Caring with Intention: Palliative Care and the Human Family

Vivian Dee, APRN-BC, RN, lives in Texas. She works on a bone marrow transplant unit and is and a doctoral student in the DNP program at Walden University.

In 2008, our organization created a new palliative care wing. No one was certified yet or knew much about caring for palliative care patients. The leadership scrambled to put together learning instructions in the form of PowerPoints and seminars.

In the midst of this flux, our unit admitted a homeless man as one of our first patients. Larry was an alcoholic who’d been out on the streets for many years. His health had deteriorated, and he’d developed liver cirrhosis. Since he couldn’t afford medical care, he’d opted for palliative care.

Larry was unpretentious and polite, and he soon became one of my favorite patients. I met him at the initial team meeting, where we established goals of care. As the days passed, I got to know Larry and his wishes, dreams, and desires. He would talk about his family, his cousins, and his mother. How he longed to see them one more time. To ask forgiveness and to say goodbye.

Days soon turned into weeks, weeks into months. Larry became weaker. Soon it was apparent that it would only be days before Larry took his last breath. […]

2018-03-22T08:25:34-04:00March 22nd, 2018|Nursing, Patients|0 Comments
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Meeting the Nutritional Needs of Older Patients and Family Members

When copies of the print version of this month’s issue arrived in the office, AJN staff found different meanings in the Albert Anker painting (circa. 1895) that graces the cover. Is the man enjoying a cup of tea in peace and quiet, or is he isolated and lonely, perhaps sipping tea to stave off hunger because there isn’t much food in the house?

The artist’s intent may be open to interpretation, but we chose this cover because it suggests one of the many social, cognitive, physical, and economic factors that can affect the nutritional status of older adults: eating alone.

Many older adults are at risk.

In a March CE article, “Malnutrition in Older Adults,” registered dietitian Ann Reed Mangels, PhD, RD, FADA, summarizes the latest information on malnutrition in older adults, including risk factors, assessment tools, and practical ways in which nurses as well as family and friends can help to ensure good nutrition for elders in the community or in long-term care. Writes Mangels:

“Malnutrition diminishes quality of life, is a strong predictor of short-term mortality, and is associated with higher health care costs.”

[…]

2018-03-19T09:05:08-04:00March 19th, 2018|Nursing, Patients|0 Comments
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Wound Care: A Common, Often Stressful Family Caregiving Task

“Teaching Wound Care to Family Caregivers” is currently one of AJN‘s most-viewed articles. As the article points out, more than one-third of family caregivers have to perform wound care, and doing so at home “can be a stressful experience.”

In a recent study of the challenges faced by family caregivers, 35% of those sampled reported performing wound care. Importantly, 66% of these caregivers indicated that wound care was difficult for them. For almost half, fear of making mistakes or causing harm was even more of a concern than the time and inconvenience of providing wound care….

The CARE Act mandates family caregiver teaching.

A nurse teaches a family caregiver how to assess a diabetic foot ulcer and safely change the dressing. Photo courtesy of the AARP Public Policy Institute.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Some other topics covered in the series include managing mobility and fall risk in the home, managing complex medication regimens, administering injections, and others.

As AJN editor-in-chief Shawn Kennedy wrote in a

2018-03-16T08:45:20-04:00March 16th, 2018|family caregiving, Nursing, Patients|0 Comments
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A Nurse’s Popular Preteen Classes on Puberty….Parents Included

Julie Metzger, MN, RN. Photo by Holly Andres.

The first time I menstruated, I knew exactly what it meant: that I could never go swimming again. I don’t know how I squared this idea with the fact that older girls and women were always in the city pool when I went there. Illogically, I was convinced I was now doomed to living without my favorite summer pastime.

A couple of years earlier my mom and I, along with most of the girls in my class and their moms, had nervously attended the school nurse’s annual lecture to fourth grade girls. Apparently, “no more swimming” was my garbled take-home from that event.

For preteen girls only, and their mothers.

Today, nurse Julie Metzger tackles misunderstandings like this with lively presentations about puberty to preteens and their mothers. She and her work are profiled in “Great Conversations: A Nurse Tackles the Puberty Talk” (free until March 28) in this month’s AJN. Metzger combines humorous props (a maxi pad stuck to her shoulder) and storytelling to talk about body changes, the opposite sex, decision-making, and friendship. […]

2018-03-20T11:56:23-04:00March 14th, 2018|Nursing|2 Comments
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Patient Safety: The Basis for Nursing

Making patients safe is where nursing begins.

by Lars Plougmann/via Flickr

It doesn’t matter how or where a nurse may practice—acute care, long-term care, home health, school nursing—making sure patients are safe is where nursing begins.

In 1999, the famed Institute of Medicine (now the National Academies of Science, Engineering and Medicine) report, To Err is Human: Building a Safer Health System, woke us up to the fact that medical errors were causing thousands of deaths annually in the very places where people go to restore their health. In 2004, another report, Keeping Patients Safe: Transforming the Work Environment of Nurses, detailed nursing’s critical role in health care delivery, particularly in ensuring patient safety.

We can always do better.

While there have been significant improvements in reducing adverse events, and nurses are leading many quality improvement initiatives, we can always do better. In May 2016, I wrote the following in an editorial (“A Culture of Safety Stars With Us“):

“Nurses have always been the sentinels, the around-the-clock watchers, detecting the changes that might herald a patient’s deterioration. Nurses are the ones that the system looks to—and often blames—when there’s a failure to rescue.”

This is still true.

This week marks an emphasis on patient safety—it’s what we do every day. In honor of the week, we’ve made the following […]

2018-03-13T07:59:37-04:00March 13th, 2018|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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