Off the Charts

Understanding Trauma-Informed Care in Nursing Practice

When I first started my nursing career, I worked on the pediatric inpatient unit. I remember feeling sad and upset when getting report on my patients who had experienced terrible trauma in their young lives. I wondered how they would make it to and through adulthood after having survived abuse, neglect, witnessing violence, or serious illness or injury.

That was over 20 years ago, and now many of these patients are showing up in the health care system carrying their pain and bad memories with them. They may be the adult we meet with a substance or alcohol use issue, chronic pain, or help-rejecting behaviors. They might be the patient whom colleagues have labeled “difficult.” Or they might be chronically late for appointments or fail to show up at all. Frequently, people with a history of trauma can be further traumatized by an interaction with an uncaring health care system and choose to avoid getting the care they need. They may be experiencing symptoms of PTSD along with their other reasons for seeking health care.

Practicing trauma-informed-care (TIC) can help address this problem. June is PTSD awareness month, and we’d like to highlight our April CE feature, “Trauma-Informed Care in Nursing Practice.” Authors Elizabeth Dowdell and Patricia Speck […]

Christine Moffa, PhD, APRN, PMHNP-BC2022-06-15T14:09:56-04:00June 9th, 2022|Nursing, patient engagement, Patients|0 Comments

When a Person with Type 1 Diabetes Goes to the Hospital

Photo by Susan Q Yin on Unsplash

I have always done everything I can to avoid hospitalization. Aside from concern about potential surprise bills, it’s a control thing: I’ve simply been afraid of turning over care of my blood glucose levels to anyone else. I’ve had numerous outpatient surgeries and procedures, but for the nearly three decades since I was diagnosed with type 1 diabetes in my mid-20s, I never spent a night in a hospital.

In retrospect, the one time I should have accepted hospital admission was immediately following the shock of the diagnosis, which followed close on several months of unexplained weight loss, increasingly unbearable thirst, blurring vision, and general disorientation. My blood glucose level had been off the charts, plus I needed time to reckon with the loss of freedom for my always more or less healthy and fit body and to begin to learn to balance insulin shots, glucose levels, food intake, physical activity, and much else. But I was in denial (with predictable consequences) for quite some time afterward, and had also turned down the cost of health insurance when entering graduate school.

In the hospital.

In any case, one frigid, iced-over night this early January, I […]

Jacob Molyneux, senior editor/blog editor2022-06-07T09:32:16-04:00June 7th, 2022|Nursing, patient experience, Patients|2 Comments

Monkeypox: The Basics for Nurses

In the past, cases of monkeypox only occasionally occurred outside of central and western Africa, where the disease is endemic, and it was virtually always related to travel or to the inappropriate relocation of wild animals. (In the US in 2003, 71 cases of monkeypox in six states were traced to pet prairie dogs that had been imported in the “exotic animals” trade.) What should we make of the outbreaks this year in 23 countries where the disease is rarely seen?

Current cases of monkeypox are occurring in people without a history of travel to endemic areas, and in some cases without obvious contact to known cases. Most of these people have had mild disease, though monkeypox can cause severe disease in young children, pregnant women, and immunosuppressed individuals. While monkeypox usually is not highly transmissible nor deadly, it has never spread to so many countries seemingly simultaneously.

A close relative of smallpox.

Monkeypox is a close relative of smallpox, and the smallpox vaccine also prevents monkeypox infection. Many experts point to the end of mass smallpox vaccination campaigns as a factor in the emergence of cases at this time. Forty years ago, about 80% of the population was vaccinated against smallpox; today that figure is only about 30%. Monkeypox cases have been on the rise since smallpox was declared to be eradicated in 1980. In one monkeypox-endemic region, cases had increased twentyfold in recent decades. At the same […]

Betsy Todd, MPH, RN2022-06-02T10:14:45-04:00June 2nd, 2022|infectious diseases, Public health|1 Comment

June Issue: Cardiac Devices for Heart Failure, Using EHR Data for Research and QI, More

“When nurses practice real self-care, they come to a place of self-respect, learn to hear their own voice, and recognize when their expressed needs are ignored. “—Emily Stice Laker in her Viewpoint article, “Nurses Need More Than Self-Care”

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

CE: Guideline-Directed Cardiac Devices for Patients with Heart Failure

The author reviews current device therapies for heart failure and uses a composite case to demonstrate how bedside nurses can help patients understand treatment options, potential complications of implantation, and post-op care.

Special Feature: Assessing EHR Data for Use in Clinical Improvement and Research

This article introduces nurses to the secondary analysis of EHR data, first outlining the steps in data acquisition and then describing a theory-based process for evaluating data quality and cleaning the data.

Nursing Research, Step by Step: Diagnostic Studies: Measures of Accuracy in Nursing Research

This article, one in a series on clinical research by nurses, reviews the use of diagnostic and screening tests and tools in nursing research and clinical practice.

[…]

Diane Szulecki, editor2022-05-31T09:08:10-04:00May 31st, 2022|Nursing|0 Comments

What Will It Take? When Will We Act?

Once again, we are sickened by another school shooting and the loss of children and teachers who tried to protect them from being mowed down by an assault weapon in the hands of an 18-year-old boy. This time Uvalde, Texas, is grieving for 19 children and two teachers, and it’s less than two weeks since a shooting in a Buffalo grocery store left 10 dead. Of course, we immediately see the messages from legislators offering their condolences and thoughts and prayers, but no promises to change anything. If not them, then who can?

I remember the awfulness of treating the occasional pediatric gunshot victim when I worked in the ER—usually an unintended target who was caught in crossfire. It was gut-wrenching, the kind of thing that should be a “never-event.” Today, ER nurses, paramedics, and physicians see young gunshot victims far too often. I don’t know how they can do it day after day, trying to comfort parents while dealing with their own trauma.

The leading cause of mortality in children and adolescents.

Firearm deaths are now the leading cause of mortality in children and adolescents (ages 1 to 19 years) in this country, according to a recent analysis by researchers at the University of Michigan reported in the New England Journal of Medicine. […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2022-05-27T14:01:41-04:00May 27th, 2022|gun violence, pediatrics, Public health|3 Comments

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In the hospital.

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A close relative of smallpox.

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The leading cause of mortality in children and adolescents.

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