People often ask me how I pick each month's editorial topic. Trends in nursing often make good subjects, especially when there's a controversial issue or a shift in thinking involved (such as the recent debate regarding the implications of 12-hour nursing shifts for patient safety). At times international or domestic crises (such as the ongoing famine in East Africa and the 2010 BP oil spill in the Gulf of Mexico) have seemed to demand an editorial response. Sometimes I'll look closer to home for my topic, highlighting an article in the journal to provide context about our decision to publish it and to jumpstart discussion. And sometimes I'll want to draw attention to a journal issue that sums to greater than its parts. That's the case this month: we're publishing several articles that show the many ways nurses can exert influence in their settings—as scholars and clinicians, bringing evidence to bear on patient care; as managers and staff nurses, implementing quality improvement projects; as innovators and change agents, testing and transforming care processes; and as advocates, working on behalf of those in need of protection.
The two CE articles focus on rather simple, commonsense practices that nurses can institute and manage. Each is germane to basic care and essential to ensuring patient safety and promoting good outcomes. In “Mouth Care to Reduce Ventilator-Associated Pneumonia,” Staja Booker and colleagues address oral care as a practice essential to infection control—yet it's one nurses often perceive “as a nonessential comfort measure” and either don't provide it or do so incorrectly. Citing current and applicable recommendations and guidelines, the authors offer an evidence-based guide to providing oral care. And in “Decreasing Patient Agitation Using Individualized Therapeutic Activities,” Christine Waszynski and colleagues describe their project to address a problem familiar to most hospital nurses: how to provide a safe environment for agitated patients who are at high risk for falls. Such patients often become more distressed and confused if they're restrained, so most facilities employ one-on-one “sitters” to provide constant supervision. The authors initiated a program in which sitters used various simple activities to engage patients, resulting in less agitation and fewer disruptive behaviors.
In a special feature, “Nursing Staff Innovations Result in Improved Patient Satisfaction,” Jeaniffr Snide and Regina Nailon address a topic that many nurses and hospitals must consider daily. (Indeed, our Facebook question asking nurses their views on the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS] scores received numerous responses, prompting my September editorial.) Since the Centers for Medicare and Medicaid Services linked hospital reimbursements to performance measures, including patient satisfaction ratings, hospitals have prioritized achieving high scores. And because a majority of performance measures are directly linked to aspects of care managed by nurses, nurses have felt increased pressure to improve patients’ satisfaction in those areas. Snide and Nailon report on how nurses at their hospital used the Transforming Care at the Bedside program's approach to initiate patient-centered care innovations. Patients’ involvement in and satisfaction with their care increased, leading to “a sustained, positive impact” on both HCAHPS results and non-HCAHPS patient satisfaction measures.
Lastly, both this month's cover photo and AJN Reports serve to increase awareness of an especially vulnerable population: children and adolescents who identify with a gender that does not conform to their biological sex. As the Centers for Disease Control and Prevention notes, “Gender identity, gender expression, and sexual orientation are separate, distinct concepts, none of which is necessarily linked to one's genital anatomy.” Yet some school officials aren't supportive of such children, and may inadvertently foster an environment conducive to bullying. In “Helping Transgender Children and Teens,” Joy Jacobson offers one child's story and highlights the crucial role that school nurses have in providing safe havens and nondiscriminatory environments for all children.
Because of the nature of what we do and our presence in people's lives, we have tremendous opportunities to influence how people think about health and issues affecting health. Let's not waste them.