We see, read, and hear so much about horizontal violence and nurses not being supportive of each other, and also about other healthcare professionals being unsupportive of nurses. Another such case is occurring, but what is striking to me, is that while this one nurse is going through this tough time, nurses on the web are rallying together to support her and encouraging others to do the same.

The case is of Amanda Trujillo, a registered nurse in Arizona. According to a letter she wrote and the posts of many nurse bloggers, Amanda has been fired from her job, her nursing license is in question, and she is undergoing psychiatric evaluation after educating a patient about his illness and options. The patient decided to forgo surgical intervention and explore hospice care. The details of her case can be read on a number of nursing blogs, including vdutton’s posterous (with the transcript of details recorded by her attorney), Those Emergency Blues, and Emergiblog. The Nerdy Nurse also has several posts and an extensive list of resources about the case and ways to show support.

I can think of several instances where patients I’ve cared for had questions that either were not answered by the healthcare team or were answered, but the patient did not fully understand his condition or options. On many  occasions in my nursing career, I provided patient education that helped a family make an  informed decision. I’ve called together family meetings with the healthcare team and requested ethics committee consultations. Advocating and educating patients, within the scope of nursing practice and institution policies, of course, is our responsibility. 

I will be following the case to see what evolves and the response of nursing organizations. Thank you to the nurses who have been sharing Amanda’s story.

I am very excited to introduce our new microsite, the Skin Care Network! This site was developed by the clinical and editorial team of Lippincott's NursingCenter.com in collaboration with the Dermatology Nurses' Association and the American Society of Plastic Surgical Nurses. Our goal is to share with you all the dermatology and skin care content from Lippincott's vast collection of nursing journals and keep you up-to-date with the latest research, news, and information your patients may be reading or hearing about in the media.

Here are some highlights of the Skin Care Network that I don't want you to miss:

• In News, you'll discover the latest research findings and evidence-based practice recommendations, as well as links to related mainstream media items that your patients may ask about.
• In Tools & Resources, we've organized content by clinical topic, created a page with all our dermatology and skin care continuing education opportunities, and compiled patient education tools for you to share with your patients.
• In Multimedia, find podcasts of presentations from Lippincott's nursing conferences. More resources will be coming soon to this section!
• Also learn more about the Dermatology Nurses' Association and the American Society of Plastic Surgical Nurses on our Society Partners page and the Journal of the Dermatology Nurses Association (JDNA), Plastic Surgical Nursing (PSN), and The Nurse Practitioner by visiting the Journals page.

Take some time to explore the site ~ I hope you find the Skin Care Network to be a valuable resource to meet your professionals needs!

February is American Heart Month! Here are some links to resources about heart disease and the campaign:

• American Heart Association
• American Heart Month feature from the CDC
• Go Red for Women (Reminder: National Wear Red Day is Friday, February 4th)
• The Heart Truth® A National Awareness Campaign For Women About Heart Disease
  
• Heart Insight: Healthy Living for Patients, Their Families & Caregivers

...and some patient education tools from our journals:

• Patient Education: Cholesterol levels  (pdf)
• Patient education: Heart-healthy living  (pdf)
• Guide to care for patients: Atherosclerosis (pdf)

Help spread the word! Have more resources to share? Please do so by leaving a comment! Thanks!

I can remember a patient with an upper GI bleed, Minnesota tube in place, on maximum vent support and two pressors, who clearly was not doing well. I was checking yet another blood product with a nurse colleague, when a consulting clinician came in and told the family members at the bedside that “his numbers look good.” He then smiled and walked out of the room. The family responded with sighs of relief and “thank goodnesses” while the other nurse and I looked at each other as if to say “what just happened here?”

Have you experienced similar situations? I hesitate to name the clinician’s area of expertise because I don’t want to give any specialty a bad rap or make a generalization. However, the point is that sometimes a person not directly involved with a patient’s day-to-day care can make an observation to patients or families and give them a message that may not be correct. It isn’t always one of false hope either; perhaps a patient is doing better, yet his _______ (you can fill in the blank - rash, glucose level, wound, etc.) is not healing or normalizing and a caregiver might focus on that one clinical finding when talking with the patient and his family members.

It is for this reason that I was both surprised and discouraged when I read the results of a recent study published in Chest, “Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients.” In this study, 135 ICU patients received ‘usual care’ and 346 ICU patients had weekly family meetings where the patient’s progress and goals were discussed. The investigators were looking at the impact of this intervention on length of stay and no significant difference between the two groups was found.

