Precarious Hope: A Hospice Nurse Balances Truth and Kindness

This couple might be your elderly neighbors: he helps his wife into the house as she moves slowly, step by unsteady step, in time with her four-point cane; at the same time, you know that he is recovering from recent chemotherapy treatments. Or they may be your aging parents: your mother’s role as primary caregiver hampered by her right leg weakness from a stroke and advancing heart disease, while your father needs more care from day to day as his renal failure approaches the decision to begin dialysis or not. They support and care for each other.

PrecariousHopeIllustrationThe December Reflections column in AJN, “Precarious Hope,” is by an RN case manager at a hospice. She describes a couple in which one partner has dementia and the other has cancer, their mutual dependency, and the challenge of knowing how best to care for them:

In hospice, I’m often confronted with the difficulty of balancing honesty with kindness. I love a quote often attributed to the Buddha: “When words are both true and kind, they can change our world.” It follows that sometimes what is true is not kind, and that truth must be cloaked in kindness—as in this instance, as I sit at the table listening to George, whose hopeful, unrealistic comments confirm that he simply can’t hear the truth.

It’s a sensitive portrait of love, the fine line between self-delusion and perseverance, and the way that sometimes simply bearing witness is the […]

2016-11-21T13:08:44-05:00December 14th, 2012|nursing perspective|1 Comment
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Top 10 New AJN Posts of 2012

British Nurse and Baby, via Flickr/jdlasica British Nurse and Baby, via Flickr/jdlasica

By Jacob Molyneux, AJN senior editor/blog editor

Maybe, who knows, some social media content isn’t really quite as ephemeral as we usually believe. Some of our posts seem to keep finding readers, like 2009’s “New Nurses Face Reality Shock in Hospitals–So What Else Is New?” They’re still relevant and timely, addressing as they do some of the more perennial topics in nursing.

Our 20 most-read posts for the year include several others that aren’t “new” this year: “Parting Thoughts: 10 Lessons Learned from Florence Nightingale’s Life”; “Confused About the Charge Nurse Role? You’re Not Alone”; “‘Go Home, Stay, Good Nurse’: Hospital Staffing Practices Suck the Life Out of Nurses”; “Is the Florence Nightingale Pledge in Need of a Makeover?”; “Do Male Nurses Face Reverse Sexism?”; “Fecal Impaction and Dementia: Knowing What to Look for Could Save Lives”; “Are Nursing Strikes Ethical? New Research Raises the Stakes”; and “One Take on the Top 10 Issues Facing Nursing.”

The upstarts. Putting aside posts that have shown a certain longevity, here are the top 10 new posts of 2012, according to our readers, in case you missed them along the way. Are they our best posts of 2012? We will leave that to you. Thanks to everyone who wrote, read, and commented on this blog over the past year.

1.

2016-11-21T13:08:45-05:00December 12th, 2012|healthcare social media|0 Comments
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Nurse Staffing Matters at the Shift Level—Evidence-Based Scenarios Illustrate How to Apply What We Know

We know that staffing matters. Studies have shown that hospitals with lower proportions of RNs have higher rates of death overall, death following compli­cations (that is, failure to rescue), and other adverse events. But how do such data on staffing translate into what the average hospital nurse experiences on a shift?

That’s the question posed by Gordon West and colleagues, the authors of this month’s CE, “Staffing Matters—Every Shift.” To address it, they reviewed findings from the Military Nursing Outcomes Database (MilNOD). MilNOD, a quality improve­ment and research project conducted in four phases between 1996 and 2009, encompassed data from 111,500 shifts on 56 inpatient units in 13 U.S. military hospitals. The project explored “the effects of staffing levels and skill mix on the probability of patient falls, medication errors, and needlestick injuries to nursing staff.”

As the authors explain, the MilNOD data showed that the number, mix, and experience of nurses on a shift—not just on a unit—were associated with adverse events for patients and needlestick injuries to nurses. West and colleagues offer several realistic, descriptive scenarios to illustrate the potential effects of staffing changes and to show how such knowledge can be applied to daily decision making.

To learn more, read the article, which is free online.—Sylvia Foley, AJN senior editor


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2016-11-21T13:08:46-05:00December 10th, 2012|nursing research|3 Comments
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Kasandra Perkins, Domestic Violence, and the Senseless Search for a Reasonable Explanation

photo via Facebook photo via Facebook

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Let’s call it what it was. Kasandra Perkins was murdered in a domestic violence attack. This was not about a football player who took one too many hits to the head. This was not about a good, loving family man who was driven to take this terrible action. This was not about someone who snapped from stress (would he get enough playing time? would he make enough money to pay for his expensive new car?).

This was about what domestic violence is always about: control, rage, and power. There is no mystery here—we don’t need to search for reasons why a good, loving family man would shoot someone he loved. Because they don’t. Violent men commit acts of violence.

This searching for a reasonable explanation distracts us from the truth. It bolsters myths and misconceptions. It creates the illusion that each domestic violence attack is a special case, not part of the fabric of our society. One in four women experience domestic violence. Over a thousand die every year. Do the math—Kasandra was one of at least three women we could expect to have been murdered in a domestic violence attack on Saturday. We didn’t read about the other two. We wouldn’t have read about Kasandra either if her murder weren’t at the hands of a professional football player.

Not that the […]

2016-11-21T13:08:47-05:00December 6th, 2012|Nursing|6 Comments
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ECRI Conference Notes: Creating and Replicating ‘Systemness’ within Health Care Delivery

By Joyce Pulcini, PhD, RN, FAAN, Policy and Politics contributing editor, AJN

The ECRI Institute’s 19th annual conference (November 28–29) looked at system-level innovation and quality in the health care system. It brought together experts from many fields, including medicine, nursing, hospital or health system administration, informatics, health care quality, policy makers, journalists, and academics. ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care. The goals of the conference were to address the following:

  1. What is “systemness”?
  2. Which elements within mature health care systems result in the best clinical outcomes?
  3. Are approaches taken by long-established systems transferable to smaller, newer, or less integrated systems?
  4. Are financial incentives enough to drive change?
  5. How can electronic health records (EHRs) help improve “systemness”?
  6. Do transformation units within health care systems produce results?

The conference essentially tried to attack in a creative way the issues around the creation of systems that function optimally. Truly changing culture and providing optimal care delivery should always result in putting the patient at the center of care. The conversation was open and the conference succeeded in fostering important dialogue among the speakers and the audience.  A major focus was on creating systems, looking at technological or financial solutions, and measuring outcomes.

The session on team care (“Creating teams to improve inter- and intra-health care systems: Does evidence show a benefit?”)  highlighted the vexing issues around how to truly foster optimal teams. Lisa Schilling, RN, MPH, VP National HC Performance Improvement, Director, Center for […]

2016-11-21T13:08:48-05:00December 5th, 2012|digital health, health care policy, nursing perspective|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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