“One expects nurses to be better informed than the general public when it comes to science and health matters.”—editor-in-chief Shawn Kennedy in her October editorial, “Getting on Board with Vaccinations”

The October issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

CE: Hypertensive Emergencies: A Review

An overview of the pathophysiology, clinical manifestations, and management of hypertensive emergency, plus nursing considerations for acute and preventive care.

CE: A Prone Positioning Protocol for Awake, Nonintubated Patients with COVID-19

How an interdisciplinary team at one Boston hospital developed and
implemented a protocol for proning awake, hypoxemic patients with
suspected or confirmed COVID-19 on medical–surgical units.

Special Feature: Preventing Medjacking

This article discusses medical device cybersecurity, the risks and consequences of compromised medical and personal data, and what nurses can do to guard against security threats and educate patients.

Transition to Practice: Transgender and Gender Diverse Nursing Care

The authors offer guidance for novice nurses on providing affirming care to transgender and gender diverse patients, including discussions of gender and pronouns, privacy considerations, and communication and advocacy.

Strip Savvy: A Case of Sudden Cardiac Arrest

This article is one in a series on the basics of ECG interpretation. After presenting a case scenario and an ECG strip, the authors take readers step by step through analyzing the heart rhythm.

There’s much more in our October issue, including:

• A Viewpoint on mitigating drowsy driving risk for night shift nurses.
• An AJN Reports on the recent surge in gun violence in the United States.
• A Profile of Jackie Campbell, creator of the Danger Assessment.

Click here to browse the table of contents and explore the issue on our website.

A note on the cover.

This month’s cover illustration shows two people walking through the Hockomock Swamp in southeastern Massachusetts. It’s a place nurse Pamela Sturtevant wrote about as an escape from the realities of COVID-19 in her July Reflections article, “Of Swamps and Pandemics.” She described the Hockomock as an otherworldly setting known for “legends and sightings of wonderfully scary things”; as such, with Halloween spookiness in mind, we decided to repurpose her article’s illustration on our October cover.

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Happy first day of autumn! Let’s have some fall talk.

If you spend any time in the acute care setting, you’ll be inundated with signs of fall precautions: yellow alert armbands, yellow nonslip socks, yellow signs on patient room doors, and of course the constant ringing of bed alarms.

It appears that hospitals put a lot of effort into fall prevention, and understandably so—falls cost hospitals money. These costs include tests and procedures that aren’t covered by insurance, increased length of stay while the patient recovers, and lawsuits from injured patients or from their families.

Checking boxes vs. individual patient needs.

However, the current approach of applying all precautions to all patients at risk for falling isn’t supported by research, and may decrease patient satisfaction. Sometimes it seems more focus is put on checking boxes about having prevention strategies in place than on the actual patient’s preferences or needs. For example, a former patient told me about a time she was in the bathroom of her hospital room and felt lightheaded. Rather than risk falling, she eased herself to the floor and hit the call bell for assistance to get back to bed. Upon finding her on the floor, the staff were so focused on filling out an incident report and assessing her for injury that they ignored her attempts to explain what actually happened.

The ‘next era’ in fall reduction.

Many of the strategies mentioned in the first paragraph focus on a blanket approach to falls, with the primary focus on reducing extrinsic or environmental risk factors. These common interventions may be helpful to some degree; however, they also put limits on patients’ mobility and autonomy.

A CE article in AJN’s October issue, “Reimagining Injurious Falls and Safe Mobility,” by Ann Hendrich, PhD, RN, FAAN, proposes the “next era” in fall reduction practices and proposes an acronym based on a three-pillared approach to fall prevention.

ERA stands for

• Electronic health record integration
• Risk factors that matter
• Assessment and care plans

The author recommends incorporating a valid tool for fall risk assessment into the EHR, where fall risk score can be recorded and updated as the patient’s condition changes. The tool selected should be valid for predicting falls, such as the Hendrich II Fall Risk Model. Once the risk factors are determined, a care plan can be created based on the 4Ms: What Matters, Mentation, Medication, and Mobility.

You can read more about this in this month’s CE feature, in which you’ll find a detailed explanation of the ERA approach and the 4Ms, infographics of the model and framework, a case study, and practice recommendations. You can also take the test and earn CE credits.

Please comment below and let us know what your facility is doing to prevent patient falls.

Christine Moffa, PhD, APRN, PMHNP-BC, senior clinical editor

The post Are Fall Prevention Precautions Missing the Mark? appeared first on Off the Charts.

In 2020, I was asked to review a submission for AJN’s Viewpoint column. Reviewers are not told who the author of a work is, nor are authors informed who is reviewing their submission. But I hadn’t gone very far when I knew exactly who the author was and what she was writing about.

Photo © Shutterstock

In my career I have read and been moved by many articles and first-person accounts, but this time was different. Each word took me closer into what I realized was a very personal viewpoint on an unimaginable national tragedy.

The author of the article was Arlene Holmes, a nurse and mother who was writing about her son James, who on July 20, 2012, opened fire on movie theater patrons in Aurora, Colorado, killing 12 and wounding 70. (Her article, “Why a Nurse (and Mother) Didn’t Know,” was eventually accepted and published in AJN‘s June 2020 issue.)

Asking the same questions over and over.

After completing the review of this article, the questions I asked myself were the same ones I ask each time we hear of such tragic events happening at the hands of someone who has a mental illness:

What could have been done to change the outcome and prevent such tragedies from happening? Why wasn’t something done by someone at some point along the way to change the direction the person and situation were headed in before it was too late?

Increasing awareness.

Who better than someone who has lived the experience to share an emic (insider) perspective? I reached out to Arlene to ask her to join me in getting the word out about increasing our awareness of mental health and illness and to offer some suggestions about what we need to know and do. She does so in my Mental Health Matters column (free until Oct. 7) in this month’s issue of AJN.

Being aware of the signs and symptoms of any disorder or disease is only the first step. Imagine being in a restaurant when another diner clutches his chest and complains of pain up his left arm. Do we look on and say, “Yes, those are the signs of a heart attack,” and then go back to finishing our meal?

Or imagine being at the mall and having the store clerk suddenly complain of a major headache and noticing she is slurring her speech and the left side of her face has started to droop. Is it enough to tell the clerk she might be having a stroke based on your knowledge of those symptoms and then take your items to be rung up by another cashier?

Absolutely not to both of those scenarios. We would step in and render care and call for help.

Unfortunately, such rapid intervention is usually not the case with mental health. With many of the cases we have seen in the past and will see again in the future, somewhere along the line there were clues and indications that, had these been followed up on, might have prevented a tragedy.

Nine critical warning signs.

In this month’s column, we review some of the things worth paying attention to, and Arlene shares important information about what nurses need to know and do. While most people who have mental health issues are not violent, it is important to consider that, at times, behavior can become violent.

