‘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 […]

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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September Issue: HIV Update, RN-Performed Bone Marrow Procedures, Debriefing Methods, More

“One day—and I remember distinctly that all I was doing was setting up [my mother’s] pills and preparing a few bites of food that I hoped she’d eat—a clear small voice inside me said, ‘You could do this for other people.’”—Linda Beall, author of the September Reflections column, “A Clear Small Voice”

The September issue of AJN is now live. Here’s what’s new:

CE: HIV Update: An Epidemic Transformed

This article describes the current state of HIV treatment and prevention—including HIV risk reduction strategies such as PrEP and PEP—and highlights the common comorbidities often seen in older people living with HIV.

Cultivating Quality: Bone Marrow Aspiration and Biopsy Performed by RNs: A Review of Clinical Practice

The authors discuss the policies and practices of their program to train RNs to perform bone marrow procedures, its clinical and diagnostic outcomes, and the opportunity for nurses to work to their full scope of practice.

Teaching for Practice: Using Debriefing Methods in the Postclinical Conference

This article examines various debriefing methods and describes scenarios in which clinical instructors can use debriefing to turn daily events into teachable moments.

CE: Original Research: Are Milk and Molasses Enemas Safe for Hospitalized Adults? A Retrospective Electronic Health Record Review

The authors of this study evaluated the safety of milk […]

2019-08-26T10:09:33-04:00August 26th, 2019|Nursing|0 Comments
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Morphine in Hospice Care: Why Family Members May Resist Its Use

Underlying his concerns was a strong sense of moral responsibility. He was his mother’s protector. He was her voice. He had a duty to keep her safe…

Morphine’s essential place in hospice care.

When I began work in a hospice, I quickly came to see morphine as a wonder drug. It was used so much more effectively in palliative care than with the med-surg patients I had cared for in the hospital!

Morphine can be given via multiple routes, it’s easy to titrate, its side effects are well-known and therefore easy to manage, and it can bring dramatic pain relief as well as markedly improved breathing.

It was common for us to admit patients to hospice whose pain had never been controlled, and they were often dumbfounded at how easily their pain could be managed. The proper medical use of morphine was literally life changing for them.

Addressing family members’ concerns.

As a result of my hospice experience, I’ve always been a big believer in patient and family education to debunk myths and highlight the optimal uses of this drug. And yet education alone isn’t always what family members need when morphine is prescribed for their loved ones. Especially when the patient is at home and it’s a family member, not a nurse, managing […]

2019-11-12T15:36:45-05:00August 21st, 2019|family experience, patient experience|3 Comments
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End-of-Life Conversations at the 11th Hour

Illustration by Gingermoth

A problem all too familiar to nurses.

How often have we nurses talked to friends, family members, or each other about the importance of making end-of-life decisions well before that decision becomes critical? We see so many deaths that come only after extended and often avoidable suffering, it’s all many of us can do to keep from grabbing a family member’s hand and whispering, “Let her go!” At home, our families are used to hearing us say again and again, “Do not let me die like that!”

If we work in a hospital, chances are that we are confronted over and over again with trying to help families make “11th hour” decisions that will affect how their loved ones die. How do we broach the subject, when time is so short?

Trust prepares the ground.

This month’s Reflections article, “Difficult Conversations,” isn’t a primer to walk us through these conversations, but it offers an example of how we can take our cue from events or changes in the patient’s condition to raise the topic of the inevitable. Author Vanessa Arroyo illustrates how, after we’ve developed a relationship with patient and family and earned their trust, it may become possible to ask the hard […]

2019-08-19T09:59:07-04:00August 19th, 2019|Nursing, nursing stories|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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