Off the Charts

Alerting Nurses to Late Effects of Pediatric Hodgkin Lymphoma Treatment

“As of January 2010, there were an estimated 379,112 survivors of childhood and adolescent cancers, of whom 35,253 (9.3%) had been treated for Hodgkin lymphoma,” according the American Cancer Society—as summarized in “Cardiotoxicity and Breast Cancer as Late Effects of Pediatric Hodgkin Lympoma (HL) Treatment,” a CE feature in the April issue of AJN.

Author Joanne Lee Candela, an adult NP in the survivorship program at the Memorial Sloan Kettering Cancer Center in New York City, hopes to raise awareness among all nurses of “residual risks associated with the various HL treatments, thereby promoting appropriate screening and, as needed, referral for specialty care.” The below table, from the article, depicts selected potential late effects of Hodgkin lymphoma treatment. Click to enlarge.

The article points out that “two of the most prevalent and life-threatening late effects are female breast cancer, secondary to chest radiation as well as to any underlying genetic tendencies, and cardiotoxicity and its sequelae, which are related to chest radiation that encompasses the heart and to the anthracycline component of chemotherapy.” […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:18-05:00April 12th, 2016|Nursing, Patients|0 Comments

The National Student Nurses Association: Always a Kick

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Once again, the annual National Student Nurses Association (NSNA, www.nsna.org) convention was packed—full of high-energy, engaged nurses-to-be. Approximately 3,000 attended this year’s meeting in Orlando from March 31 to April 3.

The NSNA meeting easily rivals those of other associations, with seemingly round-the-clock House of Delegates and state chapter caucuses (one could observe LOTS of pizza cartons moving between hotel and meeting rooms), a guidebook app, a daily convention newspaper, an impressive exhibit hall, professional motivational speakers (though motivation does not seem to be an issue with this group), award presentations, and a full slate of educational and career information sessions.

Nursing leaders and representatives from most major nursing organizations, including the ANA, National League for Nursing, American Red Cross, and the National Council of State Boards of Nursing, were there to meet students and talk about initiatives to get these future nurses ready for the real world. They received lots of practical advice, including sessions on interprofessional collaboration, disaster nursing, how they can get involved on boards, legal aspects of licensure, tips and practice for taking the licensing exam . . . even one session on how to get started writing, led by yours truly! […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2016-11-21T13:01:18-05:00April 8th, 2016|career, Nursing, nursing perspective, nursing students|0 Comments

Blood Glucose Meters in the ICU: Quick, Useful, But Regulatory Issues Still Unresolved

By Betsy Todd, clinical editor, MPH, RN, CIC

Photo © Life in View/Science Source.

Many time-saving clinical technologies are available today that were unheard of at the start of my nursing career. Have we always given careful thought to how this technology is applied? A controversy about the safe use of point-of-care (POC) blood glucose meters (BGMs) in the ICU is a case in point.

Quick, minimally invasive bedside blood glucose monitoring has become the standard of care in hospitals and nursing homes. Interestingly, though, the original FDA approval of POC BGMs was for at-home use only. But the agency waived any restrictions on inpatient use, as long as staff performing the tests were properly trained and the patients were not critically ill. The use of BGMs in critically ill patients is considered “off label.”

Early in 2014, the FDA proposed new regulatory requirements for BGM use in hospitals. Apparently in response to the FDA’s proposal, the Centers for Medicare and Medicaid Services then issued a memorandum of intent to cite and even fine hospitals for the off-label use of BGMs in critical care. A huge outcry from clinicians ensued. […]

Betsy Todd, MPH, RN2016-11-21T13:01:19-05:00April 6th, 2016|Nursing, nursing perspective|2 Comments

Nursing Insights: The Experience of a Chronic Illness as a Series of Subtractions

Chronic illness is often experienced by patients as a series of subtractions. A progressive illness like Parkinson’s reveals this process vividly as the ability to move, speak, care for oneself, all gradually disappear or diminish.

The grief of lost freedom, lost abilities, lost agency, lost avenues of communication is easy to overlook. But it’s real, and can come out in uncomfortable ways. Here’s an excerpt from the start of this month’s Reflections essay in AJN, “A Room With a View.”

David was in his late 50s and had been diagnosed with Parkinson’s disease several years previously. Following a lengthy hospitalization, David’s wife agreed to a placement on the subacute/rehab unit in the facility where I was the instructor for nursing students during their older adult clinical rotation. . . . Although ravaged by the disease, David seemed to like having students provide his nursing care. . . .

One of his favorite activities was sitting by his room window, which overlooked the facility gardens and a play area for the preschool next door. For several weeks, I discovered a nursing student and David sitting by the window watching the outdoor activities in companionable silence. […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:19-05:00April 4th, 2016|Nursing, nursing perspective, nursing stories, patient engagement|0 Comments

‘Applying QI to Care in Nursing Homes’: A Nurse’s Take on the Tools Needed for Change

A colleague once remarked, “Isn’t it strange that the universal response to hearing that someone has gone into a nursing home is ‘Ugh’?” As nurses, we might hazard a guess as to what kind of care the new resident may receive. But is there a way to reenvision the care that we provide in nursing homes?

In AJN‘s April Viewpoint essay, NP Heather Walker argues that there is, and that quality improvement (QI) can be an effective tool for change. Walker suggests that QI can do for nursing homes what it has done for acute care: focus attention on the systemic issues that stand in the way of good nursing. As she says in the article,

“QI doesn’t negate personal responsibility, but it broadens the focus so that systemic problems are taken into account.”

The QI process fosters reflection, accountability, and teamwork, which in themselves can improve the work environment and residents’ living experience. For more information about this approach, read the short article, here.—Betsy Todd, AJN clinical editor, MPH, RN, CIC

Betsy Todd, MPH, RN2016-11-21T13:01:19-05:00March 31st, 2016|career, Nursing|0 Comments