Addressing Traumatic Injury in Older Adults

By Sylvia Foley, AJN senior editor

Frank Jones, age 83, arrives at a local trauma center after falling down a flight of stairs in his home. Initially diagnosed with two fractured ribs, a fractured ulna, and a fractured tibia, he’s admitted to the ICU.  At first, things seem to go well—his electrolytes and bloodwork appear to be within normal limits, and his vital signs are stable. But the next day he becomes increasingly unstable. What’s going on?

Trauma is currently the seventh leading cause of death in older adults—and older adults are more likely to suffer complications and die than are younger ones. But as author Christine Cutugno points out in this month’s CE, “The ‘Graying’ of Trauma Care: Addressing Traumatic Injury in Older Adults,” advanced age isn’t a predictor of trauma outcome. Many trauma-related complications are preventable.

What guides current care? While standards of care for geriatric patients and for trauma patients exist, as yet none have been specifically developed for and tested in geriatric trauma patients. Until that happens, Cutugno writes, “nurses will need to be guided by measures known to prevent iatrogenic complications in other patient populations.”

To that end, Cutugno first reviews common mechanisms of traumatic injury in older adults and discusses the effects of aging and comorbidities. She points […]

2016-11-21T13:11:24-05:00November 18th, 2011|nursing perspective|1 Comment
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Physician-centric vs. Patient-centric?

By Shawn Kennedy, AJN editor-in-chief

Last week, we posted here a piece by AJN’s clinical managing editor Karen Roush, decrying the use of the term “physician extender.” It reminded me of a recent article from the New York Times on nurses with doctorates, which reported that if some physicians have their way and their legal strategy succeeds, they will be the only group permitted to use the honorific “doctor.”

Degrees vs. licenses. This borders on the ridiculous, as the title is an academic title that signifies achievement in a field of study; it is not a license. Doctoral degrees are awarded in just about every field of study, from astronomy to zoology. Physicians are awarded a doctor of medicine, dentists are awarded a doctor of dental science, and so it goes. In health care, there are dentists, psychologists, social workers, physical therapists, pharmacists, and yes, nurses too, with doctoral degrees. Nurses have been earning PhDs and EdDs (doctorates in education) and the DNSc (doctorate in nursing science) for years, and now there’s a new nursing doctorate degree—a DNP, doctor of nursing practice—that’s specific to nurses in clinical practice. They are still licensed as nurses, as that’s what they are.

This parochial thinking is held by those physicians (not all, but far too many) who still adhere to the […]

2016-11-21T13:11:25-05:00November 16th, 2011|career|3 Comments
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Autumn Leaves and Colorful Lives

By Julianna Paradisi, who normally blogs at JParadisi RN and has written for this blog before. Her artwork appeared on the cover of the October 2009 issue of AJN, and her essay, “The Wisdom of Nursery Rhymes,” was published in the February issue.

autumn leaves between sun halos and flashlight
by oedipusphinx—theJWDban via Flickr

The autumn leaves are particularly beautiful in Oregon this year. An arborist interviewed on the evening news attributed the extraordinary orange and gold to an unusually cold, wet spring, which lasted until July, followed by the intense heat and warm evenings of a brief Indian summer. According to the arborist, the combination caused a greater than normal amount of sugar in the leaves, resulting in the brilliant colors. I think about this on my morning run, as my feet scatter fallen leaves along the sidewalk.

The Season of Eating is, however, not the only messenger of the approaching holidays in a nursing unit. There is something about the holiday season that signals Death to harvest a higher than normal number of the patients we have grown to love through the course of their illnesses. Some of the deaths are expected, but not all of them. I don’t know why more people seem to lose their battles with illness around the holidays than at other times of year.

When I first began working in outpatient oncology, it took me by surprise that my coworkers […]

2016-11-21T13:11:26-05:00November 14th, 2011|nursing perspective|2 Comments
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Nurse Practitioners Are Not ‘Physician Extenders’

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

“Physician extender.” It’s way past time to kill that term.

A study published in the October issue of Surgery found that adding an NP to the surgical team decreased the number of unnecessary ED visits by 50% and increased the use of visiting nurse, physical therapy, and occupational therapy services. A Medscape article (registration required) on the study explained the importance of the findings in this way: “According to the researchers, physician ‘extenders,’ such as NPs, help maintain continuity of care while resident work hours are kept at a maximum of 80 per week. . . .”

Sure enough, the stated purpose of the study was to determine if “integrating this physician extender into the surgery team” would improve outcomes and resource allocation. Ouch.

Experts in our own right. Nurse practitioners are not physician extenders. We are highly skilled and educated nurses who provide evidence-based care grounded in the nursing model. We are not “extensions” of anyone. We are colleagues and collaborators, independent clinicians and experts in our own right. Our purpose is to provide comprehensive care, promote health, educate, and advocate. It is not to relieve interns, supplement physician education, or be the low-cost alternative when physicians have to “do more with less,” as Medscape quoted one […]

2016-11-21T13:11:27-05:00November 11th, 2011|career, nursing perspective, nursing research|6 Comments
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Learning to Serve Others: The Key to Happiness

[youtube=http://www.youtube.com/watch?v=WgdhsjZ_CyY]

With Veterans Day tomorrow, it seems appropriate to highlight the achievements of Charles Kaiman, an artist and a clinical nurse specialist in psychiatric mental health who works with veterans, primarily those with posttraumatic stress disorder (PTSD). Kaiman recently received the Excellence in Behavioral Health Nursing Award at the 2011 New Mexico Nursing Excellence Awards for his work as a caregiver for veterans at the New Mexico Veterans Affairs Health Care System in Albuquerque.

In this video interview, posted on YouTube by KASA FOX 2, an affiliate of the Fox Broadcasting Company, Kaiman speaks about how he decided to become a nurse, the symptoms of and treatment strategies for PTSD, and what he sees day to day while working with Iraq and Afghanistan war veterans—an experience he calls “one of the most rewarding” of his life.

When asked why he became a nurse, Kaiman said he was first inspired when he was 10 years old, reading a book by Albert Schweitzer that argued no one could be happy unless they learned to serve others. Later, when Kaiman was trying to make ends meet as an artist, his father suggested becoming a nurse because he would “never be out of work.” And his father was right.

Kaiman has now worked as a nurse for 31 years, 26 of those specifically with veterans. When asked about the rewards of helping others and what he would say to those interested in entering the nursing profession, his answer was clear:

“I can’t believe I get paid for this. […]

2016-11-21T13:11:28-05:00November 10th, 2011|Nursing|1 Comment
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