Are Your PCA Pumps Accurate, and Working?

Device malfunction happens.

After orthopedic surgery several years ago, I awoke in the PACU to find nurses working frantically on one side of my stretcher. Simultaneously, I realized that my leg hurt. A lot. And with another moment’s awareness—awake enough now for my nurse’s brain to begin to kick in—I understood that all of the activity concerned my PCA pump.

neeta lind/flickr creative commons

One of the nurses noticed that I was stirring. “Your pump has malfunctioned. We can’t get the replacement to work. A third pump is on the way. I’m so sorry!”

The scramble for a replacement, and then another, probably lasted less than five minutes, but it was a pretty wild ride. My deep breathing in an attempt to control the pain gave me something to focus on, but it was a pretty weak effort up against bone pain in the immediate post-op period. I’m grateful that my nurses—there were at least three involved at that point—regarded the pump failure as an emergency.

But operator errors are more common.

Needless to say, then, I was particularly interested in a new study that appears in this month’s AJN. In “Errors in Postoperative Administration of Intravenous Patient-Controlled Analgesia: A Retrospective Study,” Yoonyoung Lee and […]

2019-04-10T09:29:43-04:00April 10th, 2019|Nursing, nursing research, patient experience, Patients|0 Comments
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A Hidden History of Sexual Violence Can Complicate the Clinical Encounter

Long-term physical and psychological health effects.

illustration by hana cisarova for AJN

According to the Centers for Disease Control and Prevention, in the U.S., “one in three women and one in six men have experienced sexual violence involving physical contact at some point in their lives.” The report notes the high correlation between sexual violence and a range of adverse health effects like respiratory and gastrointestinal disease, chronic pain, and insomnia.

Not surprisingly, the terror of sexual violence is also correlated with post-traumatic stress disorder (PTSD) and its symptoms. These symptoms fall into four broad categories:

  • reexperiencing
  • hyperreactivity
  • avoidance
  • and negative emotions and thoughts about self or the world

Medical environments as triggers.

For survivors of sexual violence, medical environments can feel dehumanizing and present trauma reminders that intensify underlying post-traumatic stress. In addition, such environments can undermine protective routines and carefully delineated personal boundaries. Physical examination, being undressed, or receiving personal care can trigger powerful automatic fight–flight–freeze responses.

These responses may appear as physiological changes such as alterations in breathing and pulse, involuntary movements, or as hypervigilance, fear, anger, dissociation, withdrawal, or anxiety. Interventions like the insertion of a catheter or medications that decrease alertness or require suppositories can register subconsciously as threatening for someone who has survived […]

2019-01-23T15:58:50-05:00January 23rd, 2019|Nursing, patient experience|1 Comment
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A Black Nursing Professor’s Personal Calculus in Choosing a Birth Center

“I knew getting pregnant meant that regardless of my socioeconomic status or education, as a black woman I was more than three times as likely to die during labor or in the weeks afterward compared to my white counterparts.”

Recent news stories have drawn attention the dismaying medical experiences of black women during and after childbirth, with even celebrities like Serena Williams and others finding their concerns about potentially life-threatening symptoms going dangerously unheeded by nurses and physicians. The statistics about maternal death from pregnancy or childbirth complications among black women tell us that such stories aren’t isolated examples but part of a larger pattern.

Illustration by Annelisa Ochoa.

A thoughtful professor weighs her options.

All of which makes the personal story told by Sheria Robinson-Lane, an assistant professor of nursing at the University of Michigan, in this month’s Reflections essay (“Birthing by the Numbers“) particularly timely. And yes, nuanced. She knows the numbers and she knows the stories about communication issues experienced by black women with their providers. However, she’s also affiliated with a respected major medical center.

So when she gets pregnant with her second child at age 39, what’s her best course of action in deciding where to have her child? […]

2018-10-01T08:20:40-04:00October 1st, 2018|Nursing, nursing perspective, patient experience|0 Comments
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Quality of Life? Whatever the Patient Believes It Is

Illustration by Eric Collins / ecol-art.com

“What kind of life is that? That’s not how I would want to live.”

In AJN‘s September Reflections essay, “His Wonderful Life,” nurse Elizabeth Buckley interrogates her own judgmental response to a patient with a bluff, abrasive personality (he calls her ‘Nurse Ratchet during their first encounter) who requires nearly nonstop care to stay alive.

The patient has little hope of a meaningful recovery even if he survives the current hospitalization. The reader is surprised when, after a first grueling night of touch-and-go care, the author decides to take him on as her primary patient because she thinks it might be “a good learning opportunity.” (“I texted my friend who worked the day shift to sign me up; she replied that I was crazy.”)

A good life is in the eye of the beholder.

‘Philip,’ obese and with progressive dyspnea and multiple comorbidities, is sure he’ll soon be able to return to his bedbound existence at home watching old movies and chatting on Facebook; the physicians and other nurses are less hopeful. Gradually, over the course of five nights, the author’s respect and affection for the patient grows. He loves his life, however narrow it may seem to an outside observer.

2018-09-19T08:49:44-04:00September 19th, 2018|Nursing, patient experience, Patients, personal health practices|1 Comment
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Holding Space for Integrative Medicine in Oncology Care

When the patient distrusts the treatment.

Explaining why chemotherapy is indicated for their treatment to a newly diagnosed cancer patient is part of a day’s work for oncology nurses and physicians. Oncology nurse navigators are no exception—I am relied upon to reinforce patient education and answer questions.

While many patients come to us with the attitude “I’ll do whatever you say, let’s fight this cancer!” others present with a deep distrust of health care. Some of their distrust is justified, a result of corporate greed, Big Pharma, and federal regulations, coupled with misunderstandings of the treatment approval process of insurance companies. Depending on the intensity of these patient conversations, it sometimes feels as if we, the oncology team, are under attack, when it is our intent to help.

Despite good health habits, a cancer diagnosis.

Held / Julianna Paradisi / colored pencil and ink on watercolor paper 2018 – adapted from image author drew during cancer treatment

I was a pediatric intensive care nurse when I was diagnosed with breast cancer. My oncology experience was limited to monitoring young patients with a high risk of tumor lysis syndrome during induction of chemotherapy. The actual chemotherapy was administered by pediatric oncology–certified nurses who knew how to keep the […]

2018-07-02T13:26:59-04:00July 2nd, 2018|Nursing, nursing roles, patient experience, 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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