Acute Flaccid Myelitis: The Investigation Continues

The headlines of the past several weeks about kids with a polio-like illness have been pretty scary. The idea that a healthy child could suddenly be sidelined with extreme muscle weakness is a nightmare scenario for the parents of young children. While frustratingly little is known about acute flaccid myelitis (AFM), the good news is that it remains quite rare, affecting less than one in a million people in the U.S. each year.

According to the CDC, there have been a total of 404 confirmed cases of AFM in the U.S. since 2014, with a median age of eight years. The epidemiologic curve of cases indicates that the illness is seasonal, peaking in late summer and early fall. Oddly, the number of cases spiked in 2014, 2016, and 2018, while there were fewer cases during 2015 and 2017.

Signs and symptoms of AFM.

AFM often follows a respiratory illness or fever. Limb weakness (often unilateral) then occurs suddenly, progressing rapidly within hours or a few days. There may be facial muscle weakness, problems with eye movement, or speech or swallowing difficulties, but mental status generally is not affected. One death has been reported.

No clear cause.

Poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus are known to […]

2018-11-12T08:25:04-05:00November 12th, 2018|infectious diseases, Public health|0 Comments
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What Can Nurses Do to Influence Health in Their Communities?

What can I do as just one nurse?

As a nurse, I have often heard my colleagues question their ability to influence health in their communities. At times I have felt this same sentiment. What can I do as just one nurse?

Nurses have a unique perspective of how a community’s physical, social, and economic environment can affect patients’ health. And as we expand our understanding of what creates health, nurses have the opportunity to be a powerful voice when it comes to influencing the health of their communities.

Nightingale as precedent.

Nightingale in Scutari ward during Crimean War/Library of Congress

Nurses working to improve health through environmental modification is not new. The story of Florence Nightingale is well-known. As a nurse, Nightingale recognized changes needed to improve the health of soldiers in a hospital during the Crimean War, when more of the hospitalized soldiers were dying from the spread of infectious disease than from war-related injuries. Through her work with a group of nurses, she was able […]

2018-11-09T08:50:06-05:00November 9th, 2018|Nursing, nursing roles, Public health|3 Comments
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In Pediatrics, What’s the Best Way to Assess for Pressure Injury Risk?

The evolution of a scale.

In children, most hospital-acquired pressure injuries are related to medical devices rather than immobility. A device that can’t be repositioned, such as this cast, presents additional risk. Photo by Rafael Ben-Ari/Alamy Stock Photo.

Pressure injury prevention has always been a top nursing priority. Do you know about the latest tool for early identification of pediatric patients at risk for pressure injury?

The well-known Braden Scale, developed in 1987, was followed in 1996 by the Braden Q Scale for use in kids. Both were developed by nurses and are widely used around the world. However, the Braden Q Scale focused on immobility as a risk factor and wasn’t designed to address device-related pressure injuries, risks to children younger than three weeks of age or older than eight years, or children with congenital heart disease.

An update to include device-related risk in children.

So Sandy Quigley and Martha Curley, the nurses who modified Braden and Bergstrom’s original Braden Scale, set out to validate an updated version of their pediatric tool in order to address medical device use, a broader age range, and children born with heart disease. In “How to Predict Pediatric Pressure Injury Risk with the Braden QD Scale” in this month’s AJN, they explore the use of their Braden QD Scale (the D is for device related).

Quigley, Curley, and colleagues emphasize that while immobility-related pressure injuries in children have decreased significantly, “[in pediatrics] most hospital-acquired pressure injuries are associated […]

2018-11-07T10:32:44-05:00November 7th, 2018|Nursing|0 Comments
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Babies at the Border: Reflections on Nursing on Ellis Island

Immigrants at Ellis Island. Library of Congress.

For the past few years, the nation’s attention has been repeatedly drawn to “the immigration problem” on the southern borders of the United States. This past summer, images of babies screaming for their mothers as families were separated, and photos of teens and young children peering through chain-link fences—with foil blankets crumpled in the background—tugged at heartstrings. With recent fear-mongering about a caravan of refugees making their way through Mexico toward the United States, the issue is once again taking center stage.

A nation of immigrants.

With each image, my thoughts turn to our nation’s long history of regulating immigration. After all, we are a nation of immigrants. Many of our ancestors sought religious freedom, freedom from persecution, or economic opportunity in America. That history is replete with conflicting policies: from the exclusion of Chinese, prejudice against those of Irish and Italian descent, and the deportation of those who were seen as “unfit” physically or mentally to enter the country, to decrees from the president that all immigrants be treated with respect.

A history of working with immigrants ‘in a middle place.’

For over a century, nurses have worked with immigrants in “a middle place”—balancing the needs of newly arrived families with their […]

2018-11-02T10:17:29-04:00November 2nd, 2018|Nursing, nursing history, Public health|0 Comments
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ACA Opens Enrollment for 2019: What Patients Need to Know

Open enrollment in the Affordable Care Act (ACA) marketplace opened today, despite shortened deadlines, repeal of the individual mandate, stopping cost-sharing payments, and reduced outreach and marketing for the law. And with all the noise from political talking points adding to an already complicated process, your patients might be in need of a primer on what to do this year. Here are the basics:

Where to enroll

Some states have their own exchange, and some use the federal government’s. Patients can access www.healthcare.gov, www.cuidadodesalud.gov, find their state’s page here, or call (800) 318-2596 for more info.

When to enroll

Enrollment begins November 1 (except for in California, where it began in October). However, deadlines differ in some states. The deadline for most states this year is December 15. A handful (New York, California, Massachusetts, Minnesota, Colorado) have deadlines in January. Those who wait until January to enroll should be aware that their coverage will not start until February.

What about the individual mandate?

Included in the Republican-backed tax plan signed into law last year was a repeal of the individual mandate penalty for individuals who choose not to get insurance. For the coming year, this repeal will be in effect in almost all states (Massachusetts, New Jersey, and the District of Columbia will […]

2018-11-01T13:45:23-04:00November 1st, 2018|Patients, 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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