The following nine critical warning signs of violence, compiled by the national nonprofit organization Sandy Hook Promise, should certainly be a call for action on the part of anyone who witnesses them, especially in combination. They indicate a person may be in crisis or in need of help sooner rather than later:

1. Sudden withdrawal from friends, family, and activities (including online or via social media)
2. Bullying, especially if targeted towards differences in race, religion, gender, or sexual orientation
3. Excessive irritability and unusual quickness to anger
4. Experiencing chronic loneliness or social isolation
5. Expressing persistent thoughts of harming themselves or someone else
6. Making direct threats toward a place, another person, or themselves
7. Bragging about access to guns or weapons
8. Recruiting accomplices or audiences for an attack
9. Directly expressing a threat as a plan

The above is not an exhaustive list. Too often we find ourselves doing and asking questions after the harm has been done. Perhaps if we acted sooner, we wouldn’t need to ask why. Although it’s too late to change the course of events for past tragedies and acts of violence, it’s not too late to be the person who, armed with the knowledge that something is amiss, can make a difference in preventing a future tragedy.

Donna Sabella is a psychiatric mental health NP, a professor at the Pennsylvania College of Health Sciences in Lancaster, and the coordinator of AJN’s Mental Health Matters column.

The post Mental Illness and Public Tragedy: Recognizing Critical Warning Signs appeared first on Off the Charts.

Daily Trends in COVID-19 Cases in the U.S. Reported to CDC (9-21-21): red line shows 7-day moving average. Click image to enlarge.

According to the CDC, the delta variant now makes up more than 99% of COVID-19 cases across the U.S. Recently, though, the media has been drawing attention to the mu variant. Should we worry?

How serious are variants?

Viruses constantly change. Mutations might make a virus easier to spread or more virulent, change its clinical presentation, or alter its response to tests, vaccines, or treatment. Or there may be no observable change in its characteristics at all. Some variants simply fade away; others stick around, but can’t compete with more dominant variants and never really get a “foothold” in a particular population. At this time—and this is a pretty big caveat—the COVID-19 mu variant seems stuck in this last category, at least in the U.S.

What about mu?

Although the mu variant has been identified in more than 39 countries, including the U.S., there have been only about 2,000 cases here, mostly in California, Florida, Texas, and New York. The World Health Organization (WHO) calls mu a “variant of interest” (more on this label later), but the CDC does not. While the WHO is tracking mu’s global spread, according to the CDC the variant peaked here in late June at less than 5% of circulating variants, and since then its numbers have trended downward.

Although there is some evidence that the mu variant is more transmissible than the original COVID-19 strain, thus far it has seemed no match for the delta variant. Like most variants, it has, theoretically at least, the potential to evade COVID-19 vaccines. But there is as yet no data to suggest that it is able to do that.

How are COVID-19 variants categorized?

Both the WHO and the CDC classify COVID-19 variants as either “variants of interest” or “variants of concern.” Both agencies have similar definitions for these terms:

• A “variant of interest” is one in which genetic changes are known or predicted to affect the virus characteristics listed above. In addition, the variant is becoming more prevalent and has been identified as the cause of significant community transmission or case clusters. The WHO labels the mu variant as a variant of interest.
• A “variant of concern” exhibits increasing transmissibility OR more virulence or a change in clinical presentation OR decrease in effectiveness of vaccines, testing, or treatments used in the disease. Both the WHO and CDC label the delta variant as a variant of concern.

The U.S. adds a third category of variants:

• A “variant of high consequence” would be one for which there is clear evidence that the effectiveness of prevention or treatment measures are significantly reduced as compared with other variants, testing is producing regular false negatives for the variant, or more breakthrough infections are occurring. The U.S. hasn’t applied this label to any variants.

The classification of variants helps to direct our response. A variant of interest should trigger enhanced surveillance and epidemiological investigations; a variant of concern calls for stepped-up testing and mitigation efforts and ongoing research on the effectiveness of COVID-19 vaccines against these variants.

Testing for Variants

In theory, a new variant could elude testing. But as of today, all variants will reliably result in positive COVID-19 tests. (However, routine testing will not identify which variant has caused infection; genomic sequencing is needed for that.) As with all lab tests, we consider the test result along with the patient’s clinical presentation and history as well as the local COVID-19 epidemiology. When there is doubt about a negative test (for example, in a person who has symptoms that indicate COVID-19), a different manufacturer’s test, targeting different parts of the SARS-CoV-2 genome, may yield a positive result.

Viruses mutate.

The only way to slow this process is to limit transmission (and therefore, replication) of the virus. It has been demonstrated repeatedly in both clinical investigations and formal research studies that vaccination, masking, physical distancing, and measures to improve indoor ventilation are effective in limiting the spread of the virus.

The post Delta, Mu, and Others: What to Know About Covid Variants appeared first on Off the Charts.

Our acute care settings are in crisis—staff are physically and emotionally exhausted. And many have decided they can’t take it anymore.

“At the virtual conference of the American Organization for Nursing Leadership (AONL) in July, researcher Peter Buerhaus reported preliminary findings of his study on the impact of the pandemic on the nursing workforce. He reported that a phone survey of over 800 AONL members conducted in May revealed that more than 50% of hospital chief nurse officers were seeing “increased retirements, sick leave, and early exits, including among younger nurses.”— AJN Editorial, September 2021

It’s been no secret that the hospital work environment has been problematic for nurses and patients alike—we know stressed and worn-out clinicians make more errors, and patient care suffers. In 2004, the Institute of Medicine released Keeping Patients Safe: Transforming the Work Environment of Nurses, which disussed workplace staffing and processes as intrinsic to ensuring patient safety. More recently, the National Academy of Medicine published Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (2019), which noted, “The job demands placed on clinicians are often greater than the job resources available to them; this imbalance can lead to burnout.”

I’ve spoken with managers who are scrambling to hire nurses but finding few takers. Many nurses are now working for travel companies that offer lucrative pay. Hospitals are beginning to offer sizable sign-on bonuses, tuition loan forgiveness, and other perks, but that’s not going to fix the basic problem: the overwhelming, soul-crushing, day-to-day job stress.

Beth Wathen, MSN, RN, CCRN-K

I spoke last month with Beth Wathen, president of the American Association of Critical-Care Nurses (AACN). (Listen to our conversation below.) Part of our discussion concerned the increased stress brought on by the COVID-19 pandemic. Wathen spoke about AACN’s ongoing initiative to create healthy work environments and noted that hospitals “must make staff well-being a priority” by equipping frontline managers with the ability to help staff and ensure they get support to step away when needed. Member feedback reinforces that staffing is a key issue. Keeping staff safe has been a key priority in Wathen’s own work as a clinical practice specialist at Children’s Hospital Colorado in Aurora, and she has carried that focus over to her work with AACN.

It needs to be everyone’s focus—otherwise, who will ensure safe care if nurses leave hospitals?

AJN editor-in-chief Shawn Kennedy speaks with Beth Wathen, AACN president:

The post Acute Care Nurses: An Endangered Species? appeared first on Off the Charts.

Sam was a 17-year-old who had been admitted following a major traumatic leg injury. The surgical teams were trying to save his leg.

