“We have studied elder mistreatment for decades. . . We wait for it to happen and then find those to blame. What if we started from a position of prevention?”—Guest editorial, “Elder Mistreatment Prevention Rounds in Nursing Homes”

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

CE: An Evidence-Based Yoga Practice for Hospitalized Adults on Medical–Psychiatric Units

This article—winner of the 2021 Nurse Faculty Scholars/AJN Mentored Writing Award—describes a project in which nurses used structured yoga sessions for patients with psychiatric illness to provide stress relief, promote relaxation, reduce anxiety, and improve quality of care.

AJN Reports: Long COVID: What We Know Now

An overview of this emerging health issue—and what’s being done to study and address it.

Evaluating the Impact of Smartphones on Nursing Workflow: Lessons Learned

The authors compared nursing perceptions, satisfaction, task efficiency, and interruptions before and after introducing the use of hospital-issued smartphones in a pediatric ICU and a satellite ED.

Strip Savvy: A Case of an Asymptomatic Woman After a Fracture Repair

This latest article in a series on the basics of ECG interpretation presents a case scenario and an ECG strip and takes readers step by step through analyzing the heart rhythm.

Viewpoint: Modifying Outdated Blood Donation Restrictions on Men Who Have Sex with Men

The authors call for the end of discriminatory practices that are no longer supported by science.

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

• An Update from the CDC on telehealth expansion.
• A Supporting Family Caregivers: No Longer Home Alone article on promoting safe mobility for older adults.
• A Nurse Innovators column on how a nurse–engineer partnership addressed the issue of critical patient line dislodgment.

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

A note on the cover.

This month’s cover photo shows Rich Patterson donating blood for the 100th time at ImpactLife in Cedar Rapids, Iowa—a milestone 40 years in the making. The United States is currently experiencing a severe blood shortage. According to the American Red Cross, the COVID-19 pandemic has led to fewer blood donations and blood drive events.

The post July Issue: Yoga for Patients with Psychiatric Illness, What We Know About Long COVID, More appeared first on Off the Charts.

Shutterstock

While weighing the decision to become an NP, I thought about the time and money it would take to get into and through the program. I was very interested in the subject of psychiatry and thought it was a good fit for my personality and skill set. I found a program that worked for my schedule and budget and was able to complete the program. I’ve now been in practice for two years. What I didn’t have to worry about when I weighed the pros and cons of becoming an NP was where I would do my practicum or clinical rotations. That’s because the school I attended arranged those for me. However, many NP students are not as fortunate.

The growing difficulty of finding a placement.

Like many colleagues, I have been contacted by students on multiple occasions who are trying to arrange their own clinical placement. There are also numerous posts on message boards and social media from students pleading for someone to take them on at their clinical site. Students have reported having to sit out multiple semesters or not being able to graduate because their schools have left them with the responsibility of securing these arrangements on their own. Others report driving several hours to attend sites far from home or even moving temporarily to get to a practicum site.

One would expect that, when paying thousands of dollars in tuition, the school collecting this money would include the responsibility of finding a clinical site as part of the service they provide. However, some students have reported paying hundreds or thousands of dollars either directly to the clinical site or to an agency that locates sites for students.

This month’s AJN Reports examines this issue and discusses how stakeholders are trying to resolve it. Are you a student or former student with a similar experience? Or do you work at a clinical site or school and have ideas on how this should be approached? Please comment below.

The post Becoming an NP: The Growing Issue of Finding Clinical Placements appeared first on Off the Charts.

This month’s Reflections essay is by Britni Busfiield, who is an RN on the progressive care neuro/trauma unit at Portsmouth Regional Hospital, Portsmouth, New Hampshire. In this one-page essay, she writes about an experience during her last year of nursing school in which she observed a cerebral angiogram conducted on a patient with a suspected aneurysm.

While very little happens in the essay in any dramatic sense, we felt that we should publish it because it touched on a range of experience that is easily forgotten by those who work in health care, and by everyone else as well.

Wonder: easy to forget, difficult to convey.

The best word for this type of experience might be wonder—when technology illuminates the hidden structures of a complex and often mysterious organ like the brain; when a medical team works with seamless coordination as the patient whose fate may rest in the balance lies shrouded at their center and the physician speaks to her as he threads a catheter into her brain. She writes:

The screen lit up. Bright white fluid leaked slowly into the intricate map of vessels across the display. The dye flooded in like a drop of paint in water, dancing its way through each vein in lazy pirouettes. I felt my mouth hang open beneath my mask. The image before me was foreign yet familiar. An elaborate system of roots, a tree wrapping deep into the earth.

How to be clear about what’s mysterious?

These everyday events in health care serve a purpose and shouldn’t be seen through an aestheticized haze, but that’s not what Busfield does here. The writing is lucid but evocative. Life—the self, science, health care, technology, the human brain, pattern itself and the way it repeats throughout nature—really is a mystery, we may feel as we read. It may seem like the simplest of points, but it’s so easy to forget, and so hard to share with others in writing.

(“Second Nature” is free to read until July 15. Please also note that AJN is looking for submissions for the Reflections column. You don’t have to be a published writer…to learn more, read “Seeking Good Nurses With a Story to Tell.“)

The post What Happened to Wonder? A Nurse Looks Back appeared first on Off the Charts.

Chair exercise class at the Louis and Anne Green Memory and Wellness Center at Florida Atlantic University, Boca Raton. Photo courtesy of the Louis and Anne Green Memory and Wellness Center.

Dementia has long been a diagnosis dreaded by patients and families, as there is no cure. Despite decades of effort, scientists have had little success in developing effective treatments or methods to prevent or slow down the characteristic brain deterioration.

Nearly 6 million people in the United States, including about 14% of the population ages 71 years and older, are afflicted. Dementias, including Alzheimer disease, are among the most common causes of disability and dependency in older adults and projections of the actual number of Americans with dementia—as much as 13.8 million by 2060—suggest rapid growth as the population ages.

Some progress, however, has been made in understanding symptoms and progression of dementias. Recent studies have also shed light on potentially modifiable risk factors, identified new methods of diagnosis, and explored ways to slow disease progression and improve patients’ quality of life. Among these emerging insights are the possible influence of air pollution as a causal factor and the importance of social relationships in mitigating symptoms and reducing mortality.

Mitigation.

Researchers at the University of Adelaide in Australia compared dementia mortality rates in people over age 60 from more than 180 countries with each country’s data on household size, gross domestic product, urbanization, and aging. They found a strong positive correlation between large household size and reduced dementia mortality, independent of the other three factors. Lead investigator Wenpeng You told Neuroscience News, “[Our findings show] that human factors—relationships, a sense of connection and purpose, encouragement and praise, meaningful engagement with others—are all quite important in combating the progress of dementia.”

Causal factors.

