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At the Intersection of Hospice and Obstetrics, a True Test of Patient-Centered Care

By Jacob Molyneux, senior editor

Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks.

We’d like to draw attention to a particularly frank and thought-provoking article in the October issue of AJN. “A Transformational Journey Through Life and Death,” written by a perinatal nurse specialist who is also a bioethicist, describes a hospital’s experience in meeting the needs of a patient with two very different, potentially conflicting, medical conditions.

It was a sunny afternoon in mid-October when I first met Renee Noble. I had already heard about her from staff who had given Renee and Heidi Ricks, her friend and doula, a tour of the neonatal ICU and were taken aback when they asked to see the Hospice Inn as well. The nurses knew that Renee had been diagnosed with ovarian cancer, but no one had said anything about it being terminal. Heidi had insisted that after Renee delivered she would need hospice inpatient care. Alarmed, the staff had called me, the perinatal clinical nurse specialist, after Renee and Heidi left.

In addition, this is a patient with strong preferences about her own care, preferences that may be at odds with the more conventional approaches to treatment held by many nurses […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:03:43-05:00October 22nd, 2014|narratives, Nursing, nursing perspective, patient engagement, Patients|4 Comments

Planning Postdischarge Care with Cognitively Impaired Adults

A patient performs the CLOX 1, a clock-drawing task used to assess patients for cognitive impairment. Photo by Ed Eckstein.

By Shawn Kennedy, AJN editor-in-chief

The transition from hospital to home can be fraught with pitfalls, especially if the patient in question is an older adult with multiple conditions and a not-so-prepared caregiver. The transitional care model, in which NPs coordinate care and provide follow-up care after discharge, has been shown to be successful in reducing hospital readmissions in this group of patients.

With Medicare levying penalties on hospitals with higher-than-average readmissions rates, the stakes aren’t just high for patients and their families. Might similar models of care also work with cognitively impaired adults?

In “Studying Nursing Interventions in Acutely Ill, Cognitively Impaired Older Adults,” a feature article in AJN‘s October issue (free until the end of October), Kathleen McCauley and colleagues from the University of Pennsylvania seek to answer this question, among others.

In the article, McCauley and colleagues describe the methodology and protocols used in their study, summarize their findings, and discuss some of the challenges in conducting research in the clinical setting. Among their findings is the important lesson that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as the need for hospitals to make cognitive screening of older adults who are hospitalized for an […]

Amy M. Collins, managing editor2016-11-21T13:03:45-05:00October 15th, 2014|Nursing, nursing perspective, nursing research, Patients|0 Comments

Resisting the Rising Tide of Parkinson’s

The Reflections essay in the October issue of AJN is called “After-Dinner Talks.” These are talks with a purpose, a form of physical therapy with high stakes. Writes the author, Minter Krotzer, of her husband’s long struggle with Parkinson’s disease: “Hal always says Parkinson’s is not his identity, and it isn’t, as long as he doesn’t let it claim him, or as long as it doesn’t claim us.”

Here’s an excerpt from the beginning:

‘I’d like you two to have a conversation every night after dinner,’ Hal’s speech therapist said to us.

. . . . Over the years, Hal’s Parkinson’s disease has made him difficult to understand. His vocal cords have restricted movement and it is hard for him to make it to the end of a sentence. He often swallows his last words or they just barely come out. Sometimes he sounds like he is underwater—the words indistinguishable from one another, blurry and pitchless.

But read the short essay, which is free. In just one page it manages to say a lot about chronic illness and the constant, conscious effort it can require of both patients and family members; about a clinician’s good advice; about marriage and communication; and about the power of language to keep us human.—Jacob Molyneux, senior editor.

Jacob Molyneux, senior editor/blog editor2016-11-21T13:03:45-05:00October 13th, 2014|patient engagement, patient experience, Patients|1 Comment

Calciphylaxis: The Intriguing Case of Ms. W.

Ms. W. post-recovery, with her husband

By Sylvia Foley, AJN senior editor

“I survived, although I had been told that I’d eventually die from infection in the wounds.”

In one of this month’s two CE features, “Calciphylaxis: An Unusual Case with an Unusual Outcome,” Tina Wangen and colleagues report on the intriguing story of L.W., a 40-year-old patient who, aside from being female, had no other known risk factors for the disease. Here’s an overview of the article:

Calciphylaxis is most common in patients with end-stage renal disease, and hyperparathyroidism is often present as well. But several cases in patients with normal renal and parathyroid function have been reported; this article describes one such case. The etiology and pathophysiology of calciphylaxis aren’t well understood. There are many risk factors, and the reported median survival time is 2.6 months after diagnosis. The condition is characterized by isolated or multiple lesions that progress to firm, nonulcerated plaques and then to ischemic skin necrosis and ulceration.
In August 2010, a female patient arrived at the hospital with multiple deep, painful necrotic wounds. Given this patient’s presentation on admission, the nurses kept expecting the physicians to initiate end-of-life discussions with her and were surprised when this did not happen. After five days, the patient was diagnosed with calciphylaxis in the unusual presentation of […]

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Guest Author2017-07-27T14:44:29-04:00October 10th, 2014|Nursing, Patients|3 Comments

How Do You Want to Be Cared For?

The patient in the next bed by mynameisharsha / Harsha K R, via Flickr

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

How do you want to be cared for?

Have you written your own personal nursing care plan? I’m not asking about your health care proxy or living will; most nurses have seen enough disastrous end-of-life scenarios to understand the need for formal advance directives. But if you become comatose or unable to communicate, what small pleasures would ease your suffering? What sights and sounds would promote healing for you, or ease your dying?

I’m often dismayed by the thoughtlessness of some staff regarding what their patients see and hear. Nurses will tune an unconscious patient’s television to the staff’s favorite soap opera, or blast the music of their own choice from the patient’s radio. I’ve witnessed staff talking on cell phones, and even arguing loudly with other staff, as though the person in the bed weren’t even there. When did we lose our attentiveness to patients as unique individuals? […]

Betsy Todd, MPH, RN2016-11-21T13:03:47-05:00October 8th, 2014|Nursing, nursing perspective, Patients|2 Comments