Off the Charts

An NP’s Plea: Hold That Specialist

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

Recently someone I know woke up in the middle of the night with severe foot pain. In the morning he headed to the ED, where he was diagnosed with a fracture of one of the sesamoid bones in his foot and sent to an orthopedist. Over the three days between the ED visit and the orthopedist appointment, the pain began to ease. At the orthopedist it was determined that the problem wasn’t that little sesamoid bone, but gout.

And then they sent him to a rheumatologist.

Why? The condition was already improving and he had no comorbidities. So, why the need for a specialist visit at a cost of $500 just to walk through the door as a first-time patient? A primary care provider should be competent to manage a straightforward case of gout—order and review bloodwork, prescribe medications, educate the patient about their diet, and follow up on their progress. Then if the patient doesn’t respond to treatment or anything unusual develops, call in the specialist.

This happens all the time. When I was first diagnosed with hypothyroid I was sent off to an endocrinologist (under protest). There was nothing unusual in my presentation and I had no comorbidities or history […]

Guest Author2018-03-28T10:35:59-04:00August 2nd, 2012|nursing perspective|5 Comments

One Instructor’s Updated Nightingale Pledge

Editor’s note: This post by Lorita Renfro, BSN, RN, proposes an updated version of the Nightingale Pledge. The author is a clinical nursing instructor in the ADN/VN programs at Kaplan College in San Diego and is currently working toward an MSN with an educational focus. Let Lorita know what you think. Would your version differ in any way?

Florence Nightingale in Crimean War, from Wikipedia Commons

As the science of nursing evolves, one aspect of nursing remains the same: the art. We see it when we are inspired to do the best for our patients, develop higher standards, and provide care from our hearts. This inspiration is the basis of all good nursing practice.

The science of nursing is seen in the interventions that provide comfort and protect our patients from harm. In the past, this protection often meant cleaning floors and carrying bed pans. My father believed until the day he died that what I did was to “help the doctors” heal the patients.

This may still be true at times, but the science of nursing is now also represented by innovation, intuition, strength, and the responsibility of being a team member who collaborates in the delivery of […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:09:36-05:00July 31st, 2012|career, nursing perspective|20 Comments

AJN’s August Issue: A Metaphorical Prison, a Found Manuscript, a Nurse Carries the Torch, More

AJN’s August 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.

Nurses play a crucial role in inpatient programs for anorexia in adolescents, but how do the patients view them? Our Original Research article, “An Inpatient Program for Adolescents with Anorexia Experienced as a Metaphorical Prison,” describes the experience of adolescents in an Australian inpatient behavioral program and how both nurses’ and patients’ perception of the program as a metaphoric prison negatively affected the development of therapeutic relationships between them. This CE article is open access and can earn you 2.5 CE credits.

Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. But what does this really mean for nurses? “Health Information Technology and Nursing,” the first article in a series of three on HIT and nursing, will examine the federal policies behind efforts to expand the use of this technology. This CE article is open access and can earn you 2.1 CE credits.

According to the U.S. Department of Labor’s Bureau of Labor Statistics, more than 348,000 unlicensed assistive personnel were employed in the hospital setting in 2011. Our Cultivating Quality article, “Continuing Education for Patient Care Technicians: A Unit-Based, RN-Led Initiative,” explores how one teaching […]

Amy M. Collins, managing editor2016-11-21T13:09:36-05:00July 27th, 2012|Nursing|2 Comments

Talking About Death: Not Nice, But Necessary

Photo by Eliza Peyton, via Flickr

By Amy M. Collins, editor

Our recent blog post on “death panels” triggered a memory of my own first real experience with the death of a loved one. It was a little over 10 years ago. I was living overseas when my mother called to tell me my grandfather had liver cancer and had been given maybe a year to live.

The physician had given my family three choices: the aggressive choice, chemo; a less aggressive treatment with an experimental drug that had moderate success; or to let him live out the rest of his numbered days. We chose the middle ground.

At the time I worked in medical publishing and thought I knew everything. Over the weeks that followed I would call home to get progress reports, usually putting my two cents in about what my family should be asking the physician. Finally, when things seemed to be getting worse, I flew home to help.

Nothing could have prepared me for the emaciated man I found sitting up in bed when I went to my grandparents’ house to visit. I hardly recognized my grandfather. It hadn’t been that long, but the cancer had already ravaged him. Despite this, he was cheerful and had high hopes. He didn’t seem […]

Amy M. Collins, managing editor2016-11-21T13:09:37-05:00July 25th, 2012|patient engagement, Public health|4 Comments

Making a Case for Therapeutic Hypothermia

One of the articles published in AJN’s July issue that’s proving popular is “Therapeutic Hypothermia After Cardiac Arrest,” by Jessica L. Erb, an acute care NP at the University of Pittsburgh Medical Center Presbyterian Shadyside Hospital, and colleagues Marilyn Hravnak and Jon C. Rittenberger. The article points out that, despite evidence supporting its effectiveness, therapeutic hypothermia is not widely used.

According to the article’s overview, “Irreversible brain damage and death are common outcomes after cardiac arrest, even when resuscitation is initially successful. Chances for both survival and a good neurologic outcome are improved when mild hypothermia is induced shortly after reperfusion. Unfortunately, this treatment is often omitted from advanced cardiac life support protocols.”

The article discusses the efficacy of therapeutic hypothermia, indications and contraindications for its use, various induction methods, associated complications and adverse effects, and nursing care specific to patients undergoing this procedure.

Read the article (it’s open access)—you can earn 2.3 hours of CE credit.—Shawn Kennedy, AJN editor-in-chief