold’: The Small, Unexpected Triumphs of Nursing

“Nursing is a job that sometimes finds you investing emotionally in things you never expected to care about.”

How many times have you waxed enthusiastic at work about something that people who aren’t nurses would find weird, or even downright gross? Eyeing a patient’s Foley bag and exclaiming about how great her urine looks…praising a young man for coughing up gobs of sticky sputum….

Illustration by Pat Kinsella for AJN.

The challenge of obtaining a specimen.

In this month’s Reflections column, “Worth its Weight in Gold” (free until July 7), visiting nurse Jonathan Robb describes his efforts to obtain a urine sample for culture from an elderly woman who has minimal bladder control.

Most of us are familiar with the balancing act of obtaining a specimen under conditions that cause discomfort or embarrassment to a patient. We cajole and gently press for whatever has to be done, trying to maintain a relaxed atmosphere while hiding any urgency about completing the task that we might feel. This delicate pas de deux has the potential to be very stressful for both parties.

Robb’s sometimes comical descriptions of the contortions necessary to meet his particular challenge will ring true to nurses.

“…despite the […]

2019-06-17T10:16:20-04:00June 17th, 2019|Nursing, nursing stories, patient engagement|0 Comments
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Sickle Cell Disease: Complications and Nursing Interventions

Our cover photo this month features three-year-old twins Ava and Olivia. Both have sickle cell disease. In this tender shot, one twin is comforting her sister during treatment at Akron Children’s Hospital in Akron, Ohio.

How much do you know about sickle cell disease (SCD)?

Did you know:

  • that children with SCD can experience “silent strokes” that become clinically evident only as progressive neurocognitive deficits?
  • that renal complications account for 16%-18% of overall mortality?
  • or that SCD-induced priapism in boys and men is not only excruciatingly embarrassing and often painful but may require emergency treatment?

Recognizing common complications.

“Two of the greatest challenges faced by clinicians caring for patients with SCD are the lack of evidence-based guidelines…and the underuse of the few recognized disease-modifying therapies.”

In “Understanding the Complications of Sickle Cell Disease,” a CE feature in this month’s AJN, Paula Tanabe and colleagues provide us with readable and practical information about the complications of SCD.

If, like me, you are not an expert in SCD, this article is an excellent primer on how to recognize the most common complications of the disease, what treatments that are available, and where […]

2019-06-03T08:22:06-04:00June 3rd, 2019|family caregiving, Nursing, patient experience|0 Comments
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When Children Hurt

As an ER nurse, I saw a lot of people in pain, either arriving at our door to have their pain relieved or enduring the pain of needed treatments, knowing that the interventions were necessary. In my experience, though, there’s nothing worse than seeing a child in pain, and the younger the child, the more awful it was.

You began the encounter with a sick or injured child who was already frightened by the circumstances that had caused their parents or guardians to bring them to the hospital. It’s hard to get past the frightened eyes and tears, the little ones trying to burrow into their mother’s shoulder and not wanting to be put down on a paper-covered table. And this was before even attempting any assessment.

Nurse uses Wong–Baker FACES Pain Rating Scale to help assess patient’s pain. Photo by Gerry Melendez/The State/MCT via Getty Images.

Factors to consider in assessing a child’s pain.

We were taught that “pain is what the patient says it is,” and that still seems to be true of children’s reports of pain. But there are many factors that need to be considered, such as […]

2019-05-23T10:18:37-04:00May 23rd, 2019|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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