Just One Braid: The Power of Small Gestures to Restore Patient Dignity

Have you ever found yourself walking around your unit, overwhelmed by the prospect of managing your ever-growing workload? It sometimes feels like a never-ending cycle of assessments, medications, admissions, and discharges. I believe I’m not the only nurse who has experienced this frustration.

It is difficult to admit that, when COVID-19 entered our hospital doors, these thoughts consumed me. We witnessed the first casualties—not just of lives, but also of hope and intimacy—as we struggled to provide care and overcome our own anxieties amidst a scarcity of personal protective equipment (PPE).

Over time, we all learned a great deal about adapting to and managing a pandemic, and I have become more aware of my role within our flawed health care system. Focusing on my own fears and needs was valuable, of course, but these years opened my eyes to the injustices patients face. A significant proportion of the lives lost from COVID-19 due to ill-prepared infrastructure were from vulnerable communities. These realities transformed my perception of these injustices from distant awareness to concrete urgency.

Braiding a patient’s hair, restoring a sense of self.

The question of injustice brings to mind a recent encounter with a patient that deeply impacted me. This particular patient was young […]

2023-05-25T12:20:32-04:00May 25th, 2023|Nursing, nursing stories, patient experience|1 Comment
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Black Boxes in the Operating Room: Improving Quality of Care and Patient Safety

What’s covered in this post?

  • Black boxes record video, audio, and data from multiple sources in the operating room (OR), such as cameras, microphones, patient monitoring equipment, and medical devices.
  • By offering transparency on the multiple simultaneous processes in the OR, black box data can be used to improve safety and efficiency, train staff, and onboard new nurses.
  • The data can be used for retrospective analysis of specific events or aggregate analysis to detect patterns and variations in practice over time.
  • Black box data has been used to improve and standardize OR processes such as handling tissue samples, handoff communication during shift changes, and pre-surgical patient positioning.
  • The data is de-identified and is normally deleted within 30 days.
  • Finding what went right and learning from it is the goal, not pointing fingers.

Figures in the OR as recorded and de-identified by an OR Black Box. Image courtesy Surgical Safety Technologies.

Rebecca McKenzie, DNP, MBA, MSN, RN, assistant vice president of perioperative services at Duke University Hospital, recently spoke with AJN about her hospital’s use of black boxes in operating rooms (ORs) to standardize key processes to improve safety and efficiency, […]

2023-05-26T15:01:50-04:00May 5th, 2023|Nursing, patient safety, Quality improvement, Technology|1 Comment
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Preventable and Aggressive Care for Cancer Patients: To the Bitter End

There have been a couple of recent studies that confirm what I have observed as a palliative care nurse practitioner (NP) in an academic medical center: that there’s still a tendency to pursue very aggressive care with older people with cancer. While every situation is different, the evidence shows that people with cancer could also benefit from palliative care and advance care planning to make sure they’re getting the best and right care for them.

Palliative care could prevent many ED visits.

The first study to catch my eye as a former ED nurse was Trends and Characteristics of Potentially Preventable Emergency Department (ED) Visits Among Patients With Cancer in the US. This study reviewed data on almost a billion (854,911,106) ED visits, of which 4.2% were made by patients with cancer. The mean age of those patients, not surprisingly, was 66. The study found that more than half of ED visits among patients with cancer, 51.6%, were identified as potentially preventable, with the absolute number of potentially preventable ED visits increasing substantially between 2012 and 2019.

The authors concluded that this highlights “the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.”

This […]

2023-04-07T09:34:11-04:00April 7th, 2023|end of life, Nursing, palliative care, patient experience, Patients|2 Comments
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Pediatric Mental Health Tops ECRI’s 2023 Top 10 Patient Safety Concerns

Photo by Eric Ward on Unsplash

Each year, the ECRI Institute creates a list of top 10 patient safety concerns along with actionable recommendations for institutions to reduce these risks.

Some years, the list includes repeat offenders such as medication errors and concerns surrounding staffing. In the past few years, the list has reflected the reality of living during a global pandemic, with 2022’s top 10 concerns including clinician’s mental health, supply chain disruptions, and vaccine coverage gaps. This year’s list moves away from the pandemic somewhat, but still includes some fallout from COVID-19, with the number one concern reflecting a crisis among our youth: pediatric mental health.

According to the report:

“Concern for pediatric mental health was already high during the 2010s due to the growing use of social media, limited access to pediatric behavioral health providers, drug and alcohol use, gun violence, and socioeconomic impact, among other stressors. However, pediatric mental health issues have been exacerbated by the COVID-19 pandemic, with a 29% increase in children age 3 to 17 experiencing anxiety and a 27% increase in depression in 2020 compared with 2016.”

The report lists some recommendations to confront this issue, including securing leadership support and resources to evaluate the organization’s pediatric […]

2023-04-05T12:25:54-04:00April 5th, 2023|patient safety|0 Comments
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Access to Abortion Medications: Why Should Nurses Care?

She sat in my office, tissue in hand, tears rolling down her cheeks as she tried to process the news I’d just confirmed: she was pregnant, and really, really needed to not be. She was living in her brother’s small house, her seven-year-old son with her, sleeping on a sofa while trying to put her life back together after a divorce. She had chronic kidney disease, and had been told that another pregnancy could cause kidney failure.

She didn’t really believe abortion was a good thing to do, but also couldn’t imagine that God would want her to go on dialysis. For the most part I listened, asking a question here and there to help her clarify her own thoughts. Ultimately, she decided on an abortion, so I referred her to the closest clinic, several hours away from the rural town we met in.

Medication Abortion in the United States

By Robin Marty/Flickr Creative Commons

Even before the Dobbs decision overturning Roe v. Wade, abortion was difficult to access for people living in many regions of the country. TRAP (targeted regulation of abortion providers) laws forced many clinics to close, making abortion access challenging if not impossible even though every American was legally, constitutionally permitted to make her own decision.

Last year, […]

2023-03-16T09:55:52-04:00March 16th, 2023|Ethics, Nursing, Patients, Public health, women's 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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