Off the Charts

The School Nurse

by rosmary/via Flickr

They march into my heart like little soldiers. There are lads and lassies, rich and poor, sporting bling and brawn. Sometimes they leave the bus and walk into my office as soon as they get in the front door. The litany continues daily.

“I don’t feel good.”

“My stomach hurts.”

My responses follow the pattern.

“Did you tell your parents you didn’t feel good?”

“Did you eat breakfast?”

“Were you up late last night?”

The thermometer comes out. Triage begins. Some came in under the power of suggestion.

“My mother said if I didn’t feel good to come to the nurse’s office.”

Children always think that’s a free ticket to get out of the remaining school day. The sick ones are directed to cots in the back part of the office. Some will rest awhile. Some will have crackers or granola bars to offset the empty stomach they came to school with. Charts come out. The search begins. Some phone numbers are accurate, and parents can be reached. Some, sadly, can’t be contacted. The phone messages become trite.

“The person at this number is not taking calls now.”

“This number is no longer in use.”

I have to put my Sherlock hat on. I search all sources to see if there is a parent or relative who can come and pick up their child per protocol […]

Guest Author2018-02-01T08:23:45-05:00February 1st, 2018|Nursing|5 Comments

Experienced Bedside Nurses: An Endangered Species?

“The trend toward our hospitals being primarily populated with nurses with less than two years’ experience is worrisome.”

At least three colleagues who’ve recently been patients in hospitals or had family members who were have remarked on the youthful nurses they encountered—and on their lack of experience. In two of the conversations, my colleagues cited instances in which this lack of experience was detrimental to care, one of them dangerous. That “sixth sense,” that level of awareness that comes with lived experience and becomes part of expert clinical knowledge, is important for safe, quality patient care.

In the February editorial, I report on the answers I received when I queried our editorial board members about new nurses’ inclination to work in acute care for only two years to gain experience and then leave to pursue NP careers. Many of the board members have seen a similar trend, one reflected by research on nurse retention, some of it published in AJN (most recently, see Christine Kovner’s February 2014 study on the work patterns of newly licensed RNs, free until February 6). […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2018-01-29T09:54:37-05:00January 29th, 2018|career, Nursing, nursing roles, patient safety, Patients|28 Comments

February Issue: Updated Sepsis Guidelines, Chinese American Immigrants and Diabetes, Improving OR–ICU Handovers, More

The February 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: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes

The benefits of exercise for patients with type 2 diabetes have been studied extensively, but not among Chinese American immigrants diagnosed with prediabetes or type 2 diabetes. The authors of this mixed-methods study analyzed this population’s levels of exercise intensity, examining the types of activity performed, as well as the barriers to such activity.

CE: Managing Sepsis and Septic Shock: Current Guidelines and Definitions

This article discusses recent updates to the Surviving Sepsis Campaign’s sepsis treatment guidelines, changes in the sepsis bundle interventions, and the new definitions and predictive tools introduced in the Third International Consensus Definitions for Sepsis and Septic Shock.

Moving Closer to the 2020 BSN-Prepared Workforce Goal

The authors report findings from the four-year Academic Progression in Nursing initiative to identify and develop the most promising strategies for creating a more highly educated nursing workforce.

Cultivating Quality: A Multidisciplinary QI Initiative to Improve OR–ICU Handovers

This QI study examines […]

Diane Szulecki, editor2018-01-26T09:32:47-05:00January 26th, 2018|Nursing|0 Comments

Helping Family Caregivers with Fall Prevention in the Home

“Because mobility in later life results in positive health benefits but increases exposure to falls, many researchers and health care providers in geriatric nursing and medicine have called for ensuring safe mobility while protecting older adults from harm. It’s especially important to identify strategies that can potentially reduce the risk of fall-related injuries in older adults.This increasing focus on fall-injury prevention—in addition to fall prevention—represents a major shift in safety practice.”

(Click image to enlarge)

How can nurses best help family caregivers?

How can nurses help family caregivers identify fall risk in their family members, prevent falls, and respond to them if they occur?

According to the authors of “Preventing Falls and Fall-Related Injuries at Home“—the latest in our ongoing series of articles and videos, Supporting Family Caregivers: No Longer Home Alone—the need for better education and resources on such topics is widespread among family caregivers:

“In a national survey of caregivers who provide unpaid care to a relative or friend, 46% reported they assisted with medical and nursing tasks. Of these, 43% said such help involved the use of assistive mobility devices, such as walkers or canes. Almost half of family caregivers are also known to […]

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Jacob Molyneux, senior editor/blog editor2018-01-25T10:24:11-05:00January 25th, 2018|family caregiving, family caregiving, Nursing, patient safety|0 Comments

Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

Joan’s breathing relaxes as the morphine starts working. Her son Travis, on the other hand, is clearly upset as we sit at her bedside where she is dying. Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake. “I’m sorry, mama,” he whispers.

He turns his head my way. “I wish you hospice folks had never brought that morphine out here,” he says. “Now she’s dead for sure and it’s my fault.”

A sometimes essential medication.

For caregivers with this level of fear about morphine, it’s a painful dilemma. If you don’t use the best, sometimes the only, medication we have for getting acute respiratory distress in terminally ill patients under control, both patient and caregiver suffer. But if giving morphine is freighted, as it is for Travis, with a belief that it causes death and/or signifies giving up on, even betraying, a loved one, it can intensify a caregiver’s distress.

The hospice nurse had already given the standard education, assuring Travis that in patients near the end of life morphine is safe and effective when used as prescribed. We had given him written information debunking some of the common myths about morphine—“it kills you”; “makes you crazy”; “it’s addictive”—when used appropriately with hospice patients who have active symptoms. We had promised […]

Guest Author2018-01-22T10:19:38-05:00January 22nd, 2018|Ethics, family caregiving, Nursing, pain management|0 Comments