Off the Charts

Holding Space for Integrative Medicine in Oncology Care

When the patient distrusts the treatment.

Explaining why chemotherapy is indicated for their treatment to a newly diagnosed cancer patient is part of a day’s work for oncology nurses and physicians. Oncology nurse navigators are no exception—I am relied upon to reinforce patient education and answer questions.

While many patients come to us with the attitude “I’ll do whatever you say, let’s fight this cancer!” others present with a deep distrust of health care. Some of their distrust is justified, a result of corporate greed, Big Pharma, and federal regulations, coupled with misunderstandings of the treatment approval process of insurance companies. Depending on the intensity of these patient conversations, it sometimes feels as if we, the oncology team, are under attack, when it is our intent to help.

Despite good health habits, a cancer diagnosis.

Held / Julianna Paradisi / colored pencil and ink on watercolor paper 2018 – adapted from image author drew during cancer treatment

I was a pediatric intensive care nurse when I was diagnosed with breast cancer. My oncology experience was limited to monitoring young patients with a high risk of tumor lysis syndrome during induction of chemotherapy. The actual chemotherapy was administered by pediatric oncology–certified nurses who knew how to keep […]

Julianna Paradisi, RN, OCN2018-07-02T13:26:59-04:00July 2nd, 2018|Nursing, nursing roles, patient experience, Patients|3 Comments

July Issue: Ketamine Analgesia During Burn Care, Breast Cancer Screening Update, Difficult IV Access, More

“How powerful would it be if every nurse took one action today to improve her or his community’s health?” —Barry Ross, MPH, MBA, BSN, RN, author of this month’s Viewpoint

The July 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: The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care

Because of its unique mechanism of action and lack of association with respiratory depression, ketamine may be an ideal agent for adjunctive analgesia in burn patients. The authors of this study evaluated the efficacy and safety of a practice protocol allowing critical care RNs to independently administer IV ketamine for burn wound care.

CE: Breast Cancer Screening: A Review of Current Guidelines

In light of recent changes to national breast cancer screening guidelines, this article reviews the guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network and provides guidance to nurses as they support and educate patients.

Special Feature: Ethics Champion Programs

The authors, all of whom lead ethics champion programs at their […]

Diane Szulecki, editor2018-06-29T08:14:55-04:00June 29th, 2018|Nursing|0 Comments

The Thin Flat Line Between Life and Death

Illustration by Jennifer Rodgers.

A patient has died. His nurse begins postmortem care.

“I tell myself the things I always do—it was his time, we did everything we could. I can hear someone crying outside the room.”

In this month’s Reflections essay, author Kassandra August-Marcucio shares her feelings as she performs the steps of this protocol after a failed resuscitation attempt. We are reminded of each task, of the feelings of guilt that can arise (“I was his nurse and he died!”), of the last contacts with the patient’s family.

“The exaggerated zip of the bag is final.”

Almost every nurse has cared for a patient after the patient dies. Sometimes the nurse and patient have barely met; sometimes the patient is well-known to the staff. Many nurses (most, I hope), whatever their religious or spiritual beliefs, approach postmortem care with some sense of the gravity of the moment of someone’s passing. The “routine” tasks involved take on a slightly different aura than the other tasks of our days. Still, it’s hard not to rush through postmortem care to attend to the pressing needs of other patients.

[…]

Betsy Todd, MPH, RN2018-06-28T10:04:41-04:00June 27th, 2018|narratives, Nursing|3 Comments

Separating Children from Parents as Policy? Really?

Photo by Will Hedington via Wikimedia Commons

We’ve all seen the images of the migrant children who have been separated from their parents at the border and are living in pens in detention centers. We’ve read reports of their distraught parents, and of various government officials being turned away from the detention facilities. We’ve heard heart-wrenching audio of children sobbing for their parents, and of one young girl reciting a carefully memorized phone number and pleading to make a call to her aunt. And we’ve heard the stories of parents who have been deported without knowing where their children are being held or when they might see them again.

As a nurse, I worry about the acute and long-term health effects that this horrific experience will have on both parents and children.

As a mother, I cannot think about what these parents must be feeling without a knot forming in my stomach and my eyes tearing up—it’s a parent’s worst nightmare.

As a rational person, I cannot understand how any politician could think such actions would make for good policy.

As a citizen, I am grieved to see this unprecedented level of callousness, lack of empathy, and disregard for basic human decency from our government leaders. I’m ashamed that […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2018-06-28T10:04:01-04:00June 25th, 2018|Public health|11 Comments

Not Until Cairo: A Flight Nursing Tale

Worsening signs.

The author’s flight path circled the globe

The cabin of the Learjet is dark, the heart monitor a metronome over the drone of the engines and pulse of the mechanical ventilator. I’ve been watching my patient’s cardiac rhythm, with ominous hackles rising on the back of my neck while my partner naps. Over the course of the journey the man’s inherent tachycardia has slowly shifted into a sinus rhythm that might seem like normalization on a paper medical report, but feels wrong. After all, this patient is dying. He is returning to Egypt to die amongst family after last-ditch cancer treatments in America have failed.

“Not on this flight,” I think to myself. “Not until Cairo.”

The plane banks as it descends into the Newfoundland night. The cabin vibrates with turbulence; St. John’s may be the most easterly North American fuel stop, but its position on the Atlantic all but guarantees unpredictable weather. The lights of the town sparkle below as my partner rouses, pops his ears, and stretches.

“Look at his heart rate,” I say, quietly. “Pressure’s okay, though.”

“Yeah,” he says. There’s an unspoken accordance between us. We’ve flown together enough—been trapped in small planes for countless hours, evaluating and collaborating—that we […]

Marcy Phipps, BSN, RN, CCRN, CFRN2018-06-21T10:11:27-04:00June 21st, 2018|Nursing, nursing stories|4 Comments

When the patient distrusts the treatment.

Despite good health habits, a cancer diagnosis.

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Worsening signs.

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