A colleague asked me to ”pop in” on him, since he was having a hard time coping. Frankly, he was completely bummed out.

Sam and his mom were together in his room waiting to go to OR. I introduced myself as a nurse working with the pain management/spiritual care team. Conversation was stiff but polite. Sam made no eye contact with me at all.

Building relationships takes time.

photo courtesy of author

Following his procedure, I made a point of stopping by to visit almost every day. Mom had warmed up to me—Sam just a bit. It was an isolating time in the hospital. Visitors were not allowed, except for a single family member for pediatric patients, and the contacts with staff were often task focused and purposeful. One afternoon, I saw mom sitting in the hallway talking on her cell phone, crying. So I waited.

When she ended her call, I asked if she’d like some company. Our conversation found its way from the hospital to the kitchen, stopping along the way as we shared family and shopping tidbits. She laughed and we connected. I also learned a bit about Sam.

Sam was a bright guy, quiet, with a flair for photography. He also enjoyed fishing and had a big fish tank at home. The next time I went in to see Sam I asked him about his fish tank. It was the longest conversation we’d had so far.

On my phone I had a few pictures that a friend had shared with me from his underwater dives. There was one in particular of sea coral that I liked. I showed it to Sam and he was amazed.

Soon thereafter there was an astronomical event—a Super Pink Moon. Fortunately, I had taken a picture of it. I shared it with both Sam and his mom, who were as wowed by it as I’d been. The moon made us smile. He asked me for a copy of both the sea coral and the super moon, which I gladly shared.

Although Sam’s leg had been saved and the outcome was considered favorable, he was still struggling with adjusting to the impacts of his injury.

Slow healing, first steps.

After multiple surgeries, he had been fairly restricted, but now he was beginning to walk. I suggested that Sam let his mom take a picture of him he walked. I thought having a photographic journal of progress might be a powerful inspiration. But mom was hesitant and Sam silent on the idea.

About a week later, Sam’s mom stopped me in the hall one morning and showed me that she had taken a few photos of Sam as he was moving along. She said that he had sent them to his friend. He was walking. He was healing. Slowly he was coming around. I was through the moon!

Healing is hard work. Coming to terms with changes in physical abilities, body image, and potential alterations in lifestyle, even if temporary, can be difficult. Finding ways to demonstrate support and keeping the communication channel open to help foster a caring environment can be challenging.

In this case, I think we got lucky. Sam had a lot of support from his family and the staff. Perhaps turning the corner was just part of his natural healing timeline. But I was truly grateful for the opportunity to observe it.

Many weeks after his discharge, I received a message from Sam’s mom. She included an image of Sam with a big bright moon hanging in the background.

I guess it’s true a picture speaks a thousand words.

Barbara Wukovits, BSN, RN, BC, is director of alternative pain management services in the Department of Anesthesiology, Critical Care, and Pain Management at the Hospital for Special Surgery, New York City. She’s the author of the September Reflections essay in AJN, “My Pocket of Care.” 

The post The Power of Pictures in Therapeutic Healing appeared first on Off the Charts.

You don’t have to look far for evidence that the mental health of children and adolescents has been entering a crisis in recent years, one exacerbated by the unusual conditions imposed by Covid-19.

The June 18 Morbidity and Mortality Weekly Report (MMWR) from the CDC reported:

During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7%.

Photo by Yasser Chalid/Getty Images

As noted in a recent Washington Post story, “Emergency departments have meanwhile become a tattered safety net for adolescent mental health care.”

In this month’s AJN, Betsy Todd summarizes some of the current issues seen by school nurses and other health care professionals like nurse practitioners (NPs), who often feel overwhelmed by the intensity of the suffering and need they are now seeing in many children.

Systems pushed to their limits.

Todd notes that existing systems are proving woefully inadequate to the growing need, with wait times increasing to see child psychiatrists, therapists, and other experts, and pediatric hospitals in several states reporting “sharp increases in ED visits for anxiety, depression, substance abuse, suicide attempts, self-harm, aggressive behavior, and eating disorders.”

Areas for improvement.

The short article, which is currently free, points to several areas where advocates see room for improvement, including reducing bureaucratic hurdles to getting kids in crisis into treatment and increasing mental health screening by NPs and others, as well as substantial growth in funding and systemic support across the board.

The post Children’s Mental Health Crisis Reveals Holes in System appeared first on Off the Charts.

“No—no!” shrieked my 95-year-old patient with dementia as I turned her to her side with the help of my nursing assistant (now called a patient care tech, 30 years later).

The three daughters sitting at her bedside inhaled deeply, their eyes wide. I looked over at them, calmly explaining that their mom was just frightened, and then in a soft voice said to my patient, “Don’t worry, Mrs. Smith, we won’t let you fall,” as she continued to scream. We positioned pillows against her back, and another between her knees. As we saw the family relax, and the patient’s screams turn to a barely audible whimper, I caressed her back and felt satisfied that all was well.

Fast-forward to my retirement. Having inherited my parents’ degenerative joint disease, at age 72 I have certain specific ways to sleep so that my left shoulder doesn’t hurt, my left hip bursitis doesn’t flare, and my right arm doesn’t get numb and tingly from a pillow that’s too puffy, causing hyperflexion of my cervical vertebrae.

Never assume what the patient’s feeling.

I have flashbacks from the days I thought I was an efficient nurse—I dread having someone, someday, assume that I am just frightened in their attempts to keep me on a turning schedule to prevent pressure ulcers. While it’s possible that I was right about that patient years ago, since sometimes patients with dementia truly are just frightened, we should never assume.

I remember a caregiver getting annoyed when some patients refused to roll to their sides, telling them they were at risk for getting a bedsore. Maybe it would be better to try to figure out why a patient seems so set on lying on their back, or the reason for a confused patient’s screams. Positioning, if we are are tuned in to a patient’s cues, can work. But there is more than one solution to achieve a goal—for example, massages, alternating pressure pads, and air mattresses.

If the young knew what it was like to be older.

Imagine if we, as nurses and caregivers, aged in reverse, experiencing a fractured hip, arthritic joints, vision loss, and yes, dementia, in the first part of our lives, eventually outgrowing our infirmities and becoming young enough to have wisdom and complete empathy with our patients.

A fantasy, of course, but hopefully nursing educators are encouraging their students to hone the skill of perceiving the subtle needs within a patient’s whole being—never assuming. This approach embodies the art and science of nursing.

Mary Ann Hoyt is a retired medical-surgical nurse. Her last post for this blog was “A Proposal to Ensure Patients Don’t Fall Through the Cracks.”

The post If Nurses Aged in Reverse appeared first on Off the Charts.

“Pain is a complex experience. Offering patients an opportunity to express their feelings, listening to their words, looking into their eyes and sensing their uncertainty are all part of the compassionate side of healing.”—Barbara Wukovits in her September Reflections column, “My Pocket of Care”

The September issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

CE: Acute Ischemic Stroke

A review of ischemic stroke pathophysiology; risk factors; presentation; and the evidence-based treatments, nursing assessments, and monitoring protocols that are critical to patient recovery.

