Off the Charts

Morphine in Hospice Care: Why Family Members May Resist Its Use

Underlying his concerns was a strong sense of moral responsibility. He was his mother’s protector. He was her voice. He had a duty to keep her safe…

Morphine’s essential place in hospice care.

When I began work in a hospice, I quickly came to see morphine as a wonder drug. It was used so much more effectively in palliative care than with the med-surg patients I had cared for in the hospital!

Morphine can be given via multiple routes, it’s easy to titrate, its side effects are well-known and therefore easy to manage, and it can bring dramatic pain relief as well as markedly improved breathing.

It was common for us to admit patients to hospice whose pain had never been controlled, and they were often dumbfounded at how easily their pain could be managed. The proper medical use of morphine was literally life changing for them.

Addressing family members’ concerns.

As a result of my hospice experience, I’ve always been a big believer in patient and family education to debunk myths and highlight the optimal uses of this drug. And yet education alone isn’t always what family members need when morphine is prescribed for their loved ones. Especially when the patient is at home and it’s a family member, not a nurse, managing […]

Betsy Todd, MPH, RN2019-11-12T15:36:45-05:00August 21st, 2019|family experience, patient experience|3 Comments

End-of-Life Conversations at the 11th Hour

Illustration by Gingermoth

A problem all too familiar to nurses.

How often have we nurses talked to friends, family members, or each other about the importance of making end-of-life decisions well before that decision becomes critical? We see so many deaths that come only after extended and often avoidable suffering, it’s all many of us can do to keep from grabbing a family member’s hand and whispering, “Let her go!” At home, our families are used to hearing us say again and again, “Do not let me die like that!”

If we work in a hospital, chances are that we are confronted over and over again with trying to help families make “11th hour” decisions that will affect how their loved ones die. How do we broach the subject, when time is so short?

Trust prepares the ground.

This month’s Reflections article, “Difficult Conversations,” isn’t a primer to walk us through these conversations, but it offers an example of how we can take our cue from events or changes in the patient’s condition to raise the topic of the inevitable. Author Vanessa Arroyo illustrates how, after we’ve developed a relationship with patient and family and earned their trust, it may become possible to ask the hard questions.

I […]

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Betsy Todd, MPH, RN2019-08-19T09:59:07-04:00August 19th, 2019|Nursing, nursing stories|1 Comment

Not Your Grandma’s Simulation Anymore

Photo © Melanie Stetson Freeman / Christian Science Monitor / The Image Works.

In 1958, after pulling his drowning son from water and clearing his airways, Norwegian doll manufacturer Asmund S. Laerdal was asked to develop a manikin to teach others how to perform mouth-to-mouth resuscitation. The doll became known as “Resusci Anne” or […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2019-08-19T11:45:30-04:00August 14th, 2019|Nursing, nursing students|0 Comments

A Roundup of Women’s Health Issues

Is it Women’s Health Month? Not according to the calendar. But as you browse through this month’s issue of AJN, you may indeed get the impression that we decided to focus on women’s health for the month of August.

This month’s Viewpoint, by Julie Michelle Haracz, “Making OTC Oral Contraceptives Available for All Women,” reminds us that “No woman should have to wait months for an appointment to see a physician, travel long distances, or pay more than she can afford to prevent an unintended pregnancy.” Haracz notes that oral contraceptives already are available over the counter in more than 100 other countries.

In the news: quick takes and closer looks.

Our August news section is filled with stories of particular importance to women. Our reporters cover the flurry of recent state laws that would significantly limit a women’s ability to obtain an abortion (all facing court challenges), an interesting UK study showing that a single dose of antibiotic after forceps-assisted or vacuum-assisted births reduced the incidence of infection, and sobering new CDC statistics suggesting that 60% of U.S. pregnancy-related deaths are preventable.

Did you know that suicide is the second-leading cause of death among young people in the U.S.? Sadly, the rate of suicide among girls ages 10 to 14 is rising, narrowing the gap between rates rates for boys and girls.

Some positives.

Betsy Todd, MPH, RN2019-08-12T10:32:32-04:00August 12th, 2019|Nursing, Public health, women's health|0 Comments

Obesity-Related Cancer in Women: What Nurses Need to Know

Have we in our overweight society been trying to ignore the mounting evidence connecting overweight and obesity with increased cancer risk?

If you’ve heard stories in the general media about the relationship between breast, colon, or other cancers with obesity but “were afraid to ask,” you’ll want to read “Obesity-Related Cancer in Women: A Clinical Review” in this month’s AJN.

Sobering evidence.

Author Anne Katz shares the evidence for an increased risk of certain cancers and cancer recurrence in women who are overweight or obese, focusing on the association between extra weight and cancers of the breast, endometrium, cervix, colon, and rectum.

“Over the past decade, the role that overweight and obesity play in cancer development, recurrence, and related mortality, particularly among women, has become increasingly clear… [and] gynecologic cancers are among those with the strongest evidence for the association with obesity.”

The specificity of the research regarding cancer recurrence, cancer-specific mortality, and fewer years of disease-free survival is sobering. Obesity also increases the risk of infection and other complications arising from cancer surgery, and can increase the toxicity of radiation therapy. […]

Betsy Todd, MPH, RN2019-08-05T08:42:49-04:00August 5th, 2019|Nursing|0 Comments