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Answers to Your Nursing Career Questions

Hospice and Palliative Care Coping Mechanisms

December 6th, 2010 by – Derek Brocklehurst

What are some coping mechanisms for both the hospice nurse as well as the hospice patient in end-of-life care?

Hospice and palliative care nursing can be very fragile and emotional work environments. If a patient has a debilitating or terminal illness, it can be extremely trying for all parties involved. Remember, your #1 job as the nurse is to safely deliver care to the patient. It is also good to know that taking care of yourself and your emotional needs will in turn help you care for your terminal patient.

Some coping mechanisms for the nurse in such situations would include communicating and voicing emotions with friends, coworkers, or family about your job and hospice care in general (be careful not to bring up any specific patient information as to not break HIPAA regulations.) If a patient passes during your care, memorializing the patient and reflecting on positive aspects of the patient’s life can help to bring some closure to you. Make sure to check out the Hospice and Palliative Nurses Association website for more information.

Coping mechanisms for the patient during times of sorrow and terminal illness would include scheduling visits with family and friends to help the patient reflect on their life. Even though tears might be present, encouraging the patient to open up and reflect on past accomplishments with loved ones will help them through difficult times.

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Posted in On-the-Job Fears, Patient Interaction

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Stopping Violence Against Nurses

December 6th, 2010 by – Marijke Durning

Is physical violence against nurses rising or is it just more noticeable now? Physical assaults against nurses, particularly in front-line situations like emergency rooms have driven some nurses out of the profession, and made others question why they are staying. The thing is, why is it happening and why has it been tolerated for so long?

A study conducted by the Emergency Nurses Association found that every week, between 8 percent and 13 percent of nurses who work in emergency departments are attacked. Not only that, of 3,200 nurses who were surveyed, more than 50 percent reported either physical or verbal abuse within the previous week.

Finally, politicians and administrators are starting to sit up and take notice that their nurses are being victimized. On November 1, 2010, the state of New York passed the Violence Against Nurses law, which makes an attack on a registered nurse (RN) or licensed practical nurse (LPN) a felony, as it is with attacks on emergency responders, police officers, and firefighters.

In a press release issued by the New York State Nurses Association, Tina Gerardi, MS, RN, CAE, Nurses Association CEO says, “Providing for a felony charge against those who assault an RN or LPN at work will encourage employers to take action to address violence that occurs in the workplace and signals to nurses that it’s time to speak up about the violence they experience on the job.”

Do you agree with her belief that “Any deterrent that encourages a potential attacker to think before they assault a nurse on duty is a positive step towards increased safety for everyone”? Will this have an effect?

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Posted in On-the-Job Fears

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Enuresis

December 4th, 2010 by – Sue Barton

  What is enuresis?

Enuresis is the medical term for bedwetting, a common problem of childhood.  In the preschool years, night time wetting is not an abnormality, and the age for achieving night dryness varies considerably.  Significant numbers of children continue to have enuresis into the elementary school years and some into adolescence.  It is rare to find underlying urinary pathology, rather these children tend to be heavy sleepers.  Often there is a family history of bedwetting. 

Traditionally a variety of approaches have been advocated, usually without much success.  These include restricting fluids in the evening, and waking the child at night to go to the bathroom.  Reward systems for dry nights are occasionally helpful, although it is important for families to understand that the child does not have conscious control over the wetting episodes.  Alarm systems that aim to condition the child to wake at the onset of urination are frequently  helpful in children by about age 7-8 years.

If alarm systems are not successful and the wetting is causing distress to the child and family, medications are option.  Imipramine and desmopressin are two commonly used medications for enuresis.

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Operative Patients and Antibiotics

December 3rd, 2010 by – Derek Brocklehurst

Can you give me updates on how antibiotics should be used on operative patients?

Generally, operative patients are a delicate population with a high risk for complications and infections. Before an operation begins and the patient may become unconscious (sedation), you should always double check the patient’s chart and confirm allergies to any medications. It’s also not a bad idea to double check that the informed consent form is signed before the operation.

During the post-operation period, while the patient is staying in the hospital and recovering, it’s a good idea to have broad-spectrum antibiotics on hand. The patient will be susceptible to a whole range of bacteria, including multi-drug resistant staphylococcus aureus (MRSA). The cillin-family (amoxicillin), mycin-family (streptomycin), and cycline-family (tetracycline) antibiotics all work against a broad range of gram-negative and gram-positive bacteria. Some stronger medications handy in combating MRSA would include vancomycin and bactrim.

Before you administer any medication, you must have a provider-approved order for the patient. Remember the 5 rights: right route, right patient, right time, right medication, and right dose. Following these rules will help you avoid harming the patient and avoid liabilities for malpractice or wrongdoing. You should approach your nurse supervisor or provider if you have any questions about patient care.

