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AJN The American Journal of Nursing - Current Issue
AJN The American Journal of Nursing - Current Issue
AJN is the oldest and largest circulating nursing journal in the world. The Journal's mission is to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.

Seeing—and Nursing—Our Power
imageBy standing up for patients, we stand up for ourselves.
What RNs Can Do to Improve the Health of Their Communities
imageWe can make a difference in the places we learn, pray, work, and live.
HIV and Nurse Safety in China
No abstract available
Recognizing Lyme Disease
No abstract available
Simulation in Nursing Education
No abstract available
Joint Commission Issues Alert Addressing Violence Against Health Care Workers
imageDocument includes steps institutions can take to protect and prepare staff.
Ireland Proposes Promising Model for Nurse Staffing
imageIn pilot studies, the framework reduced adverse events and absenteeism.
NewsCAP: The American Heart Association issues corrections to 2018 stroke guidelines
No abstract available
The Impact of Legalization of Medical and Recreational Marijuana
Study looks at Colorado youth.
NewsCAP: Soldiers in the U.S. Army who deploy within six months of an earlier deployment are at higher risk for suicide
No abstract available
NewsCAP: Each year an estimated 600 to 1,600 newborns fall or are dropped while in the hospital
No abstract available
State News Roundup
No abstract available
NewsCAP: Study finds that NPs, physicians, and physician assistants (PAs) in the VA system provide comparable diabetes management
No abstract available
NewsCAP: The WHO releases Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV
No abstract available
Can You Be Fired for Taking a Sick Day?
imageKnow your rights and responsibilities when it comes to sick time.
AJN On the Cover
imageNo abstract available
AJN On the Web
No abstract available
Reducing Fall Risk in Older Adults
imageEvidence supports addressing medication management.
Promoting Drug Safety in Older Adults
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults is an evidence-based list of medications generally considered inappropriate for use in older patients.The list can be used in any health care setting and for all patients except those in hospice or palliative care.Nurses should consult the Beers criteria as a starting point when evaluating the appropriateness of a patient's drug therapy. Some patients may need treatment with a medication despite its presence on the list.
New HIV Drug Treats Patients Unresponsive to Other Therapies
Ibalizumab-uiyk (Trogarzo) is a new CD4-directed postattachment HIV-1 inhibitor approved for use in adults with multidrug resistant HIV-1 who have previously received multiple HIV medications and in whom current therapy is now failing.Ibalizumab-uiyk is administered as an IV infusion. It should never be given as an IV push or bolus.
After the Biopsy
No abstract available
CE: Original Research The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care
imageObjective: Traditional analgesic regimens often fail to control the severe pain patients experience during burn wound care, and the drugs are frequently administered at doses that can cause oversedation and respiratory depression. Ketamine may be an ideal agent for adjunctive analgesia in such patients because of its unique mechanism of action and lack of association with respiratory depression. This study evaluated the efficacy and safety of a critical care RN–driven protocol for IV ketamine administration during burn wound care. Methods: This retrospective cohort study examined all adult burn patients who received ketamine as part of a critical care RN–driven ketamine protocol for burn wound care from September 2011 through September 2013. Efficacy outcomes were opioid and benzodiazepine requirements (expressed as fentanyl and midazolam equivalents, respectively) four hours after ketamine administration compared with four hours before such administration. Safety parameters assessed were neurologic, hemodynamic, and respiratory effects. Results: Twenty-seven patients received 56 ketamine doses as part of this protocol; the mean (SD) dose was 0.75 (0.35) mg/kg. Twenty patients (74%) were male and seven (26%) were female; mean age was 39 years. The average percentage of total body surface area burned was 23.4%. With the protocol, opioid and benzodiazepine requirements were reduced by 29% and 20%, respectively. One patient experienced an episode of oversedation after concomitant administration of ketamine and fentanyl. No patients experienced neurologic or hemodynamic complications following ketamine administration. Conclusions: The administration of ketamine during burn wound care using a critical care RN–driven protocol was associated with reduced opioid and benzodiazepine requirements and few adverse effects. Prospective studies are needed to investigate additional patient outcomes and the independent administration of ketamine by critical care RNs.
1.5 CE Test Hours: Original Research The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care
imageNo abstract available
CE: Breast Cancer Screening A Review of Current Guidelines
imageBreast cancer accounts for more than a quarter million diagnoses each year in the United States. Routine screening is the primary method used to detect cancer in its earliest stages, before symptoms develop. Recent changes to national screening guidelines have resulted in a lack of consensus and confusion among health care providers and the public. This article reviews the guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network and provides guidance to nurses as they support and educate patients.
1.5 CE Test Hours: Breast Cancer Screening A Review of Current Guidelines
imageNo abstract available
Ethics Champion Programs
imageA promising practice to promote moral agency in health care settings.
The Nurse's Part in the Recognition of Cancer of the Breast
Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses’ work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times. This April 1915 article was written by surgeon Howard Lilienthal, the fifth president of the American Association for Thoracic Surgery and the sole author of the first English-language textbook on thoracic surgery. Here he writes to enlist nurses in the early recognition of breast cancer in order to “control this disease by the only means now known”—that is, early diagnosis and immediate surgery. “Your knowledge will enable you to speak with authority and you, almost as much as the surgeon who operates, may be concerned in saving a useful life.” Today, routine mammography can identify breast cancer before it is symptomatic, but there is not yet consensus among key organizations about when screening should begin or how often it should be done. In this issue, Roberta Baron and colleagues review the breast cancer screening guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network to help nurses better interpret and use these recommendations. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
