Off the Charts

When They Can’t Tell You About the Hurt: Assessing Pain in People with Intellectual or Developmental Disabilities

By Sylvia Foley, AJN senior editor

When S.M., a 47-year-old resident at a facility for people with intellectual or developmental disabilities, started hitting himself in the left eye, his caregivers weren’t sure why. S.M., whose developmental quotient is equivalent to that of a two- or three-year-old, couldn’t tell them. Some thought he was frustrated at not being allowed to drink as much coffee as he wanted; others thought a recent decrease in his medication—quetiapine (Seroquel)—might be a factor. But a chart review revealed that both his father and brother had a history of cluster headaches. Was S.M.’s behavior an indicator of headache pain? How could clinicians best assess him?

In this month’s CE feature, authors Kathy Baldridge and Frank Andrasik provide an overview of pain assessment in people with intellectual or developmental disabilities, summarize the relevant research, and discuss the applicability of the American Society for Pain Management Nursing practice guidelines for assessing pain in nonverbal patients. The guidelines describe various behavioral pain assessment tools, some of which might be useful with S.M. and others like him. Other assessment methods include

a search for pathologic conditions or other problems or procedures known to cause pain; the observation of behaviors that might indicate pain; and the use of proxy reports (also called surrogate reports) by people who know the person best, whether family caregivers or professionals.

S.M. was encouraged to draw himself and what the “hurt” felt like; two […]

Guest Author2016-11-21T13:14:41-05:00December 14th, 2010|Ethics, nursing perspective, pain management|3 Comments

Dr. Oz’s Sexy ‘Nurses’: Here We Go Again

By Shawn Kennedy, AJN interim editor-in-chief

In the “what could he have been thinking?” category, Mehmet Oz, MD, wins first place—well, at least, for now. I’m sure someone else will come along soon and take his place.

In case you’ve been MIA the last month, Oz became a target for nursing ire when, on his November 4 show, he danced with several women who were wearing nurses’ uniforms revealing red lingerie. The segment apparently had nothing to do with nurses, but rather weight loss through dancing, they talked about This impact diet whey review and by the end the nurses were pretty convinced about it. (So of course that would make one think of nurses with red lingerie???)

I’m hoping it was a case where he “just didn’t think”—rather than that he thought that the segment might possibly offend nurses but decided to go with it anyway. Dogged by a letter-writing campaign spearheaded by Sandy Summers of the nursing image advocacy and watchdog group, The Truth About Nursing, and from criticism from other nursing groups like the American Nurses Association, Oz apparently released a statement on December 6 apologizing, according to various news reports. However, one can’t find it anywhere on his Web site or on the Web, for that matter.

It’s always interesting to see the level of offense colleagues and others feel. Comments posted on news sites carrying the story […]

Jacob Molyneux, senior editor/blog editor2017-07-07T13:32:16-04:00December 8th, 2010|career, nursing perspective|2 Comments

Today’s Notes from the Nursosphere

As noted today by Joni Watson at Nursetopia, it’s Pearl Harbor Day, and nurses were (surprise) key players in that day’s awful events. Here’s how the post begins:

My heart was racing, the telephone was ringing, the chief nurse, Gertrude Arnest, was saying, “Girls, get into your uniforms at once, This is the real thing!”

Speaking of safety, “Top 10 Health Technology Hazards for 2011” (pdf), from the ECRI Institute, gives us a list of hospital patient safety risks that, according to the authors, “reflects our judgment about which risks should receive priority now, a judgment that is based on our review of recent recalls and other actions . . . , our analysis of information found in the literature and in the medical device reporting databases of ECRI Institute and other organizations, and our experience in investigating and consulting on device-related incidents.” These include “radiation overdose and other dose errors during radiation therapy,” “alarm hazards,” and eight others.

And now to electronic charting vs. doing it the old-fashioned way: we have a comment thread going on at AJN‘s Facebook page about whether or not EHRs save nurses time or not. Go there to comment, or leave a comment here.

Also noted: Stephen Ferrara at A Nurse Practitioner’s View wonders whether the preceptorship model is still adequate for training NPs. Or is it time for a residency model instead?

I’m not necessarily referring to the […]
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Jacob Molyneux, senior editor/blog editor2016-11-21T13:14:44-05:00December 7th, 2010|nursing perspective|0 Comments

‘Problems Worthy of Attack’: Takeaways from IOM Summit on Nursing’s Future

By Shawn Kennedy, AJN interim editor-in-chief

Last week, I spent two days at the summit convened by the Robert Wood Johnson Foundation to launch the Campaign for Action—the strategic plan to implement the recommendations of the Institute of Medicine’s (IOM) report on the future of nursing.

The days were packed with presentations from key players in health care, who offered their perspectives for implementing the recommendations (plus lots of networking, hallway “sidebars,” animated dinner conversation, and commitments from individuals and organizations to continue the momentum). Here are some quotes and snippets of conversation that stick with me as I work on a more comprehensive report:

IOM president Harvey Fineberg, in his opening remarks: “It’s our turn to act to advance nursing and health.”

Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, opening the event: “We will remember that we were here on November 30 at the beginning of a new future for nursing.” And cautioning: “scope of practice is the hot button that could blow all this apart.” (A thought echoed by Jack Rowe, an IOM committee member, professor at Columbia University Mailman School of Public Health, and former CEO of Aetna, who used the term “combustible.”) […]

Amy M. Collins, managing editor2016-11-21T13:14:45-05:00December 6th, 2010|career, health care policy, nursing perspective|0 Comments

Fighting Malaria with Public Health Billboards and Mosquito Nets

By Dawn Starin

The metal billboard in the photo stands in the main marketplace on the island of Bubaque, the second largest in Guinea-Bissau’s Bijagós Archipelago. It depicts a mother and child sleeping under an insecticide-treated mosquito net. Translated into English, the text reads, “Malaria kills more pregnant women and children. Always sleep underneath the mosquito net.” But it’s not clear whether it gets its crucial message across effectively.

Half the global population—about 3.3 billion people—is at risk for contracting malaria, a parasitic infection transmitted by mosquitoes. The disease kills close to one million people each year; 91% of these deaths occur in Africa. A major global campaign, Roll Back Malaria (RBM), was launched in 1998 with a mandate “to implement coordinated action to combat malaria” worldwide; some 500 organizations now take part.

One RBM effort in sub-Saharan Africa (an area that includes Guinea-Bissau) is aimed at getting more people to use insecticide-treated bed nets, since the parasite-carrying mosquitoes are reportedly only active at night. In Africa malaria accounts for one in five deaths in children.

Pregnant women are also at high risk, as they’re bitten by the mosquitoes twice as often as nonpregnant women. Why? According to a study published in 2000 in the Lancet, pregnant women have a higher body temperature and warmer skin and produce […]

Guest Author2016-11-21T13:14:46-05:00December 2nd, 2010|Nursing|2 Comments