The Role of Prevention and Standardized Care in Improving CKD Outcomes

Slowing Chronic Kidney Disease Progression

Most nurses have worked with patients with chronic kidney disease (CKD). Their condition may have been related to diabetes, high blood pressure, an acute infection, or other assaults on the kidney. I’ve tended to see a diagnosis of CKD as the beginning of an inevitable decline. Certainly, “prevention” didn’t seem a relevant concept at this point; my role was to assess and monitor, teach and support, and hope for the best.

Fig. 1. The Nephron. Blood flows into the nephron through the glomerulus. Filtrate from the glomerulus flows into Bowman’s capsule, then through the proximal tubule, the loop of Henle, and the distal tubule, a series of tubules that modifies the filtrate primarily by reabsorbing […]

2017-03-14T12:02:17-04:00February 15th, 2017|Nursing, Public health|0 Comments
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Culture as a Key to Health

By Beth Toner, MJ, RN, senior communications officer, Robert Wood Johnson Foundation

(Video caption: The Dakota are a horse tribe, and Charley, a retired reservation policeman, takes care of abandoned horses, connecting them to the tribe’s youth to help the young redefine themselves in relation to tribal history. Video used by permission; produced by Purple States LLC with support from the Robert Wood Johnson Foundation.)

I consider myself, and have been told by others that I am, an extraordinarily patient person—except behind the wheel of a car.

I commute 80 miles each way to work (that’s how much I love my job), so I spend a lot of time in the car. That, in turn, means I get annoyed—unreasonably so—by folks who are driving in such a way that forces me to spend a minute longer than I need to in that car. Now, it never leads to dangerous or aggressive driving, but it does lead to a lot of windows-up ranting while I’m on the road. One day, while I was in mid-rant, my 21-year-old daughter finally said, “Mom, you need to imagine other people complexly.”

I think of that conversation often as I listen to the polarizing dialogue that continues across our nation. What if, across the nation, we each imagined other people complexly, not just as their culture, their gender, their political party, their favorite television show? People, with all their joys and sorrows, their best qualities and their deepest flaws—uniquely themselves, yet with so much […]

2017-02-02T10:33:44-05:00February 1st, 2017|Nursing, Public health|1 Comment
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A Public Health Nurse at the Intersection of Birth and Death

by Lisa Dietrich for AJN/ all rights reserved

The January Reflections essay in AJN is called “Touching Death, Touching Life.” The author, Yaffa Vinikoor, is a public health nurse who describes a patient she refers to as Sidney. Over time, she’s come to know the worn furniture of Sidney’s small apartment and the details of his life, such as Arnold, his paid caretaker, and Sidney’s younger wife, who lives separately. Sid has dementia and several other conditions and is in decline. “Sid,” she writes “usually lay slanted, like he’d been haphazardly dropped onto the enormous mattress, hair askew and face contorted.”

The essay explores what it’s like to be pregnant while doing such work. Vinikoor’s situation that summer puts her in relation to two very different currents:

I continued to do my work in the city as a public health nurse with the chronically ill homebound up until the day I went into labor. . . . I continued to walk miles per day, the nursing supplies in my backpack bowing my back and the baby in my belly guiding me forward . . . . As I cared for those whose lives were in steady decline, I thought about what giving birth to new life would […]

2017-01-27T10:31:16-05:00January 27th, 2017|Nursing, nursing stories, Public health|2 Comments
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School Recess as a Matter of Public Health

A friend who teaches first grade finds her principal’s recess policy maddening. The children are allowed almost no recess, and some teachers have resorted to “sneaking” their classes outside when the principal is off-site. “The children have no rights,” my friend says. She adds that when they haven’t been able to run and play, “teaching is a waste” because the kids can’t focus.

The U.S. Department of Health and Human Services recommends a minimum of 60 minutes of daily physical activity for children and adolescents, and the American Academy of Pediatrics describes recess as “crucial.” Yet many schools continue to prioritize academics over physical health. In this month’s AJN Reports, author Carol Potera explores the connection between the decline in physical activity in schools and the increase in childhood obesity and describes the ways in which some schools are trying to reverse these trends. […]

2017-01-24T15:55:08-05:00January 25th, 2017|Nursing, Public health|3 Comments
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Top Nursing, Policy, Clinical Stories of 2016

Crowd members hold candles during a vigil for the victims of a mass shooting at the Pulse nightclub in Orlando, Florida. Photo © Associated Press

Late last year, we asked our editorial board members and contributing editors to tell us what they thought were the most important health news stories of 2016. In our January article “The Year in Review 2016,” we take a closer look at three of their most-mentioned topics: the Affordable Care Act (ACA), opioid misuse, and Zika virus.

What other issues stood out last year in specific areas of health care? We compiled top news story roundups for several categories—here’s an overview (click the links below to read the full articles):

Health Care Policy

  • Gun violence
  • Access to care: LGBT health, migrants, mental health care, medication costs, rural health care

Nursing

  • Workplace stress: 12-hour shifts, EHRs, evidence-based practice, staffing
  • Nursing education: increased access, faculty shortage, expanded simulation, improved employment prospects
  • Care delivery barriers: care for veterans, nurses’ practice authority

Clinical News

  • Sepsis awareness
  • Maternal mortality
  • Patient engagement
  • Population health trends

Finally, see “Stories to Watch in 2017” for a discussion of a few health topics, aside from the fate of the ACA, that we expect to hear more about this year.

2017-01-23T13:27:37-05:00January 23rd, 2017|Nursing, Public health|0 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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