Bone Marrow Aspiration: A Nursing Procedure?

Too much to do already?

A few months ago, we asked on our Facebook page whether nurses would ever be interested in adding a new “medical” skill, such as lumbar puncture, to their practice.

Common responses to this question were along the lines of “Are you crazy? I have too much to do already!” But what if you used a new set of skills as part of a small team of nurse “proceduralists” in a nurse-led clinic, and received excellent training and ongoing support?

One team’s expertise.

In “Bone Marrow Aspiration and Biopsy Performed by RNs: A Review of Clinical Practice” in the September issue of AJN, Eryn Draganski and colleagues share the details of their hospital’s longtime success in using a team of specially trained nurses to perform bone marrow aspiration and biopsies. In addition to reducing costs and allowing for more timely scheduling, this practice has also provided patients with a team of nurses whose extensive experience in the procedure ensured excellent outcomes and patient support.

“…using a small team of nursing proceduralists… provides a unique opportunity to improve consistency in practice, which may result in better quality control and, ultimately, boost patient safety.”

Nursing scope of practice.

Nurse practice acts in many states don’t specifically address whether or not this […]

2019-09-13T11:42:36-04:00September 13th, 2019|Nursing|1 Comment
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Milk and Molasses Enemas – A Tradition to Keep

By Maureen Shawn Kennedy, AJN editor-in-chief

I recall giving an “M&M” enema when I worked as a nurse’s aide in high school. The small community hospital medication room had a jar of molasses in the cabinet, and I watched the nurse mix ½ a cup of the thick syrup with ½ cup of milk and put it in an enema bag. She then handed it to me and said, “C’mon, it’s easy, I’ll show you how.” And it was, and it worked pretty quickly. Older nurses and physicians swore by it.

By the time I was out of nursing school and working in clinical practice, commercial preparations seemed to be the standard. But as the song goes, “everything that’s old is new again.” This month in AJN, Jackline Wangui-Verry and colleagues’ paper, “Are Milk and Molasses Enemas Safe for Hospitalized Adults? A Retrospective Electronic Health Record Review,” describes their investigation of this long-time and oft-used intervention for constipation.

Examining the safety of a long-established, ‘last resort’ practice.

The authors “wanted to learn whether this approach is actually safe and effective or more of a ‘sacred cow’ . . . .”

This study focused on safety and a follow-up study will include efficacy. They evaluated the hospital records of 196 hospitalized adults who received an M&M enema after laxatives or stool softeners failed to produce a bowel movement. No serious complications—“allergic reactions, bacteremia, […]

2019-09-11T10:41:01-04:00September 11th, 2019|Nursing, nursing research|3 Comments
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Multistate Outbreak of Life-Threatening Pulmonary Disease Amid E-Cigarette Use

Health officials are investigating an outbreak of severe pulmonary disease this summer that appears to be linked to the use of e-cigarettes, or vaping. One person has died, and many others have been hospitalized with a variety of symptoms in the days and weeks after they reported vaping. As of late August, 215 possible cases of e-cigarette–associated pulmonary disease have been reported in 25 states, according to the Centers for Disease Control and Prevention (CDC).

Unknown Cause

On Friday, the agency released a Health Advisory that provides information about e-cigarette products, updated details about the outbreak, and recommendations for clinicians, public health officials, and the public.

Health officials noted that respiratory (cough, shortness of breath, chest pain), gastrointestinal (nausea, vomiting, diarrhea), or nonspecific constitutional (fatigue, fever, or weight loss) symptoms have been occurring in otherwise healthy people, many in their teens or 20s, since June.

The exact cause of the outbreak is unknown, but reports point to a common factor: e-cigarette products were reportedly used by those affected. Many, but not all, patients reported that they’d used tetrahydrocannabinol (THC) and other cannabinoid products. The CDC, along with the Food and Drug Administration and local and state health departments, continues to investigate the cause of the outbreak.

[…]

2019-09-06T10:38:59-04:00September 5th, 2019|Nursing, Public health|0 Comments
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‘An Epidemic Transformed’: Where Are We With HIV Today?

“I wasn’t supposed to be here,” [the patient said] to the nurse as he watched the last few drops of his chemotherapy drug infuse into the port implanted in his chest… The nurse caring for him smiled while preparing to disconnect his IV tubing and flush the port….   What distinguished [this patient] from the nurse’s other patients was that he had been living with HIV for 32 years.”

At the very beginning of the HIV epidemic, a friend of mine worked on one of the first HIV units in New York City. The nursing staff followed Standard Precautions in their work with these patients, as we do today. They weren’t particularly concerned about risk to themselves, because it was already clear that this disease—as little as we knew about it then—was not easily transmitted to caregivers.

Remembering fear.

Yet many who worked in other parts of the hospital were not convinced of this. One of my friend’s stories always stayed with me: She relayed how dietary staff would take the elevator to the HIV unit, shove the meal cart out of the elevators into the elevator lobby, and quickly step back into the elevator and close the doors. Many times the nursing staff […]

2019-09-03T10:06:59-04:00September 3rd, 2019|infectious diseases, Nursing, Public health|0 Comments
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Memories of Beginning Nursing School

I just finished a visit with a longtime friend. Of course, we reminisced about nursing school.

We met the first week of nursing school, over 40 years ago (OMG, when did that happen?), when we and some other classmates went to buy books. She took one look at the crowd and came up with an organized and efficient approach to getting what we needed in the overcrowded college book store. She would grab four biology texts, I’d get the lab manuals, Betty would pick up the history texts, Kathy would head for the English section—and then we’d all meet at the cashier. We were in and out in no time.

During nursing school, we had many late-night tea parties, grilling each other on med/surg questions. Pharmacology was the class we all feared—it was largely a matter of memorization; we shared mnemonics and tricks for remembering drugs and dosages, and the night before the final pulled an “all-nighter” with lots of coffee, pacing up and down and citing drug facts out loud.

And when some of us had doubts, after a hard semester, if nursing was really a good choice, we bucked each other up. […]

2019-08-28T09:18:43-04:00August 28th, 2019|Nursing, nursing students|0 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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