When Family Caregivers Are Unsure

Those who care for ailing family members are often faced with new symptoms or with changes in a loved one’s condition. They have to decide if it’s a natural progression of the disease and “just” another thing to manage, or if it signals a serious problem like a urinary tract infection, pneumonia, or a COPD exacerbation that needs to be addressed. Often, they end up in the ER, in some cases needlessly.

The authors of the original research CE article in this month’s issue, “New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?,” write:

“If caregivers have a clear understanding and awareness of their loved ones’ existing symptoms, they’ll be better prepared to recognize changes and new symptoms. Early recognition makes it more likely that the patient can be treated in place and trips to the ED can be avoided.”

Are caregivers being adequately prepared?

As I write in the March editorial, with over 43.5 million adults providing care to family members, we need to ensure they are prepared to do so by the time their loved one is discharged from the hospital

These caregivers provide complex care—from injections and ostomy care to managing ventilators and tube feedings—and according to surveys conducted by AARP, they are […]

2019-03-04T07:29:14-05:00March 4th, 2019|family caregiving, family caregiving, Patients|0 Comments
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If We Know How to Prevent Falls, Why Are Our Patients Still Falling?

Falls: at least ‘theoretically preventable.’

Sometimes it can feel as though managing fall risk takes up a big part of the day. You do your regular risk assessments, put safety measures into place, and still—patients fall.

Considering the frailty of some patients, the many meds that contribute to falls, and the fact that even mild cognitive impairment can be made worse by a hospitalization, it’s a tribute to good nursing care that there aren’t more falls.

But because falls sometimes cause serious injury and are, at least theoretically, preventable, it always feels like we’ve failed when a patient ends up on the floor.

A checklist for high-risk patients.

Nurses at one hospital decided that they needed a new way to approach fall safety. In “Using a Fall Prevention Checklist to Reduce Hospital Falls,” authors Madeline Johnston and Morris Magnan describe their use of a 14-item change-of-shift checklist based on the hospital’s existing fall prevention protocol. For a patient known to be at high risk for falls, oncoming staff went through the checklist to be sure that all prevention interventions were in place before taking responsibility for the patient. […]

2019-03-01T11:40:56-05:00March 1st, 2019|Nursing, patient safety|2 Comments
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A Hidden History of Sexual Violence Can Complicate the Clinical Encounter

Long-term physical and psychological health effects.

illustration by hana cisarova for AJN

According to the Centers for Disease Control and Prevention, in the U.S., “one in three women and one in six men have experienced sexual violence involving physical contact at some point in their lives.” The report notes the high correlation between sexual violence and a range of adverse health effects like respiratory and gastrointestinal disease, chronic pain, and insomnia.

Not surprisingly, the terror of sexual violence is also correlated with post-traumatic stress disorder (PTSD) and its symptoms. These symptoms fall into four broad categories:

  • reexperiencing
  • hyperreactivity
  • avoidance
  • and negative emotions and thoughts about self or the world

Medical environments as triggers.

For survivors of sexual violence, medical environments can feel dehumanizing and present trauma reminders that intensify underlying post-traumatic stress. In addition, such environments can undermine protective routines and carefully delineated personal boundaries. Physical examination, being undressed, or receiving personal care can trigger powerful automatic fight–flight–freeze responses.

These responses may appear as physiological changes such as alterations in breathing and pulse, involuntary movements, or as hypervigilance, fear, anger, dissociation, withdrawal, or anxiety. Interventions like the insertion of a catheter or medications that decrease alertness or require suppositories can register subconsciously as threatening for someone who has survived rape. So […]

2019-01-23T15:58:50-05:00January 23rd, 2019|Nursing, patient experience|1 Comment
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Self-Disclosure in the Nurse-Patient Relationship

“How much of ourselves should we share with our patients?”

Illustration by Jennifer Rodgers for AJN

The ‘therapeutic use of self.’

Early nursing theorists wrote about how the “therapeutic use of self” helps us to forge close working relationships with our patients. Today we talk about authenticity, and it’s been noted that “the essence of nursing care comes from bringing our authentic selves to the nurse-patient relationship.”

We each develop a nursing “style,” weaving our own identities into the way we relate to patients and families. But where do the parts of ourselves that are very much “us” but not immediately evident to others come into the picture?

“Would a single mother hesitate to share her story of adopting a child without
a male partner? Would a widower refrain from correcting the assumption that
his spouse is still alive?. . . . I am compelled by the belief that sharing truth in either
scenario would enhance the authenticity of the relationship. Nevertheless, I remain
reluctant to correct my patients’ misperceptions of my family life.”

To disclose or not to disclose?

In this month’s Reflections column, “A Lie by Omission?“, nurse practitioner Charles Yingling takes a thoughtful look at what we choose to share with our patients, and what it means […]

2019-01-18T09:31:02-05:00January 18th, 2019|Nursing, nursing stories, patient engagement|0 Comments
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ACA Opens Enrollment for 2019: What Patients Need to Know

Open enrollment in the Affordable Care Act (ACA) marketplace opened today, despite shortened deadlines, repeal of the individual mandate, stopping cost-sharing payments, and reduced outreach and marketing for the law. And with all the noise from political talking points adding to an already complicated process, your patients might be in need of a primer on what to do this year. Here are the basics:

Where to enroll

Some states have their own exchange, and some use the federal government’s. Patients can access www.healthcare.gov, www.cuidadodesalud.gov, find their state’s page here, or call (800) 318-2596 for more info.

When to enroll

Enrollment begins November 1 (except for in California, where it began in October). However, deadlines differ in some states. The deadline for most states this year is December 15. A handful (New York, California, Massachusetts, Minnesota, Colorado) have deadlines in January. Those who wait until January to enroll should be aware that their coverage will not start until February.

What about the individual mandate?

Included in the Republican-backed tax plan signed into law last year was a repeal of the individual mandate penalty for individuals who choose not to get insurance. For the coming year, this repeal will be in effect in almost all states (Massachusetts, New Jersey, and the District of Columbia will still fine […]

2018-11-01T13:45:23-04:00November 1st, 2018|Patients, Public health|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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