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Insights Blog

When you hear your peers tell their own nursing stories, you gain insight into how you may want to handle your professional growth, patient care, self-care, patient advocacy, and more. You may also want to share your own stories by submitting a blog for possible publication.

May 22, 2019

By: Paul E. Coyne, DNP, MBA, MS, RN, APRN, AGPCNP-BC

In April of 2019, I had the privilege of attending the ANA Quality and Innovation Conference where Inspiren, the healthcare technology company I co-founded with fellow nurse, Michael Wang, received the inaugural Innovation Award, powered by BD. Since that time, I have received messages from nurses around the country asking me why I felt the need to innovate on this large of a scale and if I had any advice for nurses wishing to innovate as well.

While we greatly appreciate your support, we want you to know that we did at Inspiren isn’t any different than what nurses do each day. Nurses are inherently innovators by our very nature. More importantly, we currently have a unique opportunity to highlight this aspect of our profession to improve our healthcare system at every level. However, in order to truly seize this opportunity, we must embrace fully that which defines our profession.

The most defining and memorable moments of my life were spent recovering from a stroke in a hospital bed with a nurse by my side. Based on that experience, I decided I wanted to be present to others and help them during their most defining and memorable moments . . .

May 15, 2019

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

Redness, itchy, fluid filled, crusty, fever or no fever. So many rashes, so many decisions. Do I isolate the patient? Is the condition emergent or can the patient safely wait for care? Knowing how fast to act and when to isolate a patient comes as a challenge for many healthcare providers.

In Fast Facts for the Triage Nurse, 2ndEd., Anna Sivo Montejano DNP, RN, PHN, CEN, and I share insights into some medical conditions requiring patient isolation.

CONDITIONS REQUIRING ISOLATION

Many presentations require isolation to prevent exposure of other patients, visitors, and staff. The following discussion is not all encompassing but provides information that may help the triage nurse understand rash progression, determine when to initiate isolation, and guide triage decision-making. For additional information, see www.cdc.gov.

Chickenpox: Occurs in individuals with a recent exposure to someone with chickenpox; patient may or may not present with a rash since patient is contagious 48 hours before rash erupts and remains contagious until lesions crust over; incubation period is 10 to 21 days after exposure to chickenpox (CDC, 2016); rash appears first on the face, back, or abdomen and then spreads; rash starts as small red bumps (pimples) that develop . . .

May 8, 2019

By: Roric P. Hawkins, MBA, BSN, RN

Over the past couple of years, I’ve written a lot about the various parts and pieces that make up safe patient handling (SPH) programs. If you’ve followed my blogs, you sometimes may have gotten lost in some of the information, especially if you are not familiar with how SPH programs work. From patient-lift technology (equipment) to policies and processes, to buy-in and organizational cultures—all of these discussions were aimed at demonstrating how all are related to achieving one fundamental objective: creating an operational system that designates patient-lift technology as the primary means for how professional caregivers are to go about lifting and moving patients. This operations system is designed to take the place of traditional manual patient lift practices and processes. The implementation goal for SPH programs is to transition patient-lift technology from being thought of as an exceptional available option for when manual lifting practices are not probable to an accepted standard of clinical practice where using patient-lift equipment for all lifts is the hospital organization’s norm.

To make SPH programs work, patient-lift technology must be made consistently and continuously available for employees. This is why you will often . . .

May 1, 2019

By: Lynn Sayre Visser MSN, RN, CEN, CPEN

Five patients arrive simultaneously into the emergency department (ED) waiting room. Who will you see first? Who will go straight to an ED bed? Who can wait for care? The rapid triage assessment in the emergency nursing environment is a quick assessment that helps the triage nurse identify those patients requiring immediate care from those who can safely wait.
In Fast Facts for the Triage Nurse, 2nd Ed., Anna Sivo Montejano DNP, RN, PHN, CEN shares insight into performing the rapid triage assessment.

RAPID TRIAGE ASSESSMENT
A rapid triage assessment begins with an across-the-room survey. Visualizing the patient’s appearance as he or she enters the facility is the beginning of the rapid triage assessment. A great deal of information can be gathered by visualizing the patient as he or she steps into the waiting room (WR):

Does the person use a device to assist with ambulation (e.g., cane, walker)?
Does the facial expression or body language indicate pain?
What is the skin tone and color?
Is the gait slow, rapid, absent, or demonstrating signs of weakness?
Is he or she unresponsive or altered?
Is there limited eye contact? Does the person express fear, anxiety, or agitation . . .

