Children’s Mental Health Crisis Reveals Holes in System

You don’t have to look far for evidence that the mental health of children and adolescents has been entering a crisis in recent years, one exacerbated by the unusual conditions imposed by Covid-19.

The June 18 Morbidity and Mortality Weekly Report (MMWR) from the CDC reported:

During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7%.

Photo by Yasser Chalid/Getty Images

As noted in a recent Washington Post story, “Emergency departments have meanwhile become a tattered safety net for adolescent mental health care.”

In this month’s AJN, Betsy Todd summarizes some of the current issues seen by school nurses and other health care professionals like nurse practitioners (NPs), who often feel overwhelmed by the intensity of the suffering and need they are now seeing in many children.

Systems pushed to their limits.

Todd notes that existing systems are proving woefully inadequate to the growing need, with wait times increasing to see child psychiatrists, therapists, and other experts, and pediatric hospitals in several states reporting “sharp increases in ED visits for anxiety, […]

2021-09-03T12:37:10-04:00September 3rd, 2021|mental illness, Nursing, pediatrics|0 Comments
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If Nurses Aged in Reverse

“No—no!” shrieked my 95-year-old patient with dementia as I turned her to her side with the help of my nursing assistant (now called a patient care tech, 30 years later).

The three daughters sitting at her bedside inhaled deeply, their eyes wide. I looked over at them, calmly explaining that their mom was just frightened, and then in a soft voice said to my patient, “Don’t worry, Mrs. Smith, we won’t let you fall,” as she continued to scream. We positioned pillows against her back, and another between her knees. As we saw the family relax, and the patient’s screams turn to a barely audible whimper, I caressed her back and felt satisfied that all was well.

Fast-forward to my retirement. Having inherited my parents’ degenerative joint disease, at age 72 I have certain specific ways to sleep so that my left shoulder doesn’t hurt, my left hip bursitis doesn’t flare, and my right arm doesn’t get numb and tingly from a pillow that’s too puffy, causing hyperflexion of my cervical vertebrae.

Never assume what the patient’s feeling.

I have flashbacks from the days I thought I was an efficient nurse—I dread having someone, someday, assume that I am just frightened in their attempts to keep me on a turning schedule to prevent pressure ulcers. While […]

2021-08-30T14:19:59-04:00August 30th, 2021|patient experience, Patients|1 Comment
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Assessing the Post-Pandemic Future of Virtual Care

The following is a condensed version of an upcoming news article by Joan Zolot scheduled for AJN’s May edition.

Studies of safety and quality will determine the optimum use of this option.

Photo by Anna Shvets from Pexels

The use of telemedicine surged during the COVID-19 pandemic. Phone and videoconferencing limited patients’ exposure to the virus while maintaining their access to care. One estimate found that virtual care peaked at 42% of all ambulatory visits covered by commercial insurers in April 2020. The February 2 JAMA published several articles* addressing the safety, effectiveness, and quality of virtual consults and their future in health care.

Some obvious and potential benefits.

Because of its efficiency, virtual care has been shown to be particularly suitable for mental health consults, prescription refills, and straightforward evaluations. It can reduce patient inconveniences such as travel to appointments and lost work time. It can also enable patients to receive needed care sooner, especially those with limited mobility, caregiving responsibilities, or who live in remote areas. It may also have the potential to improve care coordination by enabling primary care clinicians and specialists to confer jointly with patients.

Risks, concerns, ongoing questions.

Because virtual medicine does not allow for physical examination, it’s inadequate for common clinical situations […]

2021-04-07T14:15:14-04:00April 7th, 2021|digital health, patient engagement, Patients, Public health, Technology|0 Comments
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Remembering the Polio Vaccine Rollout, Addressing Concerns Today

‘A Most Welcome Spring.’

That’s the title of the editorial in the recently published April issue of AJN. And if you receive the print issue or go to our Web site, www.ajnonline.com, I think you’ll see that our cover reflects an image that harkens to the end of a hard pandemic winter of isolation and—for many families—desolation. Spring has arrived, along with a feeling of hope that the vaccines will allow the world to open again, IF we can do so with caution and are successful in vaccine campaigns.

Remembering the relief at having a polio vaccine.

I was in kindergarten when Jonas Salk’s polio vaccine was rolled out. I remember my mother telling me that everyone was going to be getting a new medicine and I vividly recall my entire class lining up to get the injection from the school nurse.

I remember my mother being very happy about it because a boy in the neighborhood—a friend of my brother—had had polio and now wore leg braces and used crutches. When she saw him, she would sometimes say, “too bad the vaccine came too late for John.”

Nurses’ role in addressing vaccine concerns.

2021-04-26T11:50:12-04:00April 5th, 2021|COVID-19, infectious diseases, Nursing, patient engagement, Public health|0 Comments
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No Country for Old People

In my editorial in the March issue, I ask, “Where do we go from here?’” in thinking about what’s next for nursing. In particular, I wonder if we’re going to make any strides in improving the quality of how we care for older adults who need long-term care.

Disasters give rise to assessments of what went wrong.

After prior disasters like hurricanes, heat waves, and flooding, there has often been a flurry of initial concern, with many committees convened to look at the deaths that occurred.

More recently, the New York Times has reported on the fate of nursing home residents during the Covid-19 pandemic in relation to the deterioration of quality in nursing homes once they are owned by for-profit entities—as 70% of nursing homes now are. So here we are once again, this time decrying the conditions revealed by Covid-19. Will things change this time?

In answer to this question, I’m especially pleased with the article in our March issue by 22 nurse gerontology experts. They issue a call (a challenge?) for the Centers for Medicare and Medicaid Services (CMS) Coronavirus Commission for Safety and Quality in Nursing Homes to rewrite standards to finally address under-resourcing and ensure residents get the care […]

2021-03-15T15:33:48-04:00March 15th, 2021|COVID-19, nursing roles, patient safety, Patients|1 Comment
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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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