Off the Charts

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.

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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 so […]

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 easily discern […]

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

Distracted Nursing: On Personal Cell Phone Use at Work

A new societal norm.

Kathleen Bartholomew

Most of us have seen the cars on the highway that suddenly slow down in the passing lane, blocking other cars while weaving dangerously across the dividing lines between lanes. We know the signs of distracted driving well enough by now. It resembles drunk driving. Or we’ve had to dodge the people staring down at their cell phones as they blindly approach us on the sidewalk.

Divided attention in the nursing workplace.

The examples of distraction because of cell phone use are endless; in fact, especially in certain places and age groups, this form of preoccupation has become the norm. The behavior carries over into many workplaces, and nursing is not exempt. The following excerpt is from this month’s Viewpoint essay by nurse educator and consultant Kathleen Bartholomew, “Not So Smart: Cell Phone Use Hurts Our Patients and Profession.”

It is 6:45 in the morning, and as I pass a patient in the ED, I see a nursing assistant watching a movie on her phone. She is supposed to be monitoring the 1:1 suicide risk, yet she appears so intrigued with the movie that I wonder if the patient is safe—or perhaps wants to talk.

Earlier that same day, a nurse tells me a story of calling the […]

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Jacob Molyneux, senior editor/blog editor2018-06-19T11:40:33-04:00June 19th, 2018|Nursing|7 Comments

In Colorado EDs, ‘Alternative to Opioids’ Pilot Project Exceeds Goals

Ashley Copeland talks to her mother in the Swedish Medical Center ED. Copeland was treated for a severe headache with a nerve-blocking anesthetic, but no opioids. (John Daley/CPR News)

Last year, in an effort to address the state’s acute opioid abuse problem, several Colorado health care organizations—including the Colorado Emergency Nurses Association—worked together on an intervention to target patients admitted to the ED with pain. The plan? Implement a pain management program to promote alternative strategies, with a goal of decreasing opioid usage by 15% in the participating EDs.

As discussed in a June news article, the program, which was piloted in 10 hospitals and involved heavy involvement from nurses, surpassed its goal: opioid usage during the intervention period (as measured in morphine equivalent units) was 36% less than in the previous year.

The pilot project […]

Diane Szulecki, editor2018-06-14T09:29:35-04:00June 14th, 2018|Nursing, patient experience|1 Comment