CE: Reimagining Injurious Falls and Safe Mobility

This article by the author of the Hendrich II Fall Risk Model proposes a new approach to fall prevention—one grounded in evidence-based protocols known to positively impact the health of older adults.

AJN Reports: The Troubling State of Public Health

How underfunding, attrition, and COVID-19 are affecting the nation’s public health agencies and nursing workforce.

Perspectives on Leadership: Supporting Frontline Staff During the COVID-19 Pandemic

Nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients.

Mental Health Matters: Improving Mental Health Awareness

The author discusses the importance of raising nurses’ awareness about mental health problems and early detection, as well as the need to say and do something when the person experiencing mental illness is in their own home.

There’s much more in our September issue, including:

• An Editorial on the crisis in acute care nursing.
• A Viewpoint on the need for greater awareness of sex chromosome variations.
• An In the News article on COVID-19’s psychological toll on children.

Click here to browse the table of contents and explore the issue on our website.

A note on the cover.

This month’s cover honors the 20th anniversary of the September 11 terrorist attacks. The memorials (from left to right) in New York City; Shanksville, Pennsylvania; and Arlington, Virginia, stand in tribute to the 2,977 lives lost that day. Among the victims were 11 nurses—read about them in this tribute from AJN‘s September 2002 issue.

The post AJN September Issue: Ischemic Stroke, A New Approach to Fall Prevention, More appeared first on Off the Charts.

Anything but the normal school year we’d hoped for.

The 2021-2022 school year is upon us and it is anything but the normal year many of us had hoped for. For some kids, it will be the first time going back into the classroom after 18 months at home. As a mom of two kids under 12 who cannot yet be vaccinated, it is a time of anxiety as I send my kids into school with a more contagious COVID-19 variant. Despite the mitigation efforts put in place, I wonder if it will be enough.

In parts of the country, cases are still skyrocketing and hundreds of kids have already had to quarantine or switch to remote learning. Some states have layers of mitigation in place in their schools, while in others, governors are fighting to keep schools from instituting mask mandates. And through this all, the person at the front line is the school nurse.

School nurses on the front lines as the rules keep changing.

In our August issue, AJN Reports highlights how school nursing has changed amid the current pandemic. Adding to the many other challenging tasks that school nurses already have is

• having to interpret guidelines from the CDC; educate students, staff, and families on disease prevention;
• set up in-school systems to screen, test, and isolate potentially infectious students;
• and assist public health departments investigating disease outbreaks in the school community.

Stretching thin resources to the breaking point.

In many schools, resources for the school nurse were already scarce.

“The workload is tremendous, it was tremendous prior to COVID,” says Robin Cogan, MEd, RN, NCSN, a school nurse in New Jersey’s Camden City School District and an AJN editorial board member. “There have been school nurses that have resigned, there have been school nurses that are taking early retirement, there are school nurses who will not be coming back next year.”

The report discusses staffing issues, contact tracing, mental health concerns for students, and more. It remains to be seen how this current year will play out. From this concerned mother, I’m hoping for a safe successful year and thank the school nurses for doing their part in keeping our kids safe and healthy.

The post School Nurses During COVID-19: Still Holding the Line appeared first on Off the Charts.

Photo by Kelly Sikkema on Unsplash

Life with food allergies (FAs), as with any chronic condition, adds layers of complexity to decisions. As nurses with experience caring for children with FA in our families or in our practices, we understand that choosing COVID vaccination can be a tough decision for some, but are heartened by the overall safety and effectiveness of the vaccines to date.

Rapid access to information (and misinformation) on social media can complicate the vaccine decision-making process. The United States Surgeon General recently called on health care professionals, including nurses, to “take the time to understand each patient’s knowledge, beliefs, and values. Listen with empathy, and when possible, correct misinformation in personalized ways.” As nurses caring for patients who are among the estimated 30 million people with food allergies in the US, you can help patients to make an informed and timely decision.

Concerning data about COVID in children and young adults.

About half of the US population is fully vaccinated, though statistics vary by age group, leaving those who cannot receive a vaccine at great risk. Infection with the Delta variant suggests increased transmissibility and more infections in the unvaccinated, including children and young adults.

To underscore the ongoing need for vaccination (and other public health measures), the CDC recently shared concerning data about hospitalizations and severe disease in adolescents, and the American Academy of Pediatrics highlighted a growing proportion of COVID-19 cases among children. While most children do not experience severe illness, the long-term impact of the disease is unknown.

Scientists and medical experts continue to scrutinize reported complications, examine emerging data, and translate that information for health care providers and the public. For example, guidance has been updated for one vaccine after review of some hematologic complications in women ages 18 to 49. Similarly, after a CDC Advisory Committee on Immunization Practices, the FDA added a new warning to vaccination fact sheets explaining an increased risk for myocarditis and pericarditis after a scientific review.

Despite the rare heart complication in young adults, and a warning of a rare but potential link between one of the vaccines and Guillain-Barre syndrome, the CDC reassures the public that the vaccine remains safe and effective for most people and the benefits continue to outweigh the risks.

Alarming headlines about potential complications grab our attention, send us on an emotional roller-coaster, and threaten to undermine our confidence. For individuals and families with a history of FA, the feeling is a familiar one. Making the decision to be vaccinated involves the usual thought process followed when allergies must be taken into account:

Being protected from COVID infection is critical, but how will the vaccine affect the person with FA? What are the ingredients? Does a history of allergic reactions increase the risk? What precautions should be taken?

All of these questions must be considered, and decisions based on accurate information.

Guidance about the vaccine for individuals with food allergies.

Nothing in life is without risk, but current evidence provides a measure of comfort that the vaccines are not only effective but safe for those with FA. Except in very specific circumstances, the COVID vaccine can be safely administered. According to the CDC Vaccine Adverse Event Reporting System (VAERS), the risk of anaphylaxis in the general population from the COVID vaccines ranges from two to five cases per million vaccinated.

While the incidence of confirmed anaphylaxis to mRNA vaccines in one study was greater than that reported by the CDC, the overall risk of anaphylaxis to Pfizer-BioNTech COVID-19 and Moderna vaccines remains extremely low. A follow-up report of second mRNA vaccine dose safety in individuals who were deemed to have an allergic reaction to the first vaccination provides early evidence that they can be safely administered.

Careful study of the vaccines continues, including an ongoing vaccine clinical trial following healthy children under age 12 for vaccine safety. Studies are also underway through NIH/NIAID for people with a history of allergic reaction or mast cell disease and are available at multiple locations throughout the US*.

The American College of Allergy, Asthma, and Immunology detailed key guidance recommending screening for any previous reaction to vaccines, with referral to a board-certified allergist/immunologist to assess risk. COVID-19 vaccines in use in the US to date do not contain antibiotics, metals, animal protein from eggs, or other vaccine components that may cause allergic reactions. People with polyethylene glycol (PEG) allergies should not receive an mRNA COVID vaccine and should consult with their provider, and those allergic to polysorbate should also discuss their concerns. In fact, we strongly encourage anyone with questions to consult their health care provider for the best advice for their situation.

