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Vol. 4, No. 11 | November 2012
High Acuity & Critical Care Nurses Make Their Optimal Contribution
®
HAI Rates, Staffing, Burnout
Linked
Give the Gift of NTI
Chocolate& Reduced Stroke Risk
Pediatric Pharmacotherapy Symposium
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Telehealth to Treat Brain Injuries
National HAI Awards:Dec.19 Deadline
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Weekend Staffing Affects Mortality
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GO FLEXIBLEGo with digital on one, two or all three member publica-tions (AACN Bold Voices, American Journal of Critical Care and Critical Care Nurse) and print only what you want – when you want it. Get the fl exiblity that only digital editions can offer.
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Sharpen your clinical knowledge and improve your skills with the latest, authoritative references from AACN!
Core Curriculum for Progressive Care Nursing American Association of Critical-Care Nurses
ISBN: 978-1-4160-9987-1
Everything you need for success in progressive care nursing! The most comprehensive and authoritative reference on progressive care nursing, brought to you by the AACN. This complete resource includes all of the basic and advanced information you need to know both in practice andon the PCCN certification exam.
Prepares you to treat patients at every phase of progressive care, whether in step-down, intermediate, or telemetry units
Clear illustrations and quick-reference tables clarify difficult concepts and make it easy to review information quickly
Content most likely to be on the PCCN exam is highlighted to help you study more efficiently
Presents nursing management information in order of clinical priority, and integrates medical management and interventions throughout the text
AACN Procedure Manual for Critical Care, 6th EditionAmerican Association of Critical-Care Nurses; Edited by Debra J. Lynn-McHale Wiegand, RN, MBE, PhD, CCRN, FAAN
ISBN: 978-1-4160-6218-9
The procedure manual trusted by critical care nurses everywhere!The indispensable AACN Procedure Manual presents procedures in an illustrated, step-by-step format making it easy to learn and retain each skill. Each easy-to-understand procedure follows the same consistent pattern, covering everything from prerequisite nursing knowledge, equipment, and assessment through patient monitoring and care, family education, and documentation.
Covers the new procedures you need to know: Emergency Cricothyroidotomy
Identifies the support for care recommendations according to the latest AACN Evidence Leveling System, so you’ll quickly grasp the strength of the evidence base
alphabetical procedures index inside the front cover for easy access Highlights Advanced Practice procedures with a special icon throughout and
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AACN BOLD VOICES NOVEMBER 2012 3
… Hob and I decided to walk to a neighborhood restau-rant for dinner. It was early November and already dark by six o’clock. … Our meals together were quieter now. He sometimes initiated the topic of conversation, usually a well-worn one with which he was comfortable, but now I was the carrier of the conversation. …
“Remember that time …” … “Thanksgiving in Vermont” …
But I stopped. Hob’s head had dropped toward his plate. … “Hobbie, are you okay?” I reached across the table and touched his arm. No response. …
He was motionless, curled over in unconsciousness. I realized that he had passed out. I beckoned the waiter. His face softened with compassion as he listened to my explanation.
“Oh, Ma’am,” he said, putting his hand on my shoulder. “I took care of a man with Alzheimer’s. I know a lot about it. I’ll get him a cold wet cloth for his head. May help bring him back.” And he hurried off. ...
When the waiter returned and gently began administering to Hob himself, [I] said, “I think we need help. Let me take over, and get someone to call 911.” …
Dreamlike and strangely calm, I moved amidst this sudden confusion knowing exactly what I had to do: get into warrior mode. Stay with Hob. Protect him. … I barked orders at those good-hearted souls, the EMTs. I exhorted them to leave him alone. No fibrillation, no ventilators, no exces-sive steps, because, I explained, he didn’t want any of that.
“Lady, we have to follow our protocols.” … the front section opened into the back of the ambulance so I could watch what was happening. I was ready to throw myself over the seat if they started anything invasive. …
“Harrison, can you hear us! Can you hear us!” …
Something about the faint movements in his face suggested that he was straining toward speech. Then I heard him say, “Will you guys keep it down. I’m trying to die here.”
Source: Hoblitzelle, Olivia Ames. The Majesty of Your Loving: A Couple’s Journey Through Alzheimer’s.Cambridge MA: Green Mountain Books; 2008; 172-175.
An
oth
er A
ng
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Dare to Explore PossibilitiesThe first telegram read: SITUATION HOPELESS STOP
NO ONE WEARS SHOES. The second one: GLORIOUS BUSINESS
OPPORTUNITY STOP THEY HAVE
NO SHOES. What do you think happened next?
Read more in my note on page 22.
Kathryn RobertsAACN President
Never turn your back on your own ideas. Make yourself this one little promise: The next time you catch yourself saying, “Hey, that gives me an idea!” follow through on that idea to its logical conclusion.
— Dan Zadra
®
Editorial Office
AACN Communications101 Columbia, Aliso Viejo, CA 92656(800) 394-5995 ext. 512 (949) [email protected]
Editor: Ramón Lavandero; Managing Editor: Marty Trujillo; Clinical Advisor: Julie Miller, RN, BSN, CCRN; Assistant Editor: Judy Wilkin; Writers: Marijke Vroomen Durning, Jim Kerr, Neal Lorenzi, Dennis Nishi, Jason Winston; Art and Production Director: LeRoy Hinton; Design: Brian Burton Design, Inc., Matthew Edens; Web Editor: Paul Taylor; Publishing Manager: Michael Muscat; Communications Director:Richard Howell; Senior Director of Communications and Strategic Alliances: Ramón Lavandero
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AACN BOLD VOICES (print ISSN 1948-7088, online ISSN 1948-7096) is published monthly by the American Association of Critical-Care Nurses (AACN), 101 Columbia, Aliso Viejo, CA 92656. Telephone: (949) 362-2000. Fax: (949) 362-2049. Copyright 2012 by AACN. All rights reserved. AACN BOLD VOICES is an official publication of AACN. No part of this publication or its digital edition may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage retrieval system, without permission of AACN. For all permission requests, please contact Sam Marsella, AACN, 101 Columbia, Aliso Viejo, CA 92656. Telephone: (800) 899-1712. Email: [email protected]. Prices on bulk reprints of articles available on request from AACN at (800) 899-1712. Printed on acid-free paper. AACN BOLD VOICES is indexed in the Cumulative Index to Nursing & Allied Health Literature (CINAHL).
The statements and opinions contained in AACN BOLD VOICES do not necessarily represent the views or policies of the American Association of Critical-Care Nurses, except where explicitly stated. Advertisements in this publication or its digital edition are not a warranty, endorsement, or approval of the products or services by AACN or the editors and content contributors of AACN BOLD VOICES, who disclaim all responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.
Individual subscriptions by request. Institutional subscriptions: $200. Printed in the USA.
AACN Certification Corporation, the credentialing arm of the American Association of Critical-Care Nurses, maintains professional practice excellence through certification and certification renewal of nurses who care for acutely and critically ill patients and their families. AACN Certification Corporation develops and administers the CCRN, PCCN, CCRN-E, CCNS and ACNPC specialty exams in acute, progressive and critical care; CMC and CSC subspecialty exams in cardiac medicine and surgery; and, in partnership with the American Organization of Nurse Executives, the CNML exam for nurse managers and leaders.
