Walkers

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

800px-Billiards_balls By Andrzej Barabasz (Chepry)/via Wikimedia Commons

I see, crossing my path as I ride my bike along the beach, a man in his mid-20s with sandy, sun-streaked blond hair and a long sharp nose that’s a dark, angry red. His gait is deliberate, arms and legs moving in sharp angles. Occasionally I’ve seen him sitting along the path, eyes staring out across the sea, chin on fist, always alone. As my bike glides by, I glance over at his face, which lacks all expression.

It occurs to me that the reason, perhaps, that I take notice of this man is because he reminds me of a patient I once had—Charles (not his real name)—who shared that expressionless gaze and deliberate gait, one that took him nowhere in particular as he covered miles every day.

I was working as an inpatient psych nurse and attending school to finish my BSN degree. Charles was intermittently admitted to our unit. He lived on the street, for the most part, and since I lived downtown, I’d occasionally notice him walking. It’s been too long for me to remember what brought him into the hospital. I’m sure it was a variety of things. A person had to be a danger to themselves or others to stay very long in the unit, […]

2016-11-21T13:08:17-05:00February 15th, 2013|nursing perspective|4 Comments
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Youth with T1 Diabetes Not Meeting A1c Targets: What Can Nurses Do?

By Jeniece Trast, MA, RN, CDE, clinical research nurse manager, certified diabetes educator, Children’s Hospital at Montefiore, Montefiore Medical Center, Bronx, NY

bloodglucosetestingDiabetes Care recently published an article showing that our youth with type 1 diabetes, especially those in adolescence, are not meeting glycosylated hemoglobin (HbA1c) clinical guidelines. The HbA1c is a blood test done every two to three months that shows how well controlled the glucose levels were over that time period. As much as this news is disappointing, I am not shocked by it. Type 1 diabetes is a challenging disease to live with at any age; however, the adolescent years definitely intensify the challenge.

As a nurse and certified diabetes educator (CDE), I take on many roles when caring for a teenager with type 1 diabetes: educator, team member, moderator, blood glucose assessor, advocate, cheerleader, and even role model (yes, I have type 1 diabetes also).

Challenges and responsibilities. When caring for these patients, keep in mind that type 1 diabetes is a difficult disease to live with on a day-to-day basis. People with type 1 have lots of important responsibilities just to stay alive: multiple insulin administrations each day; constant blood glucose checking; understanding the effects of exercise on glucose level both during and after exercise; balancing exercise, stress, food, and insulin; […]

2016-11-21T13:08:18-05:00February 13th, 2013|nursing perspective|2 Comments
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The Hardest Decision: A Military Husband Returns to Tragedy at Home

FebruaryReflectionsIllustrationOur February Reflections essay, “The Hardest Decision,” is by a Amanda Richmond, a nurse based in Arkansas. It’s about a husband facing a drastically changed world upon return from deployment overseas—and a nurse who bears witness. Here’s the opening paragragh. Reflections essays can always be read without a subscription to AJN.—JM, senior editor

That she was still beautiful made her situation all the more tragic. She had little visible damage. An EVD tube snaked out from under her hair and deposited its contents into a drip chamber. Her chest rose and fell at a preselected rate of 14 breaths per minute. iv lines disappeared under her gown and terminated into a central line. On the monitor, her vital signs were flawless.

2016-11-21T13:08:19-05:00February 12th, 2013|nursing perspective|3 Comments
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‘Patient Activation’: Real Paradigm Shift or Updated Jargon?

By Jacob Molyneux, AJN senior editor

I attended a Health Affairs briefing yesterday in Washington, DC. Based on the February issue of the journal, it was called “A New Era of Patient Engagement.” A lot of research money appears to have been flowing to this area in recent years.

Our January article on "Navigating the PSA Screening Dilemma" includes a discussion of 'shared decision making' Our January article on “Navigating the PSA Screening Dilemma” includes a discussion of ‘shared decision making’

The basic idea isn’t entirely new to anyone who’s been hearing the term “patient-centered care” for a long time: as Susan Dentzer writes in “Rx for the ‘Blockbuster Drug’ of Patient Engagement,” a useful article summarizing the main ideas raised in the Health Affairs issue: “Wherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t.”

One might add to these projected benefits: better experiences as patients.

Something’s got to change, so why not this? If many nurses feel they’ve heard all this before, the sense of a health care system in necessary flux […]

2016-11-21T13:08:20-05:00February 7th, 2013|nursing perspective, patient engagement, Patients, personal health practices|1 Comment
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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained […]

2017-07-27T14:51:56-04:00February 4th, 2013|nursing research|1 Comment
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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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