Nursing Insights: The Experience of a Chronic Illness as a Series of Subtractions

Illustration by Janet Hamlin for AJN. All rights reserved. Illustration by Janet Hamlin for AJN. All rights reserved.

Chronic illness is often experienced by patients as a series of subtractions. A progressive illness like Parkinson’s reveals this process vividly as the ability to move, speak, care for oneself, all gradually disappear or diminish.

The grief of lost freedom, lost abilities, lost agency, lost avenues of communication is easy to overlook. But it’s real, and can come out in uncomfortable ways. Here’s an excerpt from the start of this month’s Reflections essay in AJN, “A Room With a View.”

David was in his late 50s and had been diagnosed with Parkinson’s disease several years previously. Following a lengthy hospitalization, David’s wife agreed to a placement on the subacute/rehab unit in the facility where I was the instructor for nursing students during their older adult clinical rotation. . . . Although ravaged by the disease, David seemed to like having students provide his nursing care. . . .

One of his favorite activities was sitting by his room window, which overlooked the facility gardens and a play area for the preschool next door. For several weeks, I discovered a nursing student and David sitting by the window watching the outdoor activities in […]

2016-11-21T13:01:19-05:00April 4th, 2016|Nursing, nursing perspective, nursing stories, patient engagement|0 Comments
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Do Schools Still Have Nurses?

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by woodley wonderworks, via Flickr. by woodley wonderworks, via Flickr.

In the December 1903 issue of AJN (reprinted, with an editor’s commentary, in September 2014), Henry Street Settlement nurse Lina L. Rogers described the impact of the first school nurse program in the United States. Ms. Rogers, who worked with Henry Street founder Lillian Wald to establish the program in New York City schools, emphasized that their purpose was not only to improve children’s health but to decrease missed school days.

Wise community leaders have long acknowledged the importance of school nursing in accomplishing these goals. But in recent years, this hasn’t prevented cutbacks that eliminate or severely limit the care that nurses can provide to their school communities.

An  October 10 article in the Philadelphia Inquirer describes an acute shortage of nurses in Philadelphia schools. Detailed here are multi-school coverage by individual RNs, wildly unrealistic caseloads for many of the nurses, and the significant responsibilities for “medical care” now borne by non-nurse teachers and administrators. In the article, Terry Jordan, president of the Philadelphia Federation of Teachers, underscores the complexities of school nurse work, noting, “We have so many families living in deep poverty, and for some of these families, the […]

2016-11-21T13:01:51-05:00October 16th, 2015|Nursing|4 Comments
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The First 50 Years of NPs: An Illustrated Timeline Shows Triumphs, Continuing Practice Barriers

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

This year marks the 50th anniversary of the nurse practitioner (NP) role. Themes of innovation and sustainability emerge as one examines an illustrated timeline of the history of NPs in AJN‘s October issue and reads the accompanying text. (The first section of the timeline is below. Click to enlarge.)

Screen Shot 2015-10-14 at 1.48.08 PM

How did this advanced practice nursing role come into being? As the timeline explains, ” [d]uring the 1960s, health care was becoming increasingly specialized. Physicians were moving out of general practice and into more complex and lucrative specialties, creating a void in primary care and prevention services, and in care of the chronically ill.”

To fill this void, public health nurse Loretta Ford, working with Dr. Henry Silver at the University of Colorado in 1965, launched the first NP certificate program, a seminal moment in the history of this prevention-driven, primary-care-focused nursing role.

Ford wrote about the compelling need for NPs. Calling health care a capital investment, Ford said:

“We have failed to realize the full potential of professional nurses to improve the quality of life. This group has great unused potential for bringing about health care reforms. Properly prepared and effectively utilized, nurses could advance the nation’s health […]

2016-11-21T13:01:52-05:00October 15th, 2015|career, Nursing, nursing perspective|0 Comments
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Case Studies in Effective Care Coordination by Nurses in Rural Kansas

“I did not have a clue how to proceed.”

Care coordinator Burlay Parks meets with a patient at Greeley County Health Services in Tribune, Kansas. Photo by Chrysanne Grund. Care coordinator Burlay Parks meets with a patient at Greeley County Health Services in Tribune, Kansas. Photo by Chrysanne Grund.

The opening sentence of “Pathfinding on the Frontier,” the In the Community column in the October issue of AJN, alludes to the confusion even the most organized and savvy person sometimes feels when navigating our health care system.

In rural settings, referrals to specialists from primary care providers can be difficult for patients and families to follow up on, sometimes requiring that patients travel great distances.

Patient care coordination has been shown to decrease the number of ED visits and hospitalizations. The authors of this article explore care coordination in two Kansas counties, presenting three case studies showing how a nurse care coordinator—as part of a program at a rural primary care practice funded by a two-year grant from the Robert Wood Johnson Foundation—resolved complex issues for seriously or chronically ill patients involving medications, specialists, and diagnoses. […]

2016-11-21T13:01:56-05:00October 12th, 2015|Nursing, nursing perspective, Patients|1 Comment
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Preparing Patients to Care for Themselves After Discharge

Here’s your prescription. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. See your doctor in two weeks. Want a flu shot? If you need a wheelchair to take you to the door, I’ll call. If not, you can go. Take care of yourself. You’ll do great!”

These were my nurse’s parting words before I left the hospital after a weeklong stay and surgery to remove my stomach and the tumor in it. I said goodbye. Then I panicked. What did I need to know about my new digestive system? What about that big scar? Until then I’d been closely monitored and checked on every 90 minutes.

Now it was 8:45 in the morning. My husband hadn’t arrived. I was supposed to move on.

Jessie Gruman Jessie Gruman

That’s the start of our July Viewpoint column, “Preparing Patients to Care for Themselves,” written by Jessie Gruman, president and founder of the the Center for Advancing Health, a nonpartisan policy institute that’s played an important role in the growing patient engagement movement.

In this essay and elsewhere, Gruman draws on her own experience as a cancer patient as well as her public health expertise to bring insight and clarity to the often nebulous concept […]

2016-11-21T13:04:18-05:00July 11th, 2014|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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