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. 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 […]

2016-11-21T13:03:43-05:00October 22nd, 2014|narratives, Nursing, nursing perspective, patient engagement, Patients|4 Comments
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Resisting the Rising Tide of Parkinson’s

By Barbara Hranilovich. All rights reserved. By Barbara Hranilovich. All rights reserved.

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.

Illustration by Barbara Hranilovich; all rights reserved.

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2016-11-21T13:03:45-05:00October 13th, 2014|patient engagement, patient experience, Patients|1 Comment
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End-of-Life Discussions and the Uneasy Role of Nurses

Amanda Anderson, BSN, RN, CCRN, is a critical care nurse in New York City and enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She is currently doing a graduate placement at AJN two days a week, working on a variety of projects. Her personal blog is called This Nurse Wonders.

Evelyn Simak/ via Wikimedia Commons Evelyn Simak/ via Wikimedia Commons

Nurse and writer Theresa Brown wrote a piece for this past Sunday’s New York Times on the dilemmas physicians face when their patients want to stop aggressive treatment (the latest installment of Brown’s quarterly column, What I’m Reading, is in the September issue of AJN [paywall]).

Brown’s Times column talks about physicians who have trouble letting patients go and instead push for more unnecessary and often unwanted treatment. She describes a case in which—after palliative care has been decided upon by the patient’s family members, the palliative care team, and even the heartbroken oncologist—the patient’s primary care physician intervenes and pushes for still more futile treatment. (Much of the article delves into the broader issue of palliative care and the benefits it has for patients in many stages of chronic illness.)

Have you ever disagreed […]

2016-11-21T13:03:57-05:00September 11th, 2014|career, Ethics, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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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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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 […]

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