Safety vs. Independence: When Is a Person Too Old to Drive?

I’d venture that many of us have had family discussions about whether it’s safe for a grandparent or elderly aunt or uncle to be driving. Driving is often the last vestige of independence and one that is fiercely held onto.

I had an aunt and uncle who worked out a unique and very shaky scheme so they could still get around independently: he couldn’t drive because of severely diminished eyesight, but he would direct his wife, my aunt, who had early Alzheimer’s, as she drove. Between the two of them, they could get to grocery stores, church, medical appointments, and bingo.

And one colleague, to prevent her father from driving after multiple accidents, told him she needed the car to get to work; in reality, she just drove it a few blocks from the house and parked it.

While author Loren Staplin and his colleagues note in ”Can Your Older Patients Drive Safely?” that “decline in driving abilities is related to functional status, not chronological age,” they also observe that the “greater risk associated with driving at age 75 and older is . . . evident in these drivers’ greater level of involvement in fatal motor vehicle accidents relative to their representation in the licensed driver population.” […]

2017-09-13T09:26:54-04:00September 13th, 2017|Public health|1 Comment
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The Health Impacts of Hurricane Harvey—What Nurses Need to Know

Geocolor imagery of Hurricane Harvey on verge of making landfall. Image created by the Cooperative Institute for Research in the Atmosphere.

As Hurricane Harvey, now a tropical storm, continues to affect a large area of southern Texas and other parts of the South, the full impact on human health has yet to be determined. But it’s clear the flooding has caused a historical crisis in Houston and surrounding areas—and that nurses and other health professionals will be in great demand in the coming days, weeks, and months.

Short- and Long-Term Health Concerns

The short- and long-term health consequences people are facing as they escape rising water levels are detailed in the Washington Post. Although drowning is the most immediate and dangerous threat during a flood, those seeking safety are also endangered by sharp objects and even wild animals caught up in floodwaters. Mold and its impact on human health will be a concern in the coming weeks and months, as water-damaged buildings are reoccupied.

In the meantime, health authorities are worried about the spread of infectious diseases. As sewage contaminates the floodwaters and people […]

2017-08-30T10:32:03-04:00August 30th, 2017|climate change, environmental health, Nursing, Public health|0 Comments
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Tuberculosis: Nurses Play Critical Role in Prevention, Diagnosis, Treatment

Mantoux skin test/CDC PHIL

In the U.S., the chances are that tuberculosis isn’t on your mind a lot. Most of us focus on TB only when we have a patient on airborne precautions—or when we’ve been exposed to TB at work.

Globally, TB was one of the top 10 causes of death in 2015. In the U.S., after a spike in cases early in the HIV epidemic, the incidence of TB has fallen to about three cases per 100,000 people. In TB-endemic countries, incidence rates run into hundreds per 100,000. But with TB elimination defined as a rate of less than one case per million people, we are far from eradicating this disease in the U.S. In fact, the number of TB cases in the U.S. rose slightly from 2014 to 2015.

Also, of course, nurses often work with people who are at high risk of acquiring TB—transplant recipients, others who are immunocompromised, people with HIV or certain cancers, those who are refugees or homeless—increasing our own risk for the disease as well. Therefore, the low overall U.S. incidence rate doesn’t reflect the experience (or risk) of most nurses. (And if you are “PPD positive,” click here for some reminders about what that should mean to you as a nurse: “Nurses and Latent TB Infection.”) […]

2017-08-18T08:58:20-04:00August 18th, 2017|infectious diseases, Nursing, Public health|2 Comments
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Antibiotic Stewardship: Inherent to Good Nursing Practice

neutrophil interacting with two pink-colored multidrug-resistant Klebsiella pneumoniae bacteria

Although most nurses are aware of the urgent problem of antibiotic overuse in hospitals, some may be unfamiliar with terms like “antibiotic stewardship.” This is partly because few nurses besides those working as infection control preventionists have had a formal role in stewardship programs, explain authors Rita D. Olans, Richard N. Olans, and David J. Witt in “Good Nursing Is Good Antibiotic Stewardship,” which appears in this month’s issue as a Special Feature. In the article, the authors detail how bedside nurses are vital to the success of these efforts.

What Is Antibiotic Stewardship?

Antibiotic stewardship programs offer a formal approach to addressing the current crisis, in which an increasing number of organisms are developing resistance to antimicrobial medications. In the absence of new drugs, stewardship programs have been established to improve the way currently available antibiotics are used in hospitals. These programs aim to:

  • optimize antibiotic therapy.
  • shorten the duration of use of broad-spectrum antibiotics.
  • reduce the number of adverse events.

According to the authors, “because nurses are not typically prescribers of antibiotics, they often don’t see themselves as participants in antimicrobial stewardship programs.” Yet, even though they may not know it, “staff nurses are already performing many […]

2017-08-02T11:36:27-04:00August 2nd, 2017|Nursing, Public health|1 Comment
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Why Do Pregnant Women Smoke?

 “My mother smoked [when she was pregnant] with me and I am fine.”

“I’d rather smoke a cigarette than take a drink of alcohol to relieve stress.”

“So you’re bored, what are you going to do? Sit down and smoke a cigarette.”

“It relaxes me.”

Tobacco use during pregnancy has been associated with many adverse effects, including abruptio placentae, fetal malpresentation, low Apgar scores, stillbirth, and birth defects such as gastroschisis and cleft lip or palate. Most nurses probably see these as no-brainer reasons for women to stop smoking once they become pregnant. Yet a new research study illustrates that the reasons pregnant women might continue to smoke are very individual, and that clinicians are not always skillful in supporting smoking cessation.

In this month’s AJN, researcher Geraldine Rose Britton and colleagues share the results of their qualitative study on the experiences of pregnant smokers and their health care providers. The researchers used a focus group methodology to learn about the smokers’ experiences and to better understand what motivated them to quit or prevented them from doing so.  There were also separate clinician focus groups to explore the approach of the 45 providers (71% RNs, 11% physicians, plus one NP, one nurse manager, four LPNs, and one PA) to pregnant women who smoke.

Not surprisingly, the researchers discovered that the issue is frustrating to both pregnant women and their maternity care providers. Some physicians and […]

2017-06-21T06:42:46-04:00June 21st, 2017|Nursing, personal health practices, Public health|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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