Off the Charts

‘Join Now!’: Jane Delano, Early 20th Century Red Cross Nurse Pioneer

Jane Delano

By Shawn Kennedy, AJN editor-in-chief

In 1909, Jane Delano was chair of the national committee of the Red Cross nursing services, superintendent of the Army Nurse Corps, and president of the young American Nurses Association. The Red Cross was to serve as the reserve for nurses for relief services and for the army and navy nursing services. Flickr/ via James Vaughan

At the outbreak of World War I, Delano mounted an aggressive national campaign to recruit thousands of nurses to attend to the troops in Europe and to provide services here at home during disasters and the 1918 influenza epidemic. AJN published a short biography of this remarkable woman in August 1930.

Delano also wrote a monthly column for the fledgling American Journal of Nursing. Her first column, a summary of the national meeting of the Red Cross in New York City, appeared in May 1909. Delano also founded the Red Cross Town and Country Nursing Service, which provided visiting nurses in rural areas. She died in France in 1919 while on Red Cross business.

Editor’s note: this is the second short post in a series we are publishing during Women’s History Month to draw attention to important figures or trends in the history of women and nursing. The first was “Parallel Developments: Women’s History and the Professional […]

Guest Author2016-11-21T13:01:23-05:00March 18th, 2016|nursing history|0 Comments

CDC Opioid-Prescribing Guideline for Chronic Pain: Concerns and Contexts

by frankieleon/ via flickr

By Jacob Molyneux, senior editor

The CDC’s new Guideline for Prescribing Opioids for Chronic Pain was released this week. The context for this comprehensive new guideline is widespread concern about opioid-related overdose deaths and substance abuse in the U.S.

The guidelines make 12 main recommendations, among them the following:

nonpharmacologic or nonopioid pharmacologic treatments should be considered “preferable” first-line therapy for those with chronic pain.
a daily opioid dosage limit of morphine milligram equivalents should be imposed.
immediate-release opioids should be prescribed before moving to extended-release formulations.
urine testing should precede new opioid prescriptions for chronic pain and treatment goals should be set.
clinicians should prescribe the lowest possible number of days’ worth of medication for acute pain (often three days or less).
prescription drug monitoring program (PDMP) databases should be consulted to determine patients’ past histories of opioid prescriptions.

Some of the recommendations would seem to be no-brainers, such as consulting PDMPs when writing new prescriptions. Others, such as a “one-size-fits-all” daily dosage limit and restrictions on the use of extended release formulations, have raised alarms among pain management experts. See, for example, “I’m Worried About People in Pain,” a recent AJN Viewpoint essay by Carol Curtiss, a nurse and pain management expert, who notes the increased stigmatization experienced by pain patients and the chilling effects of new […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:23-05:00March 17th, 2016|Ethics, Nursing, nursing perspective, pain management, patient engagement|4 Comments

The Challenge of Caring for a Graying Prison Population

An elderly prisoner in hospice care. Photo by Ackerman + Gruber

Inmates 54 or older are the fastest growing age demographic in U.S. prisons. According to the U.S. Bureau of Justice Statistics, the percentage of inmates who are 54 or older jumped from 3% to 8% in two decades (1991–2011). Criminal justice experts say the increase is probably an effect of the longer sentences of 1980s antidrug laws.

A 2014 report by the Vera Institute of Justice asserts that “prisons and jails are generally ill-equipped to meet the needs of elderly patients who may require intensive services” for their medical conditions. Correctional staff often lack training for treating age-related illnesses and prisons typically don’t have the ability to monitor chronic health issues or employ preventative measures. Inmates are often sent off-site for medical treatment beyond what prisons can provide.

Older adults with physical disabilities or cognitive impairments are also more vulnerable to injury, abuse, and psychological decompensation in the prison setting. “ [T]he prison environment is, by design, an extremely poor place to house and care for people as they age or become increasingly ill or disabled,” said a 2013 American Civil Liberties Union report. Even reliance on devices like wheelchairs, walkers, or breathing aids can present logistical hardships for inmates in facilities that were designed to […]

Diane Szulecki, editor2016-11-21T13:01:23-05:00March 15th, 2016|Nursing, nursing perspective|0 Comments

‘Circadian Assaults’: Daylight Saving Time May Hasten Strokes, MIs in Those At Risk

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

“Nurses and other shift workers may be particularly vulnerable to the problems that can result from sleep deprivation.”

Philippe Boulet/flickr creative commons

I don’t like daylight saving time (DST). Twice a year, when we begin and end this transition, I’m tired and cranky for a week. These sudden leaps forward and backward in time disrupt our bodies’ natural relationship to what should be gradual changes of season.

Not surprisingly, some studies suggest that these assaults on our circadian rhythms may affect our cardiovascular health. Swedish studies (here and here) based on national myocardial infarction (MI) data found small but significant increases in MI rates in the first few days to a week after the change to DST.

A Michigan study of more than 42,000 MI patients treated with angioplasty found a significant increase in MIs on the Monday after the start of DST. Their data, however, indicated that the overall incidence rate of MIs in need of angioplasty did not change, and the researchers suggested that DST may simply “accelerate” the incidence of cardiovascular events in at-risk patients, pulling them forward in time.

Researchers in Finland recently reported an increase in strokes at the start of DST, and like the Michigan researchers, concluded from their data that […]

Betsy Todd, MPH, RN2016-11-21T13:01:24-05:00March 11th, 2016|Nursing, nursing perspective|1 Comment

The Balancing Act: A Dying Patient and a Spouse Who Can’t Let Go

Illustration by McClain Moore

The Reflections essay in the March issue of AJN is called “The Balancing Act.” The author describes a situation she faced as an ICU nurse in which her efforts to keep a dying patient comfortable were complicated by a spouse’s reluctance to accept the inevitable. It’s often hard to advocate for a patient while honoring the emotional struggle of a close family member. Here’s the start of the essay.

I have just arrived to work in the ICU and am assigned a patient in respiratory distress. Her name is Darlene and her husband Tom is pacing the room. Within 10 minutes, he drinks three cups of coffee, ignoring the cot provided by the previous nurse so he could sleep next to Darlene. His wife has more than one cancer and both are growing. She left the hospital a week ago for hospice care, but has been readmitted after a decision by her husband to reattempt curative treatment.

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