CDC recommendations for vaccination centers for managing potential anaphylaxis include a longer precautionary observation period of 30 minutes, since most such reactions have occurred within 15 minutes, and immediate access to emergency medications and appropriate emergency care capability. Anyone who experiences an allergic reaction after the first injection should seek advice from their allergist before receiving the second dose.

In addition, the CDC provides helpful information about contraindications and other precautions for COVID-19 vaccination, and offers a consultation for health care professionals and health departments for “complex COVID-19 vaccine safety questions” via their Clinical Immunization Safety Assessment Project.

Nurses play a crucial role in educating patients and families.

For most of us, getting vaccinated has been both a blessing and an act of courage. For those with FA, considering personal circumstances, critically analyzing the available data, and seeking out guidance and information from reliable sources such as trusted health care professionals, nationally recognized organizations, and trustworthy experts is essential.

The science on vaccine safety continues to evolve—that’s the nature of scientific investigation. Nurses play an important role in dispelling myths and educating patients and families, including those with food allergies, about COVID-19 vaccine safety and the evolving science.

Authors: 

Josie Howard-Ruben, PhD, APRN-CNS, AOCN, assistant professor, Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL

Julianne Doucette DNP, APRN, CPNP-PC, program director and assistant professor in the Primary Care Pediatric Nurse Practitioner program, Rush University College of Nursing

Olga Kagan, PhD, RN, nurse consultant, adjunct faculty at City University of New York School of Professional Studies and Molloy College.

Susan Kelly, BSN, RN, MPH candidate, Hofstra University; food allergy support group leader

Alena Bolten, BSN, RN, allergy and asthma nurse in private practice for 5 years, Allied Physicians Group, and nurse practitioner student, Molloy College.

All of the authors of this article are members of the Food Allergy Nursing Interest Group.

Additional sources and resources:

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine. JAMA Insights.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, MMWR, December 21, 2020–January 10, 2021.

Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose. JAMA Internal Medicine; research letter.

ACAAI Updates to Guidance on Risk of Allergic Reactions to COVID-19 Vaccines

More detail on the vaccine ingredients is available in a statement from the World Allergy Organization Anaphylaxis Committee.

Allergic reactions can be reported to Vaccine Adverse Event Reporting System (VAERS) in the United States, World Allergy Organization global surveillance for anaphylaxis reactions to COVID-19 vaccines portal, and directly to Pfizer, Moderna and J&J vaccine manufacturers.

*The COVID Vaccine Allergy Study will investigate immune reactions to the mRNA COVID vaccines in people with and without allergies and is looking for participants.

The post Food Allergies and COVID-19 Vaccine Facts appeared first on Off the Charts.

Monitoring GRV is one way to assess gastric emptying in patients with tube feeding intolerance. Here aspirate is drawn from the stomach through the port via a small-bore feeding tube.

At some point in their education, nurses might have read a book or article by Norma Metheny, PhD, RN, FAAN, long considered an expert on fluid and electrolytes and tube feedings. She’s been researching tube feeding placement and assessment throughout her career—her current article in our August issue, “Monitoring Adult Patients for Intolerance to Gastric Tube Feedings,” marks her 12th publication in AJN.

Monitoring GRV.

Nurses have long been taught to check, before administering tube feedings, whether there are any residual contents remaining from the prior feeding. Monitoring gastric residual volume (GRV) was a key indicator to determine gastric emptying and thereby reduce the chance of regurgitation or vomiting and aspiration pneumonia.

Intolerance to feeding, as Metheny notes in her article, can be as high as 36% in critical care patients and approximately 27% among hospitalized patients on general units.

Which guidelines to follow?

But the proliferation of recent guidelines from various professional bodies is contradictory—no less than six groups have guidelines, some of which conflict in certain areas. One of these areas of disagreement between guidelines is about whether GRV should be used.

In this article, Metheny lays out the evidence and the controversy, and importantly, provides context based on her years of research so nurses can evaluate if and when GRV monitoring should be used.

She also covers many other topics related to enteral feeding, and includes special considerations for monitoring tube feedings in adults with COVID-19.

The article is free to read (and worth 2.0 hours of continuing professional education), and well worth it for all nurses who administer—or teach others to administer—tube feedings.

(You can listen to Dr. Metheny discuss the article and her recommendations in a podcast conversation I had with her.)

The post Monitoring for Intolerance to Gastric Tube Feedings appeared first on Off the Charts.

Photo by Elina Krima/Pexels

The self-doubt began when I applied for nursing school. I’d think, “What makes you think you should have this sort of responsibility?” or “I can’t possibly do this— everyone says nursing school is so hard.” I’d been accepted into two different programs, but this only heightened my suspicion that there had been some mistake. I worried that once I was in school people would realize that I didn’t belong there.

These beliefs were hard to shake. I thought I was the only one with such doubts, but it turns out that I’m not alone and this phenomenon has a name. Imposter syndrome (IS) is the feeling of being a fraud. It often affects women and minorities, and it tends to occur at times of career transitions and in high-achieving individuals. Nurses can be particularly affected.

What is it?

In 1978, Pauline Rose Clance and Suzanne Imes published their study on what they called the imposter phenomenon. Now commonly called imposter syndrome, it is described as having deep feelings of unworthiness and doubt of one’s capabilities, coupled with the fear of being “found out” or exposed as a fraud. It’s accompanied by an inability to acknowledge one’s accomplishments.

People with IS are often afraid to speak about these feelings, as the fear of being exposed as a fraud can run deep. Such individuals tend to lean toward perfectionism as a compensation for their self-doubt. This can lead to overwork and unrealistically high expectations on tasks and assignments—or, conversely, it can lead to procrastination due to anxiety and fear.

People with IS also rarely ask for help and feel shame if they are exposed as falling short in any way. Imposter syndrome is not considered a mental illness and there is no official diagnosis for it, though research confirms that IS is very real and that many people struggle with it.

Who gets imposter syndrome?

Anyone can suffer from IS, and it can come and go at different times of life, but it tends to occur or become more intense around times of transition. Research suggests that it affects women and minorities more frequently, but any trait that sets a person apart from the majority of their peers can add to the feeling of being an imposter. Those traits can be gender, race, sexual orientation, gender identity, and others.

It is particularly prevalent among women due to cultural and societal expectations of their behavior in the workplace. Men may experience successes as a validation of their skills and intelligence, but as women make career advancements and gain skills and competency, some may feel it is due to luck or having “conned” those in authority.

What makes an individual susceptible?

Research has pointed to various causes. One premise put forth by Clance and Imes is that being raised by parents who have high expectations can set the stage. The child who is expected to be superior in all things starts to suffer when they realize they cannot do it all and are afraid to convey this and get the help they need. This mindset can carry into adulthood. Or conversely, the parents designate a sibling or another relative to be the “smart one,” leaving the child to feel they need to work harder for recognition.

