Even in an Unimaginable Crisis, Nature Heals

“Eleven-year-old Olivia’s parents were ‘done,’ had reached their limit of bad news, and refused to enter the conference room. They didn’t want more information or what they perceived as pressure to withdraw life support.”

The hardest decision.

by Janet Hamlin for AJN

These words in the opening paragraph of this month’s Reflections column,”Little Sparrow,” describe a situation that will be instantly recognizable to many nurses, especially those who regularly work with people who have suffered severe head injuries or other central nervous system trauma. These two short sentences encapsulate the terrible crisis that develops when a tragic outcome seems inevitable to staff—while family members, in shock, struggle to absorb information and make decisions.

A healing garden.

In the essay, which will be free until February 20, Elaine Meyer, PhD, RN, describes her approach to one such family. While the parents of the seriously injured young girl pray for a miracle, staff are distressed because they feel they are inflicting unnecessary suffering on the child. […]

2019-02-05T08:19:55-05:00February 5th, 2019|family, Nursing, nursing stories|1 Comment
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Hodgkin Lymphoma: Knowing the Long-Term Treatment Effects

Most nurses will likely encounter a Hodgkin lymphoma (HL) survivor at some point, but will they know what to assess for?

‘Hodgkin’s is the good one to get.’

When I was going to graduate school, I worked part-time for a hematologist who mostly treated people with leukemias and lymphomas. Many of them had Hodgkin lymphoma (though we called it Hodgkin’s disease then). I administered chemotherapy, did a lot of patient teaching and a lot of listening and answering questions for this largely young group of patients. Most were close to my own age; it was easy to relate to their shock at finding out they had a life-threatening disease and that the treatment would not be easy.

I especially recall two young women—one had gone to her physician for a pre-marriage physical; the other went for a check-up because she felt she wasn’t “bouncing back” from the birth of her daughter three months previously. They were distraught at the diagnosis, and as they went through chemotherapy, they were often depressed over the side effects from the drugs: hair loss, GI upset, and fatigue.

But both of them did well. I remember the physician telling them his standard line, “If you had to get cancer, Hodgkin’s is the good one to get,” since it was often curable […]

2019-02-01T13:09:38-05:00February 1st, 2019|Nursing|0 Comments
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Being a Bully and Being Bullied

‘Didn’t you learn that in school?’

Have you ever worked with a nasty colleague who knew everything? A nurse that the patients loved and showered with thank you cards and notes but was despised by coworkers? Unfortunately, I knew that person all too well. That bully nurse was me. It’s been nearly ten years since I received a wake-up call from another nurse and my then health care organization, making clear that I needed to change or risk heading further down a destructive path.

A few years into my nursing career—I can now admit—I thought I knew everything; the operative word here is thought. ‘Mary,’ a good colleague and still a friend today, would tell me, “I like you. I just can’t stand working with you.”

A kind person, Mary would never elaborate on my faults. In hindsight, it’s obvious to me what Mary was referring to. I could smell the blood of weaker individuals in the clinical setting and I was deliberately inconsiderate. I never raised my voice, but could be curt and make snide remarks: “Why are you bothering me now?” “Didn’t you learn that in school?”

None of the people I bullied stood up to me, so I continued. I really don’t fully understand it today. Was I power hungry? Possibly. Whatever the case, this way […]

2019-01-30T14:36:02-05:00January 30th, 2019|Nursing, nursing career|1 Comment
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February Issue: Caring for Hodgkin Lymphoma Survivors, Acute Flaccid Myelitis, Reducing Hospital-Acquired Pneumonia, More

“I experienced the inestimable value of a healing garden . . . Regardless of diagnosis, age, circumstances, or ability to pay, nature willingly extends her gifts and does not forsake us.”—Elaine C. Meyer, author of the February Reflections column

The February issue of AJN is now live. Here are some highlights.

CE: Original Research: Midlife Hypertension and Hypercholesterolemia in Relation to Cognitive Function Later in Life in Black Women

In light of a lack of research on the associations between vascular risk factors and cognitive function in black older adults, the authors explored the relationship between two such risk factors in midlife—hypertension and hypercholesterolemia—and cognitive function later in life among black women.

CE: Caring for Survivors of Hodgkin Lymphoma

This article—winner of the 2018 Nurse Faculty Scholars/AJN Mentored Writing Award—provides an overview of Hodgkin lymphoma, the most common late effects of treatment, and current recommendations for survivor surveillance and screening.

Cultivating Quality: A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia

The authors describe a quality improvement initiative to implement an oral care protocol in the adult in-patient care areas of a level 1 trauma hospital and evaluate its impact on the incidence of hospital-acquired pneumonia.

2019-01-25T09:58:43-05:00January 25th, 2019|Nursing|1 Comment
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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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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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