By: Fiorella Martin, RN

In the intensive care unit (ICU), patients and families learn coping mechanisms to deal with stressful events and potential changes in their lives; however, the length of stay and complications can lead to ICU delirium.

As an ICU nurse, I have seen and cared for patients with delirium. They gradually manifest behavioral, cognitive, and emotional disturbances. Fortunately we use assessment tools, implement strategies, administer antipsychotic medications, and involve family members in the management of delirium. However, what do we do if the family member is showing those same signs of delirium? How can we treat him or her? Who do we call? How can we prevent it? I started asking these questions in 2018 while taking care of Mrs. S. in the Tampa hospital where I work.

Mrs. S. was a 70 year-old woman admitted with advanced thyroid cancer. She received a poor prognosis at a local hospital in South Miami where she and her family resided. Mrs. S. and her husband drove to Tampa for a second opinion, hoping to find a specialist who would operate and remove a large neck tumor. Unfortunately, despite multiple tests and non-surgical interventions, Mrs. S. became progressively sicker as the tumor . . .

April 17, 2019

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

An unexpected fall from a ladder, a motor vehicle accident, a sudden onset of acute chest pain…these are merely a few of the reasons people find their daily lives disrupted and seeking care in an emergency department (ED). Once in the ED, they are often among many others seeking care. The nurse must then use triage to prioritize patients.

Triage of incoming patients is a complex process that is frequently misunderstood by the layperson. The word triage comes from the French verb “trier” which means “to sort”. In essence, the triage nurse is constantly “sorting” by prioritizing and re-prioritizing the incoming ill or injured patients who require care. The nurse should base his or her decision-making on evidence, not only to ensure patients receive the care they need when they need it, but also because patients often misunderstand the triage process. Explaining that there is a process behind decisions may help ease anxiety.

In Fast Facts for the Triage Nurse: Orientation and Care Guide Second Edition, Deb Jeffries MSN-Ed, RN-BC, CEN, CPEN writes about triage acuity scales used in EDs around the world.

TRIAGE ACUITY: OVERVIEW

Emergency departments (EDs) have historically used triage scales or . . .

April 10, 2019

By: Julie Gardner, BSN, RN, CPN

When I joined the nursing profession, I never imagined sharing my most vulnerable thoughts and emotions as a nurse and a human just a few years into my career, nor how the experiences ahead would change me. I graduated from nursing school in 2015, bright-eyed and 22 years old, ready to take on the known physical and mental fatigue ahead. I wasn’t prepared for how exhausting it is to continually see so much pain, hurt, and suffering. Just a few years later, I now realize how deeply I have been impacted by compassion fatigue.

Figley (1995) said it well: “We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We dream their dreams. Eventually we lose a certain spark of optimism, humor, and hope. We tire. We aren’t sick, but we aren’t quite ourselves.”

I’ll never forget my first day in patient care as a newly licensed nurse. My patient’s mother was loving, kind, and grateful, wanting to . . .

April 3, 2019

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

Three months out of nursing school I was assigned to orient to the triage nurse role in a fast-paced urban emergency department (ED). Patients and their support systems lined the hallways and overflowed out the door of the small waiting room. A large glass window separated me from the incoming patients standing shoulder to shoulder in the cramped hallway. On one hand, I loved that I could see each person as they entered the facility. I could assess from a distance things like breathing and skin color and whether they could walk unassisted or with the use of a medical device. Sometimes I could quickly identify who needed immediate help, while other times the person’s chief complaint was all a mystery until I had the time to talk to him or her.

My triage orientation consisted of a see one, do one, teach one approach. Watch a triage, perform a triage, and soon precept another new nurse to triage! Almost 25 years have passed, and I’m hopeful that this approach is now a thing of the past in triage orientation.

There is something to say about “ignorance is bliss”. Being a new nurse, green as could be . . .