Authors Tulshyan and Burey look at IS as a product of societal and historical contexts that manifest themselves in subtle ways. Sexism, racism and other forms of ingrained and unconscious bias can set the stage. They warn against the tendency of much published material on IS to point the finger at the people suffering from it and frame it as a personal problem. Instead, they highlight toxic work environments, such as those with overt or subtle bullying, that can exacerbate or cause IS, and suggest we focus on making systemic changes.

Are nurses more likely to have IS?

Some research has shown that IS may be more common among nurses and student nurses. Nursing school is a pressured situation with high-stakes goals. The profession has a steep learning curve, one that can feel particularly daunting because it often involves life and death situations. Once new nurses realize how much on-the-job learning will be needed to supplement what they learned in school, IS may set in. It may also contribute to the exhaustion, frustration, and lack of energy that characterize burnout in nursing.

In 1982, Patricia Benner laid out her framework for nurses’ paths from novice to expert. It takes many years to achieve expert status, but often people begin their nursing careers with high internal expectations, which can lead to a sense of failure. Even when a nurse has achieved a level of expertise, the feelings of being a fraud can remain.

Nurses at any stage of transition in their careers can fall prey: student nurse to employed novice, staff nurse to clinical leader, charge nurse to manager, career nurse to educator. Career changes always come with a period of adjustment and feelings of doubt, anxiety, and unease.

What can be a person do about IS?

Reaching out may be very difficult, as shame—the feeling that there is something wrong with oneself—is such a large component of IS. Learning that many people suffer with the same thoughts and doubts and gaining an understanding of where these feelings come from may empower people to make changes.

Talking with others is the first step. Seeing a therapist or engaging in group therapy will help dispel distorted internal views. Identifying compassionate peers and mentors in school or the workplace and cautiously opening up to them can be a way to gain feedback and perspective.

The person with IS could also keep lists of positive feedback to help dispel the negative self-talk. They could also share their knowledge and skills through tutoring, mentoring, or training to demonstrate to themselves as well as others their own capabilities.

Changing underlying systems that feed IS.

Researchers Tulshyen and Burey focus on the systems that create environments in which IS can flourish. They suggest women and minorities need to understand that the lack of supportive workplaces as well as cultural expectations are major factors that are not a product of their own failings.

They also point out that another’s displays of “confidence” do not automatically indicate competence. Blatant displays of confidence are often overcompensating for the person’s own fears, a product of arrogance, or just plain bullying. Look for more subtle and supportive forms of leadership in your organization and reach out to those individuals. Focus on people who work toward the improvement of all the members of the group.

Self-doubt, uncomfortable feelings, and anxiety at times of transition, both in the workplace and in school, are normal. Compounding factors such as societal expectations around achievement and achievement’s connection with a sense of self-worth, bias in the workplace and school, and poor messaging from important figures in childhood all add to the likelihood of IS. But there are many ways to counteract its effects and begin to feel more comfortable and engaged in life.

Eileen J Glover, RN, has been a psychiatric nurse for 12 years. She finds fulfillment in helping patients improve their lives from within. Eileen lives in southern Vermont. Eileen can be reached at eileenjglover1965@gmail.com.

The post Understanding Imposter Syndrome Among Nurses appeared first on Off the Charts.

“I entered this new chapter in my life running at full speed. But at nearly the same time, the world seemed to be coming to a full stop.”

That’s from the August Reflections essay in AJN: “2020: What a Time to Become a Nurse.” Alicia Sgroi finished nursing school and started as an RN in a Florida ICU in February 2020, just as the pandemic was starting to get a foothold in the United States. By June, her unit had been converted to a COVID-positive step-down unit.

Much has been written about the pressures and trauma of being a nurse during the pandemic. We know that it’s been tough for all nurses, sometimes overwhelmingly so. In fact, the original research article in the August issue of AJN is a study that looks at personal and institutional factors affecting levels of well-being and resilience among nurses during the pandemic, from staffing to support networks to personal resilience.

Rising to the occasion.

As a new nurse, Sgroi was understandably worried about catching the virus and also about having the skills to care for such patients. But as she tells it, far from discouraging her from continuing as a nurse, the experience taught her confidence and made her into a nurse.

As she observes, not being prepared when she walked into a patient’s room simply wasn’t an option. The bar was set high from the beginning, both in the necessary attention to myriad details and on so many other levels.

But something in her came into focus as she rose to the challenge. She writes:

“I know the compassion and preparedness I’ve learned in this short period will stay with me throughout my career as a nurse. Being able to practice what I love while making a difference in the lives of my patients gives me an overall feeling of content and assures me that I am exactly where I am supposed to be. In fact, these are all reasons why I became a nurse in the first place. So, to the people who say to me, ‘What a time to become a nurse’—I couldn’t agree more. What a time to become a nurse indeed!”

None of this is to downplay the horrors and miseries of the past year and a half, or the ongoing struggles of weary nurses now facing yet another surge of mostly unvaccinated patients in certain areas of the country. But there’s something in this new nurse’s story that goes beyond nursing to the universal question of vocation and what we are really capable of doing under pressure, when we feel an urgent call. The article will be free to read for the month of August.

The post A New Nurse Learns Focus and Grace Under Pressure appeared first on Off the Charts.

An overview from our editor-in-chief of what you can find on AJN’s home page.

As many of you might know, the American Journal of Nursing (AJN) has been providing nurses with information since 1900, when AJN first appeared in nurses’ mailboxes. Now, when people want information, they’re more likely to head online and search for information.

Print subscriptions at many publications have declined, supplanted by the demand for online content, and most journals, AJN included, have been part of this trend. Many journals now have interactive sites hosting not only the monthly or weekly journal issue content, but supplemental digital content that includes videos (for practical, “how to” information, you can’t beat videos to show step-by-step procedures), webinars, and podcasts (and of course, links to blogs and other social media channels).

So for those of you who may not have visited us in a while (or, who knows, maybe never!), here’s a summary of what you can access on AJN’s website, AJN Online.

On the home page, you’ll find the journal’s featured articles for the month. Most of these, including the CE article or articles of the month, are usually free to read.

Under the Articles & Issues tab at the top left of the home page, you can find the archives, including every issue published since the first issue in October 1900. (We often reprint articles from our archives to illustrate how far nursing has evolved—or hasn’t evolved, in some cases—since those early days.)

Under the Collections tab, you can browse multiple topical groupings of content from clinical articles to “how to” articles and series on writing for scholarly publications, conducting research, and implementing evidence-based practice.

Under the Multimedia tab, you’ll find webinars, videos and podcasts.

Videos include video abstracts by authors of research articles, a multiyear initiative in collaboration with AARP that produced videos to support family caregivers, as well as other video series on caring for older adults. Podcasts include monthly highlights, Behind the Article podcasts (interviews with authors), Conversations (interviews with key figures on important topics in nursing and health care), and Reflections (readings of our monthly narrative writing column, Reflections). There are also interviews with nurses giving firsthand accounts of experiences in disasters, or stories and poems by nurses who served in Vietnam.