Board of Directors
ChairPamela Bolton,RN, MS, CCRN, CCNS, PCCN, ACNPCCritical Care Nurse Practitioner/Clinical SpecialistGood Samaritan Hospital, Cincinnati, Ohio
Chair-electLinda Harrington, RN-BC, PhD, CNS, CPHQ, CENP, CPHIMS, FHIMSSVice President and Regional Chief Nursing Informatics OfficerCatholic Health Initiatives, Englewood, Colo.
Secretary/TreasurerDiane Byrum, RN, MSN, CCRN, CCNS, FCCMClinical Nurse SpecialistPresbyterian Hospital HuntersvilleHuntersville, N.C.
DirectorsSonia Astle, RN, MS, CCRN, CNRN, CCNSClinical Nurse SpecialistInova Fairfax HospitalFalls Church, Va.
Karen S. Kesten, RN, DNP, APRN, CCRN, PCCN, CCNSAssistant Professor and Program DirectorGeorgetown University School of Nursing and Health StudiesWashington, D.C.
Sheryl Leary, RN, PhD(c), CCRN, CCNS, PCCNClinical Nurse SpecialistVA San Diego Healthcare SystemSan Diego, Calif.
Karen McQuillan, RN, MS, CNS-BC, CCRN, CNRN, FAANClinical Nurse SpecialistR Adams Cowley Shock Trauma CenterUniversity of Maryland Medical CenterBaltimore, Md.
Mary Frances Pate, RN, DSN, CNSAssociate ProfessorUniversity of Portland School of NursingPortland, Ore.
Consumer RepresentativeMyra ChristopherKathleen M. Foley Chair for Pain and Palliative CareCenter for Practical BioethicsKansas City, Mo.
The American Association of Critical-Care Nurses is the world’s largest specialty nursing organization. AACN is committed to a healthcare system driven by the needs of patients and families where acute and critical care nurses make their optimal contribution.
Board of DirectorsPresidentKathryn E. Roberts, RN, MSN, CNS, CCRN, CCNSClinical Nurse SpecialistPediatric Intensive Care UnitThe Children’s Hospital of Philadelphia, Pa.
President-electVicki Good, RN, MSN, CENPAdministrative Director of Patient SafetyCoxHealthSpringfield, Mo.
SecretaryMelissa Hutchinson, RN, MN, CCNS, CCRN, CWCNClinical Nurse Specialist, MICU/CCUVA Puget Sound Health Care SystemSeattle, Wash.
TreasurerMary Bylone, RN, MSM, CNMLVice President, Patient Care Services and Chief Nursing OfficerThe William W. Backus HospitalNorwich, Conn.
DirectorsLinda M. Bay, RN, MSN, ACNS-BC, CCRN, PCCNClinical Nurse SpecialistClement J. Zablocki VA Medical Center Milwaukee, Wis.
Sheryl Leary, RN, PhD(c), CCRN, CCNS, PCCNClinical Nurse SpecialistVA San Diego Healthcare SystemSan Diego, Calif.
Karen McQuillan, RN, MS, CNS-BC, CCRN, CNRN, FAANClinical Nurse SpecialistR Adams Cowley Shock Trauma CenterUniversity of Maryland Medical CenterBaltimore, Md.
Riza V. Mauricio, RN, PhD, CCRN, CPNP-ACPediatric ICU Nurse PractitionerThe Children’s Hospital of the University of Texas MD Anderson Cancer CenterHouston, Texas
Kathleen K. Peavy, RN, MS, CCRN, CNS-BC Critical Care Clinical Nurse Specialist Southern Regional Medical Center Riverdale, Ga.
Pamela Popplewell, RN, DNP, ANP-BCDirector of Nursing, SurgeryVA Puget Sound Health Care SystemSeattle, Wash.
Maureen Seckel, RN, MSN, APN, ACNS-BC, CCNS, CCRNClinical Nurse Specialist, Medical Pulmonary Critical CareChristiana Care Health SystemNewark, Del.
Clareen Wiencek, RN, PhD, ACHPN, ACNPNurse Manager/ClinicianThomas Palliative Care Unit Massey Cancer CenterVirginia Commonwealth University Health System Richmond, Va.
Mary Zellinger, RN, MN, ANP, CCRN-CSC, CCNSClinical Nurse Specialist, Cardiovascular Critical CareEmory University Hospital Atlanta, Ga.
Chief Executive OfficerWanda L. Johanson, RN, MN
4 www.aacnboldvoicesonline.org NOVEMBER 2012
AACN BOLD VOICES NOVEMBER 2012 5
AACN
Dec. 19 application deadline for awards co-sponsored with U.S. Department of Health and Human Services and the Critical Care Societies Collaborative.
Applications Invited: National Recognition Awards to Eliminate or Reduce HAIs
For a third year, the U.S. Department of Health and Human Services and the Critical Care Societies Collaborative (CCSC) sponsor a program to recog-nize teams of critical care professionals and healthcare institutions for outstand-ing leadership to eliminate or reduce healthcare-associated infections (HAIs).
Hospitals, units and teams that successfully reduce or eliminate HAIs may apply for the awards, which recog-nize benchmark systems of excellence that reduce targeted HAIs for 25 months or longer, or eliminate them. Awardees also demonstrate national leadership in sharing and disseminat-ing information.
The awards will recognize success in reducing or eliminating CAUTIs — catheter-associated urinary tract infections, CLABSIs — central line-associated bloodstream infections and VAP — ventilator-associated pneu-monia. Awards will be announced in
spring 2013 and presented at the 2013 AACN National Teaching Institute & Critical Care Exposition in Boston.
This national program strives to motivate the healthcare community to reduce or eliminate HAIs on a large scale and encourage nurses, other clinicians and hospital executives to use evidence-based guidelines to improve clinical practice.
At any given time, about one in every 20 patients has an infection related to their hospital care. These infections cost the U.S. healthcare system billions of dollars each year and lead to the loss of tens of thousands of lives. In addition, HAIs can have devastating emotional, financial and healthcare consequences.
CCSC member organizations include AACN, the American College of Chest Physicians, Northbrook, Ill., American Thoracic Society, New York and Society of Critical Care Medicine, Mount Prospect, Ill.
Information to meet the Dec. 19, 2012 application deadline — includ-ing eligibility, selection criteria and the required electronic application form — is available at www.aacn.org/haiawards2013 or email awards @aacn.org with questions.
Give Yourself and Others the Gift of NTINurse managers: Turn this year’s positive budget balance into next year’s investment in your depart-ment. Visit www.aacn.org/nti-giftcert to purchase AACN gift certificates.
