What Have We Learned About Preventing School Shootings?

On November 30, a 15-year-old sophomore at Oxford High School in Michigan killed four students and injured seven others. Both the student and his parents are presently incarcerated and charged with numerous crimes.

In the days following this tragic event, questions arose regarding what the parents and school might have done to prevent this from happening. The parents are facing charges of involuntary manslaughter and a federal lawsuit, perhaps the first of others to follow, has been filed against the school district alleging that more could have and should have been done.

Warning signs and preventive actions.

With each school shooting we again find ourselves asking ourselves what can be learned in terms of warning signs and actions that could be taken. The September Mental Health Matters column in AJN, which I co-authored with Arlene Holmes—whose son James was responsible for the mass shootings in Aurora, Colorado, in 2012—highlighted warning signs that might indicate potential violence by someone experiencing mental health problems.

What can be learned from the events that unfolded in Oxford that could be applied to a similar scenario, perhaps heading off another tragedy? The following checklist compiled by Sandy Hook Promise, a nonprofit organization that aims to educate youth to […]

2021-12-15T11:43:26-05:00December 15th, 2021|mental illness, Nursing|0 Comments
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Distinguishing Between Delirium and Dementia in a Mother’s Rapid Decline

We now know just how vulnerable older adults in long-term care have been during the pandemic. COVID-19, especially in the pandemic’s early months, cost many their lives far too early. Even today we are seeing the disease bring premature death to the elderly, especially at facilities with lower staff vaccination rates. Just two days ago, NBC news reported the following disheartening NEJM study results:

“People in nursing homes are much more likely to die of Covid-19 if the staff caring for them remains largely unvaccinated, a study published Wednesday in the New England Journal of Medicine found.”

Other forms of decline accelerated by the lockdown.

But the isolation from family members and other external contacts imposed by the many months of lockdown had other less easy to measure costs. This month’s Reflections essay, “Again in a Heartbeat,” by Jeanne Kessler, MSN, RN-BC, details her own dawning awareness that something had begun to change in her mother as time went by during the lockdown at her assisted living facility.

Suddenly her mother couldn’t talk on the phone any longer. This wasn’t like her at all. Her attention span had shortened drastically. There were other worrisome indications. While […]

2021-12-10T07:55:02-05:00December 10th, 2021|Nursing|0 Comments
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Marijuana Linked to Elevated Heart Attack Risk in Young Adults

Photo © Shuttertock.

Association is stronger when marijuana use is frequent.

As the decriminalization of marijuana becomes more widespread, its use is on the rise among young adults. Yet, the effects on overall health have not been well studied, including how marijuana use affects cardiovascular health.

Now a large-scale study in the Canadian Medical Association Journal has found an association between recent marijuana use and increased risk of myocardial infarction (MI) in young people, ages 18 to 44 years. The association was strongest among those who used marijuana at least four times a month, primarily by smoking it. Users who vaped or ingested marijuana through baked goods or other edibles also had a higher incidence of MI compared with nonusers, but only those who smoked frequently showed elevated risk that was statistically significant.

The study was based on 2017 and 2018 behavioral risk survey data from the Centers for Disease Control and Prevention. It sought to evaluate known evidence of cardiovascular effects of marijuana in the context of MI risk for individual users. Marijuana’s chemical components can increase myocardial oxygen demand while simultaneously reducing blood flow to the myocardium. This cannabis-induced oxygen supply and demand mismatch, in the setting of myocardial […]

2021-12-07T11:34:08-05:00December 7th, 2021|Nursing, Public health|0 Comments
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What Can We Do About Addressing Nurse Exhaustion?

“Even when good workplace policies and support exist, without enough staff to meet essential patient needs, nurse fatigue cannot be properly addressed.”

Photo by Matthew Waring on Unsplash

When I was working as an ED nurse, if a colleague was out sick we’d invariably be asked to work a double shift—so, 16 hours instead of our usual eight-hour shift. It wasn’t bad as a one-time occurrence. But I can’t imagine how nurses have managed working five or more days of 12-hour shifts in a row, or even more, during the surges of Covid-19 patients needing hospitalization in various parts of this country. It’s no wonder there are so many stories and reports of nurses leaving the acute care setting.

While the obvious answer is that there needs to be more staff to share the work, not only to improve staff well-being but also to make care safer—and this is not a COVID-induced phenomena; we’ve known this for years thanks to research by Linda Aiken and others—getting that to happen has largely been unsuccessful.

Hospitals staff conservatively as a policy, causing many to be short-staffed on an almost ongoing basis. This makes for a stressful work environment that in turn causes nurses to leave, thus further exacerbating […]

2021-12-03T09:51:29-05:00December 3rd, 2021|Nursing|0 Comments
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Therapeutic Humor in Nursing: More Important Than Ever

Nursing during a pandemic is no laughing matter…but it was for me.

Photo by Mathias Konrath on Unsplash

Assessing mental health patients over the phone at the VA was always challenging. I worked with the primary care providers, assessing new patients and getting them the right mental health resources.

Little did I know it was going to be taken to another level during the pandemic. It was Covid mental health mayhem: Covid cold calls, suicidal calls, PTSD patients plummeting with increased isolation and hospitalizations. There was increased depression, anxiety, and insomnia (and that was just the RN staff members, LOL!).

I couldn’t control this pandemic, my frustration over anti-vaxxers, the fatigue, fears, or sadness. But what I realized I could control was my daily interactions with the patients. I had to do review the PHQ-9 questionnaire for major depression symptoms and the GAD for anxiety. Once I’d finished the mental health assessments, I’d concentrate on the behavioral activation their results suggested.

Cultivating patient connection through laughter.

Having taken part in research on the therapeutic benefits of humor, one strategy I often used with these patients was to ask them, “What made you laugh today?”

At first, many couldn’t think of anything. So I decided to ask about more specific […]

2021-12-01T08:29:30-05:00December 1st, 2021|Nursing|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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