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In Touch
A forum to discuss the latest news and ideas in nursing and healthcare.
Tuesday, April 28, 2015
Deprivation and suffering--do these words describe the thoughts that people harbor when we educate them about healthy diet and exercise? There’s a very good chance the answer is yes more often than not. That doesn’t bode well for success. Advising individuals to consider a change in the foods they consume and to increase their activity level has deeply personal implications. Yet, with the national focus on improving population health, these are the cornerstone strategies for developing a healthy population culture.
Personal choices about lifestyle, food, activity level, and habits are key determinants of health. But how do we motivate people to change embedded patterns of behavior and personal beliefs that may have childhood or even cultural roots? They’re the blockades in the tough road ahead that we must successfully navigate to achieve desired population health outcomes.
The popular media doesn’t make our job any easier. It’s actually part of the problem. You can’t thumb through a typical magazine or newspaper without seeing ads for weight loss products that promise dramatic results without dietary changes or exercise. How easy it is to believe that simply taking a pill will somehow neutralize all detrimental lifestyle choices.
The big commercial food industry, including the fast food chains, isn’t an innocent bystander either. The abundance of cleverly packaged convenience foods labeled “healthy” is often anything but. Low fat doesn’t always equal low calorie. Many popular processed foods sport a lengthy list of chemical food additives, too much salt, and added sugars. These “foods” also may lack the beneficial micronutrients and antioxidants that real food provides. Unfortunately, a lot of people have forgotten (or never learned) what a diet containing real food looks like. Here’s a hint: Garden-fresh fruits, vegetables, grains, nuts, and legumes form the foundation (with appropriate modifications, of course, for food-allergy sufferers).
The work we need to do as nurses is multifaceted. It includes discovering more effective approaches to health education that motivate healthy lifestyle choices in children and adults; making low cost, healthy foods available to low-income communities; and influencing the food industry to remove harmful additives and improve the nutritional value of processed foods. Yes, we have a heavy lift, but what other choice do we have? The scales are definitely tipped in the wrong direction!
What do you think? Share your thoughts below!

Tuesday, April 14, 2015
April is Sexual Assault Awareness and Prevention Month. Nurses can make a difference in the lives of survivors by understanding the facts, the effects this violence can have on mental and physical health, where to find information for themselves and their patients, and how to properly care for a survivor. Statistics are grim: About 1 in 5 women and 1 in 71 men have been sexually assaulted in their lifetime.
Nurses should be aware that survivors may experience myriad physical and mental problems beyond the damages of the actual assault, such as irritable bowel disorder, alcohol or drug abuse, post-traumatic stress disorder, asthma, and more.

We recently published a CE article on sexual assault to help bring awareness to our readers. You can read it for free:

Tuesday, April 07, 2015
The mother of a nursing colleague was hospitalized recently. My colleague e-mailed me to ask what Ithought about nurses calling patients “hon” or “dear” and the like. She expressed her amazement at how often nurses seemingly everywhere referred to her mother that way. She began to wonder whether her negative reaction just stemmed from being “old school.”
Do you think that my colleague is overreacting to the very common, innocent use of terms of endearment? If so, I’ll ask you to imagine for a moment that your nursing supervisor or perhaps even the CEO of your healthcare facility becomes one of your patients. Would you be inclined to refer to him or her as hon or dear? I sincerely doubt it. To use any term other than the individual’s name would be unthinkable for vast majority of us in a scenario like this. Why? It’s a matter of respect.

Granted, some patients don’t seem to mind and might even respond positively under certain circumstances, but really good judgment is needed here. More often than not, these terms can come across as trite, condescending, or paternalistic to patients who are trying hard to preserve their sense of dignity in a healthcare setting, where maintaining dignity is a significant challenge.Patients might feel a loss of personal identity and may suffer a greater sense of powerlessness during and after the interaction. And if the nurse—or another member of the healthcare team—reverts to hon, dear, or even (heaven-forbid) sweetie because he or she can’t remember the patient’s name, now we could also have a patient safety risk.

In our basic nursing education program we learned to always initially address patients by their formal names, generally preceded by Mr. or Mrs./Ms. as a way to confirm identity and establish a professional connection. After the formal introduction, the patient then might ask us to call him or her by a first name or nickname—or we can ask for a personal preference. Once we know the patient’s wishes, we can respond accordingly. The level of respect that we receive is often a reflection of the respect that we give to others. How would you like to be addressed?
Share your thoughts below!

Thursday, March 26, 2015
The actress Angelina Jolie recently wrote an op-ed in The New York Times about her decision to have her ovaries removed after learning she has a mutation in the BRCA-1 gene. This follows her announcement in 2013 about her decision to have a double mastectomy.
Do you think that the sharing of such a story by a celebrity helps shine a spotlight on and drive conversation about a health problem? Or is it a waste of time? Share your thoughts below!   

Wednesday, March 04, 2015
A nurse colleague asked me if I'd ever written about moral distress. She'd been helping a staff member work through a situation that deeply troubled her. It's a topic that should be on our nursing leadership and organizational agendas because it can impact nurses in virtually every practice setting and at every stage in their careers.
Moral distress is the visceral response evoked by experiencing a situation that's completely counter to a nurse's personal or professional ethics, standards, and principles. It's a terrible feeling that's worsened by the sense that damage has or will be done, and the nurse lacks the power, authority, or ability to right the wrong. The nurse may be left feeling like he or she just can't live with the situation, and feels at a loss in sorting out how to effectively resolve or move beyond it. Nurses most certainly have left jobs or careers as a result.
My first experience with moral distress occurred many years ago when I was an emergency nurse at a small community hospital. I'd just successfully completed my first ACLS course and was caring for a nice gentleman in his 90s with symptomatic bradycardia. The patient had received the maximum dose of atropine, but his heart rate continued to drop. External pacemakers weren't yet available. The patient's attending physician was at his bedside awaiting the arrival of a cardiologist to insert a temporary pacemaker. I strongly advocated that we start an infusion of isoproterenol, a second-line drug, to buy time. The physician refused, saying he had no experience with that drug. I watched in horror as we lost this patient.
Perhaps, in retrospect, the outcome would have been the same even with the isoproterenol, but I was left with a deep, lingering sense that we had failed this patient. My coping response was to become an ACLS instructor to teach caregivers how to resuscitate patients; although I couldn't help that patient, maybe I could help others.
How do you manage moral distress? First, recognize that all nurses will probably experience it. When that situation happens, it's essential to talk with trusted colleagues or counselors to express feelings and gain perspective. Healthy coping comes from finding a way to use the situation constructively for problem solving, professional growth, and for helping others when they experience it. Don't dwell on the negative; turn that energy into a positive force for change.
What do you think? Share your thoughts below!
About the Author

Linda Laskowski-Jones
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM, is editor-in-chief of Nursing and vice president of Emergency, Trauma, and Aeromedical Services at Christiana Care Health System in Wilmington, Delaware.