In investigating possible environmental influences, several new studies indict air pollution as contributing to both higher incidence and greater severity of dementia. In a comparison of air pollution data with Medicare data from more than 24 million urban and nonurban U.S. residents, researchers from the Rollins School of Public Health at Emory University in Atlanta found that long-term exposure to both particulate matter and nitrogen dioxide was associated with increased incidence of dementia and Alzheimer disease. A separate 2022 study linked improvements in air quality to slower cognitive declines in older women, strengthening the case for continued pollution regulatory efforts.

Diagnostic testing.

Diagnosis of Alzheimer disease has long relied on expensive brain imaging scans or studies of cerebrospinal fluid combined with observational tests of cognitive function. Today, blood tests may be able to pinpoint people at higher risk for developing dementia, allowing for earlier intervention. In the Harvard Aging Brain Study, higher blood levels of a fragment of tau protein were associated with an increased risk of cognitive decline and Alzheimer disease. In the AHEAD trial (www.aheadstudy.org), coordinated by Brigham and Women’s Hospital in Boston, researchers at 75 centers across North America are looking at whether the PrecivityAD blood test for the amyloid-β biomarker can identify individuals at high risk for future cognitive changes.

Drug therapy.

Several experimental drugs are in the pipeline for approval by the Food and Drug Administration (FDA), but it’s too soon to celebrate success on the treatment front. In June 2021, the FDA fast-tracked approval of aducanumab (Aduhelm), a $28,000/year drug for IV administration. As the first new drug for Alzheimer disease since 2003, it generated tremendous excitement despite caution from experts about inadequate evidence of efficacy as well as serious side effects, including brain bleeds. Clinical trials only measured reduction of amyloid-β plaque in the brain as a surrogate end point; they did not document actual clinical benefit.

The FDA’s own Peripheral and Central Nervous System Drugs Advisory Committee opposed approval, calling for additional testing. Critics also noted inadequate representation of people from historically excluded racial and ethnic groups. For example, only 0.6% of clinical trial participants identified as Black, even though older Black adults experience Alzheimer disease at rates up to double those of older White adults.

In response to the criticism, the Centers for Medicare and Medicaid Services decided to pay for aducanumab treatment only for patients enrolled in clinical trials. Among the drug’s adverse effects are brain edema and/or hemorrhage (occurring in 40% of trial participants), hypersensitivity reactions, and altered mental status.

Care innovations.

In addition to insights about the value of relationships to slow progression of dementia symptoms, a body of knowledge is emerging on how to interpret the cause of certain patient behaviors. According to Natalie Baker, president of the Gerontological Advanced Practice Nurses Association, “inappropriate behaviors” in people with dementia “are the result of unmet needs.” The person might be hungry, thirsty, constipated, bored, or in pain, and therefore should not simply be labeled as uncooperative or disruptive without consideration of the cause.

Baker offered an array of tasks for cognitively impaired persons to mitigate disruptive behavior such as folding laundry, playing “their” music, dancing, kitchen duties, and gardening. She added that in institutional settings, such individualized care quality requires investment in well-trained RNs, LPNs, and certified nursing assistants and low nurse-to-resident ratios.

Sources: You W, Henneberg M. PLoS One 2022;17(3):e0263309; Shi L, et al. Nat Commun 2021;12(1):6754; Younan D, et al. PLoS Med 2022;19(2):e1003893; Chhatwal JP, et al. Nat Commun 2020;11(1):6024; Manly JJ, Glymour MM. JAMA Neurol 2021;78(11):1305-6.

(Editor’s note: You can find a version of this article and other news stories in our June issue, including articles on maternal morbidity and mortality during COVID-19 and the breast cancer screening debate. And for more on Azheimer’s disease and related dementias, see the June editorial, which provides a personal perspective on these devastating diseases, and On the Cover, which highlights a nurse-led center is a state-designated memory disorder clinic that supports the needs of individuals with Alzheimer disease and other related dementias and their family caregivers.)

The post Progress in Dementia Care as Treatments and Prevention Lag Behind appeared first on Off the Charts.

When I first started my nursing career, I worked on the pediatric inpatient unit. I remember feeling sad and upset when getting report on my patients who had experienced terrible trauma in their young lives. I wondered how they would make it to and through adulthood after having survived abuse, neglect, witnessing violence, or serious illness or injury.

That was over 20 years ago, and now many of these patients are showing up in the health care system carrying their pain and bad memories with them. They may be the adult we meet with a substance or alcohol use issue, chronic pain, or help-rejecting behaviors. They might be the patient whom colleagues have labeled “difficult.” Or they might be chronically late for appointments or fail to show up at all. Frequently, people with a history of trauma can be further traumatized by an interaction with an uncaring health care system and choose to avoid getting the care they need.

Practicing trauma-informed-care (TIC) can help address this problem. In our April CE, “Trauma-Informed Care in Nursing Practice,” authors Elizabeth Dowdell and Patricia Speck point out:

Trauma-informed care “recognizes that effective care requires an understanding of patients’ lived experiences and may improve patient participation, treatment adherence, and health, as well as provider well-being, through the use of strategies that increase hope by pointing patients toward their goals.”

So, while this approach to care can benefit the patient, there is also benefit for the health care worker and health care system. And because we can’t know the full story of the patient upon first seeing them, the practice needs to be applied universally.

Trauma-informed care is founded on the following core principles:

• safety
• trustworthiness and transparency
• peer support
• collaboration and mutual support
• empowerment (voice and choice), and
• cultural and historical sensitivity

Dowdell and Speck give a detailed explanation of the need for TIC and what it entails, and they provide a case study to demonstrate application of its steps. There is also a podcast of an interview with the authors and a table of resources for more information.

I encourage you to read the article and apply trauma-informed care where you work (if you aren’t already).

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

The post Understanding Trauma-Informed Care in Nursing Practice appeared first on Off the Charts.

Photo by Susan Q Yin on Unsplash

I have always done everything I can to avoid hospitalization. Aside from concern about potential surprise bills, it’s a control thing: I’ve simply been afraid of turning over care of my blood glucose levels to anyone else. I’ve had numerous outpatient surgeries and procedures, but for the nearly three decades since I was diagnosed with type 1 diabetes in my mid-20s, I never spent a night in a hospital.

In retrospect, the one time I should have accepted hospital admission was immediately following the shock of the diagnosis, which followed close on several months of unexplained weight loss, increasingly unbearable thirst, blurring vision, and general disorientation. My blood glucose level had been off the charts, plus I needed time to reckon with the loss of freedom for my always more or less healthy and fit body and to begin to learn to balance insulin shots, glucose levels, food intake, physical activity, and much else. But I was in denial (with predictable consequences) for quite some time afterward, and had also turned down the cost of health insurance when entering graduate school.

In the hospital.

In any case, one frigid, iced-over night this early January, I broke one of my cardinal rules (‘only go to the ER if you have a broken bone’) and went to an emergency room in the small upstate New York city where I live. After a long night being monitored in the very active Saturday night ER, I was admitted for observation because of various cardiac and neurological symptoms secondary to a fairly recent case of Covid (that had been quickly followed by a bad concussion).

