1. Kennedy, Maureen Shawn MA, RN


Are nurses becoming too narrow in their reading?


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At the recent meeting of the International Academy of Nursing Editors, I was struck by the great number and variety of "specialty journals" produced for specialty and even subspecialty nursing practices. When I speak with nurses, I sometimes ask whether they read AJN and, if not, why; many who don't read AJN say it's because they read their specialty journal. But is that really enough?

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

I don't mean to minimize the importance of specialty journals. They cover, in detail and depth, the content that nurses practicing in a given specialty need to know. But often patients have more than one problem. Many patients have multiple comorbidities and complex treatment regimens-and problems with managing those conditions and adhering to those regimens. And there are overarching professional issues and changes in health care that affect all nurses, regardless of work setting. These are subjects covered by more "general" journals like AJN. Indeed, this issue of AJN exemplifies the reasons why nurses also need to read a broad-based professional journal.


For starters, this issue features the first article in a three-part series on supporting family caregivers-a group that, in 2009, included 61.6 million adults who provided care to another adult family member or friend, according to the AARP Public Policy Institute. The series is part of phase II of an AARP-led initiative, Professional Partners Supporting Diverse Family Caregivers Across Settings. (We reported on phase I, the State of the Science symposium, in a special supplement published in 2008, accessible at Findings from focus groups conducted for this project with African American and Latino family caregivers and with nurses and social workers reveal that almost no one is satisfied with how caregivers are prepared. Most caregivers reported feeling invisible in hospital settings and unprepared when they arrived home, and many felt slighted because of their cultural or ethnic backgrounds or language difficulties. While nurses and social workers recognized that family caregivers were overwhelmed, they reported that available resource materials were too complex and that "time pressures and too many responsibilities [got] in the way" of their efforts to prepare family caregivers. This series and the accompanying videos aim to address these deficits by improving both nurses' assessment of the needs of caregivers and their increasing awareness of the issues that caregivers from diverse populations face.


This issue of AJN also presents a systematic review of practices in and attitudes about deactivating implantable cardioverter defibrillators (ICDs) at the end of life. Because these devices are so effective in treating sudden cardiac arrest, many people with ICDs die of other causes. A patient's death can be needlessly painful if the device delivers shocks during the active phase of dying; yet although device deactivation is an option, advance planning discussions don't often include it, and many providers report being uncomfortable raising the topic. When should such conversations take place?


Our article on preoperative fasting reviews the arcane practice of issuing an "NPO after midnight" order for patients who face surgery the next day-still the norm in many facilities, despite 25 years of evidence that it often causes patients unnecessary discomfort. Indeed, allowing carbohydrate-rich clear liquids a few hours before surgery actually benefits most patients. The American Society of Anesthesiologists issued guidelines reflecting this evidence way back in 1999; yet the outdated practice continues.


Other articles in this issue cover topics as diverse as how overzealous use of performance measures can lead to bad care decisions and how nurses can improve medication calculation skills. This month's In the News reports on, among other topics, the promising results of California's mandated nurse-patient staffing ratios. Then there are the columns that readers consistently rate highly: Drug Watch, Art of Nursing, and Reflections, the last providing insightful narratives about the work we do.


Our patients are multidimensional and so should be our knowledge. Read your specialty journals-but also read more widely. I know a broad-based journal I can recommend[horizontal ellipsis]