March 27, 2019

By: Catherine Meliniotis, RN

It always begins innocently, doesn’t it? “I’m just venting,” you think to yourself. But the more it goes on, the more infectious and toxic it becomes. One complaint easily snowballs into an avalanche of dissatisfaction. Before you know it, you can be pegged as the negative one that your coworkers try to avoid. Has this become the reality of today’s workplace? Why do we do it? How do we deal with it? Is there anything healthy to become of it?

If you stop and take a moment to observe, you’ll find that complaining has become an integral part of most people’s daily verbal communication. According to author and Clemson University professor, Robin Kowalski, PhD, there are two basic categories of complaints: instrumental and expressive.

Instrumental complaints are goal-oriented, meaning that we verbalize the problem in hopes of bringing about change. For example, you rant to your coworkers about how messy and disorganized the medication room is, because you are really hoping they’ll offer to help tidy it up. You gripe about how hard it is to keep up with the repositioning of an obese total care patient, in the hopes of a coworker . . .

March 22, 2019

By: Roric P. Hawkins MBA, BSN, RN

As we celebrated patient safety week this month, I couldn’t help but ponder whether safe patient handling (SPH) practices created the type of solutions that would put healthcare facilities along a path to considering themselves high reliability organizations (HROs). As I considered the safety science that supports HROs, which are designed to protect healthcare workers, it certainly reaffirmed what I have always known an SPH program to be—a well-developed care delivery improvement system intended to mitigate unsafe patient care practices with the potential of causing harm to caregivers and patients. As an added bonus, our efforts to address employee injuries through safe SPH programs have enabled us to discover opportunities to improve certain health-related outcomes by applying patient-lift technology innovations to common patient care interventions.

Technology to prevent hospital acquired pressure injuries

Through implementing patient-lift technology to protect both employees and patients, we have seen improvements in quality measures such as hospital acquired pressure injuries (HAPIs) when patient-lift equipment is appropriately applied. Though our initial focus was intended to address the epidemic of musculoskeletal injuries among healthcare professionals, the safety science associated with SPH program implementations has forced organizations to analyze and address . . .

March 20, 2019

By: Katrina Tate, RN

As a nurse and new mother, there’s one topic that seems to be at the forefront of many conversations. Immunizations. Are you going to immunize? Are you not fearful of vaccinations? As most nurses can attest to, many friends and family want advice. Should I give my daughter the HPV vaccine? How do you feel about the hepatitis vaccine? The flu vaccine? To those who ask about whether I will choose vaccination, my likely answer is, yes. Yes, I will vaccinate my little one. Yes, I think you should as well.
Whether my role is mother or healthcare provider it’s important to be knowledgeable and stay up to date regarding vaccinations. This will allow me to help my patients make informed decisions based on factual information related to vaccinations. Fredrickson and colleagues have found that social media and large news outlets have unfortunately swayed many opinions on the safety of vaccinations. Sadly, these sources spotlight the rare incident of a child who had negative side effects following a vaccine. Although many times the evidence is unfounded, these stories draw attention. Attention equals higher ratings. Higher ratings, unfortunately, mean this misinformation is disseminated to larger populations of people. Fear . . .

March 13, 2019

By: Margaret Orrell, BSN student

Self-care has become somewhat of a buzzword over the last few years to the point where when I hear someone say “self-care” I get a mental picture of a woman dressed in a perfect outfit, laughing on her way to yoga class and drinking a green smoothie afterwards. But in reality self-care is so much more than that. Self-care looks completely different for each person depending on his or her current circumstances and needs. For some of my friends self-care means setting a time limit on phone conversations with their mother-in-law, or not taking on the extra shift when someone asks them to bail them out for the thousandth time. For others, it means exercising, reading, or even just lying in their bed in silence because they have spent all day caring for people and all they want is some peace and quiet.

Nurses are notoriously horrible at self-care. We expend so much time, energy, and in fact we have made it a career to care for the needs of other people, that we have little left for ourselves. Self-care is important, however, because how are we supposed to be sensitive . . .

March 6, 2019

By: Cynthia Wachtell, PhD, AM, MA, BA

Long before the United States entered World War I in April 1917, a trained American nurse named Ellen N. La Motte volunteered to work in a French field hospital on the Western Front. The extraordinary collection of stories she wrote about her experience there, The Backwash of War, is unlike any work of its time.

