When Patients Ask About Palliative Chemotherapy

Photo © Associated Press. Photo © Associated Press.

Nurses repeatedly witness the suffering of people with advanced, metastasized cancer who are undergoing chemotherapy. These drugs often seem to diminish rather than enhance the quality of the remaining weeks of their lives.

In the first article in a new AJN series on palliative care, author Marianne Matzo points to research indicating that chemotherapy in end-stage cancer does more harm than good. So what should we do when patients ask (as in this article), “Is the chemotherapy going to help me? And if it’s not, why are they offering it?”  […]

2016-11-21T13:01:08-05:00June 14th, 2016|Nursing, patient engagement, patient experience|1 Comment
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Recent End-of-Life Care Links of Note, by Nurses and Others

nature's own tightrope/marie and alistair knock/flickr creative commons nature’s own tightrope/marie and alistair knock/flickr creative commons

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent […]

2016-11-21T13:02:42-05:00April 13th, 2015|career, Nursing, nursing perspective, patient engagement|0 Comments
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Intensive Care of a Different Ilk

MayReflectionsIllustrationThis month’s Reflections essay (“Intensive Care”) is by John Fiddler, an NP who describes his work as an inpatient hospice nurse in New York City as being “as close to the ideal of nursing as I have ever been.”

This is a big claim—but if you read Fiddler’s brief, artful summary of the evolution of his nursing career, which started in an actual ICU, and then his description of what he found when he went to work in a hospice, you might find that he makes a pretty good case.

Here’s a small excerpt:

Inpatient hospice to me was the room at the end of the palliative care corridor that I had never bothered to visit. I had pictured it as a quiet haven for the dying, where birds chirp outside and music is heard playing through open windows as patients calmly drift off and up into dusty shafts of sunlight.

Not quite.

Instead, picture a unit where patients arrive on stretchers in extreme pain and distress, afraid, breathless—usually with families trailing behind, holding on to as much emotional and personal baggage as they can carry. Often these patients bear the physical and psychic bruises of a prolonged ICU stay.

And this is what happens here…

Maybe the author will someday find another ideal of nursing care, or maybe he won’t, but it’s worth reading his account of the current one. Reflections essays are open access. (Click through to the PDF […]

2016-11-21T13:04:48-05:00May 9th, 2014|career, nursing perspective|1 Comment
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Do EHRs Rob Nurses of Voice and Oversimplify Description of Patient Care?

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology. Editor’s note: this post has been slightly revised for clarity since its initial publication a day ago.

Heroines of Nursing, mixed media collage by julianna paradisi, 2013. Text by Florence Nightingale
Heroines of Nursing, mixed media collage by julianna paradisi, 2013. Text by Florence Nightingale

Previously I’ve written that I have a new employer. Part of this transition is relearning how to use the electronic health record (EHR). Fortunately, this new employer uses the same program as my last. However, that version was EHR-lite compared to the one we use now.

For instance, the new system contains an abundance of “smart phrases” that are used to lessen time spent writing nursing notes. If you are unfamiliar with smart phrases, an uncomplicated explanation is that they are preconstructed phrases chosen from those commonly found in charting, such as “The patient arrived ambulatory for IV infusion.” Instead of typing in this phrase, nurses can click on it from a computer screen menu, and voilà! The entire phrase is electronically inserted into the notes.

Smart phrases, like charting by […]

2016-11-21T13:06:30-05:00September 23rd, 2013|digital health, nursing perspective|7 Comments
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Angelina, Florence, End-of-Life Care, Nursing History, Postpartum Depression: A Web Roundup

By Jacob Molyneux, AJN senior editor/blog editor

In the news today we have an op-ed piece in the New York Times by Angelina Jolie about her rationale for getting a double mastectomy. There are sure to be many reactions to this disclosure, with many offering praise for her frankness about her decision. There may also be some who disagree with her decision to take this preventive step because she has the BRCA1 gene, which sharply increases her risk of getting breast cancer. Jolie’s perspective seems to be one of empowerment for women rather than a sense of helplessness or sorrow. Though Jolie’s circumstances are hardly universal in terms of the cushion provided by her great wealth, it’s hard not to admire the strength it takes to see things in such a positive light: “Life comes with many challenges,” she writes. “The ones that should not scare us are the ones we can take on and take control of.”

MarchCoverIt’s come to our attention that, in honor of Nurses Week, the American Antiquarian Society blog, PastIsPresent.org, put together an interesting collection of items related to nursing from its mid-19th century archives, leading their post with a mention of AJN‘s March cover, which featured a vintage illustration, “A Map of the Open Country of  Woman’s Heart.”

A recent post we ran about the fading away of certain nursing blogs gets a mention from PixelRN, who has […]

2016-11-21T13:07:36-05:00May 14th, 2013|nursing perspective|0 Comments
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Some Observations In Response to the NY Times Article on Palliative Sedation

By Judy Schwarz, PhD, RN*  


The NY Times article of 12/26/09 that described use of palliative sedation in hospice institutional settings provided helpful and clinically accurate informative—for the most part. These few notes are meant to address those issues raised by the article that may unduly alarm dying patients, their families, and their clinical caregivers.


