Thinking About Las Vegas

This latest mass shooting, in which 59 people were killed and 500 wounded in Las Vegas, is distressing—and it won’t be the last. Again we find it incredible that this can be allowed to happen.

And again we are reminded of the unique position of the United States compared to most other countries, our astronomically higher numbers of gunshot deaths and the financial and emotional costs they exact. As I wrote in my February 2016 editorial on gun violence, “firearms accounted for 417,583 deaths—253,638 suicides and 163,945 homicides between 2003–2013.”

There’s more information about gun violence and the dismaying number of injuries and deaths among children in our report in the September issue. And a study just published in Health Affairs puts the annual cost of emergency and inpatient care for firearm injuries at $2.8 billion.

The numbers of deaths and injuries we can measure. The sense of helplessness and frustration, and the creeping sense of anxiety we experience as we go into public spaces, are more invidious. […]

2017-10-07T08:35:43-04:00October 6th, 2017|Nursing, Public health|3 Comments
Read More

Student Errors in the Clinical Setting: Time for Transparency

Mistakes happen.

When I was working as an ED nurse, we often had nursing students assigned to the area. One day we had an elderly man with asthma in one of the treatment rooms. The physician ordered aminophylline suppositories. After reviewing the “5 rights”—right patient, right medication, right dose, right time, right route—I directed the student to administer the suppositories. All seemed well.

Imagine my surprise when the student proceeded to insert the suppository into the man’s nose! She explained that since it was a breathing problem, she naturally thought they would be inserted nasally. It never occurred to her that these were rectal suppositories and it never occurred to me to ask if she knew what to do with them. We all had a good laugh and that was that.

Undocumented errors.

Another day, another patient, another faux pas: a physician said to “cut the IV,” which everyone knew (that is, we assumed everyone knew) meant to discontinue the patient’s IV. One of my colleagues intervened when she saw a determined-looking student, with bandage scissors in hand, approach the patient’s room, ready to “cut the IV.” We again marveled at the student’s interpretation of the phrasing, and that was that.

And that’s the problem—that was that. There was no documentation of these as “near-miss” errors, and while some […]

2017-10-04T09:57:24-04:00October 4th, 2017|Nursing, nursing students, patient safety|2 Comments
Read More

Palliative Care: Often Overlooked in the ‘Acute’ Setting

Does this description of a patient sound familiar to you?

“… a 91-year-old man diagnosed with moderate Alzheimer’s disease, hypertension, and benign prostatic hypertrophy whose change in mental status has prompted hospitalization from a long-term care facility…. This is his third admission in five months with similar symptoms; each time he was given IV fluids and sent back to the long term care facility within a few days.”

Figure. Photo © Photofusion Picture Library / Alamy Stock Photo.

With minor adjustments in age, gender, and the exact illnesses involved, this paragraph describes patients that I cared for on a regular basis in a large medical center. I always found such patients frustrating, and sad. I was frustrated because it seemed all we could do was “patch them up,” send them back to the nursing home, and wait for their inevitable return; and sad because there seemed so little quality of life to reach for.

In AJN’s September issue (“Palliative Care in […]

2017-10-02T08:33:17-04:00October 2nd, 2017|Nursing|1 Comment
Read More

AJN in October: Nursing Student Errors, Septic Shock Resuscitation, the Ethics of Workarounds, More

The October issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Original Research: Exploring How Nursing Schools Handle Student Errors and Near Misses

The authors investigate nursing school policies and practices for reporting and tracking student errors and near misses. The first part of a two-part series.

CE: Assessing Patients During Septic Shock Resuscitation

How to integrate capillary refill time and skin mottling score into the perfusion reassessment after initial fluid resuscitation—as recommended by revisions to the Surviving Sepsis Campaign six-hour bundle.

Obesity and Sexual Dysfunction: Making the Connection

Obesity affects patients’ general health, but does it affect their sexuality? A review of the evidence on obesity and sexual functioning, plus nursing considerations for addressing weight-loss strategies with patients.

Workarounds Are Routinely Used By Nurses—But Are They Ethical?

How nurses can be creative problem solvers without resorting to workarounds that may be ethical in intent yet potentially harmful in their consequences.

[…]

2017-09-29T08:30:14-04:00September 29th, 2017|Nursing|0 Comments
Read More

Hospital Closings Hit Rural Communities Hard, But Aren’t Inevitable

Photo by Taylor Sisk/North Carolina Health News

Community hospitals across the country have been closing in recent years. Reasons given include system consolidations, rising costs of care, Medicare reimbursement issues, and changing models of health care delivery. Few hospital closures are welcomed by patients or employees, but those that take place in rural areas, where there may not be another hospital for many miles, often affect the local community with particular severity.

A double hit for local economies.

Not only do hospital closings in rural areas make access to health care a challenge, sometimes forcing local residents to drive many miles for care. But—as this month’s AJN Reports points out (“Will Rural Community Hospitals Survive?“)—rural hospital closings also have a ripple effect on a local economy, meaning lost jobs as well as lost revenue for ancillary businesses in the area.

Hospital that innovate may survive.

Despite current pressures, some rural hospitals are finding new ways to thrive. As the article describes in greater detail, hospital “survival strategies” include partnerships and “becoming increasingly creative with providing services,” including expanding the use of telehealth. […]

2017-09-26T09:45:27-04:00September 26th, 2017|Nursing|0 Comments
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top