‘Cold Calls’: Tips for Nurses When the Patient Just Got the Bad News

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Julianna_Illustration_Cold_CallsIt’s difficult to choose which is more difficult: That moment before dialing the number of someone I’ve never met soon after they’ve received a cancer diagnosis, or the moment standing in the doorway before entering the hospital room occupied by someone I’ve also never met soon after their cancer diagnosis.

These scenarios are the health care version of a cold call. I manage them daily.

The term cold call generally refers to marketers calling someone without prior introduction with hopes of convincing them to buy their product. In the arts community, cold calling refers to an artist walking in off the street with a portfolio in the hopes of convincing a gallery owner to exhibit their art. Rarely are either appreciated.

Most nurses involved in patient care make cold calls. Walking into the room of a patient you’ve never met is a cold call. Starting an IV on someone else’s patient or in one you’ve just met is a cold call. A cold call occurs when the unconscious patient brought to the ED opens his eyes and your face is the first thing he sees.

Lots of things about nursing are difficult. For the novice and experienced alike, walking into a patient’s room after they’ve received news they or their loved one […]

2016-11-21T13:01:20-05:00March 29th, 2016|Nursing, nursing perspective, patient engagement, Patients|0 Comments
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CDC Opioid-Prescribing Guideline for Chronic Pain: Concerns and Contexts

by frankieleon/ via flickr by frankieleon/ via flickr

By Jacob Molyneux, senior editor

The CDC’s new Guideline for Prescribing Opioids for Chronic Pain was released this week. The context for this comprehensive new guideline is widespread concern about opioid-related overdose deaths and substance abuse in the U.S.

The guidelines make 12 main recommendations, among them the following:

  • nonpharmacologic or nonopioid pharmacologic treatments should be considered “preferable” first-line therapy for those with chronic pain.
  • a daily opioid dosage limit of morphine milligram equivalents should be imposed.
  • immediate-release opioids should be prescribed before moving to extended-release formulations.
  • urine testing should precede new opioid prescriptions for chronic pain and treatment goals should be set.
  • clinicians should prescribe the lowest possible number of days’ worth of medication for acute pain (often three days or less).
  • prescription drug monitoring program (PDMP) databases should be consulted to determine patients’ past histories of opioid prescriptions.

Some of the recommendations would seem to be no-brainers, such as consulting PDMPs when writing new prescriptions. Others, such as a “one-size-fits-all” daily dosage limit and restrictions on the use of extended release formulations, have raised alarms among pain management experts. See, for example, “I’m Worried About People in Pain,” a recent AJN Viewpoint essay by Carol Curtiss, a nurse and pain management expert, who notes the increased stigmatization experienced by pain patients and the chilling effects of new restrictions […]

2016-11-21T13:01:23-05:00March 17th, 2016|Ethics, Nursing, nursing perspective, pain management, patient engagement|4 Comments
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The Balancing Act: A Dying Patient and a Spouse Who Can’t Let Go

Illustration by McClain Moore Illustration by McClain Moore

The Reflections essay in the March issue of AJN is called “The Balancing Act.” The author describes a situation she faced as an ICU nurse in which her efforts to keep a dying patient comfortable were complicated by a spouse’s reluctance to accept the inevitable. It’s often hard to advocate for a patient while honoring the emotional struggle of a close family member. Here’s the start of the essay.

I have just arrived to work in the ICU and am assigned a patient in respiratory distress. Her name is Darlene and her husband Tom is pacing the room. Within 10 minutes, he drinks three cups of coffee, ignoring the cot provided by the previous nurse so he could sleep next to Darlene. His wife has more than one cancer and both are growing. She left the hospital a week ago for hospice care, but has been readmitted after a decision by her husband to reattempt curative treatment.

[…]

2016-11-21T13:01:24-05:00March 9th, 2016|Nursing, nursing perspective, Patients|2 Comments
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Just Breathe: A Nurse’s Tough Love Proves Crucial During One Mother’s Labor

Photo by chintermeyer, via Flickr. Photo by chintermeyer, via Flickr.

By Amy Collins, AJN managing editor

The pain jolted me from my sleep. It was 1:30 in the morning. The sensation was stronger than anything I’d ever felt, and I grabbed my phone to start my contraction timer. I had read loads on labor and childbirth, and everything suggested I was in for the long haul. But my timer was showing the contractions were already only five minutes apart. I spoke with the hospital’s on-call physician, who told me to relax and spend as much time as possible at home so I could be more comfortable.

But within minutes, the pain had increased to a level where it was difficult to talk. The contractions were now three minutes apart and my water had broken. My husband and I decided to go to the hospital.

I’d like to say I was strong and handled the pain of labor well, but I was quickly losing control and succumbing to anxiety. By the time we got to the maternity unit, I was sobbing. The labor nurse assigned to me introduced herself as Jean. She was older and seemed seasoned, with a stern, no-nonsense attitude. She brought me to a delivery room and gave me a gown. Before labor started, my plan had been to see how […]

2016-11-21T13:01:25-05:00March 2nd, 2016|nursing perspective, patient engagement, patient experience|0 Comments
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Nursing Reads: A Powerful New Novel Evokes Diverse Perspectives on an Organ Transplant

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By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

The Heart, a new novel by Maylis de Kerangal, caught my attention with a cover art image suggestive of the vascular and as beautiful as an angiogram. Taking place over a 24-hour period, the novel describes a 19-year-old accident victim who suffers brain death and the people who are connected to the heart transplant that follows: his parents, the doctors and nurses, the recipient of the heart. As a nurse who’s seen the organ transplant process from a number of angles, I wasn’t sure how De Kerangal could possibly navigate such material.

But the novel, which has been ably translated from French, is both subtle and powerful, casting light on the complexity of every character, from the pre-accident vitality of Simon, the donor, to the conflicted gratitude of the heart recipient; from the inexperienced ICU nurse to the surgeons.

Two important characters are nurses, though they are only a part of the larger picture:

Cordelia Owl, Simon’s ICU nurse, is an inexperienced practitioner. She carries out her nursing tasks in a distracted, perfunctory manner, speaking aloud to the unresponsive Simon as she cares for him. In doing so, she inadvertently intensifies the anguish of his parents, who are standing nearby and struggling with the concept of brain death.

Though her behavior shocks the attending physician, she’s not dealt […]

2016-11-21T13:01:25-05:00February 29th, 2016|Nursing, nursing perspective, patient experience|0 Comments
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