Pain, an Ever-Present Concern for Patients—and Nurses

Nurses at Ann and Robert H. Lurie Children’s Hospital of Chicago manage baby boy’s postoperative pain following heart transplant. Photo courtesy of Ann and Robert H. Lurie Children’s Hospital.

In my experience working with severely ill or injured patients, pain was what they talked about the most. They either asked about it prior to a treatment or intervention (“How much is this going to hurt?”), relived their history with it (“This pain isn’t as bad as the pain I had….”), or were consumed with fear that it would never end (“I can’t handle this—can’t they give me anything for it?”).

Post-op patients mostly had the same standard order, whether they were slightly built women or burly men: meperidine 25mg q3-4 h IM. I remember watching the time so I could administer the medication as soon as the clock would allow—and sometimes “fudging” the time a bit because the medication wasn’t “holding” the patient. It was one of the topmost issues for nurses in acute care—how to ensure patients were comfortable and pain free. As a nurse, not being […]

2018-01-17T10:04:37-05:00January 17th, 2018|Nursing|0 Comments
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Blood Glucose Meters in the ICU: Quick, Useful, But Regulatory Issues Still Unresolved

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

Photo © Life in View/Science Source. Photo © Life in View/Science Source.

Many time-saving clinical technologies are available today that were unheard of at the start of my nursing career. Have we always given careful thought to how this technology is applied? A controversy about the safe use of point-of-care (POC) blood glucose meters (BGMs) in the ICU is a case in point.

Quick, minimally invasive bedside blood glucose monitoring has become the standard of care in hospitals and nursing homes. Interestingly, though, the original FDA approval of POC BGMs was for at-home use only. But the agency waived any restrictions on inpatient use, as long as staff performing the tests were properly trained and the patients were not critically ill. The use of BGMs in critically ill patients is considered “off label.”

Early in 2014, the FDA proposed new regulatory requirements for BGM use in hospitals. Apparently in response to the FDA’s proposal, the Centers for Medicare and Medicaid Services then issued a memorandum of intent to cite and even fine hospitals for the off-label use of BGMs in critical care. A huge outcry from clinicians ensued. […]

2016-11-21T13:01:19-05:00April 6th, 2016|Nursing, nursing perspective|2 Comments
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Attention to Patients’ Mobility: Low-Tech But Essential

A critical care nurse led a multidisciplinary team to explore the effects of a dedicated ‘mobility team’ on functional and other outcomes in ICU patients.

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

julie kertesz/ via flickr creative common julie kertesz/ via flickr creative common

It’s long been known that immobility leads to deconditioning. Various studies indicate that muscle strength drops by 3% to 11% with each day of bed rest. As most of us have witnessed firsthand in both patients and family members, it can take months to regain pre–bed rest levels of functioning. For some people, the strength and mobility needed for independence never return.

In this month’s issue, a community hospital critical care nurse led a multidisciplinary team to explore the effects of a dedicated “mobility team” on functional and other outcomes in ICU patients. In “Implementation of an Early Mobility Program in an ICU,” Danielle Fraser and colleagues share what they learned.

The mobility team consisted of a physical therapist, a critical care RN, and an ICU rehab aide. Respiratory therapists worked closely with the team. Patients assigned to the early mobility intervention could progress through four successive levels of movement, from passive range-of-motion exercises to full ambulation.

Compared with ICU patients who received routine care, the patients in the intervention group were more functionally independent at discharge. In addition, this […]

2016-11-21T13:01:41-05:00December 7th, 2015|Nursing, nursing perspective, nursing research, patient engagement|0 Comments
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AJN EIC Talks Priorities With Leaders of Critical Care Nurses Organization

Karen McQuillan and Teri Lynn Kiss AACN president-elect Karen McQuillan (left) and president Teri Lynn Kiss

By Shawn Kennedy, AJN editor-in-chief

Last week at the American Association of Critical-Care Nurses (AACN) annual meeting (see this post), I interviewed the association’s president, Teri Lynn Kiss, or “TK,” and the current president-elect, Karen McQuillan, who will officially take office after this month. After days of rushing from session to session (and there must be 300+ sessions to choose from) and wandering through exhibits, I always enjoy sitting down with leaders of this organization and hearing what they think is important in critical care nursing.

Teri Lynn Kiss, MS, MSSW, RN, CNML, CMSRN, director of Medical Unit-2South and case management services at Alaska-based Fairbanks Memorial Hospital, has led this growing organization of over 104,000 members for the last year. I asked her what she felt she’d accomplished. She said that one of the most valuable things the association had done in the past year was to provide clear and credible information about Ebola to its members, the health care community, and to policy makers in Washington. She also believes the association’s work on creating healthy work environments is important not just for nurses but will translate to better care for patients. Her presidency, she said, enabled her to fulfill her own personal mission of service to others—one she will continue with the association in different capacities.

Karen McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, a […]

2016-11-21T13:02:29-05:00May 26th, 2015|career, Nursing, nursing perspective|0 Comments
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Critical Care Nurses: Heading Home to ‘Focus the Flame’

By Shawn Kennedy, AJN editor-in-chief

AACN president-elect Teri Lynn Kiss AACN president-elect Teri Lynn Kiss

The American Association of Critical-Care Nurses (AACN) National Teaching Institute ended last Thursday, just in time to get folks home for Memorial Day weekend. Last week, my post was about the opening session and awards. Here are some more highlights from the rest of the week:

Concurrent sessions were plentiful—too many to choose from. My top two favorites were one on transfusing blood and blood products and another on managing pain, agitation, and delirium. New this year were sessions related to health care financing, a nod to the fact that all nurses need to be cognizant of the cost of care. My other “must attends” were the poster sessions—these are largely by up-and-coming researchers and teams doing innovative projects. current AACN president Vicki Good current AACN president Vicki Good

Handling conflicts with colleagues. A “super session” by Christine Cashen, a professional speaker, had everyone on their feet in a standing ovation. Extremely funny and with a clear message about handling conflict with colleagues (a very big issue in nursing, as we know), Cashen was a […]

2016-11-21T13:04:42-05:00May 27th, 2014|career|1 Comment
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