Purchase an AACN gift certificate for the American Association of Critical-Care Nurses’ 40th annual National Teaching Institute & Critical Care Exposition (NTI), from May 18-23, 2013, in Boston, and ensure access to essential knowledge and resources that help you and your nurse
colleagues continue your professional development and elevate your careers. As the premier conference for high acuity and critical care nurses, NTI provides you and your
colleagues with an unmatched opportunity to connect with the entire AACN community as you gain new knowledge, refine practice skills and renew your passion.
With AACN gift certificates you can thank colleagues and co-workers for their extraordinary effort. Don’t miss this opportunity to explore one of America’s great cities. Boston — a modern city steeped in American history — provides the perfect backdrop for NTI 2013. At http://events.bostonusa.com/nti start exploring everything this unique colonial area offers.
6 www.aacnboldvoicesonline.org NOVEMBER 2012
AACN
Symposium Explores Complexities of Pediatric Pharmacotherapy
The October-December issue of AACN Advanced Critical Care offers a multi-article advanced symposium to explore the complexities of pediatric pharmacotherapy.
The articles in “Pharmacotherapy in Pediatric Acute and Critical Care” provide valuable information on the unique pharmacological needs of acutely and critically ill newborns and children.
Symposium editors Mary Frances D. Pate and Earnest Alexander remind readers, “Children are not little adults.” They note that pediatric life support and management of
sepsis, pain and anxiety, and nutrition all entail special challenges. The chance for medication error is magnified when working with children, because appropriate size-based dosing is challenging, some medi-cations require dilution — which is an additional opportunity for error — and children lack the skills and knowledge to question treatment the way an adult patient might.
Pate and Alexander also note that, due to
children’s unique characteristics, “an error or adverse event is not necessary for pediatric patients to be affected negatively by medications.”
The four symposium articles:
and Toxicological Emergencies”
Sepsis”
Each article offers CNE credit. The issue’s Drug Update section also offers CNE credit for “Pharmacology of Procedural Sedation.”
AACN members can call 1-800-638-3030 to receive a special $35 subscription. Or visit http://advancedcriticalcare.com.
CCRN, CCNS Certification in Pediatric Critical CareThe pediatric CCRN certification exam requires 1,750 hours of bedside care of acutely and/or critically ill pedi-atric patients within the last two years, with 875 of those hours within the most recent year prior to application.
Most of the current test plan focuses on clinical judgment with the highest emphasis on pulmonary, cardiovascular, neurology and multisystem problems. The remaining 20 percent of the exam tests professional caring and ethical practices, emphasizing caring practices, collaboration and facilitation of learning competencies.
The pediatric CCNS exam is an entry-level advanced prac-tice specialty exam for clinical nurse specialists to provide advanced nursing care for acutely and/or critically ill chil-dren. Most of the current exam focuses on professional caring and ethical practice, which most heavily emphasize facilitation of learning, clinical inquiry and caring prac-tices. The remaining 22 percent tests clinical judgment of acutely and/or critically ill pediatric patient problems.
The APRN Consensus Model — which will reshape advanced practice nursing through changes in education, certification and licensure — will impact the pediatric CNS exam. The new Consensus Model-based ACCNS-P exam will test from wellness through acute care, with 61 percent emphasizing clinical judgment. The remaining 39 percent will test professional caring and ethical practice competen-cies, emphasizing caring practices, systems thinking and clinical inquiry.
Children may be affected negatively by a medication, even without an error.
Our website provides educational information and tools designed to get users up and running quickly on RSS feeds. Subscribe or learn more at www.aacn.org/rss
AACN BOLD VOICES NOVEMBER 2012 7
AT THE BEDSIDE
VA, IU Study Tests Telehealth to Treat Brain Injuries
Military Brain Injury Tool FlopsIn an unrelated study, a highly touted $18 million software tool for studying military traumatic brain injuries (TBIs) failed to deliver the advertised capability of assessing the effects of blast injuries, according to a nextgov.com report.
Current military electronic record systems interface better and serve the same functions as the now-discarded tool, called Traumatic Brain Injury/Behavioral Health, Robert Vanecek, Air Force chief of behavioral health optimiza-tion, tells nextgov.com. “We scratched our heads over the name,” he says.
More than 240,000 troops have received TBI diagnoses from 2000 to 2012. The tool would have assisted in devising readiness assessments that measure the impact of exposure to roadside bombs in Iraq and Afghanistan on the brains of service members.
Happy Veterans Day, Nov. 11AACN and AACN Certification Corporation proudly support the U.S. Department of Veterans Affairs “Let’s Get Certified” campaign with discounts for AACN exams, membership, select review courses, products, books and recognition items. In its fifth year, the campaign seeks to increase the number of VA and U.S. Department of Defense specialty certified nurses, improve nursing recruit-ment and retention, and distinguish the VA as a learning organization. Learn more at www.aacn.org/vacertified5.
T he U.S. Department of Veterans Affairs (VA) will test the use of telehealth in treating veterans with mild traumatic brain injuries in a five-year study at five
veterans hospitals.The study — part of the VA’s increased efforts to imple-
ment telehealth and remote healthcare — is supported by a five-year, $920,000 grant the VA awarded to Indiana University School of Medicine. It will focus on self-manage-ment of brain injuries, which can be compared to chronic, lifelong conditions and, in theory, treated similarly through telehealth.
According to a university news article, the first 18 months of the grant period will be dedicated to interviewing experts in self-management and brain injuries as well as veterans to develop an algorithm to be turned into an assessment tool.
“It may be that the patient will get an iPad in a waiting room and answer five to eight questions, which in turn are informed by an algorithm that includes 200 questions,”
study director Jacob Kean tells FierceHealthIT. “So, in a span of two minutes, they’re measured against a broad
continuum … using an ultra-brief assessment that’s very precise and provides data that informs the clinical interaction.”
Providers would then use the assessment data to assist patients in determining appropriate self-care. The goal is “to understand whether the steps we’re asking our veterans to take are going in the right
direction or the wrong direction,” Kean says.The testing hospitals are Walter Reed National
Military Medical Center, Bethesda, Md.; Richard L. Roudebush VA Medical Center, Indianapolis; Michael
E. DeBakey VA Medical Center, Houston; Brooke Army Medical Center, San Antonio; and Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, Va.
Goal: Develop an electronic TBI assessment tool to guide patients in self-care.
8 www.aacnboldvoicesonline.org NOVEMBER 2012
AT THE BEDSIDE
HHouston, Texas
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Multidrug-Resistant Superbug From India Reported in U.S.
A report from the Centers for Disease Control and Prevention (CDC), Atlanta, warns of a multidrug-resistant superbug from India that infected two patients in a Rhode Island hospital this year.
New Delhi metallo-beta-lactamase (NDM) first appeared in that city in 2007, and 13 cases have now been reported in the United States.
According to “Carbapenem-Resistant EnterobacteriaceaeContaining New Delhi Metallo-Beta-Lactamase in Two Patients – Rhode Island,” the first case this year involved a Rhode Island resident who traveled to her native Cambodia and was hospitalized in Vietnam in late December 2011 with spinal cord compression. She was hospitalized upon her return to Rhode Island a week later, where she was diagnosed with lymphoma and began inpatient chemotherapy. A urine speci-men collected in March 2012 was found to have a Klebsiella pneumoniae isolate containing NDM.