My fear of turning over control of my blood sugar levels to anyone else had been based for all those years on my observation that most people in the world don’t know the difference between type 1 and type 2 diabetes (I’ve had people tell me many times that I just need to stop eating gluten, or try turmeric, and I’ll be cured…despite the fact that my body lost all its insulin-producing cells decades ago when attacked by its own immune system). To be fair, I probably wouldn’t bother to know the difference either if I didn’t have to deal with it all the time!

I’ve also encountered quite a few health care professionals over the years who don’t know very much about type 1 diabetes, in particular the complexities of managing glucose levels on a 24/7 basis to keep them within a range over the decades that won’t cost me my eyesight, kidneys, and so on, while also avoiding dangerous and exhausting hypo- and hyperglycemic incidents. This too is mostly understandable for clinicians who don’t specialize in such patients and their concerns.

The care I received during my two days and one full night on that busy hospital unit was professional and competent, and I’m grateful to the nurses and physicians who cared for me. However, right from the beginning I found myself on uncertain territory about whether or not I was allowed to treat my own blood glucose levels.

I’d brought along my two different insulin pens (the actions of various types of basal [long-acting] and bolus [rapid-acting] insulin can vary considerably), and I always have a continuous glucose monitor (CGM) sensor disc attached to the back of my arm to provide me (through a small reader or a cell phone app) with constant easy readings and alarms for highs and lows. Initially, the somewhat stern hospitalist and nurse I dealt with insisted that it was against hospital policy to allow me to have my own insulin or to give myself shots to correct overly high levels overnight between the glucose checks and shots administered at meals. In fact, they said, they really should confiscate my insulin pens if they played it by the book.

Besides the fact that they didn’t yet have any reason to trust me to safely care for myself, I could see that there might be potential liability issues involved for the hospital, so I was agreeable and placating about their concerns, and quietly tucked my insulin pens into a nearby drawer. I wanted to be on good terms with the nurses and aides who were monitoring my cardiac vitals and providing care to some much sicker people.

After that encounter, I found that I had to gently renegotiate my freedom to continue to treat my own blood glucose levels with each new nurse who came on shift. It wasn’t life or death, but it was a source of some anxiety: I didn’t want to get anyone in trouble, and yet I didn’t want to lie there all night in ketoacidosis if, for example, my blood glucose rose unexpectedly to 300 after the white pasta served with the ‘diabetic’ meal at dinner.

Each nurse I encountered had a different style and a different approach to the mildly thorny problem of me. My favorite one, who was about my age, took the time to ascertain that I really knew what I was talking about, then simply agreed (without ever saying it aloud) to look the other way as I injected myself as we happily discussed a book her husband had written and her pursuit of a spot on a traveling pickleball team.

A nearly universal quandary for patients with T1 diabetes.

By the time I was discharged after a battery of cardiac tests, I had a pretty good sense of the ways that the limited blood glucose management protocol practiced on the unit I’d been on could have had potentially dangerous effects such as prolonged hyperglycemia or untreated hypoglycemia if followed to the letter, especially over a longer hospitalization.

When I was at home, out of curiosity I joined an online discussion group for people with type 1, and posed a question about others’ experiences in the hospital over the years. The group explicitly forbids reporters from seeking out sources through the discussion, so I can’t quote anyone here. But the range of responses was overwhelming. I heard some pretty scary stories from some: affronts both to patient autonomy and frightening threats to safety resulting from unbending policies. One nurse wrote to say that she had type 1 diabetes and had been hospitalized numerous times during pregnancy and other times. What she said about the average knowledge of other nurses (except those in endocrinology and pediatrics) about glucose management for patients with type 1 diabetes was not encouraging.

The policies about diabetes self-management in the hospital seem to be more enlightened in the UK, and nurses there may therefore be better trained on the nuances of diabetes care. Some patients, chiefly those who use insulin pumps, had better experiences to describe, since some hospital policies allow for their use. But few in the United States felt that policies were clear or consistent, and nearly everyone’s take was that for people with T1 diabetes, the best move is to stay out of the hospital if possible.

Is it possible to do better?

Since then, I’ve done a bit of research into the complex web of guidelines and policies and financial and staffing realities that affect the care that people with diabetes receive in the hospital and whether they are allowed a role in glucose self-management. There are some bright spots, and some very big obstacles remaining. With this in mind, I’m writing an AJN Reports on this topic for our September issue, and am looking for stories, either from patients or nurses, about their own experiences related to this issue. Please contact me soon if you are interested in talking briefly, or know someone who is: jacobmolyneux@wolterskluwer.com.

Or leave your comments here.

The post When a Person with Type 1 Diabetes Goes to the Hospital appeared first on Off the Charts.

In the past, cases of monkeypox only occasionally occurred outside of central and western Africa, where the disease is endemic, and it was virtually always related to travel or to the inappropriate relocation of wild animals. (In the US in 2003, 71 cases of monkeypox in six states were traced to pet prairie dogs that had been imported in the “exotic animals” trade.) What should we make of the outbreaks this year in 23 countries where the disease is rarely seen?

Current cases of monkeypox are occurring in people without a history of travel to endemic areas, and in some cases without obvious contact to known cases. Most of these people have had mild disease, though monkeypox can cause severe disease in young children, pregnant women, and immunosuppressed individuals. While monkeypox usually is not highly transmissible nor deadly, it has never spread to so many countries seemingly simultaneously.

A close relative of smallpox.

Monkeypox is a close relative of smallpox, and the smallpox vaccine also prevents monkeypox infection.  Many experts point to the end of mass smallpox vaccination campaigns as a factor in the emergence of cases at this time. Forty years ago, about 80% of the population was vaccinated against smallpox; today that figure is only about 30%. Monkeypox cases have been on the rise since smallpox was declared to be eradicated in 1980. In one monkeypox-endemic region, cases had increased twentyfold in recent decades. At the same time, international trade and travel have increased, and human encroachment on wildlife habitats has intensified, bringing animals and people into closer contact with each other.

Monkeypox is not as deadly as smallpox. The “clade” or genetic group of the current cases has a mortality rate of less than one percent in the underresourced areas where monkeypox is usually found.  There have been no deaths in the current multi-country outbreaks.

What you need to know.

Characteristic monkeypox lesions/ Source: CDC

Although there are critical questions to be answered about how the current crisis will continue to unfold, we can act on what is known about monkeypox: the course of the disease, its modes of transmission, and infection control measures.

Incubation and prodromal period.

The incubation period for monkeypox is asymptomatic, and can range from 5 to 21 days; it averages 7 to 14 days. Early symptoms include fever, headache, possibly sore throat and a cough, malaise, and lymphadenopathy. The swollen lymph nodes of monkeypox distinguish it from smallpox.

Symptoms.

After the onset of fever, a rash appears. Typically, the first lesions appear all at once on one part of the body, after which new “crops” of lesions appear in different locations. The lesions resemble a varicella rash, and there often are more lesions on the extremities and face than in other areas. As described by the CDC, lesions progress over two or three weeks through four stages before crusting over:

• macular
• popular
• vesicular
• pustular

The lesions are usually painful until crusting, when they may start to itch.