Despite the negative findings of this study, it is important to remember the positives, or benefits, of sitting down with families for formal meetings where information can be shared and questions can be answered. For example, regular family meetings can allow you to:

• Provide personal contact
• Give updates on the patient’s medical condition and treatment options
• Discuss his prognosis
• Learn about the patient and family, including expectations and wishes
• Gain the opportunity to formulate a trusting and caring relationship
• Tailor the treatment plan according to the input of all staff and the patient’s family.

Please allow me to share the following quote from the authors in their conclusion of this study:

"Even if the use of regular formal family meetings does not alter resource use in all settings, the literature is replete with evidence of other beneficial effects of providing families with time to sit in a quiet location and talk at some length about the patient's goals and preferences and to explore issues related to quality of life, and providing families with consistent support as they face difficult decisions."

What is the standard procedure for initiating, scheduling, and attending family meetings where you work?

In the latest issue of the Journal of Christian Nursing, Anthony Hoffman BSN, RN, describes his experiences as a diabetic educator in Nouakchott, Mauritania (located on the west coast of Africa). In his article, Universal Principles for Culturally Sensitive Diabetic Education, we are reminded of the importance of cultural awareness.  While most of us might not travel abroad to work, we care for and will continue to care for patients from other countries or with different faiths and traditions that impact how they manage illness. Mr. Hoffman shares the following “universal principles” which truly can apply to any patient in any setting:

"1. Patients own their culture. A patient needs to be allowed and encouraged to describe his or her culture. I found travel guides and documentaries useful as a starting point in understanding culture, but quickly learned the danger of stereotyping. Having an inquisitive attitude helps us be students of our patients' cultures and avoid stereotyping.

2. Patients own their bodies. In every culture, patients have the right to make their care decisions. Sometimes cultural mores and values will make adherence to the plan of care more challenging, but the final course of action belongs to the patient. We must continue to respect and offer the best to our patients regardless of their healthcare decisions.

3. Patients own their care plans. We need to help patients design their own care plans. Let them suggest ideas for how to follow the recommended plan of care. Set small and incremental goals with the patient for lifestyle modifications and celebrate the achievement of goals. In this way, nurse and patient become teammates working together.

4. Patients are their own best advocates. Teach patients the hows and whys of diabetic care, not just the "shoulds" and "musts." A patient who understands the basic physiology of diabetes is empowered to make informed decisions regarding his or her care plan and to adhere to that care plan.

5. Honesty is always the best policy. We are sometimes tempted to tell less than the "whole truth" in the name of cultural sensitivity. For example, I didn't like telling patients that dates have a high glycemic index or that fasting and binging during Ramadan can wreak havoc on their blood glucose. Withholding unpleasant information does not honor our patients or empower them to make wise decisions about their health."

You can read Mr. Hoffman’s article in its entirety here. Let us know what you think!

Since last April, a big part of my job has been reading, researching, and writing about H1N1 influenza. Many friends, family members, and colleagues were aware of this and came to me for information about the virus, and then, in the fall, about the H1N1 vaccine.

I’ll admit that I was skeptical about the vaccine at first; however, I made the decision to follow the recommendations of the CDC and get vaccinated. I called my doctor’s office….”No vaccine in yet”. This was the response for several weeks. In the meantime, my children got vaccinated at school (seasonal and H1N1) and my husband got both vaccines at work (he’s a respiratory therapist). We also all got....THE FLU! H1N1? Maybe.

So, here it is, January 20th, and still no vaccine for me. I contemplated skipping both my seasonal and the H1N1 vaccines this year since we are so far into flu season already. Then last week, in an open letter to the American people, the CDC reminded me (and the rest of Americans) that flu season traditionally lasts until May. In that same letter, I also learned that there are currently over 110 million doses of the H1N1 vaccine available. Great – I thought – I’ll do it! I called my primary care office to make appointments for the seasonal and H1N1 vaccines but wasn’t able to schedule them because while they do have the vaccines, they don’t have enough staff to administer them. I was instructed to call back next week.

This got me thinking... While it is great that we educate and encourage people to get vaccinated, how can we make it easier for them to do so? One colleague recently needed several vaccinations as well as a titer drawn for varicella before some upcoming travel abroad. Luckily she was able to get all of her needs met at occupational health where she works. While I am happy my colleague could get her needs met in a timely fashion, in one appointment, in a convenient setting, would this be as easy for a layperson? My husband got both his vaccines at work, during his shift – great for him, but how about the patients he cares for who have to wait for appointments and may have to schedule multiple visits to get their needs met?

While it is great that we educate our patients and the public about staying healthy, how can we improve the system?