1. Berndt, Dawn DNP, RN, CRNI(R)

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Strategies for Professional Practice Challenges

I invited an esteemed colleague to expound on the impact of moral distress in nursing for this issue of the Journal of Infusion Nursing. In her guest editorial, "Advocating for Nurse Well-Being," Dr Marlene Steinheiser described some of the effects of the COVID-19 pandemic, including nurses' quality of sleep, feelings of anxiety, emotional exhaustion, and distressing memories. She reported that although the pandemic greatly influenced nurses' sense of well-being, nurses were at risk of burnout, depression, and emotional exhaustion even before the advent of COVID-19. She asks, "What can we do to influence our own well-being and that of our colleagues"? Please enjoy this guest editorial written by a nursing colleague who is passionate about your health, wellness, and professional practice.


In November 2022, INS surveyed its nurse members to share their experiences with moral distress. We were greatly affected by the volume and content of the responses. Subsequently, the INS education and publication departments will collaborate in 2023 to disseminate these findings at the INS national conference in Boston and in the INSider and the Journal.

Dawn Berndt, DNP, RN... - Click to enlarge in new windowDawn Berndt, DNP, RN, CRNI(R) Infusion Nurses Society Director of Publications and Educational Design, Editor-in-Chief,

As the COVID-19 pandemic unfolded, health care practitioners anticipated that an extraordinary volume of discovery would take place. We are now learning how clinical practice changes during the height of the pandemic have impacted clinicians, patients, and health care organizations. Weaver et al, in "Nurses' Perceptions of Infusion Therapy During the COVID-19 Pandemic," "conducted a study to explore and describe nurses' perception of managing infusion pumps outside the ICU rooms of patients with COVID-19 at 6 acute care hospitals." Based on interviews conducted with nurse managers, assistant nurse managers, clinical nurses, and vascular access team members, their study revealed the theme, "figure out a way" with "no clear-cut policy." The authors aptly stated, "Challenged with a virus that was little known, nurses were placed in situations where they drew on principles of infusion therapy, patient safety, and creativity to meet the complex infusion needs of patients with COVID-19."


I am confident that, although the Weaver study was conducted in 6 hospitals in a specific region in the United States, the overarching theme that emerged from this work applied to many clinicians, hospitals, and health care organizations worldwide as they sought to bring new clinical solutions during a crisis. We continue to marvel at the industrious and ingenious ways clinicians have persevered and practiced in the most challenging circumstances.


The US Food and Drug Administration approved a rapid infusion protocol for Ocrevus in January 2021, which could shorten the infusion time from 3.5 hours to 2 hours. In her article, "Effects of an Ocrevus Rapid Infusion Protocol: A Literature Review and Quality Improvement Project," Dr Courtney Brandt performed a "literature review on rapid infusion protocols to analyze the effects of the Ocrevus rapid infusion protocol on 2 outcomes of interest: total visit time and infusion reaction rates." This excellent study included a quality improvement project designed to fully implement and measure the impact of the new protocol on visit time duration and infusion reaction rates in 2 separate outpatient infusion centers. As stated by the author, "The growth of infusion medicine, paired with the effects of the COVID-19 pandemic, have created stressors on time and space within infusion centers." I encourage you to review Dr Brandt's findings and share them with your infusion colleagues.


In "Factors Associated With the Occurrence of Adverse Effects Resulting From Hypodermoclysis in Older Adults in Palliative Care: A Cohort Study," Mendoza et al brought an often overlooked yet useful infusion practice to the forefront. Hypodermoclysis, the subcutaneous injection of isotonic fluids and medications, is an alternative therapy often utilized in the care of older adults. This cohort study was carried out in a palliative care unit of a reference university hospital in a metropolitan region in southeastern Brazil. The authors found that the occurrence of adverse effects sometimes associated with hypodermoclysis in the older adult population was low, while still maintaining adequate hydration, nutrition, and symptom control.


I encourage you to review Standard 58, Subcutaneous Infusion and Access Devices from the Infusion Therapy Standards of Practice to refresh your clinical knowledge on this valuable infusion option. We thank our Brazilian authors for their work in conducting this study and for submitting their article to the Journal of Infusion Nursing.


The article "Scoping Review of Early IV Infiltration and Extravasation Detection Devices" by Yang et al, leads the reader through a study of peer-reviewed journal articles, patents, and doctoral dissertations on technologies that detect infiltration and extravasation. The authors assert that even with frequent vascular access device site monitoring, clinicians may not be able to detect the early signs of infiltration and extravasation. "Infiltration detection technologies provide an opportunity for earlier and more accurate detection to prevent lasting tissue damage."


I expect that in the years ahead, infiltration and extravasation detection technologies will become a tool universalized in infusion practice. I applaud Yang et al for compiling and comparing 21 studies to inform our readership about the progress and development of these devices.


Lastly, please note that nursing continuing professional development (NCPD) for nursing contact hours and CRNI(R) recertification units are available in this issue. Instructions are available at the end of this issue. Contact hours are awarded by Lippincott Professional Development, which is accredited as a provider of NCPD by the American Nurses Credentialing Center's commission on Accreditation.


In Memoriam



Kathryn Carlson, President of NITA (National Intravenous Therapy Association, now known as the Infusion Nurses Society) from 1986-1987, passed away at her home in Nashville, TN, on December 14, 2022.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Kathy's presidential theme was "Risk Management." During her tenure, NITA established a speakers' bureau, held the first Advanced Studies Program in Kansas City, MO, and identified alternative sites as an emerging clinical setting.


Kathy was an outstanding leader, mentor, and nurse, who was extremely dedicated to the Society. Her commitment to excellence and patient safety continues to be the foundation for all we do at INS. Her knowledge, support, and kind nature will be missed.