Transmission.

The person with monkeypox is considered infectious from rash onset through the scabbing over of all lesions. Transmission occurs by means of close contact with the lesions or with anything that has touched them (sheets, towels, clothing), or through prolonged face-to-face contact with respiratory secretions. Past outbreaks in Africa provide no evidence that the virus travels easily through the air. In addition, reports of “sexual transmission” may be inaccurate. The virus has not been found in semen. However, close skin-to-skin contact in sexual encounters when lesions are present will transmit the virus.

Treatment.

Smallpox vaccine may prevent monkeypox, or may shorten the course of the disease. At this time it is not available to the general public but in some cases is being used under investigational drug guidelines. Antivirals and vaccinia immune globulin have not yet been shown to be effective against monkeypox.

Infection control.

The CDC recommends standard, contact, and droplet precautions. The patient should be placed in a private room with the door closed (if possible). If transport outside of the room is necessary, provide the patient with a surgical mask and ensure that all lesions are covered. An airborne infection isolation room should be used for procedures that may aerosolize secretions, such an intubation. Staff should wear an N95 respirator, gown, gloves, and eye protection. At this time, isolation precautions should be discontinued only in consultation with the CDC or your local health department.

The post Monkeypox: The Basics for Nurses appeared first on Off the Charts.

“When nurses practice real self-care, they come to a place of self-respect, learn to hear their own voice, and recognize when their expressed needs are ignored. “—Emily Stice Laker in her Viewpoint article, “Nurses Need More Than Self-Care”

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

CE: Guideline-Directed Cardiac Devices for Patients with Heart Failure

The author reviews current device therapies for heart failure and uses a composite case to demonstrate how bedside nurses can help patients understand treatment options, potential complications of implantation, and post-op care.

Special Feature: Assessing EHR Data for Use in Clinical Improvement and Research

This article introduces nurses to the secondary analysis of EHR data, first outlining the steps in data acquisition and then describing a theory-based process for evaluating data quality and cleaning the data.

Nursing Research, Step by Step: Diagnostic Studies: Measures of Accuracy in Nursing Research

This article, one in a series on clinical research by nurses, reviews the use of diagnostic and screening tests and tools in nursing research and clinical practice.

Distrust of Public Health’s Response to the COVID-19 Pandemic

Why so many Americans have pushed back against pandemic mitigation measures—and what nurses can do to help rebuild trust in public health institutions.

Storytelling as a Tool for Nurses and Nursing Students

The authors outline a narrative writing process they developed to help nurses cope with job-related stress.

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

• An In the News article on progress in dementia care.
• An AJN Reports on finding clinical placements for NP students.
• A book review of Paul Spiegelman and Britt Berrett’s Patients Come Second: Leading Change by Changing the Way You Lead.

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

A note on the cover.

On this month’s cover, a participant in the adult day program at the Louis and Anne Green Memory and Wellness Center at Florida Atlantic University (FAU) takes part in an art class. The nurse-led center, part of FAU’s Christine E. Lynn College of Nursing, is a state-designated memory disorder clinic that aims to promote the well-being of people with Alzheimer disease and related dementias and their family caregivers.

The post June Issue: Cardiac Devices for Heart Failure, Using EHR Data for Research and QI, More appeared first on Off the Charts.

Once again, we are sickened by another school shooting and the loss of children and teachers who tried to protect them from being mowed down by an assault weapon in the hands of an 18-year-old boy. This time Uvalde, Texas, is grieving for 19 children and two teachers, and it’s less than two weeks since a shooting in a Buffalo grocery store left 10 dead. Of course, we immediately see the messages from legislators offering their condolences and thoughts and prayers, but no promises to change anything. If not them, then who can?

I remember the awfulness of treating the occasional pediatric gunshot victim when I worked in the ER—usually an unintended target who was caught in crossfire. It was gut-wrenching, the kind of thing that should be a “never-event.” Today, ER nurses, paramedics, and physicians see young gunshot victims far too often. I don’t know how they can do it day after day, trying to comfort parents while dealing with their own trauma.

The leading cause of mortality in children and adolescents.

Firearm deaths are now the leading cause of mortality in children and adolescents (ages 1 to 19 years) in this country, according to a recent analysis by researchers at the University of Michigan reported in the New England Journal of Medicine. How can we continue to do nothing as our children, our families, our neighbors are killed in places where they should be safe: schools, churches, grocery stores, community events?

In 2014, AJN published “Guns and Nurses,” a thoughtful Viewpoint by Mary Narayan on what nurses can do to reduce harms from guns. In 2016, I wrote an editorial after another slew of mass shootings. Sadly, the numbers of the dead and the shootings have only increased. So has frustration with those in Congress who refuse to take action. Their refusal to act on gun safety laws is killing us.

Many people like to hunt; others feel a need to own guns for self-protection. I get that. What I don’t get is readily available assault rifles, high-capacity magazines, the lack of a waiting period and background checks to ensure a gun purchaser is without a mental health or criminal history. Why can’t the ban on assault weapons be reinstated? Or failing that, institute a clear requirements process for those who want to purchase assault weapons, much like drivers of large vehicles must have a commercial license, specialized training, and medical clearance and be over the age of 21. It would seem that the same concern for public safety should extend to the leading cause of death among our children.

Professional and health care organizations unified in call for action.

The American Nurses Association (ANA) calls for supporting bipartisan legislation for universal background checks for gun purchases; the American Medical Association (AMA) declared gun violence a public health hazard in 2016 and has renewed calls for preventive measures since the Uvalde shooting. Other organizations, including the National  Association of Pediatric Nurse Practitioners, the National Association of School Nurses, and the American Academy of Pediatrics (AAP), have issued statements. The AAP’s president asks, “When will we as a nation stand up for all of these children? What, finally, will it take, for our leaders in government to do something meaningful to protect them?”

Exactly.

(Views expressed on the blog are solely those of the authors or persons quoted and may not reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.)

The post What Will It Take? When Will We Act? appeared first on Off the Charts.

On missing nursing conferences during the pandemic.

Almost each year since it began, I would fly to wherever the American Association of Critical-Care Nurses (AACN) was holding its annual National Teaching Institute (NTI). At first, I attended because I was a critical care nurse, working in the emergency shock trauma area of New York City’s Bellevue Hospital, and found the content invaluable. I had also joined the local chapter and knew others going to the meeting. I remember my first NTI in New Orleans—so many sessions, and meeting other nurses from around the country who were doing such amazing work gave me a sense of pride in my profession.

As my career progressed and I moved away from direct patient care into staff development, I would still attend to keep up with new information that I needed to incorporate into educational offerings. When I began working with AJN, first in CE and then as news director, I still attended to keep up to date and to network.

The COVID-19 pandemic interrupted life and conferences—while virtual conferences at least offered content updates, they lacked the opportunity for personal networking that I find so important. This year there was an in-person NTI, but I opted not to attend because of the highly contagious COVID-19 variants in circulation.

