The Bittersweet Reality of a Nurse’s Limits in Providing End-of-Life Care

Three young patients on the same trajectory.

Image by strikers/pixabay

I have recently spent time with a few young patients all on the same sharp trajectory towards their final day of life. All had different diagnoses, and on the days I had the privilege of being their nurse, they were each at different points on that trajectory.

M. was just four days away from dying, though he and all his medical caretakers thought at that point that he had at least a few more weeks.

J. was a couple of months away from dying, and on my shift with her, she knew her situation was bad but remained hopeful for some last-ditch interventions.

R. was well-appearing outside of an unsteady gait and slight sideways drift of her eyes. She maintained levity and a hopeful innocence in the first few hours of my shift with her before I took her to her MRI scan. As I watched her MRI images appear with a clear and tragic diagnosis, I heard the physicians outside of earshot from the MRI table discuss the inoperable, inevitable turn this would take for her in the very near future. R. didn’t know yet that her budding dreams for adulthood would not come to pass, and it […]

2021-04-02T15:27:22-04:00March 31st, 2021|Nursing|1 Comment
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AJN April Issue Highlights: Chemotherapy-Induced Neuropathy, a Primer on ‘Big Data’ and Machine Learning, More

“Nurses need to be out in the community—in schools, libraries, senior centers, wherever our neighbors gather—to help address COVID-19 vaccine hesitancy and ensure that people have accurate information.”—editor-in-chief Shawn Kennedy in her editorial, “A Most Welcome Spring”

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

CE: Chemotherapy-Induced Peripheral Neuropathy

The author reviews common CIPN symptoms and outlines strategies nurses can use to assess, manage, and educate patients at risk for or already experiencing this frequent complication of neurotoxic chemotherapy.

CE: Nursing Orientation to Data Science and Machine Learning

A primer on how ‘big data’ and new analytic models are transforming nursing—including the opportunities and implications for nurses in various roles.

Cultivating Quality: Continuous Physiological Monitoring Improves Patient Outcomes

How a nurse-led initiative used wearable digital devices to enhance patient surveillance and better identify early signs of patient deterioration, thereby reducing rapid response team calls and ICU transfers.
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2021-03-29T07:44:48-04:00March 29th, 2021|Nursing|0 Comments
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Will We Ever Know How Many Nurses and Other Health Workers Died from COVID-19?

By Unjay Markiewicz/ Unsplash

The lead article in the March issue of AJN examines the lack of accurate data on deaths from COVID-19 among nurses and other health care workers:

“More than a year after the first SARS-CoV-2 infection was identified in the United States, there is no reliable count of COVID-19 cases or deaths in nurses and other health care workers. The COVID Data Tracker maintained by the Centers for Disease Control and Prevention (CDC) reported 389,380 health care worker infections and 1,332 deaths as of February. Yet, as far back as November of last year, the Centers for Medicare and Medicaid Services (CMS) reported 1,162 staff deaths in U.S. long-term care facilities alone. Still another list, maintained by the Guardian and Kaiser Health News, has counted 3,258 health care worker deaths, 503 of them among nurses.”

So while praised and touted as “heroes,” those who died might not always have been recognized as casualties of the hazards imposed by their jobs during the pandemic. The report also notes:

“[B]ased on past epidemics and state data, health care workers would be expected to make up an estimated 5% to 15% of COVID-19 infections in the United States. With almost 20 million U.S. cases, that would […]

2021-03-25T10:41:28-04:00March 25th, 2021|COVID-19, Nursing|0 Comments
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Learning on the Fly: Thoughts on Birding and Nursing During a Pandemic

“This book is about interpreting what you see and hear in order to make better judgments.”

Tundra Swans, watercolor and ink, 2021 by Julianna Paradisi

It’s my opinion that every nursing textbook should open with the above statement. However, it’s from the introduction to Sibley’s Birding Basics, by David Allen Sibley.

During home isolation of the COVID-19 pandemic, my husband and I took up birdwatching as a way to get out of our home and entertain ourselves while maintaining our “bubble.” Armed with binoculars, David’s camera, and my artist’s field bag, we visit local wetlands and wildlife reserves, recording our finds. That led me to read Birding Basics.

Experience coupled with pattern recognition.

As a nurse, I can’t help but link the idea of “interpreting what you see and hear in order to make better judgments” as a definition of a nurse’s intuition, commonly referred to as a “nurse’s gut.”

While there are times when a nurse’s clinical intuition borders on the psychic, many of these revelations are a product of bedside experience. For instance, patients, including infants, sometimes exhibit facial grimaces or say words that a hawk-eyed bedside nurse rightly interprets as signs of impending doom such as a cardiac […]

2021-03-23T10:13:08-04:00March 23rd, 2021|Nursing|0 Comments
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‘Right Under Our Noses’: Nightmarish Nursing Home Conditions During the Pandemic

As vaccinations increase and COVID-19 infection rates in nursing homes plummet, it’s easy to forget just how bad things got in many of them and how ill-equipped many were in the the early months of the pandemic to provide humane and effective care.

The following excerpt is from our March Reflections essay, “Right Under Our Noses: Nursing Homes and COVID-19,” which was written by a California nursing professor who volunteered to join a California Medical Assistance Team. The mission of her team was to bring aid to a skilled nursing facility where the coronavirus was rapidly infecting both patients and staff, a facility with little PPE available and many staff members refusing to come to work out of fear of infection.

The conditions I saw were shocking, even to an experienced nurse. I saw soggy diapers on the floor at the heads of many beds on most mornings. One day a bedbound patient needed the bedpan. I searched every closet and drawer but there were no supplies. I filled a basin with warm water and cut up a PPE gown to make washcloths to clean the patient. On the second day of my deployment I realized that many of the […]

2021-03-18T12:10:25-04:00March 18th, 2021|COVID-19, Ethics, infectious diseases, Nursing, nursing perspective, safe staffing|1 Comment
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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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