How a Patient’s Family Heals a Nurse in this Era of Medicine

“This family’s brave, selfless, and clear-minded approach to their daughter’s last days showed me that it is still possible for me and my colleagues to heal in the ways we want to heal, hurt in the ways we accept we will hurt, and not harm in ways we never, ever intended to harm.”

A painful contradiction of pediatric ICU nursing.

One of the things that feels most unfair about pediatric ICU nursing is that with critically ill children, you don’t get the comfort of being able to look back and say, “At least they lived a long and happy life.” You ache that a baby, a toddler, a school-age child, a teenager was supposed to have their whole life ahead. But instead, much of their short life was marked by illness, prods and pokes, lines and tubes, sedation rather than play, a sterile environment full of strangers at all hours rather than a home full of time with friends and family.

The deep desire in both the parents as well as the health care providers to do anything possible to give them a shot at a future is in and of itself right and good. Yet the decision about how much to push both medicine, and the child as the obligatory recipient, in the fight for a future that is neither guaranteed in quantity nor quality can often be wrought with controversy and ethical distress. Clinicians do not necessarily find peace with their work just because a life was physically saved; sometimes quite […]

2018-08-01T10:47:19-04:00August 1st, 2018|Nursing|0 Comments

The 2018 ANA Membership Assembly: Making True Dialogue a Reality

By Katheren Koehn, MA, RN, FAAN, executive director of the Minnesota Organization of Registered Nurses (MNORN) and a member of AJN‘s editorial board.

I have been a member of the American Nurses Association (ANA) for over 40 years, an active member for about 35 years. I “grew up” in the association as a delegate to the House of Delegates. I learned to “edit on the fly” by debating perhaps hundreds of resolutions introduced by state nurses associations at the annual, then biannual meetings of the highest level of governance of ANA.

Debating resolutions.

Resolutions had a formal structure of “whereas” and “be it resolved.” Whereases contained the facts; the be-it-resolved contained the actions delegates wanted the ANA to enact. Whereases could not be edited or debated; be-it-resolveds could be edited and debated for hours, or until someone remembered to use the Robert’s Rule “Call the Question.” Debate over resolutions had more to do with proving your point than listening to another’s point of view. It was great theater, but I don’t know how often those resolutions moved our profession forward. I’m sure some of them did, but I remember the debate more than the resolution.

Making the ANA governing body a membership assembly.

When the 2012 ANA House of Delegates voted to change the governing body of […]

2018-07-30T08:49:53-04:00July 30th, 2018|Nursing|0 Comments

August Issue: Pain in Nonverbal Children, Sepsis Update, Particulate Matter Exposure, More

“I didn’t really know what to do . . . . This happened to other people’s families, not mine. I was supposed to be reading the monitors and titrating the drips. I was supposed to be taking care of the patient. I was supposed to be comforting the family. I was the nurse.” —Tonja Padgett, author of this month’s Reflections essay, “The Crazy Aunt or the Nurse

The August issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: Original Research: Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study

Children with medically complex conditions often experience pain, but in the absence of self-report, assessing pain can be challenging. The authors of this article sought to describe the signs and symptoms parents of such children find worrisome, the sources of pain in these children, and how to best assess their pain.

CE: A Review of the Revised Sepsis Care Bundles

An update on recent revisions to the sepsis care guidelines, including development of the new one-hour bundle, plus screening and assessment tools to identify sepsis in the ICU, in the ED, on the medical–surgical unit, and outside the hospital.

Environments and Health: Nursing Practice and Particulate Matter Exposure

Both indoor and outdoor particulate matter […]

2018-07-27T09:18:49-04:00July 27th, 2018|Nursing|0 Comments

Got Ethics?

Photo © Getty Images

We’ve published articles on all sorts of champion programs developed for various hospital initiatives. Central to these creative models (which address problems in areas like pain, mobility, elder care, and skin care, for example) is enlisting nurses to become knowledgeable about a key subject so that each patient care unit can have its own readily available resource, or “champion.”

Ethics champions programs at three hospitals.

In our July issue, we present “Ethics Champion Programs” (free to access until August 1), which describes how three pediatric hospitals—Children’s Mercy Kansas City, Children’s Hospital Colorado, and Children’s Healthcare of Atlanta—have implemented such programs to ensure that nurses have access to resources to address ethical issues. These resources include ethics rounds, monthly forums, education sessions, and unit-based and family consultations. While each program has unique components, the common goals of all three are to create a safe space for discussing ethical issues, to address moral distress, and to cultivate a climate of ethical practice.

To me, there seems to be no more important issue than ensuring ethical practice. As nurses, we face many instances in which we may question our interventions or find ourselves at odds with colleagues over treatment decisions, or in the midst of family angst over such decisions. These […]

Instructor Incivility Toward Nursing Students

“An anxious student is practicing Foley catheter insertion on a manikin in the nursing skills laboratory. The instructor rolls her eyes as the student nervously fumbles and breaks sterility.”

A less well known type of incivility.

Incivility and bullying in health care have been much discussed in recent years, as they should be. In this month’s issue, Linda Koharchik focuses on a less well known manifestation of this problem:  instructor incivility toward nursing students. This kind of vertical violence can be particularly distressing, given the fact that nursing instructors function as de facto gatekeepers for entry into practice. Student nurses can’t simply refuse to deal with them.

Eye rolling, reprimands within earshot of classmates, criticism of the student in front of the patient, and even frank bullying and intimidation are examples of instructor behaviors that some students have to cope with. It’s not hard to imagine what this kind of anxiety-provoking “guidance” can do to a student’s performance, leading to yet more abuse from the instructor.

Merely a rite of passage?

Koharchik notes that some authors have suggested that dealing with incivility is a “rite of passage” for students, one that will help them better cope with the challenges of their chosen work. But nursing students are already exposed to plenty of stress during their training, especially when […]

2018-07-23T09:15:34-04:00July 23rd, 2018|Nursing|0 Comments
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