When a Person with Type 1 Diabetes Goes to the Hospital

Photo by Susan Q Yin on Unsplash

I have always done everything I can to avoid hospitalization. Aside from concern about potential surprise bills, it’s a control thing: I’ve simply been afraid of turning over care of my blood glucose levels to anyone else. I’ve had numerous outpatient surgeries and procedures, but for the nearly three decades since I was diagnosed with type 1 diabetes in my mid-20s, I never spent a night in a hospital.

In retrospect, the one time I should have accepted hospital admission was immediately following the shock of the diagnosis, which followed close on several months of unexplained weight loss, increasingly unbearable thirst, blurring vision, and general disorientation. My blood glucose level had been off the charts, plus I needed time to reckon with the loss of freedom for my always more or less healthy and fit body and to begin to learn to balance insulin shots, glucose levels, food intake, physical activity, and much else. But I was in denial (with predictable consequences) for quite some time afterward, and had also turned down the cost of health insurance when entering graduate school.

In the hospital.

In any case, one frigid, iced-over night this early January, […]

How Should a Nurse Support Patients in Choosing a Time to Die?

Two of my six aunts died from Alzheimer disease (AD). They didn’t live nearby, so when I saw them every few months, the deterioration from the illness was evident. Both showed the same behavioral trends: some mild forgetfulness and repetitive questioning at first, then what seemed a prolonged period of incessant questions and bewilderment and anxiety over not understanding where they were or why they were there, who others were. Wandering outside at all hours, agitation and resistance to hygiene, eventually disappearing into a nonverbal, nonresponsive state.

It was painful to watch these formerly active, smart, and vibrant women decline in such a way. The most painful part was when they still understood that they were becoming confused and how frightened that made them.

Now there are alternatives available for those who don’t want to go down that road—but they are hard to come by, especially if you live in the United States.

People with dementia face particularly high hurdles.

A special feature in the March issue, “Medical Aid in Dying: What Every Nurse Needs to Know,” covers medical aid in dying and the nurse’s appropriate role in many end-of-life circumstances, including the ethically and logistically challenging situations of those with dementia who seek some agency over how […]

The Particular Pain and Challenge of Educating Patients During a Worldwide Pandemic

Working in a rural community access hospital during the pandemic has been a struggle. Here as in many areas of the U.S., many in the surrounding community have not accepted the the existence of a virus like Covid-19. Against the backdrop of this widespread disbelief in the reality of the virus, the “government-mandated” vaccine was a final straw for many.

Many of these patients wholeheartedly believe that the vaccine is the “mark of the beast” mentioned in the Book of Revelation and that this is the beginning of the end of the world, with getting the vaccine understood as an expression of loyalty to Satan.

This belief is shared by various religious groups in other areas of our country. Many patients in our community also believe the vaccine is made with stem cells and fetal tissue and includes microchips. There are widely circulated rumors of tracking devices in the vaccine itself.

How do we as nurses and advanced practice registered nurses (APRNs) educate patients on the science of vaccinations in the face of the anger and passion we experience daily from a suspicious community?

The many other strains on nurses.

It hasn’t helped that nurses and APRNs alike have had to deal with more than they bargained for on many levels in […]

2022-02-24T14:38:16-05:00February 24th, 2022|Nursing, patient engagement, Public health|0 Comments

What Have We Learned About Preventing School Shootings?

On November 30, a 15-year-old sophomore at Oxford High School in Michigan killed four students and injured seven others. Both the student and his parents are presently incarcerated and charged with numerous crimes.

In the days following this tragic event, questions arose regarding what the parents and school might have done to prevent this from happening. The parents are facing charges of involuntary manslaughter and a federal lawsuit, perhaps the first of others to follow, has been filed against the school district alleging that more could have and should have been done.

Warning signs and preventive actions.

With each school shooting we again find ourselves asking ourselves what can be learned in terms of warning signs and actions that could be taken. The September Mental Health Matters column in AJN, which I co-authored with Arlene Holmes—whose son James was responsible for the mass shootings in Aurora, Colorado, in 2012—highlighted warning signs that might indicate potential violence by someone experiencing mental health problems.

What can be learned from the events that unfolded in Oxford that could be applied to a similar scenario, perhaps heading off another tragedy? The following checklist compiled by Sandy Hook Promise, a nonprofit organization that aims to educate youth to prevent […]

2021-12-15T11:43:26-05:00December 15th, 2021|mental illness, Nursing|0 Comments

Helping Older Adults Get the Care That Matters to Them

Family caregivers should be partners in caring when family members are hospitalized.

“An estimated 41.8 million Americans were caregivers of an older adult relative or friend in 2020.” (From “The Four Ms of an Age-Friendly Health System” in AJN‘s November issue.)

That’s an impressive number, especially when one considers that any of the caregivers themselves may be older adults with chronic illness.

Are we preparing caregivers?

We ask a lot of these individuals, especially given the many complex tasks they are asked to perform, often with little or no training. And that’s nursing’s role—ensuring our patients are discharged to family members prepared to provide the care needed.

As a nurse, I felt prepared to be a caregiver for a family member who was discharged after complex cancer surgery. I was astonished at the brief discharge instructions for managing the Foley catheter, drains, and eight different medications; then I was handed a manila folder of papers about each medication. It took me a few hours to sort out schedules for medications and flushing drains.

But what about caregivers with no health care training, or who may not have manual dexterity or see clearly, or perhaps lack literacy at the level needed? Unfortunately, many hospitals are under resourced—in […]

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