Recognizing Delirium in Hospitalized Children

A hospital can be a scary place for any of us, but the experience is likely to be especially upsetting for children. An unfamiliar environment, possibly painful procedures, immobility, food that’s not from home (or no food), and disturbed sleep are hard on most people. A child’s particularly vivid imagination may exacerbate an already-frightening experience. It’s not surprising that delirium can occur in hospitalized children.

Characteristics of pediatric delirium.

Delirium in children has not been explored to the extent that it has been in adults, but research suggests its manifestations in either group can include five characteristics: agitation, disorientation, hallucinations, inattention, and sleep–wake cycle disturbances. Some evidence also suggests that children with delirium may have a more labile affect than adults, and more severe perceptual disturbances. […]

2018-04-25T10:05:56-04:00April 25th, 2018|Nursing, pediatrics|0 Comments
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The Nurse’s Temptation to Fill in the Patient Handoff Narrative

The limitations of handoff report

In bedside nursing, the nurse enters the story of the patient’s life at the point where the handoff report ends.

“Pt is an 8 mo old female, history of hypoxic ischemic encephalopathy (HIE), baseline 2L oxygen at home. Admitted to the unit for respiratory distress.”

Handoff report then goes through a systemic description of the patient’s current state: neurological, cardiovascular, respiratory, GI/GU, skin, and finally, psychosocial. The report is thorough but brief, never truly complete.

The oncoming nurse takes report and seeks to develop an accurate picture of her patient’s physiological state in order to anticipate emergencies and prioritize nursing interventions. But as any experienced nurse knows, no report can replace thorough and ongoing assessments—patients can change, and even the most expert nurses who have previously cared for this patient can miss details.

This holds true both in terms of a physiological assessment and a psychosocial assessment. What the nurse receives during handoff in terms of the patient and family’s psychosocial status is typically brief. “The patient’s parents are involved. Dad is a little more anxious and doesn’t stay at the bedside for long. Mom has a lot of questions, and she likes to help a lot with the hands-on care.”

Assumptions rush in to fill […]

2018-04-23T10:26:19-04:00April 23rd, 2018|Nursing|2 Comments
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Earth Day 2018: Making the Connection Between Environmental and Human Health

Trafalgar Square during the Great London Smog of 1952. Photo © TopFoto / The Image Works.

This Sunday is Earth Day, an annual event started by a bipartisan group of citizens and congressional representatives in 1970 to highlight the need for a healthier environment and the importance of legislative protections.

Along the mighty Hudson—beautiful, but still contaminated

Growing up just north of New York City, along one of the most beautiful but contaminated sections of the Hudson River, I’ve seen up close the effects of industrial pollution before environmental protections were put in place. In addition to producing electrical wire, cables, munitions, and other products, the factories that lined my town’s waterfront for much of the 20th century were also responsible for extensively contaminating the surrounding area with polychlorinated biphenyls (PCBs) and petroleum hydrocarbons.

For many decades, the environmental damage caused by such industry was accepted as the price of progress. Raw sewage and oil slicks in the waters of the Hudson were not unusual sights, and relatives tell stories of a popular spot along the river, from which swimmers in the 1960s would emerge covered in the dye produced—and dumped—by a nearby riverfront factory. […]

2018-04-21T08:49:06-04:00April 21st, 2018|environmental health, Nursing, Public health|0 Comments
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Seeking Good Nurses With a Story to Tell

karindalziel/ via Flickr Creative Commons karindalziel/ Flickr Creative Commons

Whenever I meet someone new who happens to be a nurse—in both clinical and social settings—I wait for the right moment to mention my work on AJN‘s Reflections column.

It’s not only that I’m proud of the column. It’s also that I’m forever on the lookout for that next submission—for a fresh, compelling story I just know is destined to shine (accompanied by a fabulous professional illustration) on the inside back page of AJN.

‘But I’m not exactly a writer…’

“I imagine you have a story or two to tell,” I’ll say to a nurse I’ve just met—which is the same thing I say, whenever I have the chance, to nurses I’ve known for years. I mean it sincerely; given the vantage point on humanity that our profession affords, I actually do believe that every nurse is carrying around material for a terrific story.

The response I usually get (along with a wry smile, the raising of eyebrows, or a short laugh) is, “Oh yes. I have stories.”

But then—even as I’m mentioning the Reflections author guidelines, even as I say warmly that we’re eager to read—I can sense the backing away.

“Sure,” the nurse will say. “I’ll check it out . . . but the thing is, I’m not […]

2021-11-29T17:32:55-05:00April 18th, 2018|Nursing, nursing stories|1 Comment
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Nursing Homes: A ‘Place No One Wants to Be’

I’m on my way home from Atlanta, site of the 2018 NICHE (Nurses Improving Care for Healthsystem Elders) conference. This organization, housed at New York University-Rory Meyers College of Nursing for the last 26 years, provides education and consultation to organizations to improve the delivery of health care to older adults. It now counts over 700 member organizations in five countries and has been successful in helping facilities implement best practices for providing care to older adults.

Redesigning long-term care.

One of the speakers, Migette Kaup, PhD, from Kansas State University and an expert in designing care facilities, spoke about current efforts to redesign long-term care. She noted that traditional nursing homes, which were designed to mimic hospitals, are “a product no one wants” and a place many people would rather die than go to.

Kaup spoke about the success of the newer “household” model of long-term care, which mimics a home setting rather than a hospital. Key aspects of this model are that it centers around an open kitchen space and is made up of a dedicated staff and small group of residents who live together and implement best practices. Kaup cited successes in decreasing depression and pressure ulcers in low-risk patients, among other parameters. Of course the real goal, as we […]

2018-04-13T11:43:57-04:00April 13th, 2018|family caregiving, Nursing, nursing perspective|3 Comments
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