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Posted in Common Nursing Procedures, On-the-Job Fears

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How HIV & AIDS Changed Nursing

December 2nd, 2010 by – Marijke Durning

Nursing has changed drastically over the past few generations, but not all changes are due to technology and progress.

Nurses who graduated before then 1980s can remember what it was like to give patient care in the pre-HIV/AIDS days. Universal precautions, which are now taken for granted in the United States, were not part of nursing practice before 1981. Patients were placed on isolation if they were known to be or suspected to be infectious, but if there was no reason to suspect, no precautions were taken.

Gloves for nursing care were reserved for isolation patients, intimate care or for cleaning body fluids. To wear gloves to give a backrub or take blood just wasn’t done. It was a waste of resources and considered not necessary.

How things have changed. Now nurses have to consider everyone and anyone as being infectious – not just with HIV, but other blood borne disease as well, such as hepatitis C. By treating everyone as infected, nursing staff decrease their risk of being accidently exposed to contaminated fluid.

While these changes have all been necessary to protect the nurses, how have they affected health care, patients and nurses?

When a patient is approached by a nurse who won’t touch him without gloves, this can be demoralizing, especially if you know you don’t have a contagious disease. While it’s understandable that a nurse will wear gloves if giving a bedpan or starting an intravenous, is it necessary to wear them while helping a patient stand up? To help him put on his hospital gown? The human touch has left nursing – there seems to always be a rubber or latex barrier between the nurse and the patient.

Nurses are more frightened now. We’re afraid of catching diseases from our patients, whether the fear is even realistic. Being pricked by a used needle has gone from concerning to frightening. Patients are assumed to be contagious, so a nurse who may have been exposed to body fluids lives with the fear of infection until tests prove otherwise.

Health care costs increase too. While gloves may seem to be a relatively inexpensive item, we now go through so many boxes now that they have become a large part of supply costs.

Yes, nursing has definitely changed.

December 1 was World AIDS Day – an important day to remember. Millions of people are still becoming infected world wide. The disease has not been beaten, only subdued in some parts of the world.

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Posted in Patient Interaction

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Free Online CEUs

December 2nd, 2010 by – Derek Brocklehurst

Hello. I am interested in CEUs for nursing. Thank you.

Continuing education units, or CEUs for short, are mandated credits that every licensed nurse must complete in order to get a license renewal. Usually, these credits come in the form of lectures, talks, conferences, workshops, or courses you can sign up for. Your employer or state nurses union should have online links or postings in the workplace of ways to obtain the credits needed for license renewal.

Medi-smart offers free online CEUs in this directory. Check out this link for ways to get free CEUs in the convenience of your home, an internet cafe, library, or health care setting. A typical course will take a couple of hours to go through the online workshops and then open a series of prompts or questions. Answer these questions and submit the form at the end to get the CEUs you deserve! Make sure you know when your license needs to be renewed so you give yourself enough time to complete and submit the CEUs.

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Posted in Continuing Education Units

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Clinical Nurse Specialists

December 2nd, 2010 by – Sue Barton

  What are the roles of a clinical nurse specialist? 

According to the NACNS (National Association of Clinical Nurse Specialists), a CNS is a licensed registered nurse who has completed a master’s or doctoral graduate level degree in nursing as a clinical nurse specialist.  The role may be defined by expertise in the nursing care of select patient populations ( such as geriatrics ), or by care setting (critical care, emergency room), as well as by disease or medical subspecialty (diabetes, cardiac care, othopedics).  The CNS role is also defined at times by the type of care or type of problem. 

The clinical nurse specialist role is one of the advanced practice roles open to nurses.  In addition to providing direct patient care, the CNS often functions as a consultant to other nurses, and works to improve the delivery of nursing care in the health care system.  Some clinical nurses specialists are also certified as nurse practitioners.  Salary ranges according to NACNS are from $65,000 to over $110,000 per year, depending on the practice settings and part of the country.

The expertise of clinical nurse specialists helps to reduce medical complications, and thus decreases both length of hospital stays and health care costs. Other outcomes are improved pain mangement and overall patient satisfaction.  The CNS also contributes to professional nursing by research and teaching activites.

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Nurses Don’t Need Confrontations – Discussions Will Do

December 1st, 2010 by – Marijke Durning

It may be a sign of the times, but whenever there are issues that need to be resolved, someone inevitably says that the “perpetrator” needs to be confronted. Have an issue with a fellow nurse not helping you when you asked? Confront her, you may be told. Is there a certified nursing assistant (CNA) who you feel isn’t doing her job properly? Confrontation is needed, someone will say. Have an issue with bad scheduling? Why – you must confront the charge nurse! Or must you?

