Should Adults Experiencing In-Hospital Cardiac Arrest Be Intubated?

Photo by A.J. Heightman / Journal of Emergency Medical Service / PennWell Corp.

Although it’s commonly practiced, results from a large new study call into question the effectiveness of intubating adults who experience in-hospital cardiac arrest.

As we report in a May news article, researchers analyzed data for 108,079 adult patients who experienced cardiac arrest in the hospital between 2000 and 2014—and found that patients who were intubated within the first 15 minutes of arresting were less likely to survive than patients who were not.

Among other findings, intubated patients were less likely to experience a return of spontaneous circulation and had a lower rate of good functional outcome (defined as either mild or no neurological deficit, or only moderate cerebral disability).

The researchers concluded that the study results do not support early intubation for adults who experience cardiac arrest. However, they noted that their analysis was unable to eliminate potential confounders like the skills and experience of health care professionals, the underlying cause of the cardiac arrest, and the quality of chest compressions. Additional clinical trials are needed to yield useful results and to better understand the influence of confounding factors. […]

2017-05-15T09:13:26+00:00 May 15th, 2017|Nursing|2 Comments

Establishing the Evidence for Clinical Ladder Programs

Nursing Advancement Before the Clinical Ladder

When I took my first job as a hospital staff nurse, pretty much the only path to advancement in the clinical setting was moving into an administrative position. Nurses moved up by becoming nurse managers, then supervisors, and eventually nursing directors. It was considered unusual for someone to stay at the bedside for many years.

Benner’s Novice-to-Expert Model

Then along came the clinical ladder—a way for nurses to advance clinically. Patricia Benner’s landmark work on identifying the hallmarks of novice-to-expert practice laid the foundation for identifying the different stages of acquisition of skills (see her article on the topic published in AJN in 1982; free until May 22).

Evolving Competencies Require New Paths to Advancement

But while the competencies nurses need to practice effectively are vastly different today, many hospitals haven’t updated their clinical advancement programs to reflect the knowledge, skills, and attitudes (KSAs) that nurses need to practice effectively in today’s complex health systems. Moreover, there’s been little research to provide the evidence for identifying the various competencies and the associated KSAs. Our original research article in the May issue provides that evidence.

Creating an Evidence-Based Progression

The authors of “Creating an Evidence-Based Progression for Clinical Advancement Programs” used the […]

2017-05-12T10:50:46+00:00 May 12th, 2017|Nursing, nursing career|0 Comments

The Nurse Who Saw Me: Easing the Strain of a Mother’s Vigil

Illustration by Barbara Hranilovich. All rights reserved.

The Nurse Who Saw Me,” the Reflections essay in the May issue of AJN, is by JR Fenn, a writer and lecturer in upstate New York. The author, who is not a nurse, describes a night of uncertainty she spent in an isolation room on a pediatric unit with her sick daughter.

This is the kind of writing that helps a reader understand the perspective of a scared parent in a disorienting and uncomfortable environment. The care is efficient, and the clinicians she encounters all seem to be doing the right things for her baby. But reassurance is not immediately forthcoming, as we see in this passage from near the beginning:

The attending looks at us over her white mask when I ask if my daughter is going to be OK. ‘There isn’t the research for babies this young,’ she says, her eyes so huge I can see my terrified face reflected in them. I can’t ask any more questions because my throat has swelled closed as I fight tears.

[…]

2017-05-10T11:09:22+00:00 May 10th, 2017|Nursing, patient experience|0 Comments

The Essence of Nursing Care: A Powerful Tribute for Nurses Week

“Frontline nurses, as the health professionals who spend the most time with patients and their families, are central to ensuring that the patient experience is a positive and dignified one.”

Susan Hassmiller

This sentence from “The Essence of Nursing Care,” a guest editorial in the May issue of AJN, isn’t just rhetoric. It’s based on a recent and unforgettable personal experience of the power nurses have to recognize and sometimes ease a family member’s suffering at the very worst of times.

In this moving editorial, Susan Hassmiller, the senior advisor for nursing at the Robert Wood Johnson Foundation, writes about the nurses who helped her in the terrible days following her husband Bob’s tragic bicycle accident last fall. Writes Hassmiller:

“My life changed forever on Sunday, September 25, 2016, at 11:09 am. . . .That’s when I learned that Bob, my best friend and husband of 37 years, lay paralyzed in the trauma unit of a nearby hospital . . . .During those 10 brutal days, I learned anew the crucial role that nurses play in caregiving and compassion. Three nurses stood out in particular.”

I won’t attempt to summarize the rest of this guest editorial. It’s as eloquent a tribute as nurses are likely to get this year on Nurses Week. The article is free, so we […]

2017-05-08T10:15:48+00:00 May 8th, 2017|Nursing|1 Comment

Nurses, What’s Your ‘Elevator Speech’?

“We need to value ourselves—what we do, all that we know, how we change lives. If we don’t own and value our worth, no one else will.”

It’s always nice to write about some good things happening, and this week there are two that gave me a lift.

First, an award: The American Society of Healthcare Publication Editors (ASHPE) recently named this blog the winner of the 2017 gold ASHPE award for best blog. I’m pleased that the hard work by blog editor Jacob Molyneux and the AJN editors and authors who contribute to the blog was recognized. AJN also received a gold award for best cover illustration for our October 2016 political cartoon cover, a silver award for best peer-reviewed journal, and a bronze award for best news coverage. I’m thankful every day that I work with such talented people. They’re committed to upholding AJN’s reputation and mission:

to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.

Second, it’s time for Nurses Week: This Saturday begins Nurses Week (May 6-12), the last day of which always marks the anniversary of […]

2017-05-05T10:13:36+00:00 May 5th, 2017|Nursing|2 Comments