The second patient occupied the same hematology/oncol-ogy unit as the first patient but not the same room.
After extensive “additional cleaning of patient rooms and hallway high-touch surfaces,” the Rhode Island hospi-tal reported no further cases, the CDC reports. “Similarly aggressive infection control efforts can limit the spread of NDM in acute-care medical facilities.”
The CDC recommends “a robust infection control effort … to limit or slow the spread of all Carbapenem-Resistant Enterobacteriaceae (CRE), including NDM, at the local, nation-al and international levels.” Steps that healthcare facilities can take include hand hygiene compliance, contact precau-tions and minimal use of invasive devices and antibiotics. Additionally, written plans on identifying CRE and reporting them can play a role in preventing widespread outbreaks.
Aggressive infection control can limit spread of superbug in acute care facilities.
AACN BOLD VOICES NOVEMBER 2012 9
AT THE BEDSIDE
Brain-eating Amoeba After Using Neti PotsResearchers from the
Centers for Disease Control and Prevention (CDC), Atlanta, say that two adults who died in Louisiana hospitals last year from a brain-eating amoeba contracted the infection after using neti pots with tap water harboring the bacteria, according to “Primary Amebic Meningoencephalitis (PAM) Deaths Associated With Sinus Irrigation Using Contaminated Tap Water,” published online in Clinical Infectious Diseases.
The deaths, the first PAM cases recorded in the U.S., were linked to the presence of Naegleria fowleri in the tap water the patients used to regularly clear their sinuses with neti pots, the study says. Municipal tap water tested negative for the bacteria, but one patient’s tank-less water heater and the other’s sink and faucet tested positive for the bacteria.
As a result, CDC recommends that people who use a similar device for nasal irrigation distill, filter or boil the water before use.
CDC recommends users distill, filter or boil water before using
nasal irrigation devices.
Self-Neglect Among Elderly Predicts Hospice UseThe presence and severity of self-neglect among elderly persons independently predict hospice use and are
not mediated by the presence of health-related factors, according to “Association Between Elder Self-Neglect and Hospice Utilization in a Community Population,” published online in Archives of Gerontology and Geriatrics.
Use of hospice services has important implica-tions for healthcare systems and policy, suggest the researchers, who note that medical expenditure is higher at the end-of-life than at any other time.
These findings also indicate that elderly individuals who neglect themselves and end up in hospice care live less time after hospice admission than their counterparts who enter hospice care without evidence of self-neglect.
“Clinical experience suggests that those who self-neglect often may not recognize or refuse to recognize the dangers of their self-neglectful behaviors and often only encounter the healthcare system after a catastrophic event has occurred,” XinQi Dong, of Rush University Medical Center, Chicago, and Melissa Simon, of Northwestern University Medical Center, Chicago, tell www.news-medical.net.
Dong and Simon observed a 2.63-fold increased risk for hospice care among the self-neglect group compared with the no-neglect group, after adjustment for age, gender and race. Further adjustment for potentially confounding medical conditions such as hypertension weakened the association slightly.
Use of hospice services has important implications for end-of-life health policy.
PAM symptom onset occurs one to seven days after expo-sure. Symptoms are similar to bacterial or viral meningitis — headache, fever, stiff neck, anorexia, vomiting, seizures and coma.
Naegleria fowleri is usually found in warm freshwater such as lakes, but these deaths suggest the bacteria can colo-nize in household plumbing and tap water also. CDC researchers say there has been a shift north in the geographic pattern of where PAM cases are reported, perhaps due to
climate change or local heat waves. “It is unclear whether the
increased temperature and heat waves projected in climate change models will lead to further expan-sion of the [amoeba’s] geographic range,” writes Jonathan Yoder, of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases in Atlanta, and colleagues.
10 www.aacnboldvoicesonline.org NOVEMBER 2012
AT THE BEDSIDE
Alternative Treatment for Arthritis May Harm Liver
Flavocoxid, a prescrip-tion-only blend of plant compounds used to treat arthritis, can cause acute liver injury and should be used with caution, finds a study in Annals of Internal Medicine.
“Acute Liver Injury Due to Flavocoxid (Limbrel), a Medical Food for Osteoarthritis: A Case Series” enrolled 877 patients with suspected drug-induced liver injury and identified four with liver injury due at least partly to flavocoxid. The four were women, ages 57 to 68, taking the supplement daily for arthritis pain and symptoms, states an Annals summary.
“Within 1 to 3 months after starting flavocoxid, the patients developed signs and symptoms of liver injury, including jaundice, abdominal pain, fever, itching and rash, and elevations in serum liver enzyme levels,” the summary says. Symptoms began to resolve within weeks after stopping flavocoxid, with no evidence of chronic liver injury.
A related Los Angeles Times article notes that clinical trials of flavocoxid released in 2009 and 2010 favorably compare the drug’s effectiveness to prescription naproxen. But in an editorial accompanying the Annals study, Stephan Reichenbach and Peter Juni of the Institute of Social and Preventive Medicine, University of Bern in Switzerland, write that while flavocoxid is “an interesting therapeutic alternative to non-steroidal anti-inflammatory drugs,” it and other herbal products used as food supplements or medical food can be associated with liver injury.
They conclude, “Because none of these products was endorsed in the latest American College of Rheumatology recommendations on the treatment of osteoarthritis, we suggest discouraging patients from using any of them.”
Reversible liver injury may offset flavocoxid’s comparable effectiveness to NSAIDs.
Sit More, Live Less?
Reducing sedentary behavior, such as sitting and television viewing, may increase life expectancy by up to two years, according to a recent life table analysis.
Limiting television watching to less than two hours a day added 1.38 years of life, and cutting total sitting time to less than three hours a day increased life expec-tancy by two years, Peter Katzmarzyk, Louisiana State University in Baton Rouge, and I-Min Lee, Brigham and Women’s Hospital in Boston, reported in “Sedentary Behaviour and Life Expectancy in the USA: A Cause-Deleted Life Table Analysis,” published in BMJ Open.
The analysis measured relative risks of all-cause mortality in association with sitting and television view-ing derived from a meta-analysis of studies of that relationship, and from National Health and Nutrition Examination Survey data from a 2009-2010 study on sitting and a 2005-2006 study on television viewing, medpage.com reports.
The cohorts included a combined 166,738 respon-dents followed for an average of 9.28 years and included mortality measures and time spent engaged in sedentary behavior. How time was broken down varied among the studies and included time as a frac-tion of a person’s day or absolute hourly measures, although all studies stratified time by three levels (most, median and least).
Less sitting and less TV may increase life expectancy.
AACN BOLD VOICES NOVEMBER 2012 11
AT THE BEDSIDE
UA/NSTEMI Treatment Guidelines Updated
Updated guidelines for managing patients with unstable angina/non-ST-
elevation myocardial infarction (UA/NSTEMI) suggest considering new drugs such as ticagrelor and prasugrel as treatment options, CardioSource reports.