But what I did do was what something that has become an AJN-AACN tradition—I interviewed the outgoing president (Beth Wathen) and the incoming president (Amanda Bettencourt), who will take the helm on July 1. We talked about Beth’s year as president during a pandemic and about what she felt was her main focus (advocacy for nurses, including participating in the recent, multi-organization Nursing Staffing Think Tank).

And Amanda outlined her forward-thinking theme—“Starting Now”—to note that we can shape our future and right now there is a great opportunity and sense of urgency for nursing to do that.  Her quote from writer James Sherman summed it up: “You can’t go back and make a brand-new start, but you can start right now and make a brand-new ending.”

Framing our work in broad terms: why keynotes actually matter.

In the early part of my career, I often didn’t attend the keynote sessions at conferences and concentrated on mostly clinical content. But I gradually realized that the messages delivered in keynote sessions were valuable in framing our work in a broader way. They often provided context on issues and concerns that I realized I had but hadn’t really thought about. I sometimes found myself mulling over the presentation long after it was finished. Wathen’s presidential theme, “Rooted in Strength,” was hopeful and much needed during the pandemic. Bettencourt’s theme for her upcoming year, “Starting Now,” is appropriate as the nursing profession grapples with moving forward to address the many challenges exacerbated by the pandemic.

Conferences: a crucial element of professional development.

Last week’s Nurses Month theme focused on professional development. If you haven’t yet experienced a national conference, give yourself a gift and attend one of the many that occur each year. Not only will you update your clinical knowledge and make new contacts (and maybe friends!), but you might also come away thinking differently about what you do, how you do it, and what might be a different career path.

You can listen to the podcast interview with the AACN presidents here:

The post Nursing Conferences: A Vital Part of Professional Development appeared first on Off the Charts.

The Importance of Community Engagement, Volunteering, and Why Nurses Should Get Involved

Many of us became nurses because we wanted to heal and help others, and we believed that there is no greater honor and privilege than aiding another human being.

Nurses can offer so much to communities. People trust us, and we bring a health lens to everything we do. We know that people need safe places to exercise and play, a comfortable place to call home, clean air to breathe and water to drink, grocery stores with healthful food in our neighborhoods, and human connectedness. When we join boards or volunteer with organizations, we make our communities healthier.

During the pandemic, nurses volunteered at vaccine clinics and distributed food to people in need. Nurses served as a voice of reason when community members did not know who to turn to for health advice. Nurses are the backbone of disaster-relief efforts, and we teach our neighbors how to get and stay healthy.

A sense of empowerment and fulfillment.

My experiences serving as a disaster nurse with the Red Cross have been among the most rewarding of my career. I served on the ground after tornadoes struck the South (Dispatches from the Alabama Tornado Zone) and the Midwest and in the days following Hurricane Andrew, September 11th, the 2004 Florida hurricanes and Hurricane Katrina, and the Indonesia tsunami.

Through my volunteer work, I met people in my community and developed leadership skills. I learned how to speak in front of groups, as well as governance and advocacy skills. Volunteering made me more compassionate. It’s good for families, and it strengthens marriages. My husband and children came with me on Santa runs to deliver toys to those affected by home fires throughout the year when we lived in New Jersey. We visited individuals at the local nursing home who had no family and brought them to our home for holidays.

Seeking and finding how to serve.

The great humanitarian Albert Schweitzer said:

“I don’t know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who have sought and found how to serve.”

The Red Cross is struggling once again to meet the demands of our nation’s disasters, especially as COVID has significantly decreased our volunteer ranks. Please consider volunteering with them if you are able.

Self-care comes first.

I realize that many nurses are bruised and battered from the pandemic and are experiencing moral injury. Many of you are caring for children and elders when you aren’t working and can’t take on anything else. A recent study from Health Affairs found that the total supply of registered nurses decreased by more than 100,000 in 2021—an unprecedented drop. Nurses left the workforce due to early retirements, pandemic burnout and frustration, interrupted work patterns from family needs such as childcare and elder care, COVID-19 infection and related staffing shortages, and other disruptions throughout health care delivery organizations.

For those of you who are struggling, take the time for self-care, and do not overcommit. There will be time for volunteering once you are in a better place. It’s okay to dial back and to take care of yourself. We need you to be healthy to effectively care for others.

As we celebrate Nurses Month, I am filled with gratitude for you and your service and I have never been more proud to serve as a nurse.

Susan Hassmiller, PhD, RN, FAAN, has devoted her career to strengthening the nursing profession, improving population health, and advancing health equity. During her 25 years at the Robert Wood Johnson Foundation (RWJF), she served as the senior adviser for nursing and the senior scholar-in-residence/senior adviser to the president at the National Academy of Medicine. She also established and served as the director of the Future of Nursing: Campaign for Action, a nationwide initiative led by AARP, the AARP Foundation, and RWJF, to transform health and nursing. She has served on the Board of Governors of the American Red Cross, is an elected member of NAM, and is a fellow in the American Academy of Nursing, where she holds the Living Legend status.

She is a Hudson/ICF certified executive/leadership coach and founder and principal of Sulu Coaching and Consulting (www.sulucoaching.com) with a practice focused on health care leaders.

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What you didn’t know you needed to know.

AJN’s interim editor-in-chief Christine Moffa likes to say that when you read articles online rather than subscribing to and thumbing through a print issue of a journal like AJN, you risk missing out on all the rich content “you didn’t know that you needed to know.” For this reason, we’ve taken to highlighting some of our columns here—and we thought our Professional Development column was particularly appropriate this week as we celebrate Nurses Month and the American Nurses Association four weekly themes: self-care, recognition, professional development, and community engagement.

Lifelong education to advance careers, improve patient care.

The Future of Nursing: Leading Change, Advancing Health report highlights the importance of lifelong education, not only so nurses can advance their own careers but also as a way to improve patient care. AJN’s Professional Development column focuses on professional and leadership development. It includes a series on leadership coordinated by the American Organization of Nurse Executives, highlighting topics of interest to nurse managers and emerging nurse leaders, and a series on conflict engagement.

Other varied topics include finding joy in the workplace and supporting staff during the COVID-19 pandemic. Upcoming installments include an article on narrative writing as an outlet for stress and burnout and an article on peer reviewing.

To see what our professional development column has to offer, see our regularly updated collection. If you subscribe to AJN, you can access all of the articles in the collections and much more. (For Nurses month, take advantage of discounts in subscription rate.)

Want to get a taste of AJN before subscribing? For Nurses Month, the entire May issue is free to read until the end of the month.

The post Column Spotlight: Professional Development and Leadership   appeared first on Off the Charts.

A challenging few years.

The last few years have been especially challenging for the nursing profession. We fought a virus that wreaked havoc on our patients, families, and on ourselves. We struggled with equity, diversity, and inclusion issues and we had to adjust how we educate nursing students, moving from in-person to hybrid and online models. Faced with inadequate numbers of competent staff, we developed innovative workforce and care models while focusing on fostering resiliency.

