Off the Charts

Ethical Practice with Patients in Pain

Photo @ AJ Photo / Hop Americain / Science Photo Library

Pain is difficult to define and hard to convey. The way both patients and clinicians respond to it can be influenced by a multitude of possible biases. This month’s Ethical Issues column in AJN is by Doug Olsen, PhD, RN, an associate professor at Michigan State University College of Nursing. In “Ethical Practice with Patients in Pain,” Olsen summarizes the challenge nurses and other clinicians face in treating patients’ pain:

Responding to a patient’s pain is a fundamental ethical obligation in nursing. However, nurses caring for patients in pain can run into ethical conflicts from both over- and undertreatment of pain. Undertreatment of pain represents a failure to fulfill the core nursing obligation to alleviate suffering—but overtreatment may ultimately harm the patient, contradicting a core nursing value, nonmaleficence. The complex nature of pain complicates efforts to provide treatment that is ‘just right.’ Nurses must understand that complexity if they are to make ethical decisions in the care of patients who experience pain.

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:32-05:00January 20th, 2016|Ethics, Nursing, nursing perspective, pain management, patient experience|1 Comment

Nurses and Latent TB Infection

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

Mantoux skin test/CDC PHIL

Are you “PPD positive”?

In December, a California maternity nurse was diagnosed with active tuberculosis. More than 1,000 people, including 350 infants, may have been exposed. In infants, tuberculosis can be hard to diagnose and is more likely than in newly infected adults to progress to active disease and to disseminate to extrapulmonary sites. Therefore, a course of isoniazid was recommended for each of these exposed infants, as well as for any parents, visitors, or staff who tested positive after the exposure.

Some of the details of this incident weren’t released to the media. In my experience, active infection in a health care worker who has not recently traveled to a TB-endemic area is almost always the result of reactivated latent infection. That was the case in a similar exposure more than 10 years ago, when a New York City maternity nurse exposed more than 1,500 infants and adults to active tuberculosis.

And in three of the largest TB exposure investigations on which I’ve worked, the index cases were nurses in oncology, transplant, and the ED whose latent tuberculosis infection progressed to active infection. In these three cases, neither the RNs nor their own primary care providers connected their persistent febrile respiratory infections with their […]

Betsy Todd, MPH, RN2016-11-21T13:01:33-05:00January 18th, 2016|infectious diseases, Nursing, nursing perspective|0 Comments

Managing the All-Too-Real Symptoms of Fibromyalgia Syndrome

By Sylvia Foley, AJN senior editor

(click image to expand)

Fibromyalgia syndrome (FMS) is one of the most common rheumatic disorders, affecting as many as 15 million people in this country, the vast majority of them women. People with FMS typically experience chronic widespread pain, as well as various concurrent symptoms that can include fatigue, cognitive disturbances (such as memory problems, confusion, and difficulty concentrating), distressed mood (especially anxiety and depression), nonrestorative sleep, and muscular stiffness. One study found that up to 65% of patients experienced lost workdays as a result.

Yet as author Victoria Menzies reports in one of our January CE features, “Fibromyalgia Syndrome: Current Considerations in Symptom Management,” many health care providers “doubt the syndrome’s validity.” Diagnosis is often delayed for years.

Menzies provides a concise overview of the illness, which has no known cure, and then focuses on what can be done to alleviate symptoms and improve patients’ quality of life. Here’s a brief overview of the article:

Symptom management appears to be best addressed using a multimodal approach, with treatment strategies tailored to the individual. While medication may provide adequate symptom relief for some patients, experts generally recommend integrating both pharmacologic and nonpharmacologic approaches. Some patients may benefit from the adjunctive use of complementary and alternative medicine (CAM) modalities. Because symptom remission is rare and medication adverse effects can complicate symptom management, well-informed […]

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Guest Author2016-11-21T13:01:33-05:00January 15th, 2016|Ethics, Nursing, nursing perspective, pain management, patient engagement, Patients|2 Comments

Health Technology Hazards, 2016: Inadequate Disinfection of Flexible Endoscopes Tops ECRI List

hazard/jasleen kaur, via Flickr

The ECRI Institute has released its Top 10 Health Technology Hazards for 2016 report, highlighting health technology hazards for health care facilities and nurses to focus on this year.

Although alarm hazards, which topped the list for the past four years, still pose a significant threat, topping the list at number two, a different repeat offender has claimed the number one spot: inadequate cleaning of flexible endoscopes before disinfection.

Proper reprocessing and cleaning of biologic debris and other foreign material from instruments before sterilization is key, according to the report. And flexible endoscopes, especially duodenoscopes, are difficult to clean because of their long, narrow channels. Failure to clean properly can result in the spread of pathogens. The report points to a series of fatal carbapenem-resistant Enterobacteriaceae infections in the last two years to illustrate this particular threat, and recommends that facilities emphasize to their reprocessing staff that inattention to proper cleaning steps can lead to deadly infections.

Some hazards, such as those arising from health information technology (HIT) issues, insufficient training of clinicians in operating room technologies, and failure to appropriately operate intensive care ventilators, have been touched on in previous years. (See our past posts on ECRI top 10 health technology hazards from 2013, 2014, and […]

Amy M. Collins, managing editor2016-11-21T13:01:33-05:00January 14th, 2016|Nursing|3 Comments

‘I’m Worried About People in Pain’: A Nurse’s Take on Opioid-Prescribing Regulation Changes

by frankieleon/ via flickr

Many patients and clinicians have strong feelings about opioids: they’ve seen a loved one denied adequate pain control, or they’ve seen a family member or friend’s son or daughter lost to prescription pill and/or heroin addiction, or they’ve worked in an ED with too many drug-seeking patients, or they’ve seen a patient in terrible pain waiting for a new analgesic order from an unavailable or uncompassionate physician.

But feelings don’t solve complex problems, and an excessively punitive or permissive approach can do more damage than good. Recently, there have been almost daily headlines and policy recommendations about the importance of restricting opioid-prescribing practices. The trend is alarming a number of clinicians with expertise in working with patients in pain. Clinical nurse specialist and pain management consultant Carol Curtiss addresses what’s at stake in “I’m Worried About People in Pain,” the Viewpoint essay in the January issue of AJN:

According to a 2011 Institute of Medicine report, chronic pain is a public health crisis . . . Well-intended efforts to address prescription drug abuse—another public health crisis—may place heavy burdens on people with pain who benefit from opioids and use them responsibly as part of a comprehensive treatment plan. . . . Gains made in pain treatment are at risk. New regulations threaten access […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:34-05:00January 12th, 2016|Ethics, nursing perspective, pain management, patient experience, Patients|3 Comments