At the journal home page, you can also access, via the For Authors and Journal Info tabs at the top, author guidelines and information about the journal (policies, staff, editorial board, contact information, faculty information, and awards programs).

And here on AJN’s award-winning blog AJN Off the Charts you can scroll down to see what your colleagues are reading and what’s new (subscribe via the field in the right sidebar to receive new posts in your email inbox). Other social media options are our Twitter feed, @AmJNurs, which has over 55,000 followers and our Facebook account, @AJNfans.

So yes, we’ve diversified our content portfolio—and we are much more than “just” a journal. Feel free to let us know if there’s anything you’d like to see more of, whether in terms of content topics or modes of online presentation.

The post AJN – More Than ‘Just’ a Print Journal appeared first on Off the Charts.

by Casey Horner/via Unsplash

My hairdresser made a comment that I hear from a lot of people who are not in health care.

“I don’t know how you do a full 12-hour shift when it’s life-and-death work. I mean, I have long days working too, but cutting and styling hair isn’t life and death. I just can’t understand how you do it.”

I smiled and shrugged, as I usually do.

“Thanks for recognizing that. I don’t know. We get used to it, and we have a certain flow at work, even when it gets crazy. Plus it cuts down on the number of days I have to commute to work since I get so many hours in in one day.”

I had so much more to say, but that wasn’t the place for it. This is.

It’s true that at our core, we nurses are just wired to do this kind of work and we can push through it beyond a standard eight-hour work day. It also works well for consistency in ICU patient care to only have one changeover of the patient’s nurse from one 12-hour day shift to the incoming 12-hour night shift. We have generally found ways to ride the waves of an especially high census mixed with especially sick patients, typically followed by at least a brief respite before the next wave.

All that having been said, I wrote a lot during pre-pandemic days about how hard the work was, and now it is curious and sobering to me to look back and feel that nursing was so much easier just two or three years ago.

Nursing at a tipping point.

At this current point in time, however, nursing and its role in our wild pandemic-stricken world seems to be reaching a tipping point that we’ve never quite found ourselves in before. A profession that was already facing a shortage is seeing a new exodus that appears to be only just beginning as nurses burnt-out from the pandemic are leaving the bedside all over the country.

Those of us who remain at the bedside are physically, emotionally, and mentally spent. We are deeply concerned about compromise in the quality of care we can provide when we as a profession are running on short (and shortening) staff and fumes. We are deeply concerned about our own well-being and longevity. We wrestle with a new kind of moral distress because of the barriers and politicization impeding progress in recovery from this COVID pandemic.

The immediate obvious solution would be to recruit more nurses to fill the gaps, but health care organizations and nursing schools have long known that this is much easier said than done. Now, as the work has become so much more difficult, with still more new waves of COVID patients, cracks in the system leading to larger fissures, and PTSD from the collective experience of it all, we teeter precariously at this tipping point and look with some trepidation at the cliff we hope to avoid toppling over.

What nurses need right now.

I would venture to say that what nurses need at this point includes at least the following:

• Concrete recognition of the work we do, beyond words of empathy or appreciation and beyond token gifts like pins and tote bags, which don’t actually make our work or lives more manageable (hello, extraordinary cost of living in Los Angeles). To put it bluntly, we want better compensation to recognize and reflect the highly specialized, intensely stressful, and irreplaceable work we do at the bedside.
• Management and administration on all levels showing us—again not only in word but in action and policy—that they truly respect our voices when we express what we need in order to do our work safely and sanely.
• Respect from the general public when we voice our expertise (and our despair) about health and preventable illness—particularly around COVID exposure risk and vaccine safety and effectiveness.
• Ultimately, a revamping of the health care system through the proactive move of governmental authorities to address deficiencies in the system highlighted by the pandemic.

What concerns me the most for myself and my colleagues nationwide is that our hope for the above feels shaky at best, but the need for it has never felt more urgent.

What nurses everywhere are saying and feeling.

This is not intended to be a criticism of my personal workplace, but rather a lament for what I see and hear from nurses everywhere. Additionally, this is not meant to be a doomsday post, but rather a plea and call to action from those who have power to change the above:

Administrators, policy makers, and you, the general public.

Please. We are so weary but we want to keep our heart for this profession. We want to keep our heart for you and your loved ones when you land in our hospitals. But we are hurting and we cannot continue this way. It simply is not sustainable, and the reasons it feels unsustainable go far beyond the fact that we do life-and-death work for 12-hour shifts at a time.

Please. Listen to us. Do your part.

(An earlier version of this post was originally published on the author’s blog, The Heart of Nursing.)

The post A Plea for Help in Making Nursing Sustainable appeared first on Off the Charts.

“If there is any group that needs a day at the beach, it’s nurses.”—editor-in-chief Shawn Kennedy in her August editorial, “Nursing Is No Day at the Beach”

The August issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study

The authors of this study surveyed health care staff (58% nurses) in June and July 2020 to identify modifiable environmental factors in the workplace that affect well-being and resilience.

CE: Monitoring Adult Patients for Intolerance to Gastric Tube Feedings

An overview of recent guidelines and best practices for the care of enterally fed adults.

AJN Reports: School Nursing During a Pandemic

How COVID-19 introduced new challenges for school nurses—and what may lie ahead this fall.

Question of Practice: Secondary Medication Administration and IV Smart Pump Setup

This article discusses the technical requirements that every nurse should know when administering secondary medications using an IV smart pump.

Ethical Issues: Care and Ethics: Inseparable and Relational

The author presents a real case in which, unbeknownst to the patient, a planned appendectomy led to removal of more than his appendix—demonstrating the ubiquity of ethical issues in patient care.

There’s much more in our August issue, including:

• A Viewpoint article on changing the narrative of African-American race as a nonmodifiable risk factor.
• A Nursing Research, Step by Step column on selecting and implementing outcome measurements in clinical research.
• A Reflections essay on being a new nurse at the start of the COVID-19 pandemic.

Click here to browse the table of contents and explore the issue on our website.

A note on the cover.

The summer sunset on this month’s cover, photographed at Lake Michigan, produces a much-needed feeling of serenity in light of the past year. Nurse wellness is addressed in several articles in this issue.

The post AJN August Issue: Studying Nurses’ Well-Being and Resilience During the Pandemic, Much More appeared first on Off the Charts.

“Negativity and angst dissolved. Silence seeped into our spines, relaxing our amplified neural conversations and untying cranky muscles. We were just two insignificant human specks surrounded by a massive, glacier-carved swamp; its deep bowl filled with the layering detritus of millennia…”

Illustration by Janet Hamlin for AJN. All rights reserved.

The above quote is from the July Reflections essay in AJN. We’ve been running this column for decades, each month a one-page personal essay by a different outside author, many but not all of them nurses.

