How Much Was Your Last Blood Test?

By Shawn Kennedy, AJN editor-in-chief

500px-Vraagteken.svgWe all know that prices for medical procedures often vary without rhyme or reason. But an article on Vox.com brought home just how ridiculous this price variation really is. The article describes the findings of a new study published in BMJOpen, the open access arm of the British Medical Journal.

The study evaluated costs charged for 10 common blood tests at more than 100 general acute-care California hospitals. Most were not-for-profit, urban, non-teaching hospitals with under 300 beds and an average of 25% Medicaid patients and 41% Medicare patients. The results were astounding:

“We found significant variation in charges for 10 common outpatient blood tests performed at California hospitals. For example, hospitals charged a median of US$214 for a basic metabolic panel, but the charges ranged from US$35 to US$7303. A lipid panel generated a median charge of US$220 at California hospitals, but the maximum charge of US$10, 169 was over a thousand times the minimum charge of US$10.”

It seems incredible: $10 vs. $10,000 for a lipid panel. As the authors conclude: […]

2016-11-21T13:04:04-05:00August 18th, 2014|patient engagement, Patients|0 Comments
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On the Phone: Punctuation for a Parent’s Decline

Illustration by Elizabeth Sayles for AJN. All rights reserved. Illustration by Elizabeth Sayles for AJN. All rights reserved.

“It’s ridiculous. I’m deciding the rest of my mother’s life based on research I did on the Internet,” I tell him.

“You’re really good at that. Research, I mean,” he says, hope in his voice.

I want to scream that I don’t think an undergraduate degree in biology and a long relationship with Google qualify me as a medical professional.

Many of us don’t use the phone as often as we used to, but there are times of strangeness and loss when it may still assume the central role it played in an earlier era. The passage above is from “On the Phone,” the August Reflections essay, which finds a novel way to talk about the strains and strangeness of finding oneself a family caregiver—the gradual withdrawal of a once vibrant parent (or spouse or sibling) from the home that had once seemed to be defined by their presence, the isolation, the learning curve when faced with medical emergencies and the need to make crucial decisions that can’t wait, the reliance on the advice and interventions of nurses and physicians.

All Reflections essays are free and can be read in just a few minutes. This month’s is about an experience, family caregiving, that more and more of us are having in one form or another, whether we find a way to tell about it […]

2016-11-21T13:04:04-05:00August 15th, 2014|narratives, Nursing, Patients|1 Comment
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If She Yells ‘Help Me’ – Poster Therapy to Convey the Needs, Identity of an Ailing Parent

Joan Melton, MSN, lives in Indiana.

Photo by Ann Gordon, via Flickr Photo by Ann Gordon, via Flickr

I am a geriatric nurse practitioner and have also been the daughter to an ill, aging parent. I felt well trained for my professional role but struggled with the latter.

I joked that, despite my logical understanding of what was going on with my mother, it could be hard to accept her physical and functional changes, which sometimes seemed to fly in the face of logic. There were days Mom’s hospice nurses spent more time with me than with my mother. They’d sit and allow me to vent my frustration at watching my mother slowly leave me, at feeling overwhelmed and “losing my cool” with her, at not being able to practice the advice I’d so readily handed out to so many other families over the years, not being able to “fix it” and successfully comfort all of Mom’s fears and ailments 24 hours a day, seven days a week.

Yes, I know how unrealistic that last statement sounds. Thank goodness for hospice nurses, who reminded me that I was “the daughter” and did not need to be “the nurse practitioner.” They reminded me that as the daughter I had amazing insight no one else […]

2016-11-21T13:04:15-05:00July 23rd, 2014|Nursing, Patients|7 Comments
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The Ethics of a Nurse’s Refusal to Force-Feed Guantanamo Hunger-Strikers

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

The Miami Herald reported this week that a U.S. Navy nurse and officer refused to take part in force-feeding hunger-striking detainees at Guantanamo Bay.

There’s much we still don’t know about this story, but the force-feeding of prisoners at Guantanamo has been a contentious issue for some time. The practice has been compared by some to torture, and ethicists in the medical literature have urged the physicians involved to refuse to participate, while the U.S. government and President Barack Obama defend the practice on humanitarian grounds of preventing the deaths of the detainees.

Whether or not one feels that nurse participation in the force-feeding is justified, this officer, whose identity has not been released, appears to deserve the profession’s praise for taking a moral stand in an extraordinarily difficult circumstance. All nurses have the […]

2016-11-21T13:04:16-05:00July 18th, 2014|career, Ethics, Nursing, Patients|10 Comments
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Diabetes and Puberty – How Nurses Can Help Teens and Their Parents Manage Blood Glucose

Trenton Jantzi replaces his insulin pump infusion site during a break at school. The high-school senior must change his infusion site every three days. Photo by Mark Ylen / Democrat-Herald. Trenton Jantzi replaces his insulin pump infusion site during a break at school. The high-school senior must change his infusion site every three days. Photo by Mark Ylen / Democrat-Herald.

A new article in AJN gives crucial information on the challenges to managing diabetes, both type 1 and type 2, that are faced by teenagers and their parents during the physical and psychosocial changes of puberty.

Any nurse can tell you that it’s not easy to manage diabetes. I got type 1 diabetes when I was 27 years old and it took me more than ten years to really understand how to balance the effects of diet, exercise, insulin intake, and other factors like illness or stress.

There’s a lot at stake, too, in terms of long-term complications linked to poor blood glucose control, including blindness, heart disease, neuropathy, and a host of other unpleasant complications. In addition, there are serious potential short-term risks of diabetes like hypoglycemia or hyperglycemia that can land you in a coma or worse.

Even […]

2016-11-21T13:04:19-05:00July 7th, 2014|Nursing, patient engagement, Patients|1 Comment
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