Off the Charts

Managing Acute Pain in People with Opioid Use Disorder

Photo © IStock.

Have you ever used the Clinical Opiate Withdrawal Scale (COWS) to ascertain whether your patient might be experiencing opioid withdrawal?

Considering the current prevalence of opioid misuse, it’s not unlikely that a patient admitted for a non-drug-related cause could be a person who uses opioids—someone who may or may not have shared that information with you.

The Clinical Opiate Withdrawal Scale is one of many helpful points of assessment and management discussed in this month’s CE article, “Acute Pain Management for People with Opioid Use Disorder.”

Compassionate, informed, nonjudgmental care.

This article, not specifically about unrevealed opioid intake, focuses on the management of acute pain in a person who is known to use opioids because they are currently on medication-assisted treatment (MAT)—that is, someone receiving methadone, buprenorphine, or naltrexone for opioid use disorder who is also experiencing acute pain from (for example) cancer, or after surgery or trauma.

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Betsy Todd, MPH, RN2018-10-29T08:03:46-04:00October 29th, 2018|Nursing|0 Comments

November Issue: Patient Handling in Nursing Curricula, Pediatric Pressure Injury Risk, More

“The technical skills and knowledge needed for nursing can be learned. For some nurses, this is enough. They do nursing, but nursing isn’t part of their identity. So how do we change that?” —EIC Maureen (Shawn) Kennedy in her November editorial

The November 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: Patient Handling and Mobility Course Content: A National Survey of Nursing Programs

What do nursing programs teach students about lifting, turning, transferring, repositioning, and mobilizing patients? Despite evidence supporting the use of safe patient handling and mobility practices, the authors’ findings suggest that most curricula need updating in this area.

CE: How to Predict Pediatric Pressure Injury Risk with the Braden QD Scale

This article offers guidance on use of the Braden QD Scale—a pediatric risk assessment instrument that reliably predicts both immobility-related and medical device–related pressure injuries. Readers can test their skills by assigning scores to patients in a variety of scenarios.

Looking Back: Nurses Fight for the Right to Vote

The author shares the stories of four nurse suffragists—Lavinia Lloyd Dock, Mary Bartlett Dixon, Sarah Tarleton Colvin, and […]

Diane Szulecki, editor2018-10-26T08:30:41-04:00October 26th, 2018|Nursing|0 Comments

Violence Against Health Care Workers: Time for a Zero Tolerance Approach

“Staff should know implicitly that they don’t have to work in an unsafe environment . . . “

The October issue of AJN has two articles that focus on workplace violence. We’ve shared them through social media—and sadly, the response and comments indicate that this information is sorely needed.

One, described in last week’s blog post by clinical editor Betsy Todd, is an article from a health system reporting on how they developed an innovative program to train their employees to deal with violent situations.

‘Staggering numbers.’

The second article (free until Nov. 8) is from nurse and attorney Edie Brous, our contributing editor and coordinator of our legal column, and covers what staff should expect from management in striving for safe workplaces. The numbers of workplace injuries and violent episodes are staggering—the CDC, Bureau of Labor Statistics, and other government agencies dealing with health and safety all show significant increases in the last five to ten years. Brous cites many of these data and notes, “The health care industry experiences almost as many violent injuries as all other industries combined.”

Organizations must be proactive . . . and held accountable.

What responsibility do health care organizations have? Brous writes:

“Organizations must be proactive in protecting their workforce and held accountable for failing […]

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Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2018-10-25T10:18:03-04:00October 25th, 2018|Nursing|0 Comments

Reexamining Resilience

Words matter.

As I have been presenting at various nursing gatherings and conferences about the topic of resilience in light of work-related grief, I have been struck anew by the definitions of resilience that I find in the literature.

The ability to return to a state of normalcy or to “bounce back” from adversity or trauma and remain focused and optimistic about the future (Dyer & McGuinness, 1996).
The “ability to face adverse situations, remain focused, and continue to be optimistic for the future” (Kester & Wei, 2018).

While I understand and very much appreciate the intent (and necessity) behind these definitions, I have to ask whether we are adequately exploring the meanings of the words used within these definitions and the implications for what nurses should expect of themselves in seeking to be resilient.

Does short-term resilience look different from long-term resilience?

For example, in the definition presented by Dyer and McGuinness, a resilient nurse should be able to return to a state of normalcy. There is certainly a need for nurses to be able to maintain a steadfast mind and emotional state in the short-term moments of acute crises with their patients. A nurse returning to work after a difficult shift just the day before has to find a […]

Hui-wen Sato, MSN, MPH, RN, CCRN2018-10-23T10:04:47-04:00October 23rd, 2018|Nursing, nursing perspective, wellness|0 Comments

Worker Health Charts: Comparing the Health and Safety of Your Nurses to the Nation

Is this facility’s problem unique?

Most health care facilities conduct regular employee surveys to identify and address problems among their workforce. However, it can be difficult to for a facility to determine if the issues identified in their employee survey are unique to their institution or similar to what is happening at other facilities nationwide.

To answer this question, it would be helpful for health care facilities to have a national data set for comparison. Recently, the National Institute for Occupational Safety and Health (NIOSH) created Worker Health Charts, a tool that charts data from the Bureau of Labor Statistics, National Health Interview Survey (NHIS), and other national and state-level data sources. The data cover various topics ranging from psychosocial exposures in the workplace (e.g., high job demands and work–life imbalance) to chronic conditions (e.g., cancer and high blood pressure) found among certain jobs, industries, or demographics. Nurse managers and occupational health staff can use Worker Health Charts to include questions in employee surveys and compare their data to national statistics.

How national data can inform a local plan of action.

Guest Author2018-10-17T11:05:56-04:00October 17th, 2018|Nursing|0 Comments