The author of “Of Swamps and Pandemics” in July (free until August 20) is Pamela Sturtevant, a nurse in Massachusetts. She writes deeply and well about a simple thing: taking a walk with a companion in an ancient and fabled swamp during the height of the COVID-19 pandemic.

Taking refuge in ‘deep time.’

While the most frightening surges of the coronavirus may be in the past, and the initially bewildering and all-powerful virus has been tamed by vaccines and precautions if not vanquished, our world hardly feels more stable than it did a year ago. Smoke from wildfires 3,000 miles to the west recently tinted a sickly yellow the air of states in the Northeast. Everything is connected. Political instability fomented by demagogues and misinformation seems here to fill the vacuum left by old certainties like the orderly progression of the year’s seasons and weather.

And so this essay resonates far beyond its moment. It’s about leaving behind the usual human time scale of action and reaction, assertion and response, the cycles of appetites and emotion and habit that shape our days. And it’s about entering a different kind of time scale that has proceeded by centuries and perhaps millennia—and finding it both eerie and comforting at the same time.

Walking and listening as ancient healing activities.

But most of all it’s about walking and listening. The simplest and most grounding (and ancient) of human behaviors, ones we rarely make time for.

What’s listened for? What’s heard? What’s imagined? What settles and what rises to the surface? That depends on the listener. But we hope you’ll take a moment to read this imaginative and thoughtful essay as a brief respite in your week. As the author writes:

 “[W]e dreaded returning to the pandemic, with all its caustic complexities….In the Hockomock we could breathe. Just breathe.”

You can also listen to a podcast reading of this and other AJN Reflections essays at the following web page (we’re adding our growing library of podcasts to Spotify in the near future as well, for easier listening and access).

The post Finding Perspective In an Ancient and Fabled Landscape appeared first on Off the Charts.

As a retired RN who was certified in medical-surgical nursing, I remember the goals of the hourly rounding policy. Our patients were reassured to find out that staff would check on them every hour at a minimum for any needs they might have, and families could rest easy knowing their loved ones would not be ignored. Hourly rounding also helped prevent a patient from falling through the cracks on a busy shift—always my biggest fear, and one that would keep me up at night.

Obstacles to hourly rounding in acute care.

I also remember the challenges to this policy. Because in hospitals we are dealing with humans and not machines, unlike in factories, there are countless variables to sabotage our best efforts. Everyone has heard the line from the Robert Burns poem, “The best-laid plans of mice and men often go awry.”

The patient variables are unique to each primary nurse and her patient care technician (PCT) who have a plan to alternate rounding on those in their care: the patient who codes, the hemorrhaging post-op patient, the incontinent patient, and the cancer patient with intractable pain. The list is endless—situations that keep the primary nurse or PCT tied up in a room during their turn to do hourly rounds.

Some hospitals may have instituted tracking systems that can show proof of a caregiver’s entrance into a patient’s room. While these may be helpful, legally, to prove the caregiver’s presence, tracking systems may be perceived as punitive—and how do they help caregivers in the scenarios above? Timed hourly rounding alerts on a nurse’s cell phone may be helpful, unless both caregivers are simultaneously in challenging patient situations. Communication breakdowns do happen.

One nurse’s modest proposal.

I am quite sure that the methodology of hourly rounds will continue to inspire new ideas, but an idea I had while working has been stubbornly popping into my mind ever since I retired. It’s not a solution to the challenges of proactive hourly rounds. I’d call it more of a backup safety net for the patient.

The idea is to create a visual that would alert staff that a patient has not been seen for 60 minutes. Imagine that next to the red cancel call button on the wall above the patient’s bed there is a purple button with a 60-minute timer and a silent audible purple light above the patient’s door, next to the red call light.

Oh no, you’re thinking—not another call light! Another setup for failure!

But bear with me. While the patient’s nurse and PCT often return to the same rooms multiple times in a shift, there is always another room with the “stable” patient who never rings his bell and is about to code, or a dying cancer patient on a morphine drip who cannot ring her bell. When the primary nurse and PCT are both involved with patients whose imminent needs take priority, it’s easy to lose track of time.

A visual alert as safety net?

But here is the safety net: whenever a caregiver—be it a nurse, a PCT, a physical therapist, or social worker—fulfilled a function in the room, they would ask the patient if they had any other needs, and then restart the timer by pushing the purple button above the bed before they left. A purple light above the doorframe (which goes on after 60 minutes) would be a visual that alerted all available staff walking by the room that someone needed to go in—whether it be the staff nurse, the nurse manager, or ancillary medical personnel.

With this visual alert and team effort, my guess is that purple lights would be few. Besides preserving a patient’s trust, it would contribute to every nurse’s peace of mind by keeping patients from falling through the cracks on a busy day.

Of course there would be abuses of the system, as there are with any system. And if the timer were placed above a patient’s bed, restarting it in the doorway wouldn’t be an option. We wouldn’t want to disturb a sleeping patient, but walking to the head of the bed would ensure that we had assessed that they were truly sleeping and not in distress.

I have always felt that nurses are by nature conscientious and would welcome any help to ensure the safety of those in their care. Keeping patients from falling through the cracks is more necessary than ever in this time of high patient acuity, staffing challenges, and mental strain on the primary nurse.

What’s your take?

Whether this idea seems workable to you or not, I’d love to hear your thoughts and ideas about how best to address the challenge of hourly rounding.

Mary Ann Hoyt is a retired medical-surgical nurse. 

The post A Proposal to Ensure Patients Don’t Fall Through the Cracks appeared first on Off the Charts.

AJN recently learned it had won several publishing awards, both for its social media and journal content. We are grateful to all the writers, artists, (and editors!) who help us keep up with the times. The articles (and AJN cover) noted below are all worth revisiting, and not just because they serve as a window on a time of particular urgency, improvisation, and courage.

APEX Awards

This blog won a 2021 APEX Awards Grand Prize in Social Media for the following three blog posts published during the height of the COVID pandemic in 2020.

“Deserted: Note from a Young ICU Nurse as COVID-19 Pandemic Intensifies in U.S.”

“A Message from Frontline Nurses: Let’s Keep the Real Enemy in Sight”

“Practicing the ABCDEs of Self-Care in Pandemic Times”

AJN also won an APEX Award of Excellence in the writing/news writing category.

“AJN Reports: The Politicization of COVID-19”

Clarion Awards (Association for Women in Communications)

Entry Category: Magazine Feature Article, External Publication – Circulation of 100,000 or less – Current News

Winner: “AJN Reports: The Politicization of COVID-19”

Entry Category: Special Design/Creation

Winner: AJN’s June 2020 cover (see accompanying image; click to enlarge). For more info about the image, read “On the Cover” from the same issue.

Entry Category: Best Overall Social Media Content – Business

Winner: the American Journal of Nursing’s blog, Facebook, and Twitter. Please consider joining the many thousands who already follow us on social media; you can subscribe to this blog in the upper-right corner of this page.

The post Some Recent APEX and Clarion Award Winning AJN Content appeared first on Off the Charts.