Through it all we recognized the need to acquire new knowledge and skills through continuing professional development to keep up with the demands of the evolving health care paradigm.

‘Every day we learned something new.’

Investment in professional development is essential so that we are prepared to care for our patients and ready to help shape and lead the future of health care. Every day during the pandemic we learned something new about caring for patients with COVID-19. Learning new skills, investing in new knowledge and education, challenging ourselves to think differently about situations, and being mindful can all help propel and focus our nursing journey.

The willingness to takes risks and challenge the status quo.

Our profession was built on nurses who were willing to take risks, learn, and challenge the status quo. The future of our profession will be secured if enough of us have the courage to keep moving forward.

This Nurses Month, let’s remember to invest in our own professional development and knowledge acquisition to move our own practice and the profession forward and optimize patient outcomes.

By Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, chief nurse, Health Learning, Research & Practice, Wolters Kluwer

The post Driving the Nursing Profession Forward with Continuous Professional Development appeared first on Off the Charts.

A blog is born.

Five years ago, I attended a blog writing workshop at the National Association of School Nurses (NASN) annual conference. It was led by Margaret Cellucci, the former director of communications for NASN. The hands-on workshop was a primer on blogging and included an assignment that the participants needed to submit a blog post about their conference experience before the end of the event. That is how The Relentless School Nurse blog was born. Five years, 818 blog posts, and almost 400,000 views later, I can say with confidence that school nursing is a vibrant and innovative specialty practice.

Amplifying the voice of school nursing.

My aim has been to amplify the voice of school nursing. At first, I focused on sharing stories from my health office. But soon I wanted to spotlight school nurses from around the country who were doing amazing things but did not have a national platform to share their experiences. As my readership grew, so did my reach and within a short time, I was highlighting school nurses from coast to coast.

To tell our own stories—not to boast but to educate.

Recognition in school nursing, like in most nursing, has been hard-fought, both within our own walls and outside as well. So many school nurses have said to me, “I don’t like to brag or boast about what I do,” when asked if they would contribute a guest blog. When I frame the request as a way to educate people about our role, there is more acceptance and acknowledgment that we do need to tell our own stories. I always explain that if we do not control the narrative, others who are not school nurses will define who we are and what we do.

Covid brought new urgency and visibility.

I have had the honor to speak to groups of school nurses about the importance of sharing their work with a broader audience. Like in most nursing, we do a fantastic job of speaking to each other. Within our own specialties we are adept at inward facing. What we have not been as skilled in is sharing our value beyond our nursing specialties or outward facing. COVID changed that dynamic. With all of the loss, stress, angst, and intolerable working conditions, COVID changed the narrative around the urgency of protecting the nursing workforce.

The definition of who was a frontline nurse in COVID also includes school nurses. We were tasked with protecting our nation’s children as schools reopened with very few protective measures. During the pandemic, school nursing stories from our health offices were often headlines in the national news. Suddenly what had been a hidden health care system was front and center as the battle against Covid moved into the schools.

Be relentless in your practice.

Finding our voices in nursing and in school nursing was never more important than during COVID. There are more than 4 million nurses in our country. It should have not taken a pandemic for the nation to understand the importance and impact of nurses, but here we are. Let’s leverage our numbers, our contributions, and our importance in all aspects of nursing practice. As I remind the readers of my blog:

“Be Relentless in Your Practice, Whatever it is…”

Robin Cogan, MEd, RN, NCSN, FAAN, is a blogger, a school nurse in Camden, New Jersey, and the clinical coordinator for Rutgers-Camden Nursing school nurse MSN Program. She also serves on the board of directors for the National Association of School Nurses as the director for New Jersey.

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Photo by Javardh on Unsplash

Most nurses I know enjoy Nurses Week as an acknowledgment of the very important work we do every day. Nurses’ Week can also be an opportunity to think about our own needs, or to practice “self-care,” a term I find problematic because I worry it has become one of those ideas that nurses get blamed for the absence of, as in, a nurse is stressed on the job because he hasn’t done his “self-care.” However, regardless of how management discusses “self-care,” it’s an important idea: that nurses need breaks, moments to relax, have fun, and nourish our own humanity so that we come to work ready to humanely care for patients.

The problem with doing a hard job, like nursing, is that recovery is hard, too, and when the job itself seems to expect employees to be superhuman, finding the will to really care for ourselves can be difficult. I discovered how truly challenging that can be after being diagnosed with stage 1 breast cancer in September 2017. At the time I was working as a per diem home hospice nurse and I knew instinctively that I could not care well for dying patients when I was worried about dying myself. That is, I felt I owed it to my patients to take a leave of absence, but as a nurse I felt like a failure. Wasn’t I supposed to be invulnerable?

A time to tear and a time to mend.

In my new book, Healing: When a Nurse Becomes a Patient, I write about making the decision to take a leave from work and how hard it was. Nothing in my training supported the idea that taking time off might be the right thing for me to do as a person and a nurse. Ultimately, I found comfort in Bible verses, applying ancient wisdom to my struggle to reconcile the emotional weight of my diagnosis with the demanding work ethic of nursing:

Fear messes with your mind. I’ve known nurses and doctors who worked through their cancer treatment. I don’t know why they were able to do it when I couldn’t. Maybe they were less afraid than I was, or maybe they never acknowledged their fear, or maybe they had to work…I only know that I could not be a cancer patient and a hospice nurse at the same time. Do you know these lines from Ecclesiastes?

There is a time for everything,
a time to be born and a time to die
a time to tear and a time to mend.

A time to tear and a time to mend. It makes sense, but I had never applied that dichotomy to myself: A time to care for others and a time to be cared for? Maybe so. A time to work and a time to heal, for me, I guess. Of course.

As time passed during my cancer treatment, I came to understand that not working as a nurse was absolutely the right decision for me. I was lucky, too, in that my husband and I could afford for me to take time off. And, when it felt right, I returned to work in home hospice, a better nurse because of being a patient, and because I had not pressured myself to be a superhuman cancer patient–nurse.

The point is, the health care system rides nurses hard and we drive ourselves pretty hard, too. During Covid it became clear that people can break under that strain—and a lot of nurses, and other health care workers, did. As I’ve gone around the country giving talks to promote Healing, I’ve often quoted this line from Mona Masood, a psychiatrist who treated doctors struggling during the pandemic: “You don’t have to set yourself on fire to keep other people warm.”

A nurse who is also a person.

Too often as nurses we stand ready with the match, or someone hands us the match. But we don’t have to sacrifice ourselves to do the job well, and we shouldn’t. Burned up nurses are no good to anyone, most of all themselves.

So this Nurses Week, think about yourself as a nurse who is also a person. Think about what might make you happy, and then, if at all possible, do that thing, or some approximation of it. Your patients need you to focus first on yourself.

