As Patient Handling Injury Rates Remain High, Schools Teach Outdated Methods

The old-fashioned way to reposition patients.

I haven’t seen draw sheets in hospitals for years now. “Back in my day,” those narrow sheets we placed across the middle of the bed were considered essential to patient care. Draw sheets were easier to change than the full sheet and they kept the bed neat. They always seemed to be hard to come by—probably because most nurses had stashed their own supply of them in patients’ rooms.

But more importantly, they were what we used to reposition patients. We used to work in pairs on turning rounds—one of us on each side of the bed, rolling the draw sheet tightly to get a grip, then sliding the patient up in bed or turning them on their sides. It was hard work, and no form of “good body mechanics” saved your back or shoulders and neck from strain when you needed to stretch across a bed—or, many times, climb on top of it—to move an unconscious patient. It’s no wonder that nurses and nursing assistants had such high rates of serious musculoskeletal injuries.

The institution of ‘No-Lift’ policies.

Then came electric beds, overhead lifts and transfer stretchers, and “No Lift” policies, which were based on data from the Occupational Safety and Health Administration (OSHA) on the frequency of injuries and supported by nursing organizations. Many hospitals and nursing homes implemented safe patient handling and mobility (SPHM) […]

To Recruit More Men, Rebrand Nursing as ‘Masculine’? Or Just Stop Oversimplifying the Profession

As a registered nurse for more than 40 years—with experience in pediatrics, public health, and philanthropy—I read a recent article by NPR’s Shankar Vedantam (“Why More Men Don’t Get Into The Field Of Nursing”) with interest. Vedantam essentially argued that more men don’t enter nursing because it’s seen as a “feminine” profession and proposed that we start emphasizing the more “masculine” attributes of the profession.

From youthful contrarianism to a deeper vision of the profession.

When I became a nurse in 1975, my choice was shaped first by my youthful desire to be contrarian: to bend gender norms by being a man in a “woman’s” profession.

When I began practicing nursing, however, I grew in my understanding that a commitment to nursing, particularly in my specialty field of public health, provided me with the means to act every day in concrete ways to further healing and build community. And so I applaud calls like Vedantam’s drawing attention to the need for more men in nursing. The need for diversity (of all kinds) in nursing was highlighted in the 2010 Institute of Medicine’s Future of Nursing report.

The deep-rooted public view of nursing as ‘women’s work.’

2018-11-14T10:57:09-05:00November 14th, 2018|men in nursing, Nursing|6 Comments

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 (rarely) cause […]

2018-11-12T08:25:04-05:00November 12th, 2018|infectious diseases, Public health|0 Comments

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 to significantly […]

2018-11-09T08:50:06-05:00November 9th, 2018|Nursing, nursing roles, Public health|3 Comments

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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