A Dream of Horses: An Aging Veteran’s Healing Encounter

“Let’s go for a ride,” I said to Joe as he lay expressionless on his bed, covered in blankets and staring at the ceiling. The room was stuffy with hot, stale air. No bigger than a walk-in closet, the space held the lifetime possessions, many of them scattered on the bed, floor, and windowsill, of a 75-year-old veteran residing in an assisted living facility. Joe appeared frail and bored in the silence of the room.

Illustration by Janet Hamlin for AJN.

That’s the start of the Reflections column, “A Dream of Horses,” in the January issue of AJN. Written by a nurse at the Department of Veterans Affairs, the short, moving essay describes a series of healing encounters between a frail older man, who seems to have given up on life, and the horses at a therapeutic equestrian barn.

The here and now.

The story told here reminds us how much we humans can cocoon ourselves against the more elemental forces of the natural world, and how healing it can be to encounter a magnificent animal that asks only that we be present in the here and now. The senses awaken. We look beyond our own habitual ways of thinking […]

2018-01-16T10:00:35-05:00January 16th, 2018|Nursing, nursing stories, Patients|0 Comments
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When a Patient Turns Scary, a Nurse’s Options Aren’t Always Clear

I was leaning over my patient, listening to his lung sounds, when his hand tightened around my wrist. “Why don’t you get in the bed with me?” he said.

Illustration by McClain Moore

That’s the arresting opening of “The Squeeze,” the Reflections essay by nurse Danielle Allen in the September issue of AJN. Such scary experiences happen, as many nurses can attest. What behaviors cross the line? Who decides? After all, nurses put up with lots of challenging behavior. What’s unacceptable, and what constitutes a real safety issue?

Complicating these questions may be the responsibility a nurse feels to not let down their equally burdened nursing colleagues. No one, as Allen writes, wants “to be that nurse. You know, the complainer, overly sensitive, not-a-team-player nurse.”

Allen vividly evokes her encounter with the patient, the varied responses of nursing colleagues later, the emotional aftereffects of the event, and the larger question she finds herself asking about what can be done to keep nurses and other health care workers safe. […]

2017-08-28T08:37:02-04:00August 28th, 2017|Nursing, nursing stories|1 Comment
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Antibiotic Stewardship: Inherent to Good Nursing Practice

neutrophil interacting with two pink-colored multidrug-resistant Klebsiella pneumoniae bacteria

Although most nurses are aware of the urgent problem of antibiotic overuse in hospitals, some may be unfamiliar with terms like “antibiotic stewardship.” This is partly because few nurses besides those working as infection control preventionists have had a formal role in stewardship programs, explain authors Rita D. Olans, Richard N. Olans, and David J. Witt in “Good Nursing Is Good Antibiotic Stewardship,” which appears in this month’s issue as a Special Feature. In the article, the authors detail how bedside nurses are vital to the success of these efforts.

What Is Antibiotic Stewardship?

Antibiotic stewardship programs offer a formal approach to addressing the current crisis, in which an increasing number of organisms are developing resistance to antimicrobial medications. In the absence of new drugs, stewardship programs have been established to improve the way currently available antibiotics are used in hospitals. These programs aim to:

  • optimize antibiotic therapy.
  • shorten the duration of use of broad-spectrum antibiotics.
  • reduce the number of adverse events.

According to the authors, “because nurses are not typically prescribers of antibiotics, they often don’t see themselves as participants in antimicrobial stewardship programs.” Yet, even though they may not know it, “staff nurses are already performing many critical […]

2017-08-02T11:36:27-04:00August 2nd, 2017|Nursing, Public health|1 Comment
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Nurse-Author Theresa Brown Reflects on Recent Book About Doctor-Patient Communication

Nurse and frequent contributor to the New York Times Theresa Brown writes a column for AJN called What I’m Reading, in which she reflects on a recent book about an aspect of health care. This month she examines What Patients Say, What Doctors Hear (Beacon Press, 2017), by physician Danielle Ofri.

The book is about communication with patients, about real listening and the kinds of listening that often substitute for it, sometimes to the real harm of patients. Brown also considers some differences between the ways physicans and nurses tend to talk to patients. Here’s a brief excerpt, but we recommend that you read the short article, which is currently free:

Can any of us, nurses or physicians, say that we always listen as well as we should, giving each patient’s story our full attention? Like physicians, nurses feel the unrelenting pressure of time constraints. Although I try very hard to listen well, I’m sure there are times when I fail. Ofri’s book reminds us that it is clinically important to listen to what our patients say. Ironically, such listening can save time in the long run. But the main reason for doing so is simple: in order to give patients the best care possible, we need to hear what they’re actually trying to tell us.

Brown’s column is not a book review; while she draws readers’ attention to books that are well worth reading, the column goes beyond this purpose, […]

2017-07-31T09:33:35-04:00July 31st, 2017|Nursing|0 Comments
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Connecting Emotional Intelligence, Team Communication, and Patient Safety

An Early-Career Nursing Memory

Photo by Barry Diomede/Albany Stock Photo.

Many years ago, fresh out of nursing school, I was in charge one night, with no other RNs on the unit. We had an “active GI bleeder” who needed hourly boluses of either ice water or iced milk through an NG tube. (Yes, the standard treatment at that time was gruesomely uncomfortable for the patient, and in later years determined to be counterproductive.) I had more than a dozen other patients to care for, but everyone got their meds and, miraculously, the bleeding man made it through the night.

When my supervisor made rounds at the end of the shift, I reported that all was well and that my critical patient had survived. Her only response: “Mrs. Todd! There is blood on your shoes!”

This senior nurse, standing there in her starched whites and impeccable shoes, didn’t recognize that I had feared I would be inadequate to the task, or even acknowledge my pride as a brand-new nurse in actually saving someone’s life. In retrospect, I can’t help wondering if her choice to focus on a superficial fact, irrelevant to the crisis, could be interpreted as an indication […]

2017-07-17T16:49:20-04:00July 17th, 2017|Nursing, patient safety|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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