Theresa Brown, nurse and writer, is a frequent contributor to the New York Times and writes AJN’s What I’m Reading column. Her most recent book is Healing: When a Nurse Becomes a Patient (Algonquin Books, 2022). Visit her website at www.theresabrownrn.com. 

To hear Theresa Brown discuss her new book and how the American health care system lets patients down with AJN editor-in-chief emerita Shawn Kennedy, listen to this podcast:

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The post A Time to Heal: Taking a Break from Nursing After a Cancer Diagnosis appeared first on Off the Charts.

‘Even my hair is tired.’

If you’ve been faced with death, trauma, significant stressors, and losses, you’ve had to be resilient. And boy, did I choose a career with all of the above. I started my nursing career during the AIDS epidemic, and later moved to active duty Air Force nursing, travel nursing, polytrauma, rehab, chronic pain, spinal cord injury, working with the homeless, mental health, and lastly COVID-19. After 27 years of this, even my hair is tired. But I’ve never been so proud to pick this career—it is a calling. As Nurses Month begins, I tear up thinking there aren’t enough words to express my gratitude.

During COVID, understaffing, hourly policy changes, increased workloads and responsibilities, an increase in mental health disorders, the political climate, and anti-science rhetoric only added to the stressors. I had to look hard to find the gold, because every day you could definitely find the rust. I often asked myself, “How can I keep a healthy attitude, a warm heart, continuous focus, and a genuine nurse smile?” The answer for me has been my humor, hounds, and holistic medicine approaches.

Humor as stress relief.

This realization started when I landed in the ED after a period of not taking care of myself after learning my patient died by suicide. Me, an RN, ended up in the ED to be treated for dehydration. And after some embarrassment, I thought, “This is pretty funny.” I had to laugh at myself. I had to make light of it. We can save everyone else, but we can’t always save ourselves.

I had to disclose my diagnosis to my coworkers and boss. We all laughed, out of total fatigue and worry and relief. We held a sharing circle, all of us taking part in some self-deprecating humor: “I ate a gallon of ice cream . . . I went to the gym, but sat in my car.” I liked my colleagues more after our discussion. Self-deprecating humor shows you are humble, reliable, friendly, funny, and trustworthy. In addition, it neutralizes negative information.

After that day, I started using humor more with my coworkers, leaders, and patients. And guess what? It works. So, every day at work, I use humor to make mundane chores or sad news lighter. Humor is a tool that has not only helped me survive nurse days, but to thrive in them.

Hound therapy.

After laughing a lot and working hard at my job, I come home to my hound therapy. I use ecotherapy (forest walking, hiking, being in nature) with my 13-year-old dachshund Lenci, who I adopted during a difficult depression while taking care of soldiers with no legs. Lenci’s demeanor, humor, tail-wags, and unconditional love brought me back to myself.

Even science confirms that dogs make us feel less alone, help our hearts, lower cortisol levels, decrease stress, increase coping skills, and encourage us to move. My wiener Lenci has done all of these things every day after my nursing shift. I promised that when I could, I would rescue another wiener dog, since Lenci had rescued me. I adopted Cali, a four-year-old wiener dog used as a birthing machine at a puppy mill in Fort Lauderdale. I know I have given her a second chance to live her best life. Nurses rescue humans every day—let a fur baby rescue you.

Holistic therapies.

And lastly, a variety of holistic therapies and self-help strategies have kept me resilient. I don’t have time each day to do everything on my list, but I pick one: counseling, positive thinking books, exercise, yoga, self-love with mantras, and meditation. I specifically like guided breathing and mindfulness eating. I encourage others to utilize free apps with some of these practices. One of these practices a day grounds me and brings me back to stillness, peace, and self-love. It reminds me that I am an amazing human, doing amazing things to help others.

So, humor keeps me happy in nursing. My hounds keep me humble and loved after a hard day of caretaking. And holistic medicine keeps me mentally and physically ready for duty. I hope I can influence other nurses to find what makes them resilient and to stay in a profession that is so critically needed. Happy Nurse’s Month my amazing superheroes and sheroes! Keep going! And comment below with what keeps you resilient in your nursing practice.

By Judy Oliverio, RN, BSN, CRRN, CCM. She is a case manager in a VA homeless program, a USAF veteran, and an AATH member.

The post RN Resiliency: Humor, Hounds, and Holistic Medicine appeared first on Off the Charts.

Photo by Dương Nhân from Pexels

A few years ago, I wrote a blog post directed towards friends and family members of nurses, entitled “How to Support the Nurse in Your Life.” While the ideas in that post still hold up today, so much in nursing has changed, the COVID pandemic being the obvious main factor. With nurses in more need of support than ever, I find it important to revisit this idea of helping friends and families supporting the nurses in their lives at this unique point in time.

1. Listen to what the nurse is actually distressed about in the moment, and stay with them there.

In normal, non-pandemic times, nurses already have many people, situations, and issues to tend to in addition to the actual patient. There are so many unique aspects of the nurse role that challenge us, all of them rolled into a tangled ball in the course of a 12-hour shift. If we are distressed about one particular aspect, please stay with us in your focus on the actual issue at hand so we have time and space to unpack it without all the other competing stressors vying for all our attention.

For example, we might be upset one day after dealing with an anxious and belligerent family member who was at the bedside for most of our shift. While the nurse’s friend may be tempted to ask questions about the sad condition and prognosis of the patient, what the nurse is actually most distressed about in this moment is the amount of emotional and social energy she spent on trying to deescalate the behavior of the patient’s family member.

Just listening may be enough sometimes. But helpful questions from the nurse’s friend in this situation might include: “What was it about the patient’s family member that made you so sad, stressed, or uncomfortable? What struggles did you encounter in trying to attend to those dynamics as the nurse, while also doing the other parts of your job? What kind of support did you get from other colleagues, or did you feel alone in trying to manage this?”

We can see through these questions how this friend is providing focused support on this singular issue that the nurse is currently trying to process. We don’t expect our friends and families to fix all our woes, but we greatly appreciate those who can hear and focus on our actual issue at hand after a particularly hard day.

2. Please don’t tell the nurse, “You chose this.”

I have heard countless nurses lament this response from their friends and family.

What this phrase suggests is, “You’re not allowed to complain because you chose a hard profession.” I’ve been a nurse for 11.5 years, and while nursing has always been challenging, what I “chose” to walk into at the start of my career is not what the current conditions are. We’ve grieved over how intensely difficult this profession has become over time. We are lamenting the loss of a dream as we wonder whether or not we can stick with a profession we once loved but now struggle to make sense of.

Yes, I chose to enter a career where I would care for sick people, but at that point in time, it was with the belief that the infrastructure to provide that care safely and meaningfully would hold up. The pandemic threw at us a wildly unpredictable virus threatening our personal safety, stretching our infrastructure beyond its capacity, revealing alarming flaws in our system, and robbing many of us of the ability to provide quality care and attention to our patients and their families because of staffing shortages and/or visitor restrictions. I can’t name one nurse who chose any of that.

