A Matter of Public Health: Physicians Make Case for Vaccinating Immigrants in Custody

For three days last week, physicians from around the country led demonstrations and a vigil outside of Customs Patrol and Border Protection (CBP) facilities in the San Diego area. After receiving no response to their repeated offers to the departments of Health and Human Services and Homeland Security to provide free flu vaccinations to immigrants in custody, the physicians (and a few NPs) had come to the border with donated influenza vaccine to press for a pilot vaccination program. CBP officials finally said they would pass the request up their chain of command.

Preventable deaths, plus a matter of the larger public health.

Three migrant children died in CBP detention centers during last year’s flu season. The last hours of 16-year-old Carlos Gregorio Hernandez Vasquez, who died in May of influenza, were documented on a grim surveillance camera video that recently circulated widely on the Internet. But the issue of influenza vaccination for migrants is not “merely” one of such preventable deaths; it is a  public health issue. This year’s flu season has ramped up in recent weeks, and a “window of opportunity” for vaccinating this vulnerable population is closing.

The CDC recommends that everyone six months of age and older receive influenza vaccination each […]

2019-12-19T14:10:39-05:00December 19th, 2019|infectious diseases, Nursing, Public health|1 Comment
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The Burden of Diabetes

It’s exhausting, it is exhausting. It really is, to constantly take care of yourself and have to worry about everything you eat, everything you do, every move you make.

Flickr / Harshit Sekhon

This quote is from the original research article in AJN’s December issue, “Experiences of Diabetes Burnout: A Qualitative Study Among People with Type 1 Diabetes.” (You can read it for free and can also earn CE credits.)

Defining burnout.

The report details the results of interviews conducted by the authors to learn more about diabetes burnout, a phenomenon they define as “a state of mental, emotional, and physical exhaustion following an apathetic detachment from one’s illness identity, diabetes self-care behaviors, and support systems, which is commonly accompanied by a feeling of powerlessness.”

In the interview excerpt above, one of the study participants, a 36-year-old woman with type 1 diabetes, aptly describes the constant attention required to manage the disease. This relentless focus on time, diet, activity, and blood glucose levels are wearying in themselves. When this 24-7 effort is still not enough to control glucose levels, the resulting sense of frustration and lack of control contribute to burnout. […]

2019-12-17T10:05:56-05:00December 16th, 2019|Nursing|0 Comments
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Dissonance and Harmony: Balancing Nursing and Home Life During the Holidays

Between worlds.

There is nothing quite like the holiday season in a culture obsessed with happiness at all costs to make me feel the complexity of navigating back and forth between work and home life as a pediatric ICU nurse.

Home life as a mother to two young children, wife, friend, and community citizen takes on an intense pace from just before Thanksgiving through the new year. I am coordinating celebrations with family and friends, keeping tabs on the kids’ school holiday programs, addressing Christmas cards, and deftly dodging BOGO promotional emails day and night. Life feels boundless with possibilities for activity and opportunity.

I arrive at work and enter the room of my patient, whose life has been brought to a screeching halt. She lies sedated, restrained by lines and tubes, barely oriented to day versus night. If not for the holiday decorations that we put up around the unit, there may be no indication of what season it is.

What is cheerful for me to anticipate at home during the holidays may be potentially disheartening for my patients and their families to consider. I can leave the hospital at will. They cannot. I am sensitive to this fact, and my demeanor when I talk about the holidays at work becomes […]

2019-12-12T10:47:01-05:00December 11th, 2019|Nursing, nursing perspective, wellness|0 Comments
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Hematologic Childhood Cancers: An Issue for Kids and Adults

“A diagnosis of childhood cancer is a stressful event. It takes time for families to emotionally process the diagnosis before they can learn how to care for their child as therapy is initiated…”

Photo courtesy of the Children’s Hospital of Michigan.

Essential information for nurses.

In “Hematologic Childhood Cancers: An Evidence-Based Review” in this month’s AJN, author Jessica Lynne Spruit provides an overview of hematologic childhood cancers—among the most common types of cancer in kids—written for nurses who work with kids, teens, and adults. Spruit discusses symptoms, diagnosis, staging, treatment, and longer-term issues, as well as supportive care for both child and family.

The article focuses on acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), Hodgkin lymphoma, and non-Hodgkin lymphoma. A section on survivorship care, with an emphasis on the often-difficult transition from months of intensive treatment to less frequent primary care visits, reminds us to be sensitive to the life-changing nature of any cancer, but especially cancer in kids, for both child and family.

Problems among adult childhood cancer survivors.

We usually think of leukemias and lymphomas as pediatric territory. But today, more children are surviving childhood cancers, and problems related to the cancer itself, or to late treatment affects, can […]

2019-12-10T10:48:48-05:00December 10th, 2019|Nursing|0 Comments
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EHRs: Losing the Nuances of Nursing Care, and the Value

Image by mcmurryjulie from Pixabay

Our December issue is out, but before we move on from the November issue I want to highlight the Viewpoint, “Advocating for HIT That Captures Nursing Process.” It’s about something that greatly affects nurses’ work, seems to be the bane of all clinicians, and, I think, often prevents individualized patient-centered care.

I’m referring to the electronic health record (EHR), a system built to capture data important for billing and tracking aggregate patient outcomes—but arguably not designed for what clinicians deem as most important for understanding and documenting patient care.

Dylan Stein and colleagues Jasmine Travers and Jacqueline Merrill write what most nurses know about EHRs:

“The nuances of our care get lost in task-oriented, quantitative drop-down menus and checkboxes, while the qualitative value of our interventions and impressions are not encoded in a useful way.”

Nursing notes devalued.

In the old days BC (before computers), clinicians used some checklists for charting but also relied heavily on narrative notes to describe the patient’s individual story. While there are areas one can add notes in an EHR, nurses tell me that it’s not very easy to do so and that no one really reads them because they’re […]

2019-12-05T12:03:16-05:00December 5th, 2019|digital health, Technology|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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