Patients Archives - Page 27 of 71

Viewpoint: A Limitation of Preprocedure Checklists

I once worked at a hospital where some of the surgeons regarded safety checklists as an inconvenience. They saw them as bothersome intrusions by the nursing staff into the surgical suite. One OR nurse was even “counselled” by her supervisor (in the presence of the complaining surgeon) to avoid upsetting the doctors by using the preprocedure time-out.

How important are these tools? Are we using them well, or do we speed through them as rote exercises? Might we even expect too much of them? In AJN’s July Viewpoint, nurse Elizabeth Anne Crooks relates a frightening episode (she was the patient) that led her to think about time-outs in a different way.

Crooks was about to undergo a colonoscopy. The clinical team seemed relatively unconcerned about her bradycardia, which was a significant change from her normal heart rate. After completing the usual time-out protocol, sedation was initiated and the physician began the procedure. Suddenly, Crooks’ heart rate and blood pressure dropped precipitously.

I remember waking in distress and hearing the monitor alarming. The team was working rapidly to stabilize me with fluids and medications.

A routine procedure had suddenly become an emergency.

In reflecting upon her experience, Crooks wonders whether the preprocedure time-out may have given her clinical team a false sense of security—one that led them to downplay a clinically significant change. And yet, as we know, these time-outs focus on ensuring that the correct patient is receiving the correct procedure, and not on other safety […]

Betsy Todd, MPH, RN2017-06-28T09:19:40-04:00June 28th, 2017|Nursing, patient safety, Patients|3 Comments

Exploring Irritable Bowel Syndrome

Illustration by Sara Jarret.

Irritable bowel syndrome (IBS) is one of those conditions that is maddening for patients and clinicians alike. Its pathophysiology is unclear, the symptom picture varies widely from patient to patient, there is no test to confirm the diagnosis, and treatment is directed at managing symptoms because there is no cure.

To make things even more difficult for the person with IBS, there is a recognized psychological component of the disease. Therefore some friends, family members, and clinicians might tell people with IBS that their suffering is “all in their head.” And yet there is demonstrable proof (via neuroimaging studies) of differences in central processing mechanisms related to the “brain–gut axis” between people who have IBS and those who do not.

Kristen Ronn Weaver and colleagues explore these and other aspects of IBS in a clinical feature article in AJN’s June issue. The authors review the latest findings related to IBS etiology and pathophysiology, the relationship between IBS symptoms and stress, and the updated Rome IV criteria that help guide diagnosis. Of particular interest is the authors’ presentation of research confirming the value of several nonpharmacologic interventions, including dietary modifications, probiotics, moderately increased physical activity, yoga, and traditional Chinese medicine.

See “Irritable Bowel Syndrome” in the June issue to learn more, and to find out how nurse-led initiatives can lead to long-term health benefits for people with IBS.

Betsy Todd, MPH, RN2017-06-26T09:07:44-04:00June 26th, 2017|Nursing, patient experience|0 Comments

Those Who Comfort Us

There was only a tiny drop of blood. I was worried, of course, but I went to my OB-GYN for reassurance more than anything else. Maybe she would tell me I was doing too much and needed to rest. Maybe it was just normal. But as soon as she looked at the ultrasound screen, I knew.

Usually when I went for a scan, she immediately turned the screen toward me. Until now, every scan had been great. I had just entered my second trimester. The barrage of tests given to women of “advanced maternal age” had all come back normal. The baby’s heartbeat was strong at every visit, and I was riddled with nausea, something I’d been told was a “good sign.”

This time she stared at the screen for what seemed like forever. Then, quietly, she told me that my baby of 16 weeks’ gestation no longer had a heartbeat. Moments later, the high-risk doctor came in to confirm this. I turned away as he talked to my doctor about the “degradation” he could see, suggesting the death had happened over a week before. Somehow this terrible word—and image—is what stuck with me, even weeks after the event.

Later I entered the ambulatory center where I would […]

Amy M. Collins, managing editor2017-07-12T16:22:50-04:00June 19th, 2017|Nursing, patient engagement, patient experience|2 Comments

Night Watch

Editor’s note: In this tightly observed guest post, a nurse visiting a sick family member experiences the hospital as a kind of foreign country.

Eileen McGorry, MSN, RN, worked as a registered nurse in community mental health for over 30 years. She currently lives in Olympia, Washington, with her husband Ron.

The walkway is hard, the concrete cold, and I am immersed in darkness. Then there is the swish of the hospital doors and whispery stillness. The light over the reception desk shines on a lone head, bent over a book. A clipboard is pushed toward me. The paper on it is lined with names, some boldly printed, others scribbled, the letters unrecognizable. The spacious lobby is filled with individual groups of soft stuffed chairs and love seats. All of it quiet and empty. Over the chairs and sofas, the black of the midnight hour is changed into twilight.

I remember the bustle of the area at midday. Families gathered together, eyes searching the crowd for the green scrubs of surgeons. “She will live,” they say to some, and to others, “We will wait and see.” The frenzy of the day over, the empty chairs wait for tomorrow.

I sign my name in script. I use the old Catholic school script. The script preached by my mother, who is upstairs recovering from heart surgery. I walk past the chairs along walls so white […]

Guest Author2017-05-17T11:11:27-04:00May 17th, 2017|family, family experience, Nursing, patient experience, Patients|0 Comments

The Nurse Who Saw Me: Easing the Strain of a Mother’s Vigil

“The Nurse Who Saw Me,” the Reflections essay in the May issue of AJN, is by JR Fenn, a writer and lecturer in upstate New York. The author, who is not a nurse, describes a night of uncertainty she spent in an isolation room on a pediatric unit with her sick daughter.

This is the kind of writing that helps a reader understand the perspective of a scared parent in a disorienting and uncomfortable environment. The care is efficient, and the clinicians she encounters all seem to be doing the right things for her baby. But reassurance is not immediately forthcoming, as we see in this passage from near the beginning:

The attending looks at us over her white mask when I ask if my daughter is going to be OK. ‘There isn’t the research for babies this young,’ she says, her eyes so huge I can see my terrified face reflected in them. I can’t ask any more questions because my throat has swelled closed as I fight tears.

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