True, I make a choice to stay for now. Each time I get up and go to work, no one is putting a gun to my head to make me show up. But it’s overly simplistic to dismiss our pain and struggles by saying, “You chose this. You still have a choice.” Some of us have families to support, monthly mortgages and bills to pay, and other external factors that don’t make it easy to just walk away from an entire profession. Some of us still do love and believe in the work, and want to be able to keep choosing it, even for all its dark sides. But we hurt in ways we’ve never hurt before. We need support, not the blaming spirit that comes from the response of, “You chose this.”

3. Help us regain balance in our lives.

In normal nursing, we already deal with a tremendous amount of stress, suffering, and death. In COVID times, we confronted extremes in all these areas. Many of us are parents who bore dual burdens of nursing in a pandemic and also helping our kids full-time at home with distance learning. Life and its demands on every front became exponentially more intense.

Many of us tend to be type A personalities, which can help make us good nurses. We stay busy and operate in a way that’s familiar to us, taking care of others and deflecting care from ourselves. However, this default mode of operating can also become a dangerously effective mask when what we need is to slow down and deal with some of our personal demons. We need honest, courageous loved ones who will call us out on our imbalance, and nudge us back into spaces of rest and beauty.

4. Community support matters more than ever.

If I may be very honest for a moment, I have had countless conversations with veteran nurses about how much we have all entertained the thought of leaving the profession. I genuinely still love being a nurse, but I’ve wrestled with the question of my longevity in this work more than I ever have before. It is friends and family who have intuitively extended the kind of support outlined here, who have helped keep my head above water when I was otherwise drowning in sorrow, exhaustion, and misgivings about my job.

The post How to Support the Nurse in Your Life, May 2022 appeared first on Off the Charts.

“Put simply, we know burnout exists and we know it’s getting worse. Let’s leave it at that and move forward. Let’s focus on what we know might mitigate burnout…”

That’s from this month’s Viewpoint, “Burnout Research at a Crossroads,” by Tim Cunningham and Sharon Pappas. Some readers may find it a relief to have this stated so baldly: let’s move on to solutions, say the authors. Let’s put research dollars, time, and energy behind the search for clearer information about what works and what doesn’t.

A two-pronged approach.

The authors see a crucial and legitimate place for investigation of what works and what doesn’t in wellness initiatives to support “personal resilience” through self-care (an increasingly nebulous term in itself).

But they caution against shifting the responsibility onto nurses’ shoulders and ignoring real systemic issues.

With this in mind, they call for research that first of all examines systemic factors:

“It’s only commonsensical that burnout and work experience are intimately tied. It’s time to look more closely at staffing, work hours, team nursing, equitable pay, and other work environment factors that may decrease burnout.”

In search of a blueprint grounded in data and nurse experience.

The ultimate goal, the authors write, is to create a “blueprint” to better align workplace systems and types of support offered to nurses with what research, much of it about and by nurses, will be able to tell us.

Too optimistic? Read the one-page essay and let us know your thoughts about current and future nursing research priorities into burnout and its opposite, however we define the latter.

The post Time to Stop Proving Burnout Exists and Start Researching Real Solutions appeared first on Off the Charts.

“This is the third Nurses Day celebrated since the start of the pandemic and nurses’ work has gotten more recognition than ever. But is that recognition enough?”—AJN senior clinical editor Christine Moffa in her editorial, “Honoring Nurses Where They Need It”

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

Original Research: Combating the Opioid Epidemic Through Nurse Use of Multimodal Analgesia: An Integrative Literature Review

This review presents strong evidence on the benefits of multimodal analgesia in reducing opioid use for pain management in the acute care setting.

CE: Chemicals in the Home That Can Exacerbate Asthma

The authors describe how the use of cleaning and disinfectant products may affect asthma and asthma-related symptoms and report the findings of a recent study they conducted that identified how these products could reduce asthma control in older adults.

Effective Holistic Approaches to Reducing Nurse Stress and Burnout During COVID-19

This quality improvement project evaluated the use of serenity lounges—dedicated rooms where nurses can take workday breaks to relax and rejuvenate—and massage chairs on nurses’ anxiety, stress, and burnout.

Assessing Chest Pain

An overview of revised guidelines by a joint committee of the American College of Cardiology and American Heart Association to improve early identification and management of chest pain.

Teaching Elementary School Students to Be Emergency Responders

How school nurses from one Texas school district taught students cardiopulmonary resuscitation and how to recognize and use automatic external defibrillators and provide basic first aid.

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

• A Viewpoint on the need for a new direction in nursing burnout research.
• An In the News article on the travel nurse industry.
• An AJN Reports on overcoming mental health stigma.

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

A note on the cover.

This month’s cover photo—chosen in honor of Nurses Day—shows ICU nurse Elizabeth Carr caring for a patient with COVID-19 at Jefferson Hospital in Jefferson Hills, Pennsylvania, in January. Carr is one of several Jefferson Hospital nurses featured in a photo-essay, “Finding Hope Amid Darkness,” published by the Pittsburgh Tribune-Review.

The post May Issue: Addressing Nurse Burnout, New Chest Pain Assessment Guidelines, More appeared first on Off the Charts.

A code or rapid response announced over the hospital PA system typically leads to a flurry of activity and a swarm of people responding to the patient’s needs. Many steps of the ACLS algorithm happen rapidly and concurrently, and can be difficult to track with accurate timestamps by the person assigned the role of scribe.

Clear and accurate documentation is critical for post-event analysis to demonstrate the team did everything according to standards and determine if things could have gone better. Many facilities use a code sheet kept on or near the crash cart and others use real-time charting in the EHR. Often the details are written on scrap paper and added to a document later. All of these methods are cumbersome and can lead to inaccurate data collection.

Using an app for documentation during code events.

This month’s Cultivating Quality article, “Improving Accuracy in Documenting Cardiopulmonary Arrest Events,” describes the use at one hospital (Beth Israel Deaconess Medical Center in Boston) of a handheld electronic device for code documentation that makes it simpler and more organized to capture this information.

The project took place on four medical–surgical pilot units, where nurses were trained in the use of a documentation app for live cardiopulmonary arrest events. The American Heart Association’s Full Code Pro app is available for free in the iOS app store. The app has buttons for the steps of the ACLS algorithm, such as CPR, shock, epinephrine, and rhythm check, and keeps note of times that each intervention occurs. There is also a metronome to help keep the time of chest compressions.

Improved accuracy in documentation.

The authors found that:

“Data accuracy was significantly greater in the electronic group compared with the paper-based group for recorded rhythm (100% versus 13%, P = 0.01) and end-tidal carbon dioxide (67% versus 0%, P = 0.02). The electronic method significantly outperformed the paper-based method in legibility (100% versus 13%, P < 0.01). Staff reported increased satisfaction with the electronic documentation method.”

The authors conclude that “electronic documentation was superior to paper in overall documentation quality and allowed providers to identify and quickly document the initial rhythm of the event.”

Because this was a small study, the authors recommend that a larger study be performed in the future to further determine the benefits of using this method of documentation.

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

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