Throughout the book, La Motte highlights the senselessness of war and the suffering of those caught up in it. Midway through the volume she writes, “Well, there are many people to write you of the noble side, the heroic side, the exalted side of war. I must write you of what I have seen, the other side, the backwash.”

The book was published in September 1916 and immediately banned in England and France. Two years later, after being hailed as “immortal” and widely praised as America’s greatest war work, it was banned in the United States, and for a century it remained all but lost to obscurity. The time has come to embrace it as a seminal work of war writing and an unparalleled examination of the role of the war nurse.

On the pages of Backwash, La Motte boldly defied wartime conventions and . . .

February 20, 2019

By: Armi Earlam, DNP, MPA, BSN, RN, CWOCN, and Lisa Woods, MSN, RN-BC, CWOCN

Seven Bridges Charles was born in 2008 with serious health issues that required 26 subsequent surgeries and required him to wear a colostomy pouch. News reports stated that he was bullied in school for being an ostomate.

On January 19, 2019, this 10-year-old boy from Kentucky died by suicide. His mother found him dead in his closet. She had just returned from the grocery store; the young man’s father was at church choir practice.

This news rocked the world of the certified ostomy nurses here in the United States. We work tirelessly everyday helping ostomates in different health settings—hospitals, long-term care, skilled nursing facilities, community settings, and ostomates’ homes. We teach our patients and their support persons how to take care of their ostomies: how to apply their appliance, empty their pouches, choose the appropriate ostomy supplies, prevent leakage, treat peristomal skin issues, proper diet and hydration, and many other topics, all intended to help them cope with living with an ostomy. We also actively participate in ostomy support groups to be a resource for the members.

It’s always a challenge to help our patients accept their ostomies. Anxiety is not an unusual response . . .

February 13, 2019

By: Susan Fowler, PhD, RN, CNRN, FAHA; Cara Santos, MS-BC, RN; and Suzanne Ashworth, MSN, APRN, CCRN, CCNS

Patient diaries during and after hospitalization have been used to facilitate coping of both patients and family members. Patient diaries during hospitalization include comments and descriptions about the patient’s experience. Entries can be written by clinicians, patients, or family members/visitors.

We want to share an innovative twist on the use of diaries that we pilot tested in the ICU—a paper chain of messages posted in the patient’s room to provide a visual of the patient’s journey.  The chain, visually displayed in the patient’s room, often prompts the question:  What is this? Creating an opportunity for conversation.

Effectiveness of patient diaries

The use of patient diaries has been studied in the critical care setting. Here are three examples of what has been reported.

Jones, Bäckman, and Griffiths found that the use of diaries, written by hospital staff with the option for family members to contribute, reduced symptoms associated with posttraumatic stress syndrome at 3 months after ICU discharge in families in which the diary was provided compared to families who did not receive the diary.

Ewens, Chapman, Tulloch, and Hendricks studied the use of diaries after hospital discharge by critical care adult survivors. Survivors . . .

February 6, 2019

By: Roric P. Hawkins RN, MBA, BSN

Given the fast pace of nursing work environments, implementing innovative ideas or processes in clinical settings can be challenging. This is especially true if the worker perceives that the new transformation in some way will impede or hinder the “normal” way of completing work efficiently. It’s no secret that people in general are initially resistant to change. President Woodrow Wilson once said, “If you want to make enemies, try to change something.” With this said, it’s important that change agents are thoughtful and diligent in their approach to implementing new practice ideas.

As it relates to health care, particularly direct patient care as delivered in hospital settings, thoughtfulness and diligence are two essential factors to consider when the overall goal is to achieve staff buy-in for any new initiative. Thoughtfulnessas it relates to identifying and applying tools and resources that may already exist in the work environment. Diligence in the sense of ensuring that new change practices or processes are rooted in simplicity because change is perceived as cumbersome or burdensome. This common perception is why most change efforts fail to yield the change agent’s intended outcomes. As for healthcare workers, thoughtfulness and diligence are especially . . .