The 2012 “Focused Update” from the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) continues to recommend that patients with UA/NSTEMI receive aspirin, stating “Aspirin should be administered to UA/NSTEMI patients as soon as possible after hospital presentation and continued indefinitely in patients who tolerate it.” The update also suggests that patients at medium or high risk receive dual antiplatelet medications on admission.
Consideration of prasugrel and ticagrelor, approved by the Food
and Drug Administration in 2011, is recommended as a treatment option in addition to clopidogrel.
“The AHA and ACCF constantly update their guidelines so that physicians can provide patients with the most appropriate, aggres-sive therapy with the goal of improving health and survival,” says lead author Hani Jneid, assis-tant professor of medicine at Baylor College of Medicine, Houston. In the case of this update, “we have put [ticagrelor] on equal footing with the two other antiplatelet medica-tions, clopidogrel and prasugrel.”
Specific recommendations also include:
NSTEMI at medium or high risk should receive dual antiplatelet medications on admission.
intervention, it is reasonable
to use 81 mg per day of aspirin rather than higher maintenance doses.
or NSTEMI, it is reasonable to use an insulin-based regimen to achieve and maintain glucose levels < 180 mg/dL while avoiding hypoglycemia.
-able in patients with mild (stage 2) and moderate (stage 3) chronic kidney disease (CKD). There is insufficient data on the benefits and risks of invasive strategy in patients with UA or NSTEMI with more advanced (stages 4 and 5) CKD.
with cardiac catheterization and possible revasculariza-tion within 12 to 24 hours of admission in initially stabilized high-risk patients with UA or NSTEMI.
genotyping testing for CYP2C19 loss of function allele may be considered in select patients with UA or NSTEMI who are using P2Y12 receptor inhibitors, and when the results of testing may alter management.
Recommendations place ticagrelor on equal footing with clopidogrel and prasugrel.
‘Reproducibility Initiative’ Seeks to Replicate Study Findings
In an effort to validate findings in published papers, a California company has established a “Reproducibility Initiative” to redo experiments and determine if the new results support the claims.
Because studies later proven erroneous can waste both public and private money in investments in drugs that ulti-mately do not work, Science Exchange, Palo Alto, Calif., will match an appropriate lab to the experiment and attempt to replicate it. According to “More Trial, Less Error: An Effort to Improve Scientific Studies,” published by Reuters, one company’s scientists could not reproduce 75 percent of published findings, and another could confirm just six out of 53 cancer studies.
“‘Published’ and ‘true’ are not synonyms,” Brian Nosek, a member of the initiative’s advisory board, tells Reuters, which explains that many scientific studies cut corners to get results signifi-cant enough to be published in top journals. “People start playing with how they handle missing data, outliers, and other statistics,” study critic John Ioannidis of Stanford University tells Reuters.
‘Published’ and ‘true’: not synonyms.
12 www.aacnboldvoicesonline.org NOVEMBER 2012
AT THE BEDSIDE
HHS-CCSC-HAI AwardMultidisciplinary award program for reduced
healthcare-associated infections
Apply by DECEMBER 19www.aacn.org/haiawards2013
Higher HAI Rates, RN Staffing, Burnout Linked
A study in American Journal of Infection Control uncovers a link between nurse burnout and higher healthcare-associated infection (HAI) rates.
The findings in “Nurse Staffing, Burnout, and Health Care-Associated Infection” estimate adding just one extra patient to a nurse’s average workload could lead to one addi-tional HAI per 1,000 patients, which amounts to 1,351 additional infections per year. Nurse burnout, for example, was found to be the only consistent factor associated with catheter-associ-ated urinary tract infections (CAUTIs), one of the most common HAI infec-tions included in the study. CAUTIs can cost a hospital an average of $749 to $832 per patient.
Study authors estimate that a 20 percent reduction in burnout rates could prevent as many as 4,160 infec-tions annually and save Pennsylvania hospitals, for instance, $41 million. They found that hospitals where burnout was reduced by 30 percent had a total of 6,239 fewer infections, for an annual cost savings of up to $68 million.
Jeannie Cimiotti, Linda Aiken and colleagues at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, Philadelphia, studied data on more than 7,000 RNs from 161 Pennsylvania hospitals. Survey data was linked to the Pennsylvania Health Care Cost
Containment Council report on hospital infections and the American Hospital Association Annual Survey. Study authors note nearly 7 million hospitalized patients acquire infections during treatment for other conditions.
Researchers also found one-third of the nurses included in the study
were already showing symptoms of job-related burnout. Responses were analyzed using the Maslach Burnout Inventory-Human Services Survey.
Burnout was the only consistent factor associated with CAUTIs.
AACN BOLD VOICES NOVEMBER 2012 13
AT THE BEDSIDE
Gram Stain Can Be Inconsistent Predictor of VAP
Gram’s staining produces inconsistent predictive value in trying to reach a diagnosis of ventilator-associated pneumonia (VAP), and its usefulness in making rapid therapy decisions is questionable, a recent study finds.
“Is the Gram Stain Useful in the Microbiologic Diagnosis of VAP? A Meta-analysis,” published online in Clinical Infectious Diseases, indicates that while negative Gram’s staining can effectively rule out a VAP diagnosis, a positive does not offer definitive information. “Therefore, a positive Gram stain should not be used to narrow anti-infective therapy until culture results become available,” the study concludes.
The meta-analysis of 24 studies revealed a negative predictive value of 91 percent for VAP prevalence but a posi-tive predictive value of 40 percent, notes a related article in Medscape. Since cultures of respiratory specimens require 48 to 72 hours to confirm a VAP diagnosis, the study cautions against using a positive Gram stain as a guide to therapy.
“Presence of a single type of organism on Gram stain does not allow narrowing of initial therapy,” the study notes. Clinicians should continue to use antibiotics “with a broad spectrum of activity directed against the common pathogens implicated in VAP.”
Because of the strong negative predictive value, “in the absence of a high clinical pre-test probability for VAP, a negative Gram stain in a clinically stable patient with suspicion for infection should prompt a search for alternative sites of presumed infection,” the study adds. A clear-cut VAP diagno-sis requires “the consideration of multiple laboratory, physical examination findings and radiographic features.”
Look for alternative sites if a clinically stable patient suspected of infection has a negative Gram stain.
The Gram staining procedure.
How Accurate Are Google Searches for Health Information?
Searching for health information on Google does not guarantee accuracy, according to “Google It?: Internet Searches Often Provide Inaccurate Information About Infant Sleep Safety,” a study in The Journal of Pediatrics.
Researchers entered 13 key phrases pertaining to infant sleep safety, then analyzed 1,300 websites found through Google search. Fewer than half (43.5 percent) of the sites contained infant sleep safety information that reflects American Academy of Pediatrics (AAP) recommendations, Healthcare IT News reports.
Some of the sites with inaccuracies include the popular eHow.com and About.com, which researchers say typi-cally enlist the expertise of professionals for article topics. These sites contain “frequently inaccurate informa-tion” pertaining to safe infant sleep, according to AAP recommendations.
