1. Kennedy, Maureen Shawn MA, RN
  2. Ferri, Richard S. PhD, ANP, ACRN, FAAN
  3. Sofer, Dalia

Article Content

Healing from the Violent Death of a Child

Parents respond in surprising ways.


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According to the most recent statistics available, sudden, violent death (accident, suicide, or homicide) now accounts for 80% of all deaths of young Americans between the ages of 12 and 28 years. Authors of a new study funded by the National Institute of Nursing Research sought to uncover differences between how parents are thought to react to such events and how they actually do react. They created a list of commonly held beliefs-"myths," defined as "beliefs whose truth or reality is accepted uncritically"-about such parents and looked for evidence to support them. They reviewed materials published in print and on the Internet and used findings of their own study, which examined "bereavement stress" in parents over a five-year period.


Myth 1. The death of a child by suicide is the most difficult death for a parent to cope with. This could not be supported by the literature. While there was some evidence that these parents have some unique grief responses, there was insufficient evidence to conclude that a child's suicide was the most difficult death for a parent to cope with.


Myth 2. Divorce is more common among the parents who've lost a child and may be inevitable. The evidence does not support the notion that the divorce rate among grieving parents is higher than that in the general population. Two controlled studies supported this theory, but numerous other studies offered conflicting or inconclusive results.


Myth 3. Parents must "let go and move on" to recover from a child's death. The evidence seems to belie this notion. "Moving on" and loosening the bond with a deceased child are concepts not completely supported in the bereavement literature, especially in cases of violent death. Moreover, it seems that while bereaved parents may "move on," they do not "let go." Rather, they seek ways to maintain a bond with their dead child (for example, creating scholarships and memorial funds).


According to Shirley A. Murphy, the primary investigator, there is a tendency for professionals to rush the healing process. Parents often want to remain attached to the deceased child in some way. "There are no deadlines for managing this loss," she says. Most important, she adds, is listening.


Murphy SA, et al. J Nurs Scholarsh 2003;35(4):359-64.



Characteristics of a 'Good' Nursing Home

Enough nurses to provide exemplary care is crucial.

An analysis of outcome data on all nursing home residents in Missouri, along with direct observation of care, allowed researchers to rate facilities as good, average, or poor. Facilities that were rated as good tended to be smaller, for-profit organizations in rural areas. In addition, they had more experienced administrators and nurse managers and nursing groups or committees involved in making decisions. They also had active quality improvement programs and adequate staffing. High-quality resident care was marked by frequent ambulation (stressed by the authors as the foundation for improved outcomes), good food served in a pleasant atmosphere, easy access to fluids, frequent toileting, good skin care, and frequent assessment of pain.


Rantz MJ, et al. J Gerontol Nurs 2003;29 (11):15-25.


Life in the Fats Lane

Are schools selling out children's health for profits?


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In the last 20 years, the percentage of children and adolescents in the United States who are overweight has nearly tripled, now accounting for 15% of 12-to-17-year-olds. A recent study published in Pediatrics examined the diets of 6,212 children and teenagers four to 19 years of age and found that on any given day about 30% of them consume fast food-food that is served in massive portions; appeals to taste preferences for fats, sugar, and salt; and contains high levels of saturated fat and trans fatty acids and little fiber.


Fast food, the researchers found, doesn't discriminate: consumption was prevalent among all age groups, both sexes, all income levels, all racial and ethnic groups, and all regions of the country. Children who ate fast food obtained 29% to 38% of their daily calories from fast foods and took in more calories per day than children who didn't eat fast food. Fast food eaters also took in more fat, more carbohydrates, more added sugars, more sugar-sweetened beverages, less milk, and fewer fruits and nonstarchy vegetables.


Attention has been placed on schools and their role in helping children adopt more healthful diets and lifestyles. Much of the spotlight has been on vending machines that spew out soda cans and candy bars at all times of the day. But according to the National Conference of State Legislatures, the money schools earn from vending machine contracts adds up, helping schools fund activities, computers, software, and academic and sports programs. According to Tim Lynch, director of governmental affairs at the American Dental Hygienists' Association, "Asking schools to turn away vending machine money [is] about as likely as asking a child to turn down ice cream on a hot summer day."


But many legislators and nursing and medical associations are doing just that. Arkansas, for example, has passed legislation banning all vending machines in schools. California recently passed a law prohibiting beverages other than water, milk, 100% fruit juice, or fruit-based drinks containing at least 50% fruit juice with no added sweeteners in every elementary school beginning on July 1, 2004; in middle schools and high schools, only specific, reasonably healthful beverages may be sold from half an hour before the start of the school day until half an hour after the day ends. In January, the American Academy of Pediatrics released a statement recommending that school districts restrict the sale of soft drinks in schools.


The National Association of School Nurses (NASN) echoes this recommendation, but Janis Hootman, president of the NASN, says that school nurses intervene in other ways as well. In Portland, Oregon, for example, nurses have worked with a local philanthropic organization to obtain funding for several pilot projects for overweight students. One nurse has initiated support groups through which she motivates children to make healthful choices. Another is working with her school's physical education teacher to implement a daily walking program for students and teachers.


The authors of the Pediatrics study recommend measures to limit the marketing of fast food to children. But in an industry whose biggest icon is a red-haired clown in yellow overalls, that may be more easily said than done.


Too Much of a Good Thing

Surgical infection rates can increase with high concentrations of oxygen.


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Providing high concentrations of supplemental oxygen during and immediately after surgery has been thought to provide clinical benefit. However, this practice has not been supported by research.


