Questions of Priority, Written in Vernix and Blood: Two Poems in ‘Art of Nursing’

By Sylvia Foley, AJN senior editor

Jenna Kay Rindo’s poem “An Ode to My Certified Nurse Midwife” (Art of Nursing, August) brims with the narrator’s gratitude for the clinician who has seen her through a “gloomy complicated gestation” with great skill and compassion. (Art of Nursing poems are always free online—just click through to the PDF files.)

This is no sentimental paean, though. This ode is a gritty read, full of vernix and “unrehearsed pain,” euphoria and shame. The child, we learn, was “conceived completely out of wedlock, / in a rush of holy illicit love.” The narrator at first only wants to know how long she can hide the pregnancy. It’s the nurse midwife whose “jubilant congratulations” never seem to waver, whose “size seven hands covered in  / sterile latex” draw the infant’s wide shoulders into the world, and give the young mother courage. It’s an ode, perhaps, to something we strive for but rarely attain: a nonjudgmental attitude.

“It is lucky to live outside the target groups,” begins the narrator of Erika Dreifus’s poem “The Autumn of H1N1” (Art of Nursing, October). She is referring to those considered most at risk for the flu and thus at the top of the list for immunization.

But when she finds herself hemorrhaging and frightened, waiting to be seen by a gynecologist who minimizes her distress, she reveals far more complicated feelings about “the prioritized.” It’s an unusually frank […]

2016-11-21T13:15:31-05:00October 1st, 2010|patient engagement|1 Comment
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No Country for Old Women

By Amy M. Collins, associate editor

For the past few weeks, my family has been living a health care nightmare. My 85-year-old grandmother, physically fit and as beautiful as an old-time movie star, but suffering from the first stages of Alzheimer’s disease, had a major meltdown. Her assisted living facility called to say she was harassing the residents and staff, claiming her belongings had been stolen, shouting at people at random, and even calling the police. Clearly not equipped to handle this level of agitation, the facility turned to us to pick her up and keep her for a few days.

The week that followed proved arduous—nobody seemed to know what to do with her. Her GP was at a loss, suggested that we bring her to the ED. Her neurologist prescribed Seroquel (after having to tackle and physically restrain her from the subsequent episode of screaming and pounding her fists on the wall, we called to tell the neurologist that the pill wasn’t working; he said to give her more; four pills later, she was still mildly agitated.) This went on for over a week. She came to live with us, where we listened, exhausted, to constant chatter that didn’t make sense. The talking never stopped—her voice grew hoarse […]

2016-11-21T13:15:38-05:00September 22nd, 2010|nursing perspective, patient engagement|7 Comments
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Taking Away Choice — The Wrong Answer to Domestic Violence

By Meg Stone, MPH. Stone is the executive director of IMPACT Boston, an organization that works to prevent violence and abuse by giving people the tools to protect their safety and advocate for healthy relationships and sexual respect in their communities. A long-time domestic violence advocate with a degree in public health, she has, in her own words, “a strong interest in raising awareness of the issues facing women who present to emergency departments with injuries related to abuse. My professional background includes training nurses and first responders in asking about domestic violence and documenting incidents of abuse on medical records.”

This post is longer than our usual, but we thought it was worth running in entirety. The names and identifying details of those mentioned have been changed.

In the mid-1990s it was rare in most places for nurses and social workers to call domestic violence organizations when women came to the emergency department with injuries related to abuse. I only remember one call from a hospital social worker in the upstate New York town where I worked as an advocate at the local battered women’s program.

Carolyn, the director of the battered women’s service, called me at home on my day off. Nobody else was available, she said, so could I please please […]

2016-11-21T13:16:11-05:00August 10th, 2010|Nursing, patient engagement, Patients|1 Comment
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Open Medical Records: A Question of Safety

By Christine Moffa, MS, RN, AJN clinical editor

We’ve all watched our health care provider writing or typing while we answered questions or described our symptoms. Before becoming a nurse I used to wonder what they were putting in my chart and if they got it right. And now that I am a nurse I can’t believe how often a medical assistant or nurse will take my vital signs and write them down without telling me what they are. How can it be possible that adults are kept from knowing their own or their children’s health information? Back when I worked on a pediatric floor my colleagues gasped in shock when I allowed a parent of one of my patients to look at his child’s chart. And I actually let them make me feel like I had done something wrong!

Last week this issue was the topic of a column by Dr. Pauline W. Chen in the New York Times, where two related blog posts (here and here) also received much reader commentary. The sudden flurry of interest in the subject was occasioned by an article published in the Annals of Internal Medicine detailing the preliminary findings of a study following a national project called OpenNotes, funded by the Robert Wood Johnson Foundation, in which “more than 100 primary care physicians and 25,000 of their patients will have access to personal medical records online for a 12-month period beginning in summer 2010.” Readers’ comments ranged from one extreme to the other, such […]

2016-11-21T13:16:18-05:00August 3rd, 2010|nursing perspective, patient engagement|3 Comments
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Reflections on the Freedom to Harm Yourself

By Marcy Phipps, RN

(Identifying details of the patient and clinician mentioned in this post have been changed to protect their anonymity.)

Last week I took care of a woman who’d shot herself in the abdomen. This was the third suicide attempt she’d survived. She was physically compromised, to say the least, and was looking at a long recovery. Her despondence was palpable. 

A clinical psychologist came to evaluate her and determined that she was experiencing major depression with suicidal ideations. 

Usually, such patients are “Baker Acted.” In accordance with the Florida Mental Health Act, commonly referred to as the Baker Act, individuals who are deemed to be a danger to themselves or to others are held involuntarily and transferred to a treatment facility.

But because this patient stated to the psychologist that she was not only willing to seek mental health treatment, but also planned on checking herself into a facility near her home, she didn’t qualify to be involuntarily hospitalized. She was free to leave at any time.

As the psychologist explained to me, the first criterion of the Baker Act only considers whether or not the person in question is refusing treatment. According to Florida Statute 394.463, as long as said person does not refuse to be examined, the Baker Act does not apply.          

Although the psychologist assured […]

2016-11-21T13:16:51-05:00July 8th, 2010|Ethics, nursing perspective, Patients|3 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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