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Delegating during a pandemic

Like many clinical nurses, I've been struggling to maintain professional standards during the COVID-19 pandemic. For example, given the shortage of licensed personnel, I am sometime expected to delegate nursing responsibilities to nursing students and even volunteers. Does this violate the standard of care for professional nursing practice?-M.S., MASS.

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Due to the resource limitations and overwhelming situations imposed by the COVID-19 pandemic, the American Nurses Association (ANA) has released a document entitled Crisis Standard of Care: COVID-19 Pandemic. The ANA is the umbrella organization that sets standards for nursing practice in the US. These standards serve as the basis for evaluating whether or not any given act or failure to act related to nursing care meets professional standards of care or falls short ethically.


The ANA recognizes that changes in the standards of care can occur in certain circumstances when resources are limited or clinicians are practicing in an unusual setting or with unfamiliar patient needs. Addressing the issue of delegation, for example, the guideline states that "registered nurses may be asked to delegate care to others, such as students, staff displaced from another institution, or volunteers. This will require a rapid assessment of the skills of the others available to assist in patient care. Nurses must continue to emphasize patient safety and appropriate delegation."


Besides providing an outline of practice guidelines for RNs and healthcare facilities, the document includes links to resources that offer additional information on ethical issues. Access it at



Food for thought

Many of my patients want to lose weight. As part of patient education, I advise them to keep track of calories by reading food labels. However, some patients have trouble interpreting serving sizes, especially in products containing more than one serving. How can I guide them toward healthy choices?-L.C., S.C.


A new FDA initiative may help. The Nutrition Facts label on packaged foods and beverages has been updated to highlight and clarify key nutritional information.1 For example, the calorie count stands out in much larger, bold print. The serving size is given in an everyday measure, such as 1 cup, followed by the weight in grams. Because many packages contain more than one serving, some labels have two columns-one column listing the amount of calories and nutrients in one serving and the other listing this information for the entire package. Tell patients that serving size is based on the amount of food customarily eaten at one time and is not a recommendation for how much to eat.


Based on current scientific evidence, the newly revised label is the first major update in over 20 years. Serving sizes have been modified to reflect changes in the amount of food and beverages people typically consume today. For more helpful information about nutritional choices, refer patients to the FDA website below.



1. US Food and Drug Administration. What's new with the Nutrition Facts label. 2020. [Context Link]



Evidence supports acupuncture

My patient experiences episodic migraine headaches. The prophylactic medications prescribed for her have not been very effective. She has heard that acupuncture may help and wants to try it. Does any recent evidence support the use of acupuncture for migraine prophylaxis?-N.B., FLA.


Yes. In a recently published multicenter, randomized, controlled clinical trial, researchers studied 150 acupuncture-naive patients with episodic migraine without aura.1 Participants were randomized to receive manual acupuncture plus usual care, sham acupuncture plus usual care, or usual care alone. All patients received 20 sessions of 30-minute acupuncture treatments or usual care over 8 weeks. The main outcome measures were change in migraine days and migraine attacks per 4 weeks during weeks 1 to 20 after randomization compared with baseline (4 weeks before randomization). The final analysis was based on 147 participants.


Findings showed that manual acupuncture resulted in a "significantly greater" reduction in migraine days at weeks 13 to 20 and a significantly greater reduction in migraine attacks at weeks 17 to 20. No serious adverse reactions were reported.


For prevention of episodic migraine without aura, the authors concluded that 20 sessions of manual acupuncture was superior to sham acupuncture and usual care. "These results support the use of manual acupuncture in patients who are reluctant to use prophylactic drugs or when prophylactic drugs are ineffective, and it should be considered in future guidelines."



1. Xu S, Yu L, Luo X, et al Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. BMJ. [e-pub March 25, 2020] [Context Link]