Smoking, Nurses, Knowledge: We’ve Come a Long Way, But Not Far Enough

By Shawn Kennedy, MA, RN, AJN editor-in-chief

"Smoke break"/by sylvar, via Flickr “Smoke break”/by sylvar, via Flickr

Back in the day, I remember riding in the car with my parents, both of whom smoked. My siblings and I used to jockey for the window seats so we could be near the fresh air streaming in.  And I recall holidays with visiting relatives when all the adults would sit in the living room smoking cigarettes. (Kent filter-tips for the women; Camels for the men.) And as kids, we used to “smoke” candy cigarettes. The ones that “puffed” when you blew into them were our favorites.

But I also recall getting older and not wanting to visit my Uncle Joe, a once tough New York City police detective, because he would just sit on the edge of his chair, leaning over a table and struggling to breathe. This made my dad quit cold turkey after he had a heart attack at age 48 and our family physician told him he could either keep smoking or quit and see his children get married. My mom quit when she was pregnant with my youngest sister, after the surgeon general’s report said smoking could harm the fetus.

Our parents were constantly telling us that they wished they’d never started (my […]

2018-03-28T10:27:17-04:00January 22nd, 2014|nursing perspective|3 Comments
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Patient Decisions: When You’re Just Not Up to Making the Call

By Karen Roush, MS, RN, FNP, clinical managing editor

Photo by the author Photo by the author

For most patients and in most clinical situations, decision making is and should be a shared process between the patient and the clinician (and often the family). But there are some cases when we, expert clinicians versed in scientific and experiential knowledge, need to make a decision for the patient—not out of some paternalistic idea of our authority or superiority, but because the patient really wants or needs us to take on that burden.

I was six months pregnant with my second child. The pregnancy had gone smoothly, which was a blessing after having delivered my first child 10 weeks premature following two weeks spent in a tertiary care center. That pregnancy had been problematic from the beginning—early bleeding, and then a hemorrhage at five months, at which time they’d diagnosed me with placenta previa. It was one of those pregnancies where you were thankful for each additional day that brought you closer to the nine-month mark.

But this time, everything was going smoothly—no bleeding or cramps, an active baby that ultrasounds confirmed was growing well . . . until one morning in February, when I started with cramps that progressed to pain and a lot of pressure. An hour later, I was in the labor and delivery […]

2016-11-21T13:05:37-05:00January 17th, 2014|career, nursing perspective, patient engagement, patient experience|1 Comment
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Health Technology Hazards: ECRI’s Top 10 for 2014

hazard/jasleen kaur, via Flickr hazard/jasleen kaur, via Flickr

It’s that time of year again—the ECRI Institute has released its Top 10 Health Technology Hazards for 2014 report, and with it come new (and old) hazards to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the third year running. Other repeat hazards included medication administration errors while using smart pumps (in at number two), inadequate reprocessing of endoscopic devices and surgical instruments (number six), and, at number eight, risks to pediatric patients associated with technologies that may have been designed for use in adults (such as radiology, oxygen concentrators, computerized provider order–entry systems, and electronic medical records). For an overview on these, see our posts from 2012 and 2013.

And here’s a snapshot of new hazards that made the cut, along with some of the report’s suggestions on how to prevent them.

Radiation exposures in pediatric patients (#3)

The risk: Although computed tomography (CT) scans are valuable diagnostic tools, they are not without risk, and children, who are more sensitive to the effects of radiation than adults, are more susceptible to its potential negative effects. According to the report, new empirical studies suggest that “diagnostic imaging at a young age can increase a person’s risk of […]

2016-11-21T13:05:37-05:00January 15th, 2014|digital health, Nursing, Technology|1 Comment
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Chronic, Common, Hidden: Helping Patients With Urinary or Fecal Incontinence

Article illustration by Gingermoth. All rights reserved. Article illustration by Gingermoth. All rights reserved.

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

Urinary and fecal incontinence are not the kinds of health topics widely discussed—people may compare notes about knee or hip replacements or their cholesterol levels, but you’ll find few people talking about leaking urine or feces. Even at medical and nursing conferences—unless one happens to be at a conference specifically dealing with those issues—you might be hard-pressed to find the topic on a program agenda.

But these are common problems—a 1995 report in the CDC’s MMWR estimated that 15%–30% of adults over age 60 suffer from urinary incontinence. (And that was 10 years ago. No doubt that number is higher by now, given the higher numbers of people who are over 60.) Fecal incontinence occurs in about one in 12 adults—in a 2009 report, that was 18 million people.

It’s the kind of problem that can drastically change the quality of life for those who have it, due to their fear of having an “accident” in public. Think about it: no extended excursions unless there are facilities all along the way (this can rule out many outdoor activities like golf, trips to the beach, or hiking); timed meals and beverages to reduce the chance of […]

2016-11-21T13:05:38-05:00January 13th, 2014|nursing perspective, nursing research|2 Comments
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What Ever Happened to a Good History?

ky olsen/via Flickr ky olsen/via Flickr

By Karen Roush, MS, RN, FNP, clinical managing editor

What ever happened to a good history? We were taught as NP students that the history portion of the exam was as important as the physical. In fact, in most cases it’s what you learn in the history—from asking the right questions and really listening to the patient’s answers—that gives you the information you need to figure out what is going on. The physical findings either support what you’re thinking or lead you to ask more specific questions.

A good history isn’t just listening to the patient’s answers to your questions; it’s listening to all the information they offer. Take for example, the middle-aged construction worker who takes his lunch hour to come in to the clinic complaining of a cold. He lists the usual symptoms, cough, fatigue, a little shortness of breath, and then as you’re starting the exam he casually mentions that he hasn’t been to a doctor in 15 years.

Someone who’s managed to stay out of a doctor’s office for 15 years and now shows up, on his lunch hour, because of a simple cold? So, you ask some more questions and learn about some chest pressure he attributes to the coughing he’s been doing and about his […]

2016-11-21T13:05:39-05:00January 10th, 2014|nursing perspective, Patients|4 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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