An Unusual Privilege: A Patient’s Memorable Grace

Jonathan Peter Robb works as a district nurse for the National Health Service in London and has published two essays in AJN‘s Reflections column in recent years, “How I Built a Suit of Armor as a Nurse (and Stayed Human)” and “Verification.”

I was working an evening shift and it was five o’clock when my mobile rang for a call-out. The patient was a woman I’d seen before, who’d been on and off our books for the past few years. She was old, and unwell, and when she last returned home, we were told she was dying. She had been made palliative. Her name was Ruth.

Even with her fluctuating health, Ruth remained incredibly sharp. She was also persistently positive. Ruth was the type of patient you could talk to and forget they were a patient. She asked me questions about myself. Despite the number of people I care for and my enquiries into their health and lives, it is a rare person who asks questions about my life.

I headed out […]

2017-12-01T14:06:39-05:00December 1st, 2017|narratives, Nursing, nursing stories, Patients|3 Comments
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A Closer Look at the Joint Commission’s New Guidelines for Pain Assessment and Management

Photo © Burger / Phanie / Science Photo Library.

Starting on January 1, 2018, the Joint Commission’s new and revised pain assessment and management standards for accredited hospitals will go into effect. Notably, the guidelines—as we report in a November news article—address safe opioid prescribing practices.

Among new requirements, the Joint Commission says hospitals should:

  • Designate a leader or team responsible for pain management and safe opioid prescribing.
  • Include patients in developing a pain management treatment plan—including realistic expectations and measurable goals—and educate them on discharge plans related to opioid adverse effects and safe use, storage, and disposal of opioids.
  • Use prescription drug monitoring program (PDMP) databases to identify patients at risk for opioid addiction.
  • Identify opioid addiction treatment programs for patient referrals.
  • Inform staff about consultation and referral services available for patients with complex pain management needs.
  • Collect and analyze data on pain assessment and management to identify areas in which safety and quality could be improved.

The full list of new and revised guidelines is available here. How might these changes affect life for nurses and patients? Comments are welcome below.

2017-12-13T15:23:52-05:00November 17th, 2017|Nursing, pain management, patient experience|8 Comments
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Update on Preeclampsia: What Nurses Need to Know

Illustration by Sara Jarret.

Preeclampsia is the most common hypertensive disorder of pregnancy, yet there is still much we don’t know about why it develops and how to prevent it. It can present in different ways, from hard-to-ignore symptoms such as constant headache or severe right upper quadrant pain, to no symptoms at all before elevated blood pressure or urine protein is detected at a routine prenatal visit.

Did you know that:

  • despite a long list of known risk factors, most cases of preeclampsia are diagnosed in healthy nulliparous women?
  • both moms diagnosed with preeclampsia and infants exposed to it in utero are at greater risk for cardiovascular disease?

Update your knowledge by reading “Preeclampsia:  Current Approaches to Nursing Management” in the November issue of AJN. This CE article provides a helpful clinical update, including the pathogenesis of preeclampsia, diagnostic criteria, screening tests on the horizon, 2017 recommendations for pharmacologic management, optimal timing of delivery, and nursing management.

2017-11-06T09:49:41-05:00November 6th, 2017|Nursing, patient safety|0 Comments
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Through Song, a Nurse’s Renewed Connection to An Ailing Mother

Illustration by Barbara Hranilovich for AJN.

Millions of Americans are now acting in some capacity as caregivers for an ailing parent. This month’s Reflections column is by a nurse who describes a moment in time as she helps to care for her home-bound and dying mother. Her mother remains, on occasion, as judgmental and offputting as the mother of her childhood.

But in such cases, there’s little to gain by dwelling on old disappointments and hurts—and in this instance, there are good memories as well.

The common language of song.

These good memories are primarily associated with her mother’s love of and talent for singing. “Moon River and Mom” describes this nurse’s experience of tending her mother’s leg wound as the Meals on Wheels man visits, and what happens afterward when the author prompts her mother to sing. […]

2017-11-03T07:50:46-04:00November 3rd, 2017|family experience, Nursing, nursing stories|0 Comments
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Despite Outreach Cuts, Open Enrollment for the ACA Underway

Open enrollment for insurance through the Affordable Care Act (ACA) starts tomorrow, and ends December 15, allowing people half the time to enroll compared with previous years. There is much confusion and misinformation surrounding the ACA, particularly after recent executive orders by President Donald Trump to stop cost-sharing reduction (CSR) payments.

In addition, budgets for ACA advertising and outreach have been slashed by the Trump administration this year, which will inevitably lead to fewer people getting covered.

Bridging the ACA outreach gap.

To help bridge the gap left by the reduction in outreach, advocacy groups such as Get America Covered are reaching out to inform the public about enrollment. And nursing groups such as the American Nurses Association have stated their commitment to informing patients on how and when they can enroll. Below is some information for patients who might be confused about the law and how it currently stands. […]

2017-10-31T11:36:37-04:00October 31st, 2017|health care policy, 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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