Addressing Harassment and Intimidation by Patients and Family Members

Since arriving at the skilled nursing facility after surgery for throat cancer, Ray had been attempting to touch female nurses inappropriately and had recently started making kissing motions at one of them whenever she entered and left the room.

Tacit acceptance of the unacceptable.

Though his behavior was recognized as unacceptable, most nurses had simply been redirecting him or telling him to stop, with no further consequences. Some explained the harassment away as the crude behavior of an old man who didn’t know any better. He’s from a different time; things were different back then. Some dismissed it as harmless. He thinks he’s being flirty. For others, his behavior was a mild though not particularly threatening irritation. He can’t even get out of his wheelchair—what’s there to worry about?

A symptom of cognitive decline, or plain old bullying?

The situation was complicated by the fact that Ray could not communicate verbally as a result of surgery, had short-term memory impairment, and difficulty concentrating. Although he appeared cognitively sound, there were just enough complications in communication and attention to cause some to speculate that he might be having neurocognitive decline that had disinhibited his self-restraint.

For others, Ray was a bully, maybe even a predator. He was taking advantage of access to female staff who were required to […]

2019-11-14T10:28:12-05:00November 13th, 2019|career, Nursing, nursing career|0 Comments

Caring for the Patient You Never Had a Chance to Get to Know

“For months, we simply knew him as this often agitated, sometimes unstable, generally nonverbal, nonpurposeful patient whose actual personhood seemed, if I’m honest, unrecoverable. We didn’t even know who we were trying to recover…”

This month’s Reflections essay in AJN is by Hui-wen Sato, a pediatric intensive care nurse in California. This piece is difficult to describe because it fits no clear category; this is also what makes it alive and engaging.

In “Beholding the Returning Light,” Sato explores the the experience of caring for a patient without ever having had a chance to get to know that person. What do you feel for that patient, and how much do you invest yourself in his or her possible future?

The ‘unthought known.’

Such questions and others may exist on a subconscious level throughout an ordinary work day for nurses in a number of settings. Sato, as she traces the sequence of events, her own emotions, and the role of the patient’s family, adroitly brings them to the surface. […]

Dia De Los Muertos: Thoughts On Life, Death, Nursing, and Time With Our Families

I discovered she died the way I typically learn a patient I’d navigated for died: the tiny abbreviation “dcsd” appeared next to her name on my computer’s patient list. Although her passing was not unexpected, I felt a deep sadness at the loss of her beautiful soul. From my desk, I sent a silent prayer of remembrance, and then another asking comfort for her family.

She was about the same age as my daughter, and like her, married to a devoted husband, the mother of young children. She was also an only child like my daughter, and feeling this connection, I grieved for her mother too. I wondered if there were things she would have done differently if she’d known their time together would be cut short.

Nursing doesn’t stop for the holidays.

Dia de Los Muertos. Illustration by Julianna Paradisi

We are entering the holiday season, and nurses begin scheduling their holidays off, and on. Not everyone will get what they desire. Perhaps it’s not coincidental that ringing in this season is the Latino celebration, Dia De Los Muertos (Day of the Dead, Oct. 31-Nov. 2), which is not only […]

2019-10-30T09:58:35-04:00October 30th, 2019|Nursing, nursing career|0 Comments

Revising Protocols in the Midst of Disaster Response

Refining an unsuccessful triage process.

Health care moves at such a rapid pace these days that quality improvement (QI) seems to be never-ending. We know these projects can help us to better our care, but it sure does become tiring when yet another new protocol or data responsibility falls on our shoulders. What if you were tasked with an urgent QI project in the midst of responding to a disaster?

Considering our own repeated scrambles to squeeze QI into ordinary workdays, imagine what it would be like to manage QI in a setting of extremely limited resources, where many people were desperate for emergency services—and you had to “get it right,” ASAP.

In “Implementing a Fast-Track Team Triage Approach in Response to Hurricane Maria” (free until November 15), Brittany Parak and colleagues describe their efforts to improve emergency services after their mobile military hospital was deployed to Puerto Rico, just 16 days after Hurricane Maria devastated the island.

“We soon discovered it would be necessary to refine our triage process, as our initial strategy resulted in limited access to care, prolonged wait times, many people leaving without being seen, and patients with acute problems not being cared for in a timely manner.”

2019-10-24T10:04:30-04:00October 24th, 2019|Nursing, Public health|0 Comments

Precision Medicine as a Nursing Competency

Precision medicine, genomic-driven treatment, phenotyping—it all sounded like too much dense material to cover in one article. But I’m happy to say that the authors of the October CE feature, “Knowledge of Precision Medicine and Health Care: An Essential Nursing Competency,” take this complex content and present it in a clear, straightforward, and interesting way.

‘Omics’ sciences.

We’re delighted to be able to bring you this timely and important content. As the authors explain, advances in the study of genes have given rise to the ‘omics’ sciences—the study of how genes function and how treatments can be tailored to an individual’s genetic makeup, i.e., precision medicine. While we’ve long found ways to tailor care to specific characteristics determined all or in part by genetic differences—–for example, prescription lenses to correct vision, blood typing—the completion of the Human Genome Project has given impetus to using genomics in many areas of care.

The completion of the Human Genome Project . . . provided insight into both mutations (genetic variations that occur in less than 1% of the population) and polymorphisms (genetic variations that are sufficiently common to be considered normal). Genetic variations confer not only such unique individual characteristics as eye color and blood group, but also susceptibility to such diseases as sickle cell and Tay–Sachs as well as […]

Go to Top