Recognizing and Managing Late or Long-Term Complications in Adult Allo-HSCT Survivors

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

Everybody, myself included, thought he was going to die. Another nurse on another floor had administered his stem cell transplant a few weeks prior, but as his primary nurse I was now in charge of managing its aftereffects.

Ben (not his real name, and some details have been changed) was one of the many young patients I’d cared for who suffered from a violent course of complications following allogeneic hematopoietic stem cell transplant (allo-HSCT). Intractable diarrhea and skin sloughing led to graft-versus-host-disease’s usual sequelae: wounds, drug-resistant infections, looming sepsis. The walls of his bladder, scarred and irritated by the myriad of toxic drugs he’d been given, bled. One day, while I slept at home between night shifts, he lost so much blood that they rushed him to the OR. The treatment—never before performed—stopped the bleeding. But it left him in excruciating, around-the-clock pain.

Between regular doses of Dilaudid and PCA pump pushes, he cried out to me, “I can’t do this. I don’t want this anymore.” I couldn’t blame him—his cancer fight raged on endlessly. Watching his boyishly handsome face grimace with so much pain, I remembered other young allo-HSCT patients’ faces, some of them peaceful only in the postmortem.

As it turned out, Ben survived his ICU stay. I heard about his discharge to the bone marrow transplant unit after I returned from a vacation. I lost touch with him, in the […]

2016-11-21T13:01:46-05:00November 17th, 2015|Nursing, nursing perspective, Patients|0 Comments
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No Longer Alone: Nurses Supporting Family Caregivers

By Susan C. Reinhard, PhD, RN, FAAN, senior vice president and director, AARP Public Policy Institute, chief strategist, Center to Champion Nursing in America; Elaine Ryan, MPA, vice president of state advocacy and strategy integration, AARP government affairs; and Trish O’Keefe, PhD, RN, NE-BC, interim president, Morristown Medical Center, New Jersey

Teaching a daughter to help her mother with range-of-motion exercises. Teaching a daughter to help her mother with range-of-motion exercises

The public trusts nurses to care for them and to teach them how to care for themselves and for those they love. But a 2012 AARP/United Hospital Fund report funded by the John A. Hartford Foundation, Home Alone: Family Caregivers Providing Complex Chronic Care, shows there is a big disconnect. In this first nationally representative study of families providing complex care activities, almost half reported that they had provided medical/nursing treatments, including injections, wound care, administering multiple medications, managing colostomies, and giving tube feedings and nebulizer treatments—among many other tasks that nursing students find daunting when they are first learning how to do them.

Family caregivers are expected to step right in, with little to no instruction or support. Most (nearly 7 out of 10) of those they cared for did not get a home visit by a health care professional, despite multiple encounters with […]

2016-11-21T13:01:47-05:00November 13th, 2015|Nursing, patient engagement, Patients, Public health|3 Comments
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Preventing Newborn Falls

Photo by Joseph Sacchetti. Photo by Joseph Sacchetti.

An acquaintance of mine once admitted to dropping her newborn baby while feeding her in the middle of the night. At the time I inwardly scoffed—how can someone be that tired, I thought judgmentally. Fast-forward to a few years later when I can now speak as a new mother—and to being that tired.

Sleep deprivation is no joke. And it doesn’t necessarily begin when the baby is born. The last few months of pregnancy and the discomfort that comes with it make for difficult sleep preceding the birth.

Many maternity units now promote “rooming in,” where a newborn baby stays in the mother’s room rather than with the nurses in the nursery. This makes newborn fall prevention an important issue. Take poor sleep in the last months of pregnancy and the physical and mental exhaustion of labor and add pain and limited mobility from the birth itself, especially a C-section birth; large rails on hospital beds making the transfer of one’s baby from bassinet to the mother’s bed difficult; and possible pain meds for mom, and the recipe could spell disaster.

In my case, with an emergency C-section and limited mobility, I found it very hard to pick my baby up from his bassinet and bring him into my hospital bed for a feeding. Luckily my husband stayed […]

2016-11-21T13:01:48-05:00November 4th, 2015|Nursing, patient engagement|0 Comments
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Final Connection: An ICU Nurse Revises Her Feelings About Cell Phones

Illustration by Denny Bond. All rights reserved. Illustration by Denny Bond. All rights reserved.

Many of us have a love-hate relationship to smartphones, and each person (and generation) draws the line in the sand between invasiveness and usefulness in a different place. Cynthia Stock, the critical care nurse who wrote the Reflections essay in the November issue of AJN, “Final Connection,” starts her brief and moving story with honesty about such matters:

On Monday, if you had asked me how I feel about cell phones, I would have come up with this: I hate to listen to the drone of conversation coming from the person next to me on the treadmill at the gym. I don’t care about trouble with the HOA. I don’t care about a son who can’t decide on a career as a director or an actor. I work out to smooth the kinks in my soul from a job that requires me to navigate a relationship with life and death.

Today, ask me how I feel about cell phones. . . .

A good essay or story often centers around a reversal of some sort. What the protagonist believed may not be so true after all, or may be more complicated than first thought. As you can probably guess, in the course […]

2016-11-21T13:01:49-05:00November 2nd, 2015|narratives, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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Practical Steps for Nurses to Reduce Prescription Opioid Diversion

By Shawn Kennedy, AJN editor-in-chief

“Opioids diverted from friends and family members who have legitimate prescriptions are a major source of abused prescription opioids.”

More than 800 lbs. of drugs have been collected in Lycoming County, PA, since drug collection boxes were placed in law enforcement agencies over a year ago, allowing residents to safely dispose of unwanted drugs. Here the drugs are separated from their containers before incineration. Photo courtesy of Karen Vibert-Kennedy / Williamsport Sun-Gazette. More than 800 lbs. of drugs have been collected in Lycoming County, PA, since collection boxes were placed in law enforcement agencies over a year ago, allowing residents to safely dispose of unwanted drugs. Here the drugs are separated from their containers before incineration. Photo courtesy of Karen Vibert-Kennedy / Williamsport Sun-Gazette.

Amid recent reports from the CDC drawing attention to a prescription painkiller and heroin overdose epidemic, last week President Obama announced an initiative to address both prescription drug and heroin abuse in the United States. In addition to a […]

2016-11-21T13:01:50-05:00October 28th, 2015|Nursing, pain management, Patients|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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