Retail product-review sites, blogs and personal sites had the highest rates of inaccurate data, the study notes, adding that many of these product-review sites claim certain prod-ucts are AAP-endorsed when, in fact, they are not.
Websites with consistently accurate data include government sites (80.9 percent accurate) followed by organiza-tion sites (72.5 percent accurate). Most of the sites ending in .org, .state or .gov contained the most
accurate information, the study says.Researchers say these inaccuracies are no fault of
Google’s but rather rest on the numerous websites that are presenting viewers with this information. They caution healthcare providers to be aware that patients and their families may be obtaining and acting upon inaccurate information they may have obtained from the Internet.
Websites ending in .org, .state or .gov contain the
most accurate information.
14 www.aacnboldvoicesonline.org NOVEMBER 2012
AT THE BEDSIDE
Skimping on Sleep May Affect Immune Response
Delirium Tools From AACNSleep disruption is a principal cause of delirium. Here are AACN resources to help you prevent and respond to delirium:
Bundle Into Practice,” CNE article in Critical Care Nurse, April 2012
Practice Alert
Sleep-deprived people may not get the full immune response from vaccinations, possibly putting themselves at risk for increased susceptibility to infectious diseases, according to a study in SLEEP.
In “Sleep and Antibody Response to Hepatitis B Vaccination,” University of Pittsburgh researchers examined immune responses in 125 adults who received a standard three-dose hepatitis B vaccination series. Six months later, those who slept less than six hours a night were 11.5 times more likely to remain unprotected from the virus than participants who slept at least seven hours.
The vaccine failed to protect nearly 15 percent of partici-pants six months after receiving the three injections, reports Daily Dose, a boston.com health blog. “These findings provide initial evidence that natural variation in sleep may contribute to clinically relevant differences in the magnitude of immune responses to vaccination,” researchers say, “possibly providing a physiologic basis for observed differences in susceptibility to infection.”
Because the study only observed sleep patterns and made a statistical association, it couldn’t prove that lack of sleep
reduced antibody response to the vaccine, Daily Dose reports. “It does, though, provide further evidence that skimping on sleep isn’t great for the body’s immune system.”
The study adds to recent evidence involving the critical role sleep plays in maintaining health and well-being, including a study examining the impact of hospital noises on patient care.
“Sleep Disruption Due to Hospital Noises: A Prospective Evaluation” in Annals of Internal Medicine finds that sounds during sleep influence both cortical brain activity and cardio-vascular function. “This study systematically quantifies the disruptive capacity of a range of hospital sounds on sleep, providing evidence that is essential to improve the acoustic environments of new and existing healthcare facilities to enable the highest quality of care,” it notes.
Study provides evidence for improving hospital acoustics.
AACN BOLD VOICES NOVEMBER 2012 15
AT THE BEDSIDE
e-Devices Increase Distracted Walking, ED Visits
The Associated Press reports injuries to distracted walkers treated in emergency department (EDs) have more than quadrupled during the past seven years and
were in most cases the result of distraction caused by electronic devices.
Walking while using a cellphone or other electronic device led to about 1,150 ED visits in 2011, a 400 percent increase over the past seven years, the Consumer Product Safety Commission estimates.
Instances may be even higher, because patients may not mention they were using an electronic device,
or medical staff may neglect to report it, says Tom Schroeder, director of the commission’s data systems, in “Distracted Walking a Growing Phone-related Danger,” an Associated Press/CBS News report. Further highlighting the danger, National Highway Traffic Safety Administration data show that in 2010, pedestrian fatalities increased 4.2 percent and injuries rose 19 percent, even though overall traffic deaths were down.
The issue, researchers say, is that most people can’t focus on two things at once. One study at Stony Brook University in New York tested people’s performance walking to a target — first without distractions and then while talking on a cellphone or texting. The cellphone-talking group walked slightly slower, while the texting group walked 33 percent slower and veered off course 61 percent more often.
“People really need to be aware that they are impacting their safety by texting or talking on the cellphone” while walking, study co-author Eric Lamberg, an associate physical therapy professor, says in the AP/CBS report. “I think the risk is there.”
Texters walked 33 percent slower and veered off course 61 percent more often.
Tracking Flu Trends With TwitterResearchers from the University
of Rochester in Rochester, N.Y., have been using Twitter to accurately predict when individuals would get the flu up to eight days before symp-toms appear.
Details about the unpublished study appear in “AI Predicts When You’re About to Get Sick,” in New Scientist. The article compares the project to Google Flu Trends, an online service that uses flu-related search terms to track illness globally
in real time. But Adam Sadilek, a postdoctoral fellow at Rochester and one of the study authors, sought to apply his
online methodol-ogy to individuals instead of regions of people.
Using a machine-learning algorithm that can differentiate between phrases sent out by poten-tially healthy and ill individuals, Sadilek and his team monitored a month’s worth of messages tweeted by 630,000 users in the New York City area in 2010.
They analyzed approximately 4.4 million tweets that were tagged with GPS location data and were able
to predict when healthy people were about to fall ill with 90 percent accuracy.
Despite the initial success, Sadilek admits there
are a few issues that need to be worked out with the system, such as users who don’t accurately tweet their symptoms and other unac-counted-for factors that contribute to getting ill.
Photo: ©The Millennial Times.
16 www.aacnboldvoicesonline.org NOVEMBER 2012
AT THE BEDSIDE
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In Our JournalsHot topics from this month’s AACN journal
Misunderstandings about brain death create inaccurate perceptions that ICU teams and patients’ families are at odds. Families are perceived as protect-ing and speaking for patients when they’re most vulnerable. ICU teams seem interested in withdrawal of support to reinforce a diagno-sis of brain death. This month’s editorial explores how members of inter-disciplinary teams can repair this damaged communication. Above all, clinicians should choose their words carefully. And as members of a community of care, take a stand when the media misrepresent the clinical and communication complexity of brain death. (Savel et al, AJCC, Nov 2012)
How valuable are “slim” stroke scales in assessing acute stroke? Some clinicians find the full National Institutes of Health Stroke Scale (NIHSS) time consuming. Comparison of scores from the Glasgow Coma Scale (GCS) and slim versions of the NIHSS with the full scale showed they reduced the value of a structured neurologic examination, particularly when patients had low scores using the full NIHSS scale. In patients with isch-emic stroke, the study recommends using the full NIHSS to obtain a baseline assessment, to identify neurologic status changes and at discharge. Slim versions may be accept-able in time-sensitive situations. (Nye et al, AJCC, Nov 2012)
Psychological distress in family members of high-risk ICU patients often decreases three months after discharge but remains high enough to warrant concern. Symptoms of stress may include expressions of tension, restlessness, worry and inability to relax. Family members also may neglect their own physical needs; food, sleep and personal hygiene among them. Clinicians may use preventive measures that include consistent staffing; open visitation; family education during the first visit about what the family may see, hear, smell, and feel; engaging family members during visita-tion to assess for psychological symptoms; and becoming familiar with support available for families. (McAdam et al, AJCC, Nov 2012)
www.ajcconline.org
twitter.com/ajccmefacebook.com/ajccface
AACN BOLD VOICES NOVEMBER 2012 17
AT THE BEDSIDE
Chocolate and Reduced Stroke Risk in (Swedish) Men
A long-term study of Swedish men shows a possible correlation between the highest consumption of chocolate and a reduced risk of stroke, notes a report in Neurology.