The definition of confront is to meet face-to-face, generally in a critical or hostile manner. Is that how we deal with our problems now right off the bat? Critically and with hostility? Is this really the best way to get people to work together as a team. No, it’s not.

Discussion is what is needed when you begin to have problems or issues with a colleague or anyone. Let’s say you asked “Jim,” the other LPN on duty with you, to help you perform a nursing procedure. You go into the patient’s room and wait, but Jim doesn’t come – so you finally do it alone. Is confrontation really the answer? Or how about asking him, politely, what happened?

It could be that Jim was side tracked by an emergency or something urgent or it could be that he forgot. Either way, confrontation doesn’t change what happened – but discussing it could help reduce hard feelings, especially if you find out there was a good reason for his absence.

Now, you’re working with “Sherry,” your CNA for the day. You check on your patients and find that Sherry didn’t do a great job; it looks like she rushed through her tasks and now you have trouble finding her. Once you do find her, is confrontation the best route? Once again, no – it’s not.

Obviously, Sherry didn’t do her job properly and as her superior, you do need to speak with her about it. But if you confront her, the chances of her becoming defensive and angry are much higher than if you speak with her calmly. Of course, there is no excuse to not do your job properly, but trying to get along with her calmly and rationally may have a better outcome all around than if you are critical and hostile.

Finally, the last example. “Evelyn” is in charge of putting together the nursing schedule. Every single time you come look at the new schedule, yours is the pits. You have the worst of shifts and rarely get your requests for days off. Of course you have a right to be upset – after all, why should you get a rotten schedule time after time. But confrontation – is that really a good idea? Asking for a meeting with Evelyn to talk about  your schedule may result in a much better outcome than an angry confrontation – and there’s no such thing as a calm confrontation.

Nursing is stressful enough. If we have issues with others, from coworkers to superiors to visitors, we don’t have to automatically go into confrontation mode. A little sugar goes a long way sometimes.

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Posted in On-the-Job Fears

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Dysmenorrhea

November 30th, 2010 by – Sue Barton

  What is the best plan to relieve menstrual cramps? 

Painful menstrual cramping that is not caused by any identifiable pathology such as endometriosis, for example, is referred to as primary dysmenorrhea.  It’s a common problem, although the severity may be quite mild or significant enough to disrupt a woman’s life.  Primary dysmenorrhea typically begins during the adolescent years as ovulation becomes established.  Increased levels of prostaglandins appear to be the cause of the painful cramping.  Some women also experience nausea, vomiting, and diarrhea during the cramping episodes, which are typically at the start of menstruation. 

The most effective medications for cramps are the NSAIDS, which inhibit prostaglandin release.  A good choice is naproxen sodium, which is available without prescription.  Medication should be started at the first sign of menses or even a day or two in advance.  Birth control pills are also very helpful in both regulating menses, and decreasing menstrual discomfort.

For women who are interesting in alternatives to medical treatment, there are a wide range of options, although evidence for effectiveness varies.  Acupuncture, heat application in the form of a heating pad or a warm bath, regular excercise, vitamin B and vitamin E are among the treatments that may have merit.

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Antepartum and Postpartum Care Plans

November 29th, 2010 by – Derek Brocklehurst

What is a good care plan for the antepartum and postpartum patient population?

Maternal and child-bearing health care can be an extremely fragile field of work for nurses and patients alike. Unlike all other fields, maternal health focuses on the life of the mother and her unborn fetus or newborn child. As the nurse, it is important for you to take special care of each individual patient and cater care plans to their needs.

In antepartum or “pre-birth” care, there are a number of things that can arise affecting the health of the mother and the fetus. Some of the potential complications concern location of placental attachment (placenta previa and placenta abruption), electrolyte imbalance and dehydration (hyperemesis gravidarum), infections (UTIs), and vitamin deficiencies (anemia).

In postpartum or “after-birth” care, a whole new set of complications might arise. Be on the lookout for vaginal lacerations (could lead to infections), uterine atony, hemorrhaging signs and symptoms, depression signs and symptoms, thrombophlebitis, and mastitis (affecting breast feeding).

Prepare a care plan focused on the mother’s needs as well as the needs of her child. Remember to collaborate with other health care professionals including physical therapists, dietitians, respiratory therapists, and the primary care provider.

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Posted in Common Nursing Procedures, On-the-Job Fears

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The material on this site is for informational purposes only, and is intended as a supplement, not as a substitute for medical advice, diagnosis, or treatment provided by a qualified health care provider.