The Reality of Depression Following Stroke

Photo by David A. Grossman.

This month’s CE article, “Early Intervention in Patients with Poststroke Depression,” hit home for me. It brought back memories of my Aunt Rita’s decline from a once-vibrant and independent career woman. As authors Gwendolyn Hamid and Meredith MacKenzie note, poststroke depression “often goes unrecognized and untreated because the physical and cognitive repercussions of stroke make it difficult to identify.”

Aunt Rita lived alone in an old Victorian house in Massachusetts. She was fun-loving and lively and enjoyed going to the theater and dinner in Manhattan, shopping, and sipping a beer and rooting for the Red Sox and Boston Bruins—especially when she was with her New York nieces and nephews. When she had cardiac bypass surgery in her 70s, however, things changed drastically. She didn’t bounce back from surgery. Aunt Rita was slow and tentative in moving about and became quiet and withdrawn. A niece came to live with her as a caregiver, but Aunt Rita didn’t seem to want to eat, drink, or even bathe. Her physician diagnosed organic brain disease secondary to the effects of a stroke.

About three months later, I drove up from New York to visit her along with my mother (Rita’s younger […]

2017-07-10T09:31:27+00:00 July 10th, 2017|Nursing|0 Comments

A Nurse Takes a Fall, and Loses More than Her Mobility

The Reflections essay in the July issue of AJN, “An Inconsolable Loss,” tells the story of a traumatic event that interrupts and forever changes a retired nursing professor’s relationship with her mother, “whose gentle touch and approving smile” she had always craved. Writes author Brenda Kelley Burke:

For a number of years, I’d made daily trips after work to a nursing home to visit my mother . . . .The roles of child and mother were now reversed because of her dementia. I felt acutely aware of the mother–child bond and how it transcends time and circumstance. How could I measure up to this wise and loving woman, who so many years ago would kiss my small feet before she put on my socks and whisper, ‘God, guide them to the safe places’?

But one bitterly cold and snowy night, writes Burke, “like the famous nursery rhyme character, I too had a great fall that left me broken.” Sometimes the seemingly fixed patterns of our lives depend on the most fragile of balances—one change can lead to many others, and suddenly nothing seems the same. […]

2017-07-05T11:03:05+00:00 July 5th, 2017|narratives, nursing stories|1 Comment

International Health, Nurse Staffing, the Power of Social Media

I previously posted on this blog in anticipation of attending my first international nursing meeting—the  2017 International Council of Nurses Congress in Barcelona—and wrote about it later in a joint post with AJN‘s editor-in-chief Shawn Kennedy. There will also be a full report in the August issue of AJN.

Based on subsequent reflection, here are some lasting takeaways:

International health is an American nursing problem.

“Shamian asked what American nurses do for their fellow nurses around the world.”

There was a lot I didn’t know about global health. I was thankful that I’d taken some time to study a few key concepts, especially the sustainable development goals (SDGs).

In the opening session, ICN president Judith Shamian charged all nurses to take seats at policy tables and draw upon their expertise. Through her passion, I began to see a part I could play in policy making simply by keeping abreast of issues and sharpening my nursing voice.

From the plenary speech by former Secretary of U.S. Health and Human Services, Mary Wakefield, I began to see the necessity of grounding policy work with reliable, relevant evidence. And in our interview with Shamian, policy and evidence met collaboration as Shamian asked what American […]

2017-07-10T07:54:39+00:00 June 30th, 2017|Conference reports, Nursing|6 Comments

Viewpoint: A Limitation of Preprocedure Checklists

I once worked at a hospital where some of the surgeons regarded safety checklists as an inconvenience. They saw them as bothersome intrusions by the nursing staff into the surgical suite. One OR nurse was even “counselled” by her supervisor (in the presence of the complaining surgeon) to avoid upsetting the doctors by using the preprocedure time-out.

How important are these tools? Are we using them well, or do we speed through them as rote exercises? Might we even expect too much of them? In AJN’s July Viewpoint, nurse Elizabeth Anne Crooks relates a frightening episode (she was the patient) that led her to think about time-outs in a different way.

Crooks was about to undergo a colonoscopy. The clinical team seemed relatively unconcerned about her bradycardia, which was a significant change from her normal heart rate. After completing the usual time-out protocol, sedation was initiated and the physician began the procedure. Suddenly, Crooks’ heart rate and blood pressure dropped precipitously.

I remember waking in distress and hearing the monitor alarming. The team was working rapidly to stabilize me with fluids and medications.

A routine procedure had suddenly become an emergency.

In reflecting upon her experience, Crooks wonders whether the preprocedure time-out may have given her clinical team a false sense of security—one that led them to downplay a clinically significant change. And yet, as we know, these time-outs focus on ensuring that the correct patient is receiving the correct procedure, and not on other safety […]

Exploring Irritable Bowel Syndrome

Illustration by Sara Jarret.

Irritable bowel syndrome (IBS) is one of those conditions that is maddening for patients and clinicians alike. Its pathophysiology is unclear, the symptom picture varies widely from patient to patient, there is no test to confirm the diagnosis, and treatment is directed at managing symptoms because there is no cure.

To make things even more difficult for the person with IBS, there is a recognized psychological component of the disease. Therefore some friends, family members, and clinicians might tell people with IBS that their suffering is “all in their head.” And yet there is demonstrable proof (via neuroimaging studies) of differences in central processing mechanisms related to the “brain–gut axis” between people who have IBS and those who do not.

Kristen Ronn Weaver and colleagues explore these and other aspects of IBS in a clinical feature article in AJN’s June issue. The authors review the latest findings related to IBS etiology and pathophysiology, the relationship between IBS symptoms and stress, and the updated Rome IV criteria that help guide diagnosis. Of particular interest is the authors’ presentation of research confirming the value of several nonpharmacologic interventions, including dietary modifications, probiotics, moderately increased physical activity, yoga, and traditional Chinese medicine.

See “Irritable Bowel Syndrome” in the June issue to learn more, and to find out how nurse-led initiatives can lead to long-term health benefits for people with IBS.

 

2017-06-26T09:07:44+00:00 June 26th, 2017|Nursing, patient experience|0 Comments