Losses: In Search of an Honest Prognosis

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Several years ago I took care of a lady who’d suffered a small cerebral hemorrhage after falling and hitting her head. She was in the ICU for several days. Her husband stayed at her side constantly, and he became a part of a never-ending loop in which she would wake up startled to be in a hospital, and then notice her husband and ask him where she was and what had happened.  He’d hold her hand and gently relay the events of her injury, after which she’d react with mild surprise, every single time. Then she’d close her eyes and doze until she woke up to reinitiate the same conversation.

Her husband, after days of patiently playing his role in this repetitive scene, was clearly wearing down. He waited anxiously for the neurosurgeon, expecting explanations and hoping for reassurance.

When the neurosurgeon rounded later that day I heard him speak at great length about the details of her injury and the treatment plan. He ultimately advised that, although he thought she’d recover well, only time would tell.

Her husband wanted more […]

2016-11-21T13:10:27-05:00March 19th, 2012|patient engagement|1 Comment
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The Elusive Strict Diet

By Amy M. Collins, associate editor

Several days ago, we linked on our Facebook page to an abstract of a JAMA article that found that women hospitalized for myocardial infarction were more likely than men to present without chest pain. A few days later, my 59-year-old mother was told by her general practitioner that her ECG had shown an electric “blip” that could be due to scarring from an unnoticed heart attack. My mother—always too lax about these things (unlike her hypochondriac daughter)—calmly told me she always has random chest pains and it could have happened at any time.

A visit to the cardiologist a few days later eased our fears. She hadn’t had a heart attack, but was diagnosed with right bundle branch block and has to undergo further testing. With high C-reactive protein levels, elevated cholesterol, and a history of heart disease in the family, one can’t be too careful. A stress test and cardiac ultrasound have been ordered.

In discussing her cholesterol level, which had increased since my mother’s last wellness exam, the cardiologist suggested she start taking statins. Not keen on medication, and worried by recent reports of adverse effects from these drugs, she said she’d rather only start with that if there were no other options. His suggestion […]

2016-11-21T13:10:30-05:00March 14th, 2012|patient engagement, personal health practices, Public health|4 Comments
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‘Like an Origami Swan’ – Remembering Tea with Miss Elsie

“Hello,” I said. “I’m the nurse. I’m here to see Miss Elsie.”

“I know,” he answered, grabbing my wrist and pulling me inside.

The heat of the cramped house slammed into my face. The windows were closed and the shades pulled down. Without a word, my little escort guided me down a narrow hallway into a room not much bigger than a closet, then deftly released my wrist and slipped out of sight.

So starts “Tea With Miss Elsie,” by Claire Schuster, MSN, RN, APRN-BC, CWS, associate professor emerita in the nursing program at Berea College, Berea, Kentucky. The Reflections essay in the March issue of AJN is a subtle, quiet portrait of a moment and the gesture at its heart, and it’s well worth a read. (For the most appealing version, click through to the PDF version link in the upper right of the landing page.)—JM, senior editor  

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2016-11-21T13:10:32-05:00March 8th, 2012|Nursing, patient engagement|0 Comments
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Are You Ever Justified in Deceiving a Patient?

A patient’s irrational refusal to take medication can be frustrating for the nurse. Crushing the pill into applesauce or ice cream saves time and effort, and spares the patient the aggravation of quarreling. But while hiding medication is sometimes ethically justified, often it is not.

That’s the start of the “Putting the Meds in the Applesauce,” an article (free for March) by nurse ethicist Douglas Olsen in the current issue of AJN. Olsen notes that studies suggest hiding medications in food may be a relatively common practice, considers the ethical principles at play in such a decision, and offers advice for those who may be considering it. (Added: The column chiefly concerns the nursing care of cognitively impaired patients—not those who simply don’t want medications or those with with psychiatric illnesses who may be endangering themselves or others by refusing medication.)

Says Olsen, “[t]wo factors must be considered in determining whether hiding medication is justified or not: the nurse–patient relationship and the patient’s rights.” He adds that such a decision “requires the nurse and surrogate decision maker to imagine how the patient might have reasoned: would the earlier, cognitively intact patient have agreed that, given the present impairment, the providers shouldn’t be morally bound to accept the patient’s decision to decline medication?”

Another question he suggests asking oneself is this: “could the deception survive public scrutiny, including that of professional peers?”

What’s your take? What’s your experience?—JM, senior editor

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2016-11-21T13:10:34-05:00March 1st, 2012|Ethics, Nursing, patient engagement|3 Comments
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The Cruel Irony of Alzheimer’s Disease

By Amy M. Collins, associate editor

As I watch my grandmother navigate the murky waters of her Alzheimer’s disease, it continues to surprise me that parts of her brain work at warp speed, while other parts seem to be completely defunct. For example, although she can’t remember what she’s done from one minute to the next, she can make up a lie to compensate for the memory loss in less than 30 seconds.

“Where did you get that new necklace, Grandma?” I recently asked at a family party. “Oh I bought it at the place where I work, you know, I type at a school,” she said, with certainty. Or when asked where she got a new sweater, she told my mother she went to the store. “How did you get there?” my mother asked. “I drove,” she said. “But you don’t have a car.” “Oh, well then I must have walked.”

She no longer remembers my name unless prodded, but she does remember that she has a cat in her room at the independent living center, and worries about it constantly. “I have to get back to take care of my cat,” she says when she visits us, becoming increasingly stressed the longer she’s away. Yet it’s hard for her to […]

2016-11-21T13:10:47-05:00February 6th, 2012|patient engagement, Patients|7 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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