In Colorado EDs, ‘Alternative to Opioids’ Pilot Project Exceeds Goals

Ashley Copeland talks to her mother in the Swedish Medical Center ED. Copeland was treated for a severe headache with a nerve-blocking anesthetic, but no opioids. (John Daley/CPR News)

Last year, in an effort to address the state’s acute opioid abuse problem, several Colorado health care organizations—including the Colorado Emergency Nurses Association—worked together on an intervention to target patients admitted to the ED with pain. The plan? Implement a pain management program to promote alternative strategies, with a goal of decreasing opioid usage by 15% in the participating EDs.

As discussed in a June news article, the program, which was piloted in 10 hospitals and involved heavy involvement from nurses, surpassed its goal: opioid usage during the intervention period (as measured in morphine equivalent units) was 36% less than in the previous year.

The […]

2018-06-14T09:29:35-04:00June 14th, 2018|Nursing, patient experience|1 Comment
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Who’s Listening to Hospitalized Patients with Hearing Impairment?

In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of his intact […]

2018-06-12T12:53:06-04:00June 12th, 2018|Nursing, nursing research, patient experience|1 Comment
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Is It Time to Relax Food Restrictions on Women in Labor?

Three years ago, I went into labor in the middle of the night, 10 days before my expected due date. Things ramped up fast, and by the time I got to the hospital an hour later, I was almost ready to have the baby. However, when my son’s heart rate suddenly dropped and wouldn’t recover with medication, I was told I had to have an emergency C-section immediately.

As I hadn’t planned on surgery, or labor, that night, I had eaten a full three-course meal earlier in the evening. The nurses asked me if I had eaten, and I had to admit yes, and then some! I did feel nauseous as the procedure began, but luckily the wonderful anesthesiologist quickly helped, when I told him how I felt, with some miracle medication in my IV. The surgery proceeded without incident.

Nil by mouth? New research questions a tradition.

It was with interest, then, that I read AJN’s March original research CE feature, “An Investigation into the Safety of Oral Intake During Labor.” In this article, the authors compared maternal and neonatal outcomes among laboring women permitted ad lib oral intake with those permitted nothing by mouth except for ice chips. Restriction of oral intake in laboring women has traditionally been, as AJN’s editor-in-chief […]

2018-03-02T08:27:46-05:00March 2nd, 2018|nursing research, patient experience|1 Comment
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Simple Intervention Decreases Oral Mucositis from Head and Neck Cancer Treatment

A painful effect of cancer treatment.

Nurse Cindy Dawson provides patient education on oral care kit used in a nurse-led intervention to reduce oral mucositis severity in adults treated for head and neck cancer. Photo courtesy of Kay Klein.

Years ago, when I worked with patients being treated for head and neck cancer who had been admitted for one reason or another, I felt helpless in the face of their extremely uncomfortable oral mucositis. None of our topical concoctions seemed to bring much relief to these patients, who had often endured disfiguring surgery as well.

While there is as yet no perfect solution to this uncomfortable side effect from the radiation or chemotherapy used to treat head and neck cancers, a group of oncology staff nurses and their colleagues have demonstrated that a consistent, standardized approach to oral care for these patients may significantly alleviate the pain of this almost universal treatment effect.

Consistent, standardized oral care.

After reviewing the literature on oral care, Cullen and colleagues enhanced their usual patient teaching with […]

2018-01-12T09:13:13-05:00January 12th, 2018|Nursing, nursing research, patient experience|1 Comment
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Comforting Our Patients: The Importance of Well-Chosen Words

‘What I Said,’ ink and crayon on paper, Julianna Paradisi 2018

Nurses and writers understand the importance of well-chosen words. Precision of language is important for both. But nurses learn the emotional impact of words, wisely or poorly chosen, on the job, directly from our patients. There’s seldom an opportunity to edit or revise on the floor of a nursing unit. Words cannot be unsaid.

As an oncology nurse navigator, my nursing practice is almost entirely based on words. My stethoscope, which rarely left my body when I was a PICU nurse, now rests coiled like a snake in a basket, nestled among the art supplies I used to illustrate this post.

Since patients rate my nursing skills by my words, the ability to pass the ‘bs test’ is more important than ever before in my career. As a navigator, I have impressed a patient or two (and helped them get proper care) by recognizing over the phone that the symptoms they described were cardiac related and not the side effects of cancer treatment. But for the most part, words are the tool I rely on to prove my value.

It’s the nature of nurses to want to comfort our […]

2018-01-09T10:09:34-05:00January 9th, 2018|Nursing, nursing roles, patient experience|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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