Off the Charts

Can’t Even Think About It: An ICU Nurse’s Personal Taboo

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

The weekend was busy in the ICU; several critically ill trauma patients were admitted in quick succession and the unit was filled with grieving families. The air was heavy with tragedy and misery, and it was draining to work under such weight.

I had a single day off, which didn’t feel like enough, and when I returned to work there were new patients in the beds and the mood in the unit had drastically changed. Disarming, but not surprising; the ICU is always the same and yet different.

One of the young patients from the weekend had become an organ donor, which had been anticipated and was considered a positive outcome, relatively. In discussing the weekend events and the ways in which things had resolved, one of my colleagues mentioned that, if given the opportunity, she’d embrace the chance to go to the operating room with the organ procurement team. Her beloved niece had been an organ donor and she sees organ donation as a validation and continuance of life, an ultimate example of “paying it forward.” She takes great comfort in knowing that her niece did not die in vain; lives were saved. She’d like to see, firsthand, the workings of the surgical team as they extract the organs.

“I would never do that,” […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:07-05:00October 10th, 2012|nursing perspective, Patients|4 Comments

What Do You Value?

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

“ ‘The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.’—Hubert Humphrey

These are the words that physician Donald Berwick saw as he went to work in the building that bears Humphrey’s name and houses the U.S. Department of Health and Human Services in Washington, DC. They reminded Berwick, the former administrator of the Centers for Medicare & Medicaid Services (CMS), of his most important mission: “to help the people who need our help the most.” And they are at the heart of an important topic of debate during this election season: what is the proper role of government in our lives?”

AJN Oct. cover, detail

So begins a blog post on the JAMA Forum by Diana Mason, PhD, RN, Rudin Professor of Nursing and codirector of the Center for Health, Media, and Policy at Hunter College, City University of New York, as well as president-elect of the American Academy of Nursing (and, for the sake of transparency, former editor-in-chief of AJN).

Her question is a critical one and one that has been a fundamental issue, tug-of-war even, for Americans. Our citizens take a great deal of pride in being independent, self-made, and self-reliant—yet it’s obvious that most of us also believe […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:09:08-05:00October 8th, 2012|nursing perspective|4 Comments

‘No One Ever Put the Puzzle Pieces Together’: A Nurse’s Guide to Celiac Disease

By Sylvia Foley, AJN senior editor

Wheat spikes by Dag Endresen, via Flickr

If you’ve thought that celiac disease is just another disease-of-the-moment that few people actually have, this month’s CE by McCabe and colleagues, “Celiac Disease: A Medical Puzzle,” might make you reconsider. The disease is an autoimmune genetic illness that typically targets the small intestine, and it’s caused by an intolerance to ingested gluten, a complex protein found in wheat and certain other grains. Until recently, celiac disease was considered rare; but widespread serologic testing has indicated otherwise. Experts estimate that up to 1% of the U.S. population—more than 3.1 million people—are affected.

Yet celiac disease remains widely underrecognized. For one thing, clinicians are still being taught that it’s a childhood illness, although onset can occur at any age; for another, disease presentation is highly variable (there are more than 200 associated signs and symptoms). All of the article’s six authors have themselves “either personally endured or witnessed the misery of misdiagnosis.” To help raise awareness, they offer several illustrative stories, including this one:

I am a registered nurse. I was treated for irritable bowel syndrome for more than 10 years. Although I was very careful with my diet, I never seemed to get better and felt sick most of the time. One day, I was admitting an elderly woman to home care and was reviewing her many diagnoses. She told me about her celiac disease and the symptoms she’d experienced. As […]

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Guest Author2017-07-27T14:53:00-04:00October 5th, 2012|nursing perspective|0 Comments

Evidence Contradicts AAFP: NPs Ideal for Leading Patient-Centered Medical Homes

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

What will it take to end the turf war physicians are waging against nurse practitioners? The latest foray is over who should lead patient-centered medical homes (PCMH). According to the American Academy of Family Physicians (AAFP), only physicians should. They insist that nurse practitioners do not have the knowledge or skills to do so and that expanding the NP’s role in primary care would create a “two-tiered health system,” with patients who are cared for by an NP receiving a lower level of care.

That’s not what the evidence says. Or patients for that matter. Studies consistently find that when care provided by NPs is compared to care provided by physicians, the care is similar as far as prescriptions ordered and referrals made—most important, outcomes are the same.

Well, there is one area where differences keep showing up: patient satisfaction. Patients consistently say that they are more satisfied with care provided by nurse practitioners. They say that nurse practitioners listen better, spend more time with them, and provide them with more information.

Not only are nurse practitioners capable of leading medical homes, their education and skills make them ideal for this role. Whereas physicians focus on pathology and have the depth of knowledge and skill to manage highly complex patients, NPs focus on the “human response to disease” and take a more holistic approach to patient care. Nurses coordinate care all the time, identifying […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:09:11-05:00October 3rd, 2012|nursing perspective|4 Comments

AJN’s October Issue: Breast Cancer, Celiac Disease, the Fall Elections, More

AJN’s October issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

All women who inherit a BRCA1 or BRCA2 mutation have a significantly increased risk of developing breast or ovarian cancer or both. This month’s original research article, “Being Young, Female, and BRCA Positive,” explores the psychosocial consequences in young women who test positive for one of these mutations—especially where it concerns marriage and childbearing. This CE article is open access and can earn you 2.1 CE credits.

Diagnosis of celiac disease in adults is often missed or delayed because clinicians often consider it to be a childhood disease. “Celiac Disease: A Medical Puzzle,” provides an overview of this widely underrecognized disease, outlines the pathophysiology and the four types of celiac disease, addresses diagnosis and disease management, and offers illustrative stories in the interest of raising nurses’ awareness of the disease. This CE article is open access and can earn you 2.1 CE credits. For more information, listen to a podcast with the authors.

Being unaware of the realities of licensure can damage a nurse’s career, even permanently. “Common Misconceptions About Professional Licensure” is part one of a three-part series that will discuss nursing disciplinary actions and provides tips for maintaining one’s license in good standing. For more, listen to a podcast with the author, […]

Amy M. Collins, managing editor2016-11-21T13:09:11-05:00October 1st, 2012|Nursing|0 Comments