Using detailed dietary informa-tion on 37,103 men ages 45 to 79 obtained in 1997 and following up 1,995 stroke cases through 2008, “Chocolate Consumption and Risk of Stroke” finds that the highest quar-tile of chocolate consumers had a 17 percent lower risk of stroke compared with those in the lowest consumption quartile. According to a related article at theheart.org, “The age-standardized incidence rates of stroke were 85 per 100,000 person-years for those
consuming the least chocolate and 73 per 100,000 person-years for those in the highest quartile.”
A meta-analysis that includes four other studies and 4,260 cases of stroke finds a 19 percent overall reduced risk of stroke for the highest chocolate consumers, the article adds. Research suggests the presence of flavonoids in chocolate might have antioxidant, antiplatelet and anti-inflammatory effects that help prevent cardiovascular disease.
The article notes that study limi-tations include consumption being self-reported and measured at only one time, as well as the inability to differentiate between dark and milk
chocolate consumption. The former has been linked to other health benefits. However, researchers add that “chocolate is high in
sugar, saturated fat, and calories and should be consumed in moderation.” They recommend further research to focus specifically on the direct associations between consumption of chocolate and reduced risk of stroke.
Highest chocolate consumers showed a 19 percent reduced risk of stoke.
Intensive Training Workshops Prepare Nurse Preceptors
Astudy in Journal for Nurses in Staff Development found that intensive workshops such as the Nurse Preceptor Academy (NPA) — which was deployed to increase
the workforce in the Kansas City, Kan., metropolitan area — are helpful to prepare preceptors to work with nursing students.
Since healthcare institutions are responsible for transitioning new hires, the need for well-trained preceptors has become an important tool in helping to reduce attrition, finds “Enhancing the Effectiveness of Nurse Preceptors,” especially since experts predict there will be a 25 percent nursing workforce shortfall by 2020.
The workshops typically provide teacher training to preceptors that, for example, helps them deal with different personality types and learning styles and provides effective feedback — something with which even experienced nurses struggle.
Approximately 49 percent of survey respondents said they used the Myers-Briggs Type Indicator assessment and other self-awareness information they received at the workshop. Preceptors found that having resources readily avail-able was important and identified taking a normal clinical workload while precepting as a major stressor. Researchers emphasize that managers need to provide a collaborative and supportive work environment that allows preceptors to meet the demands of their workload.
The study included 714 working RNs from 18 different hospitals who attended an eight-hour NPA workshop. Survey respondents ranged in ages from 20 to 50, and all had already precepted new hires in a hospital setting.
Photo: ©The University of Texas at Tyler, College of Nursing.
18 www.aacnboldvoicesonline.org NOVEMBER 2012
AT THE BEDSIDE
‘Weekend Effect’ in Hospitals Affects Patient Mortality
Patients with atrial fibrillation (AF) admit-ted to the hospital over the weekend have a 23 percent greater chance of death than those hospitalized on weekdays, according to a recent study.
“Comparison of Outcomes of Weekend Versus Weekday Admissions for Atrial Fibrillation,” in The American Journal of Cardiology, accessed the 2008 Nationwide Inpatient Sample, “the largest all-payer data-base of hospital inpatient stays available in [the] United States,” to analyze 86,497 patients with a primary discharge diagnosis of AF. Of these, 16,949 were weekend admissions, and 69,548 were weekday.
A related article on the study in The Daily Briefing notes patients with AF admitted on the weekend:
days compared with 3.5 among patients hospitalized during the week;
among patients hospitalized during the week; and
week.”The study surmises that one reason for the “weekend
effect” may be differences in staffing. On weekends, “hospi-tal staffing is reduced in overall quantity and in the number qualified to perform certain procedures.” Early, subtle signs of critical problems may go undetected until later, it adds.
Despite the strengths of this study — including a large sample size and the absence of patient selection — there were limitations, especially the “effect of unmeasured confounders,” such as data on the time from symptom onset to presentation, type of AF and medications taken before or during hospitalization.
Subtle signs of critical problems may go undetected with lower weekend staffing.
AACN BOLD VOICES NOVEMBER 2012 19
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Raising Awareness About Pressure Ulcers
Worldwide Stop Pressure Ulcers Day, Friday, Nov. 16, raises awareness of the growing problem of pressure ulcers and the consequences — such as increased pain, less vitality, reduced physical activity and generally lower quality of life — for patients who develop them. By educating people around the world about pressure ulcers — called bedsores, pressure injuries or pressure areas — organizers aim to minimize the impact and associated costs.
For several years, many Spanish-speaking countries have participated in “Stop Pressure Ulcer Day.” Last year, organiza-tions within
those countries issued the “Declaration of Rio de Janeiro” to put a spotlight on the proliferation of patients who develop pressure ulcers.
The European Pressure Ulcer Advisory Panel (EPUAP) has played an active role in publicizing “Stop Pressure Ulcer Day.” More information about Worldwide Stop Pressure Ulcers Day is available at www.epuap.org/stop-pressure-ulcer-day. For additional pressure ulcer prevention resources, visit the National Pressure Ulcer Advisory Panel website at www.npuap.org.
Bedsores lead to pain, less vitality, lower physical activity, lower quality of life and higher healthcare costs.
Recommendations for Prevention and Care of Pressure UlcersA study in the Journal of the American Geriatrics Society— “Hospital-Acquired Pressure Ulcers (PUs): Results From the National Medicare Patient Safety Monitoring System Study” — found that “(i)ndividuals who developed PUs were more likely to die during the hospital stay, have generally longer hospital lengths of stay, and be read-mitted within 30 days after discharge.”
To minimize PUs:
patient at admission
To prevent PUs from developing while care is being provided:
higher risk
Recommendations to minimize and prevent PUs were developed by the European Pressure Ulcer Advisory Panel.
Save the dateAACN Conferences 2013:
AACN Progressive Care PathwaysSeptember 17-20, 2013MGM Grand, Las Vegas
AACN Nurse Manager PrioritiesSeptember 18-20, 2013MGM Grand, Las Vegas
A Slice of AACN NTIApril 1-5, 2013MGM Grand, Las Vegas
AT THE BEDSIDE
20 www.aacnboldvoicesonline.org NOVEMBER 2012
CERTIFICATION
Find AACN Chapter Events Near You Fall is a busy time of year for AACN chapters, when many
it a perfect opportunity to look for chapter events in
(www.aacn.org/chapters) to find resources that include a Chapter Events Calendar, (Find a Chapter) search engine
your local chapter and play a more active role in our AACN community.
