2017 Gold Report Refines COPD Treatment Algorithms

“As with many other chronic diseases, laboratory measures don’t always consistently reflect the extent of a person’s clinical symptoms or quality of life.”

Updated recommendations for managing COPD.

(click image to expand)

It’s nearly autumn, the time of year when we start to see exacerbations of chronic lung disease, including COPD. That’s why we’ve included an informative and readable COPD update in this month’s AJN.

Authors Amy O’Dell and colleagues discuss the latest recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD was launched 20 years ago in order to disseminate strategies for the prevention and management of this disease. The most recent GOLD report was released in 2017, with its recommendations further tweaked this year.

Treatment category based on spirometry plus symptoms and history.

One of the most exciting aspects of the 2017 recommendations is the way in which spirometry and a person’s clinical symptoms and history of exacerbations have been put together in order to determine a patient’s treatment category.

In the past, spirometric measurements have been key drivers of treatment. Yet as with many other chronic diseases, laboratory measures don’t always consistently reflect the extent of a person’s clinical symptoms or quality of life. Some people have “off the charts” lab readings for some condition, […]

2018-09-21T08:52:41-04:00September 21st, 2018|Nursing|0 Comments
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Quality of Life? Whatever the Patient Believes It Is

Illustration by Eric Collins / ecol-art.com

“What kind of life is that? That’s not how I would want to live.”

In AJN‘s September Reflections essay, “His Wonderful Life,” nurse Elizabeth Buckley interrogates her own judgmental response to a patient with a bluff, abrasive personality (he calls her ‘Nurse Ratchet during their first encounter) who requires nearly nonstop care to stay alive.

The patient has little hope of a meaningful recovery even if he survives the current hospitalization. The reader is surprised when, after a first grueling night of touch-and-go care, the author decides to take him on as her primary patient because she thinks it might be “a good learning opportunity.” (“I texted my friend who worked the day shift to sign me up; she replied that I was crazy.”)

A good life is in the eye of the beholder.

‘Philip,’ obese and with progressive dyspnea and multiple comorbidities, is sure he’ll soon be able to return to his bedbound existence at home watching old movies and chatting on Facebook; the physicians and other nurses are less hopeful. Gradually, over the course of five nights, the author’s respect and affection for the patient grows. He loves his life, however narrow it may seem to an outside observer. […]

2018-09-19T08:49:44-04:00September 19th, 2018|Nursing, patient experience, Patients, personal health practices|1 Comment
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The Nurse Who Saw Me: Easing the Strain of a Mother’s Vigil

Illustration by Barbara Hranilovich. All rights reserved.

“The Nurse Who Saw Me,” the Reflections essay in the May issue of AJN, is by JR Fenn, a writer and lecturer in upstate New York. The author, who is not a nurse, describes a night of uncertainty she spent in an isolation room on a pediatric unit with her sick daughter.

This is the kind of writing that helps a reader understand the perspective of a scared parent in a disorienting and uncomfortable environment. The care is efficient, and the clinicians she encounters all seem to be doing the right things for her baby. But reassurance is not immediately forthcoming, as we see in this passage from near the beginning:

The attending looks at us over her white mask when I ask if my daughter is going to be OK. ‘There isn’t the research for babies this young,’ she says, her eyes so huge I can see my terrified face reflected in them. I can’t ask any more questions because my throat has swelled closed as I fight tears.

[…]

2017-05-10T11:09:22-04:00May 10th, 2017|Nursing, patient experience|0 Comments
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The Essence of Nursing Care: A Powerful Tribute for Nurses Week

“Frontline nurses, as the health professionals who spend the most time with patients and their families, are central to ensuring that the patient experience is a positive and dignified one.”

Susan Hassmiller

This sentence from “The Essence of Nursing Care,” a guest editorial in the May issue of AJN, isn’t just rhetoric. It’s based on a recent and unforgettable personal experience of the power nurses have to recognize and sometimes ease a family member’s suffering at the very worst of times.

In this moving editorial, Susan Hassmiller, the senior advisor for nursing at the Robert Wood Johnson Foundation, writes about the nurses who helped her in the terrible days following her husband Bob’s tragic bicycle accident last fall. Writes Hassmiller:

“My life changed forever on Sunday, September 25, 2016, at 11:09 am. . . .That’s when I learned that Bob, my best friend and husband of 37 years, lay paralyzed in the trauma unit of a nearby hospital . . . .During those 10 brutal days, I learned anew the crucial role that nurses play in caregiving and compassion. Three nurses stood out in particular.”

I won’t attempt to summarize the rest of this guest editorial. It’s as eloquent a tribute as nurses are likely to get this year on Nurses Week. The article is free, so […]

2017-05-08T10:15:48-04:00May 8th, 2017|Nursing|1 Comment
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The Limitations of Rating Nursing Care by Customer Surveys

Ink and collage on paper by Julianna Paradisi 2017

Either They Loved It or They Hated It

While toasting the same English muffin for the second time that morning and cursing that it would make me late for work, I conceded we need a new toaster. It doesn’t matter whether I set the darkness level on 1 or 4;  the muffin comes out barely tinged. Select 5 or beyond, the muffin is burnt, and sets off the smoke detector. It’s time to buy a new toaster.

I found one I liked, shopping online. It had been purchased by over 1,500 other people; 55% of them rated it 5 stars. The other 45% of ratings ranged between 1 and 4 stars. The comments, however, were evenly split, 50/50. People either loved it or hated it. There was no in-between.

This made me laugh.

As with Toasters, So with Nursing Care

Likewise, many hospitals, in an effort to improve care, send out satisfaction surveys asking patients to rate their nursing care. In my experience, the results are similar to the toaster’s ratings: about half the patients rave about their care. Some mention their nurses by name, elaborating on specific details about their experience.

The other half complain bitterly that their […]

2017-03-31T10:28:07-04:00March 31st, 2017|Nursing, nursing stories, patient experience|3 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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