Nursus Paradoxus

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

Black Hole Paradox/ Angel’s Gate, via Flickr

We’ve been using a new piece of hemodynamic monitoring equipment in our ICU. Considered minimally invasive, it uses an arterial line to measure fluid balance status by measuring stroke volume variation (SVV). The derived values are useful in guiding fluid resuscitation, and are based on a principle with an interesting and contradictory name. Instead of pulsus paradoxus (variations in arterial pressure during spontaneous breaths), the SVV is calculated based on reverse pulsus paradoxus (variations in arterial pressure during mechanical, positive pressure ventilation).

I’m a “numbers” person. From a scientific perspective, I totally get this. But the concept of monitoring hemodynamics using a principle described as a reverse paradox is unsettling. I don’t want paradoxes, especially reverse paradoxes, to exist in nursing; I don’t need or want circular logic to confound and muddle my days. And yet, as I’ve considered paradoxes in general, I’ve found nursing-related situations that seem to fit the definition:

2016-11-21T13:11:43-05:00October 17th, 2011|nursing perspective|1 Comment
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Toward a Less Painful Death: ICD Deactivation at End of Life

By Sylvia Foley, AJN senior editor

A few years ago, in a letter to the editor of another journal, an NP described how one of her patients, a man on home hospice care, had suffered 33 shocks as he lay dying in his wife’s arms. The source of those shocks, his implantable cardioverter-defibrillator (ICD), reportedly “got so hot that it burned through his skin.” The device that had been implanted to save his life caused this man and his wife great distress in his final hours. Device deactivation at the end of life is an option; but in this case, apparently, it had never been discussed.

Stories like this one helped to inspire the research reported in this month’s CE feature, “Deactivation of ICDs at the End of Life: A Systematic Review of Clinical Practices and Provider and Patient Attitudes,” by James Russo.

ICDs, standard treatment for people at risk for life-threatening cardiac arrhythmias, work to restore normal rhythm by delivering a high-energy, painful electrical shock. The devices are so effective that people with ICDs often die from causes other than heart disease. But once a person with an ICD begins actively dying, as in the case above, the device may cause needless pain and prolonged suffering. So […]

2016-11-21T13:11:44-05:00October 14th, 2011|nursing research|0 Comments
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Nurses and Patient-Centered Research

By Shawn Kennedy, editor-in-chief

I’m immersed in nursing research and nursing leaders this week, attending (in order and immediately following one another) meetings of the Council for the Advancement of Nursing Science (CANS), the 25th anniversary concluding scientific symposium of the National Institute of Nursing Research (NINR), and finally, the American Academy of Nursing.

Wednesday was CANS and its focus on comparative effectiveness research. After an opening keynote by Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), who discussed the need to accelerate progress in improving U.S. health outcomes, a panel of nurses discussed different methodological considerations, from databases to competencies.

Research to help people make informed decisions. Especially interesting was a discussion of the Patient-Centered Outcomes Research Institute (PCORI), the research entity which was mandated by the 2010 Patient Protection and Affordable Care Act. […]

2016-11-21T13:11:45-05:00October 13th, 2011|nursing perspective, nursing research|0 Comments
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Domestic Violence Screening Matters

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

I am a nurse. I am a doctoral candidate and a writer. I am a domestic violence survivor. I lived for years with fear and uncertainty—will this be a good day, a day of laughter and affection? Or a brutal day of fists and humiliation? Like many women experiencing domestic violence, I hid it from my family and friends. In fact, I even hid it from myself. I couldn’t see myself as a battered woman, wouldn’t accept that I was that kind of person. But domestic violence doesn’t happen to a certain kind of woman—it happens to anyone, rich or poor, college educated or high school dropout, urban and rural, of every ethnicity. We—you and I—all are the faces of domestic violence.

Just ask. October is National Domestic Violence Awareness Month. How many of your patients have you asked about domestic violence this month? Or any month? Twenty? Ten? None? Screening matters. One of every four women you see has experienced domestic violence. Research tells us that women will talk about it when asked by a provider that they feel cares and can be trusted. They will leave an abusive situation when they feel supported and resources are available to them. […]

2016-11-21T13:11:46-05:00October 12th, 2011|Nursing|6 Comments
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Killing Traditional Nursing Duties #3 – NPO after Midnight

fasting Buddha/ via Wikipedia Commons

By Shawn Kennedy, editor-in-chief

In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post called “Killing Traditional Nursing Duties #1.” We did another post on the answers to our second question, “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)?” This also got many comments in response.

Our last question was this: “Does your institution routinely follow ‘NPO after midnight’ for preoperative patients?” Here’s some of the comments we received on the blog:

My institution does follow the NPO after midnight for preop patients. I sometimes disagree d/t the time patients may be going to surgery. If a patient is not scheduled for the OR until the following day at 5 pm, why should they have to be NPO after midnight the night before?

…most of the younger anesthesiologists/CRNA’s allowed BLACK COFFEE to be drunk right up until time  of surgery. No dairy or sugar in it, obviously.

The facility that I work for does routinely follow ‘nothing by mouth’ after midnight guidelines. If the patient  is scheduled for a late surgery I may call the doctor and request that the orders be altered and in most cases the doctor’s are agreeable and will change the orders, […]

2016-11-21T13:11:47-05:00October 11th, 2011|nursing perspective, nursing research|0 Comments
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