Congratulations to 40-Year AACN Chapters
These 13 chapters celebrate their 40th anniversary
It’s time to start planning for Certified Nurses Day 2013, which will occur March 19. Learn about the many resources to help you honor, recognize and celebrate certified nurses at your facility and chapter. Some ideas to kick off your plans:
for certified nurses
logo/recognition products, lapel pins, pens, retractable name badges, lunch totes, etc. — with credentials on them
nurse that is later given to the next certified nurse
them
nurses from the administrator or manager
pictures of the certified nurses in front of the wall
certified nurses
about the different certification programs
with “Celebrate Certified Nurses” in the subject line-
fied to [email protected] with “Cert Testimonials” in the subject line
American Nurses Credentialing Center designed this special day to honor the birthday of the late Margretta “Greta” Madden Styles, an international pioneer in nursing certifica-tion and longtime friend of AACN and AACN Certification Corporation. Styles designed the first comprehensive study of nurse credentialing.
Start planning now to celebrate certified nurses on March 19.
Certified Nurses Day 2013
facebook.com/aacnface
facebook.com/ntiface
twitter.com/AACNme
twitter.com/NTIAACNme
AACN BOLD VOICES NOVEMBER 2012 21
PATIENT SATISFACTION
Re: Page 8 in August AACN Bold Voices
I agree with Theresa Brown’s concern about reimburse-ment and patient satisfaction. Although I believe patients have the right to have a say about their care, I do not think reimbursement decisions should be based only on subjective data. Objective data should be measured whether or not a patient was pleased with the care. The goal is for a patient to improve and be able to go home.
Angie PhillipsMesa, Ariz.
When people are sick, many of them only think of how they feel at the moment. They do not care if the discom-fort caused by nurses and doctors will make them feel better tomorrow or next week. Explaining the reason for the discomfort does not make a person comfortable, which is all he or she cares about. Does a hospital main-tain average or better-than-average length of stay for measurable illnesses? This would be a better measure to determine hospital reimbursement. However, it would still have to allow for patients who are frequently read-mitted because of non-compliance. Even when, such as with patients who have chronic obstructive pulmonary disease, non-compliance is because they can’t afford an air conditioner or its high electric bill.
Sherry ZurloWoolwich Township, N.J.
Healthcare is a service industry and patients are consumers with choices. I work in a Level 1 trauma center in a city where people can choose from four other hospi-tals in a two-block radius. We need to compete for high patient satisfaction scores so our hospital is also chosen for other than trauma care. As healthcare providers we
need to make inva-sive, painful and sometimes dehuman-izing experiences as tolerable as possible. This is what former patients will most remember when the survey comes in the mail. If people are treated with respect and dignity, they will comment favorably about it.
Dayna MorganSeattle
ACCEPTING THE DARE
Accepting this year’s Dare To challenge, my CVICU’s educator and I asked every team member to consider identifying his or her own Dare To. It’s a yearlong project. With their dare written on the front and their name on the back, team members place a cardboard shooting star on a Dare To theme bulletin board. When the Dare To is achieved, they place the star in a box from which, at the end of the year, we’ll have a random drawing for a $100 gift card. So far, Dare To’s include CCRN certification, applying for the professional advancement ladder and developing an abstract to submit for next year’s NTI. Some are working in groups. Excitement has spilled over to the PCU which has started its own campaign.
Cathy JohnsonHouston
LETTERS
TransitionsEvents in the lives of members and friends in the AACN community
Send new entries to [email protected] or remember your colleagues with a gift to AACN at www.aacn.org/gifts.
Michele Armstrong Deborah Bullock Anne Davis Mi Ja Kim Diana Mason Patricia Gonce Morton Ann Nicoll Susan Ruppert Maria Shirey Carolyn Tadeja, new position
AACN Bold Voices invites your letters for possible print and/or online publication. Please be concise. Letters may be edited before publication. Include your name, credentials, city, state and email address (for verification). Write to [email protected].
Room With a View
Make sure you have the best view of scenic and historic Boston for the 2013 AACN
National Teaching Institute & Critical
room now with AACN Housing at www.aacn.org/nti or call (800)
-able until April 2, but we strongly advise
you to book early.
Back in the days of the telegram, a shoe company sent two scouts to explore business opportunities in a developing nation. The first scout sent back a telegram that read: SITUATION HOPELESS STOP NO ONE WEARS SHOES. The second one excitedly messaged: GLORIOUS BUSINESS OPPORTUNITY STOP THEY HAVE NO SHOES.
What do you think happened next?I come across this paradox daily. At times within myself. How is it that I
embrace some new ideas with optimistic enthusiasm? Yet I approach other ideas like Eeyore, the gloomy donkey in “Winnie-the-Pooh.” Does it happen to you?
If it does, have you considered that you may be getting in your own way? Doubts, fears, an inherent tendency toward caution about change — these
powerful forces distract us from possibilities that may do even more than solve a thorny situation. They may create an entirely better state of affairs.
Rosamund and Benjamin Zander challenge us to consider the full realm of possibility by looking at things from many different perspectives. In “The Art of Possibility” they explain that, when we’re open to new and different ideas, we gain knowledge by invention. The full realm of possibility generates an appreciative perspective that focuses on what can be done, instead of what cannot.
How do we turn the corner to become explorers of possibility? One way is to hang around with people who appreciate possibility. David Bayles talks about
going for a walk in the woods with an experienced mushroom hunter. He said, “… within minutes it became abundantly clear that the mushroom hunter not only lived in a world that had more mushrooms than mine, she lived in a world where the routes toward mushrooms were clear and visible.” (Another Angle, AACN Bold Voices, July 2011). But don’t just hang around with them. Ask how they develop and sustain their enthusiasm for “what ifs.”
A tactic I’ve used is paying attention to my response when someone shares a new idea. If I become skeptically suspicious — Is she nuts? How on earth could that work? — I consciously make myself pause and ponder before responding. My questions often make a 180-degree turn once I start to wonder: What if we could really do that? How can we get others to buy in?
Do you recall last year’s Facebook dialogue when AACN issued a Practice Alert on family visi-tation and presence in the ICU? A lively NTI panel followed [link to a recording from this issue’s digital edition]. Some of our colleagues weren’t convinced open visitation can be successful. But many posts described success with comments such as: We have done this for years. The patients really like it, and the families feel like they are involved. Have you had an immediate family member in the ICU?
And Angela Benefield’s especially powerful perspective: “Can there be innovative ways of implementing 24/7 visitation? I certainly do not want to be the one who may have prevented family from seeing their loved ones. (Who knows, it may be their last time to say goodbye or provide some closure for them.)”
Have you successfully turned the corner to become an explorer of possibility? I’d love to hear what you’ve learned and achieved. Share your stories with me at [email protected] or with all of us at facebook.com/aacnkathrynroberts.
FROM THE PRESIDENT
Dare to Explore Possibilities
Kathryn Roberts
Never turn your back on your own ideas. Make yourself this one little promise: The next time you catch yourself saying, “Hey, that gives me an idea!” follow through on that idea to its logical conclusion.
— Dan Zadra
22 www.aacnboldvoicesonline.org NOVEMBER 2012
AACN BOLD VOICES NOVEMBER 2012 23
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