In a new study, researchers examined the effects of hyperoxygenation on surgical site infection rates among patients who underwent major abdominal surgery. The 165 patients were randomized to receive fractional inspired oxygen concentrations of either 35% or 80%. Oxygen administration was begun during the induction of anesthesia and continued until two hours after admission to the postanesthesia unit. For safety reasons, anesthesiologists could vary the percentage of oxygen administered to keep the patient's serum oxygen saturation above 94%. Patients were assessed for infection during hospitalization and again at their first postoperative visit to the surgeon.


Of the 160 patients who completed the study (there were 80 in each group), 29 (18%) developed infections. There were 20 infections (25%) in the 80%-oxygen group, more than twice the rate in the 35%-oxygen group (nine infections, or 11.3%). And the presence infection resulted in significantly longer hospitalizations and greater costs.


These findings weren't altered by a patient's obesity, the amount of blood loss, a history of smoking, or comorbid conditions such as diabetes, hypertension, and chronic lung disease. The authors speculate that hyperoxygenation causes physiologic changes that result in cell damage and decrease normal antibacterial functions. Until further studies can be done, the authors recommend that hyperoxygenation not be a routine part of general surgical care.


Pryor KO, et al. JAMA 2004;291(1):79-87.


What Eats Up a Hospital's Profits?

It's not the number of nurses.

According to a recent article , increasing the number of full-time nurses in hospitals raises operating costs but leaves the bottom line intact.


Researchers studied records from 422 hospitals in 11 states to determine whether changes in nurse staffing affected operating costs, profit margins, and quality of care; they also considered whether ownership and a significant managed care presence (referred to as "managed care penetration") have effects on nurse staffing, a hospital's financial performance, or the quality of the care provided.


Results showed that on average, full-time nurses made up about 25% of hospitals' full-time personnel, although the percentages varied from as low as 8% to as high as 43%. While a 1% increase in the number of nurses increased operating expenses by about 0.25%, it had no effect on the profit margin. By contrast, a 1% increase in nonnurse personnel (such as administrative and operational support staff) increased operating costs by 0.18% and diminished profits by 0.21%.


Managed care penetration didn't have an effect on costs but was shown to decrease profit-less so, however, than when several health plans were competing with one another. Larger hospitals serving a large number of Medicare and Medicaid patients and those recently acquired by a multihospital system also showed diminished profit margins.


McCue M, et al. J Health Care Finance 2003;29(4):54-76.


World health Roundup

Mesothelioma "epidemic" in Britain.


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The January 31 issue of the British Medical Journal reports that over 1,800 people (one in 200 men and one in 1,500 women) in the United Kingdom die annually of the disease, which is caused by prolonged exposure to asbestos and can arise as long as 50 years after first exposure. Deaths are expected to peak at 2,000 annually between 2015 and 2020. Death usually occurs within a year of diagnosis. The authors call for more research on effective treatments.


The ICN focuses on poverty.

Citing statistics that 1.2 billion people live in extreme poverty, and that poverty and poor health are related, the International Council of Nurses has chosen "NURSES: Working with the Poor; Against Poverty" as its theme for the 2004 International Nurses Day on May 12. The group is calling for nations to commit to equal access to health care, fair labor practices, safe working environments, and equal rights for women.



"Go Red for Women" is the slogan for the American Heart Association's new campaign to promote cardiac health and announce the release of the first evidence-based guidelines for preventing and managing cardiovascular disease in women. The new guidelines stratify a woman's risk of heart attack and detail specific clinical management for each category. For more information, go to


Prolonged aspirin use may increase risk of pancreatic cancer in women, according to a report in the January 7 issue of the Journal of the National Cancer Institute. Using data from the Nurses Health Study that tracked more than 88,000 women over an 18-year period, researchers found that women who regularly used aspirin (two or more 325-mg tablets a week) over a prolonged period had a greater risk of developing pancreatic cancer than women who didn't use aspirin. The risk increased with dose and duration of use, with the highest risk in women with a body mass index greater than 25 and in those reporting aspirin use of longer than 20 years' duration.


A long way to go. A report in the January 21 issue of the Journal of the American Medical Association that compared two large databases of patients with diabetes, one that tracked patients from 1988 to 1994 and one that tracked the same patients from 1999 to 2000, found that, in general, little progress has been made in meeting recommended goals for control of blood pressure and lipid and glucose levels. The study showed that only 7.3% of patients with diabetes were meeting these goals, and the authors recommend that more public health education and medical resources be devoted to this problem.


Along the same lines, a special report in the January 15 issue of the American Journal of Medicine finds that, contrary to recommendations, [beta]-adrenergic blocking agents are not being used to treat heart failure, despite evidence that they increase survival and decrease hospitalizations. The authors suggest that although chances of survival increase and costs to patients decrease with use of [beta]-blockers, hospitals and physicians have little incentive to prescribe the recommended treatment because they lose revenue. In addition, a lack of prescription drug coverage makes patients less likely to take them.


Can abstinence programs lead to more sex? A study released by the Minnesota Department of Health revealed that an abstinence-only education program established in that state between 1998 and 2002 helped teens and parents talk more comfortably and frequently about sex. But after the program's first year, the percentage of teens who reported having sex jumped from 5.8% to 12.4%, although this cannot necessarily be attributed to the program since there was no control group.


A special service for nurses. The Florence Nightingale Evensong Service will take place on Sunday, May 9, at 4 PM, at the National Cathedral in Washington, DC. Details will be available on the cathedral's Web site ( in late April.


Skilled nursing facilities may have to track nursing staff. The Centers for Medicare and Medicaid Services has proposed a new rule, published in the February 27 issue of the Federal Register, that will require skilled nursing facilities to keep a record of nursing staff engaged in direct care for each shift. The rule also provides for public access to information on nurse staffing. The period for public comment on the rule ends April 27. More information is available at