Off the Charts

Healthcare Editors Society Gives AJN Awards for Cartoon Cover, Three Blog Posts

To briefly toot our own horn: The American Society of Healthcare Publication Editors (ASHPE) recognizes editorial excellence and achievement in the field of health care publishing. AJN has received 2013 silver awards for the October 2012 cover (see image below) and for three blog posts:

“Grief: The Proposed DSM-5 Gets It Wrong,” by Karen Roush, AJN clinical managing editor

“The Cruel Irony of Alzheimer’s Disease,” by Amy Collins, AJN editor

“Forward or Back? Some Personal Notes on Why the Affordable Care Act Matters,” by Jacob Molyneux, AJN senior editor/blog editor

Jacob Molyneux, senior editor/blog editor2016-11-21T13:07:42-05:00May 1st, 2013|nursing perspective|1 Comment

The Nuts and Bolts of Fluid Therapy in Critically Ill Patients

By Maureen Shawn Kennedy, AJN editor-in-chief

Back in the day when I was a bedside nurse, hemodynamic monitoring was just coming into play, and then only in coronary care. In the ER, we relied on a combination of vital signs (pulse and BP), urine output, and central venous pressure (CVP) to guide fluid administration. Later, patients in need of close monitoring received arterial lines to monitor pulmonary arterial pressures; monitors and stopcocks were everywhere (and soon after, infections, but that’s another story . . . ).

But things are changing again, and the trend is toward less-invasive monitoring. In our May issue, we’re pleased to bring you a comprehensive CE article (worth 2.6 contact hours), “Using Functional Hemodynamic Indicators to Guide Fluid Therapy.” The author is Elizabeth Bridges, PhD, RN, CCNS, an associate professor in biobehavioral nursing and health systems at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center in Seattle. Many critical care nurses will know her from her “standing room only” research sessions at the American Association of Critical Care Nurses National Teaching Institute (this year it will be in Boston, May 20–23), in my view one of the best annual national nursing meetings.

Here’s the article abstract:

Hemodynamic monitoring has traditionally relied on such static pressure measurements as pulmonary artery occlusion pressure and central venous pressure to guide fluid therapy. Over the past 15 years, however, there’s been a shift toward less invasive or noninvasive monitoring methods, which […]

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Jacob Molyneux, senior editor/blog editor2013-05-01T09:38:12-04:00May 1st, 2013|nursing perspective|0 Comments

AJN’s May Issue: Telephone Follow-Up After Myocardial Revascularization, Hemodynamic Monitoring, Staffing Levels, Nurses Week, More

AJN’s May issue is now available on our Web site. Here’s a selection of what not to miss.

Coronary heart disease afflicts more than 16 million American adults. Myocardial revascularization has long been considered an effective treatment for this disease. Findings presented in our May original research article, “Telephone Follow-Up for Patients After Myocardial Revascularization: A Systematic Review,” support the use of telephone follow-up intervention after hospital discharge to assess patient knowledge, discuss patient concerns, and encourage behavioral and lifestyle changes. This article can earn you 2.6 continuing education (CE) credits.

Recently, there’s been a shift toward less invasive or noninvasive hemodynamic monitoring methods, and the use of “functional” indicators that more accurately predict fluid responsiveness. “Using Functional Hemodynamic Indicators to Guide Fluid Therapy,” a CE article that can earn you 2.6 credits, reviews the physiologic principles of functional hemodynamic indicators, describes how these indicators are calculated, and discusses when and how nurses can use them to guide fluid resuscitation in critically ill patients.

Celebrating Nurses Week. May’s In Our Community article describes how nurses from one hospital decided to forego traditional gifts during National Nurses Week and instead implemented a “Nurses Give Back” program in their community. How does your hospital celebrate? If you’re reading AJN on your iPad, you can listen to a podcast interview with the authors by clicking on the podcast icon on the first page of the article. The podcast is also available on our […]

Amy M. Collins, managing editor2016-11-21T13:07:43-05:00April 26th, 2013|career, nursing research|0 Comments

Misplacing Our Focus on Quality Improvement

By Maureen Shawn Kennedy, AJN editor-in-chief

I welcome manuscripts written by nurses in clinical practice, especially comprehensive updates on managing a clinical syndrome or a common problem that readers would find informative and interesting. I call these the “meat and potato” papers—the ones that provide substantial content, the need-to-know information that will help nurses provide quality, evidence-based care. The best ones discuss the physiology and pathology underlying clinical symptoms, practice implications for ongoing monitoring and management, and patient and family teaching and concerns.

The other papers I value are those that describe quality improvement initiatives or processes that improve outcomes and, by following the SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines, are sufficiently detailed so that others can replicate them. (For information on what we seek to publish, see a recent blog post.)

Lately, though, I’m seeing more and more submissions that are not so much focused on how to use best practices to improve care, but rather on ways to improve scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The authors typically describe the impetus for the improvement as low scores, get administrative support to set benchmarks for improving scores, and define success as improved scores. Often the changes are clinically insignificant but scores increase, so everyone is happy.

While the HCAHPS is a national measure that has been adopted as a measure of quality, it’s important to keep in mind that it measures […]

Amy M. Collins, managing editor2016-11-21T13:07:44-05:00April 24th, 2013|nursing perspective|1 Comment

Good Medicine

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:07:48-05:00April 22nd, 2013|nursing perspective|5 Comments