January 30, 2019

By: Eric Keller, BSN, RN

This time of the year is a busy time in the gym as most Americans find themselves replete with goals for the new year—mostly recycled from last year’s unsuccessful attempts like weight loss. As the days go by, fewer and fewer people find the personal resolve to take the next step, and the gym becomes less crowded. It’s difficult to realize and appreciate any progress in such a short time frame, and bad habits are hard to break. This creates an environment that often cuts a journey of a thousand miles into just a few misplaced steps, leaving the goal in an abyss and in an unreachable and mysterious state…until next year’s haphazard attempt.

Lao Tzu once said, “The journey of a thousand miles begins with one step.” This quote emphasizes the importance of small and humble beginnings towards accomplishing monumental goals. Whether learning to crawl, walk, or run, an individual must first find personal strength and courage to take the first step, regardless of how small and insignificant it is.

Each year people across the globe take time to celebrate a period of rebirth and exploration, setting goals and attempting to change their life . . .

January 23, 2019

By: Joseph L. Greene, MSN, RN-BC, CEN

I am not a religious man, although I have a system of beliefs. I do not always share my feelings at work, but at one point in my career, had allowed myself to develop an emotional callous in order to block out the negative experiences associated with working in an emergency department (ED). This is an occupational hazard, I suppose, but it enabled me to compartmentalize, adjust, and deal. Certainly, I’m not the only person with this malady, though at one point in my career it led to a cynicism that quickly approached burnout. That is, until I had my Miracle. Let me explain.

The ED in which I have worked for 17 years is very busy, and the population in the area continues to grow. The catchment area is many square miles, and at the edges it can be a 45-minute ETA to the hospital. Designated as a Level II Trauma Center, the ED is also Emergency Department Approved for Pediatrics by the Department of Health Services in Los Angeles County, and as such, we see 12,000 children a year. Very often, they come in quite sick. As any emergency nurse will tell you, when a . . .

December 19, 2018

By: Lisa Miller, BSN, RN, CCRN, CVRN

Have you ever wondered about a patient’s quality of life after receiving an organ transplant? We’ve all heard about the success of kidney transplants, but what do you know about lung transplants? Before I started working in the bronchoscopy unit, I didn’t know anything about these patients. I had never met or cared for a patient who had received a lung transplant in my 20 years as an ICU nurse. Based on my experience in the bronchoscopy unit, I’m able to share my perception of these patients’ quality of life after receiving a transplant.

Part of the postoperative care these patients receive, whether it’s a single or double lung transplant, is a bronchoscopy a few days before being discharged. This initial bronchoscopy is for surveillance purposes—to make sure there are no signs of rejection and to clean out any sloughed tissue at the anastomosis site. Patients usually have six to seven bronchoscopies at various times during their first year after transplant to make sure they don’t have any infections or any signs of rejection. I administered the sedation for their bronchoscopies, so I was able to follow these patients throughout their first year . . .

December 12, 2018

By: Eric Keller, BSN, RN

As the clock slowly pushed toward three o’clock, motionless hands grinding the gears that perpetuate the workday stood as a moribund reminder of each still moment. Like the last grains of sand in an hourglass waiting to fall, time stood completely still. Conversations with coworkers and small talk about life filled the void that time left behind. When the call came from the fire department that a full arrest was a few minutes out, everyone was ready.

Everyone took their place and found an intrinsic comfort in the chaos that swarms a code. Everyone but me, that is. I had not been in a code before and just completed my Advanced Cardiac Life Support (ACLS) training. The emotions crawled into every nook and cranny of my thought process, leaving me with doubt, anxiety, and hopelessness. As I aimlessly circled the room, looking for something to do…something impossible to mess up, I found myself lost in the moment. I tried to collect my thoughts and remember everything that I learned in class. That’s when the attending told his residents that nurses have more experience and training in codes.

In fewer than 5 minutes, I went from a confused . . .

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American Nurse Today attempts to select contributors who are knowledgeable in their fields.  However, it does not warrant the expertise of any contributor, nor is it responsible for any statements made by any contributor.  Nurses should not use any procedures, medications, or other courses of diagnosis or treatment discussed or suggested by contributors without evaluating the patient’s conditions and possible contraindications or dangers in use, reviewing any applicable manufacturer’s prescribing or usage information and comparing these with recommendations of other authorities.