Patients Archives - Page 39 of 71

‘I’m Worried About People in Pain’: A Nurse’s Take on Opioid-Prescribing Regulation Changes

by frankieleon/ via flickr

Many patients and clinicians have strong feelings about opioids: they’ve seen a loved one denied adequate pain control, or they’ve seen a family member or friend’s son or daughter lost to prescription pill and/or heroin addiction, or they’ve worked in an ED with too many drug-seeking patients, or they’ve seen a patient in terrible pain waiting for a new analgesic order from an unavailable or uncompassionate physician.

But feelings don’t solve complex problems, and an excessively punitive or permissive approach can do more damage than good. Recently, there have been almost daily headlines and policy recommendations about the importance of restricting opioid-prescribing practices. The trend is alarming a number of clinicians with expertise in working with patients in pain. Clinical nurse specialist and pain management consultant Carol Curtiss addresses what’s at stake in “I’m Worried About People in Pain,” the Viewpoint essay in the January issue of AJN:

According to a 2011 Institute of Medicine report, chronic pain is a public health crisis . . . Well-intended efforts to address prescription drug abuse—another public health crisis—may place heavy burdens on people with pain who benefit from opioids and use them responsibly as part of a comprehensive treatment plan. . . . Gains made in pain treatment are at risk. New regulations threaten access to […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:34-05:00January 12th, 2016|Ethics, nursing perspective, pain management, patient experience, Patients|3 Comments

A Nursing Perspective on a Recent NEJM Palliative Care Article

By Pam Malloy, RN, MN, FPCN, director and co-investigator of the ELNEC Project, American Association of Colleges of Nursing (AACN), Washington, DC.

I just read a New England Journal of Medicine article by Drs. Craig D. Blinderman and the late J. Andrew Billings that came out on Christmas Eve, 2015. “Comfort Care for Patients Dying in the Hospital” was a thoughtful, informative article and I am grateful that it appeared in a journal that wasn’t focused solely on hospice/palliative care.

While the information in the article is essential for all health care professionals, I would like to take this opportunity to remind my nursing colleagues that we have a tremendous opportunity and privilege to plan, provide, and orchestrate the care that was described in this article—and we have been doing so for some time.

Nurses spend more time at the bedside and out in the community assessing and managing patients with serious, complex illness than any other health care professional. Our interdisciplinary colleagues depend on our assessments and we play a major role in developing plans of care with our diverse team. We are there having difficult conversations with patients—many times in the middle of the night when they cannot sleep. We are […]

Guest Author2016-11-21T13:01:34-05:00January 8th, 2016|Nursing, nursing perspective, pain management, patient experience|2 Comments

Watching a Friend Fade Away: A Nurse’s Account of the Progress of Dementia

By Jacob Molyneux, senior editor

Alzheimer’s disease and dementia have been in the news. There have been major movies about what’s it’s like to suffer the gradual loss of the ability to understand and to negotiate the world around us, with leading roles played by stars like Julianne Moore. The challenges of caregiving are receiving increasing attention, as are the growing pressures on our medical system. Every month there’s a report of a new potential cure, or a potential cause, or ways we might be able to fend off the illness through exercise, mental calisthenics, diet, and medications.

The January Reflections essay, written by Deborah Lane, a critical care nurse and community volunteer in St. Augustine, Florida, is called “Watching a Friend Fade Away.” Here’s the opening paragraph:

Frankie was a fast wit, a ginger-headed joker, impeccably dressed, and the first to laugh. She was a master’s-educated teacher who developed programs for at-risk teens, teaching pregnant high school students skills for employment and effective childcare. She loved to cook and her home was warm with beautiful arts and crafts she had made. She was a wonderful friend. Disease changed it all.

The author brings the perspective of both a loving friend and a nurse to this short, beautifully told account of the changes in her friend over the years, the efforts of two couples to keep spending […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:38-05:00December 29th, 2015|narratives, nursing perspective, patient engagement|0 Comments

How a Nurse Quietly Helped One Intern Out of a Tricky Situation

In this month’s Reflections essay, “My Turn,” a recently retired physician tells a story of how a nurse adroitly helped him through a very disorienting moment when he was still an intern. Here’s a bit of the setup:

Medicine was my first rotation as an intern. . . . [T]he medicine rotation had a particularly intimidating reputation and a red-hot I was not. I was terrified.

On morning rounds every day our entourage of physicians, nurses, and students would go room to room discussing each patient. I can still see the open door to Mrs. Finkelstein’s room near the morning sunlight at the end of the hallway. Mrs. Finkelstein was old and was dying. And every morning when we walked in, her husband was sitting there next to the bed, holding her hand. He told us regularly how many years they had been together. We each dreaded being the one on call when she died.

There are many situations in medicine and nursing that require a certain amount of experience—most readers will agree that this is definitely one of them. At a certain point in the story, the author finds himself being asked a question that absolutely needs to be answered, and answered immediately. It’s not just the […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:41-05:00December 9th, 2015|career, narratives, Nursing, nursing perspective, patient engagement, Patients|0 Comments

Attention to Patients’ Mobility: Low-Tech But Essential

A critical care nurse led a multidisciplinary team to explore the effects of a dedicated ‘mobility team’ on functional and other outcomes in ICU patients.

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

julie kertesz/ via flickr creative common

It’s long been known that immobility leads to deconditioning. Various studies indicate that muscle strength drops by 3% to 11% with each day of bed rest. As most of us have witnessed firsthand in both patients and family members, it can take months to regain pre–bed rest levels of functioning. For some people, the strength and mobility needed for independence never return.

In this month’s issue, a community hospital critical care nurse led a multidisciplinary team to explore the effects of a dedicated “mobility team” on functional and other outcomes in ICU patients. In “Implementation of an Early Mobility Program in an ICU,” Danielle Fraser and colleagues share what they learned.

The mobility team consisted of a physical therapist, a critical care RN, and an ICU rehab aide. Respiratory therapists worked closely with the team. Patients assigned to the early mobility intervention could progress through four successive levels of movement, from passive range-of-motion exercises to full ambulation.

Compared with ICU patients who received routine care, the patients in the intervention group were more functionally independent at discharge. In addition, this early mobility […]

Betsy Todd, MPH, RN2016-11-21T13:01:41-05:00December 7th, 2015|Nursing, nursing perspective, nursing research, patient engagement|0 Comments