Death by PTSD: When Patients Are Afraid of Health Care

“I pleaded with her to go to the hospital.” Don’s voice is suffused with sadness as he sits at the bedside of his dying 39-year-old partner, Clarisse. “She was terrified of medical tests and procedures. By the time she saw a doctor the cancer had spread. She was so overwhelmed she refused any treatments.”

Over the years, I’ve had several patients like Clarisse; younger people who refused to seek medical care or declined treatments that might have cured them. Some were depressed, others worried about the financial burden. But there was a common thread: all were intensely distrustful, avoidant, and afraid.

Depressive thoughts, distrust, avoidance, and fear are all common features of post-traumatic stress disorder (PTSD) and every one of these patients had either been diagnosed with PTSD or would have if they’d sought psychological care.

Effects of PTSD in patient response to health care.

Clarisse had survived childhood sexual abuse at the hands of one of her mother’s boyfriends. This had left her intensely sensitive to intrusions into her personal space, terrified of being touched or probed by medical staff, and distrustful of men and authority figures. There were a number other common effects of PTSD evident in my work with Clarisse.

2023-01-18T09:55:42-05:00January 17th, 2023|Nursing|0 Comments
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Every Patient Needs an IV, or Do They?

(This post is by an author of AJN‘s January CE feature, “Evidence-Based Practice for Peripheral Intravenous Catheter Management.”)

Questioning the status quo.

As a former critical care nurse and now a vascular access nurse researcher, I’ve had the good fortune to travel widely and work with nurses from around the globe on multiple projects. As a researcher, part of my role is to question clinical practices we often take for granted and to ask, “Is this the best way? Could there be a better way?” Identifying practice that may not always be evidence-based is how research often begins.

Prior to the Covid-19 pandemic, I undertook a two-month fellowship in the US and visited several hospitals where, time and again, I noticed the majority of hospital patients had a peripheral intravenous catheter (PIVC) in place, but many were not in use. When I asked the nursing and medical staff why patients had a PIVC that was not in use, I was repeatedly told, “Every patient needs an IV, just in case.” When I pointed out that some patients had two or three PIVCs not in use, or a central venous access device as well, it became obvious that this is a common problem.

An ‘idle’ catheter is a PIVC that has […]

2023-01-11T11:41:34-05:00January 11th, 2023|Nursing, patient safety|0 Comments
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January Issue: Best Practices for PIVC Management, CAUTI Prevention, More

“Growing, evolving, and progressing are part of the natural order of things. In my almost 40 years as an RN, I have seen enormous evolution and elevation of nurses in the delivery of health care.”—AJN editor-in-chief Carl Kirton in this month’s editorial, “Evolution in a New Year”

The January issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

The Year in Review: 2022

The top health care, clinical, and policy news stories of the year, plus stories to watch in 2023.

Original Research: Practice Variations in Documenting Neurologic Examinations in Non-Neuroscience ICUs

This study explored existing practices for documenting neurologic examinations by RNs and providers in medical, surgical, and cardiovascular ICUs, which don’t routinely admit patients with a primary neurologic injury.

CE: Evidence-Based Practice for Peripheral Intravenous Catheter Management

The authors discuss the evidence for the appropriate use of short PIVCs in hospitalized patients, assess the ongoing need for PIVCs, provide recommendations for alternative options, and argue for promptly removing a PIVC that is no longer in use.

[…]

2022-12-27T10:14:58-05:00December 27th, 2022|Nursing|0 Comments
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Potential Changes to Blood Donation Policies for MSM in the United States

Critical blood shortages persist.

Blood supply shortages heightened by the effects of the Covid-19 pandemic continue to persist in the United States. Major blood suppliers report that this is the lowest level of blood supply they’ve experienced in a decade. Despite this, the Food and Drug Administration (FDA) continues to uphold a longstanding ban on donations from men who have sex with men (MSM), even those who are HIV-negative and in monogamous relationships. The current ban, revised in 2020 due to blood shortages during the pandemic, recommends deferrals for all men who report having sex with men within the last three months.

In early January of this year, the American Medical Association (AMA) sent a strong message to the FDA recommending a change in the current practices. After much external debate, the FDA recently took a significant step by initiating a national pilot study to examine these deferral policies. This study, entitled Assessing Donor Variability and New Concepts in Eligibility (ADVANCE), aimed to guide the FDA in revising the current screening questionnaire and deferral practices. Since the study’s conclusion in September, news outlets have reported that the FDA is considering revising the questionnaire to shift its focus to individual risk, based on […]

2022-12-19T13:03:58-05:00December 19th, 2022|Nursing, nursing perspective, Public health|0 Comments
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The Many Masks Nursing Students Wear

In my experience, nursing students often have an intense drive, intelligence, curiosity, and resilience to get them through the two years of the specialty courses in our BSN program. But sometimes the strain of the many demands and new experiences can be overwhelming, and over the years I have had numerous students come to my office for reassuring words and a safe space to reveal their struggles.

Amidst the rigors of nursing school (and their nursing careers to come), it’s important that students find a way to balance studying with self-care. We all wear masks in our lives; in fact, they are essential. Here are some of the masks that I’ve noticed students adopt when they feel particularly under pressure.

Always smiling.

When I was a student almost 20 years ago, I was stressed more days than I was happy. While everyone has a different temperament, I know I was not alone in this. As an educator, I’ve noticed that some students seem to be always smiling, as if the smile is frozen on their faces. There are some real advantages to friendly, caring smiles from a nurse, in that they can help build rapport with patients who are in a vulnerable position. But in some cases, by always smiling, the students may be trying to live up […]

2022-12-12T10:08:10-05:00December 12th, 2022|Nursing, nursing students|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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