1) There is a consensus among palliative care clinicians that “palliative sedation to unconsciousness” (a descriptive term that eliminates some of the visceral reaction elicited by use of the term “terminal sedation”) is an intervention used only when other therapies that do not compromise patient consciousness have failed and the patient continues to experience intolerable and intractable suffering that cannot otherwise be relieved.

2) Use of palliative sedation to unconsciousness has NOT been shown to cause a hastened death. Research showing that patients at the very end of life who receive palliative sedation do not die more quickly than patients who are not sedated has been published in such peer-reviewed journals as Annals of Oncology, Journal of Palliative Medicine, Journal of Pain and Symptom Management, Archives of Internal Medicine, and Palliative Medicine. (In response to the Times article, the National Hospice and Palliative Care Organization has made available a bibliography of these articles.)

This intervention is generally only provided when patients are “imminently” dying (a condition the recognition of which requires experience and clinical judgment) and is distinct from “respite sedation,” which is used when clinicians plan to awaken a patient from the unconscious state to […]

2016-11-21T13:20:16-05:00January 7th, 2010|Nursing|1 Comment
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Journal Watch: Short Takes on Recent Notable Research

This month we’re spotlighting our Journal Watch department. Here you can find short takes giving just the essential take-home points from notable studies that have been recently published in respected journals.

If you need to keep up with current research but don’t have time to do so, we suggest you start here each month.

The following six short articles will be free for the month of July.

Deprescribing in patients with a history of falls isn’t so easy, for either clinicians or patients. “Multifaceted, multilevel approaches are needed to overcome common barriers.”

Many women who have ovarian cancer still receive aggressive end-of-life care despite recommendations emphasizing early palliative care . . . and nonwhite women are more likely to receive aggressive care.

Discontinuation of thyroid hormone replacement is possible in some cases.
“Nearly one-third of patients remained euthyroid after discontinuation.”

Changes in ED use during the pandemic.
“Shifts in the pattern of ED visits . . . highlight the need for mental health, substance abuse, and violence risk screening and prevention during public health crises.” […]

2021-07-06T15:53:08-04:00July 6th, 2021|Nursing|0 Comments
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AJN March Issue Highlights: A Nurse’s Guide to COVID-19, QSEN in an Amazon World, Opioid Dosing, More

“This will be nursing’s postpandemic challenge: to identify how, with all our competing organizations, unions, and special interest groups, we can come together in this pivotal moment to remodel our health system . . .”—editor-in-chief Shawn Kennedy in her editorial, “Where Do We Go from Here?”

The March issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

A Nurse’s Guide to COVID-19

An evidence-based review of the care of hospitalized adults with this disease, including pharmacological management, critical illness management, oxygen therapy, prone positioning, and an overview of investigational agents.

Policy and Politics: A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes

The authors address the association between low RN staffing levels and poor health outcomes in nursing homes and urge the Centers for Medicare and Medicaid Services to enact reform.

Special Feature: QSEN in an Amazon World

Citing Amazon as a powerful social force, the authors examine its impact on both the health care industry and the six Quality and Safety Education for Nurses (QSEN) competencies, and outline steps nurses can take to incorporate the QSEN competencies into practice. […]

2021-03-01T08:39:16-05:00March 1st, 2021|Nursing|0 Comments
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August Issue Highlights: Experiencing Racism in Nursing, Promoting Publications by Nurses, Much More

“Six of the nurses quit when they found out I was coming on because they said they would not take orders from me . . .”—nursing leader Bernardine Lacey on encountering racism in her career, as described in this month’s Historical Feature

The August issue of AJN is now live. Here are some highlights.

Original Research: Understanding Nursing Home Staff Attitudes Toward Death and Dying: A Survey

In this multisite study, the authors surveyed nursing home staff to gain insight into their perspectives on end-of-life care and to identify needs in such areas as pain control and palliative care education and training.

PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection

A review of the pathogenesis, clinical presentation, diagnosis, and treatment of pediatric neuropsychiatric disorders associated with strep infection, plus teaching points for parents and patients.

Historical Feature: ‘You Don’t Have Any Business Being This Good’: An Oral History Interview with Bernardine Lacey

This article details, in her own words, black nursing leader Bernardine Lacey’s experiences with racism in her childhood, education, and career.

[…]

2020-07-29T09:27:02-04:00July 29th, 2020|Nursing|0 Comments
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COVID-19

This page collects all AJN’s posts on the coronavirus pandemic. We’ve been bringing you a broad range of nursing perspectives and stories since the first days of COVID-19. The page is regularly updated, with the newest posts at the top.

2022

2021

2022-08-16T13:57:53-04:00March 18th, 2020|Comments Off on COVID-19
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