New Medical Residents and Patient Mortality—Does the ‘Nurse Effect’ Lessen the ‘July Effect’?
Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool
imageBackground: Establishing peripheral IV access for infusions is one of the most common invasive procedures performed in the hospital setting, but it isn't always successful on the first attempt. Multiple attempts delay treatment and cause stress in patients and nurses. The literature reports that venipuncture skills are among the most challenging for novice nurses to master. Objectives: The goal of this quality improvement (QI) initiative was to develop, validate, and refine a simple evidence-based tool that novice nurses can use in the clinical setting to better identify those patients with preexisting conditions or anatomical variances that result in difficult IV access. Methods: Novice nurses employed in an urban medical center were enrolled in a vascular access education program with didactic and skill-enhancement components. Based on evidence found in the literature, the QI team developed and piloted a difficult intravenous access (DIVA) tool tailored to the adult patient population served by this institution. Following an initial trial, the tool was further refined and retested with a larger group of novice nurses. In the first phase, there were 94 IV insertion attempts; in the second, there were 971 attempts, for a total of 1,065. The two samples were analyzed independently using descriptive statistics, and Pearson product moment correlation coefficients were calculated to examine the relationship between the DIVA tool and the various factors that could affect the establishment of IV access. Results: Analysis of the first sample showed moderate positive correlations between DIVA tool scores and five variables: tough skin (scars, tattoos, or both), vein not palpable with tourniquet, vein not visible with tourniquet, IV drug use, and chronic renal failure. Analysis of the second sample showed high positive correlations between DIVA tool scores and the two vein visibility variables; moderate positive correlations between DIVA tool scores and chronic renal failure, altered fluid status, diabetes, IV drug use, tough skin (scars, tattoos, or both), and only one arm available; and low positive correlations between DIVA tool scores and frail and/or elderly skin and chemotherapy. Analysis of the degree of correlation between DIVA tool scores and the total number of IV insertion attempts per patient showed a moderate correlation (r = 0.32). All correlations were significant at P < 0.01. Eighty percent of the novice nurses who used the pilot tool and 84% who used the modified tool rated it as a good indicator of the degree of difficulty of IV access. Conclusions: The DIVA tool gave novice nurses a reliable indication of the probable difficulty of an IV insertion and resulted in a change in the IV policy standard at the institution, which now limits the number of peripheral IV insertion attempts to two per nurse and four per patient, bringing current policy into alignment with the 2016 Infusion Therapy Standards of Practice. Use of the revised and validated DIVA tool has the potential to enhance patient comfort and satisfaction and effect significant change in nursing practice.
Antibiotic Treatment for Clostridium difficile Infection in Adults
Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
Nursing Instructor Incivility Toward Students
imageThis article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. In this article, the author discusses instructor incivility toward students, the possible reasons for this behavior, the outcomes of instructor incivility, and suggestions for remediation.
Azithromycin Reduces Childhood Deaths in Africa
According to this study: Mass distribution of oral azithromycin to children in sub-Saharan Africa significantly lowered childhood mortality, as compared with placebo.It is possible that the development of antibiotic resistance could erase the difference, although that effect was not seen in this trial.
Patients with Dementia have Better Surgical Outcomes in Hospitals with Better-Educated Nurses
According to this study: Patients treated in a hospital with better-educated nurses are less likely to die after surgery than those in a hospital with less-well-educated nurses.The benefit is particularly pronounced in patients with dementia.
New Screening Tool Useful in Nurse Recruitment
According to this study: A 16-item scale created from identified characteristics of high-performing nurses is useful in recruiting nurses who best fit an organization's nursing culture.
Nonprescription Treatments are an Option for Many Women with Postmenopausal Vulvovaginal Symptoms
According to this study: Active treatment with either vaginal estradiol tablets or vaginal moisturizer provided no additional benefit over placebo in women with postmenopausal vulvovaginal symptoms.Many women can be treated with a nonprescription vaginal lubricating gel.
We Remember Them, Too
imageA nurse's open letter to families who have lost a child.

Modern Healthcare
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Latest News from Modern Healthcare -

Advanced practice and nurse practitioners bring more profit, productivity to medical practices
Physician-owned practices with more non-physicians earned $100,748 more in net income, according to a new report from the Medical Group Management Association.
NYC nurses to get $20.8 million in gender bias settlement
New York City will pay a group of nearly 1,700 nurses $20.8 million to settle a gender discrimination complaint filed by the U.S. attorney for the Eastern District of New York.
Nurses at Vermont's largest medical center go on strike
About 1,800 unionized nurses at Vermont's largest hospital launched a two-day strike Thursday following unsuccessful contract negotiations, but hospital officials say operations continued with little disruption for patients.
More nurse practitioners now pursue residency programs to hone skills
A growing cadre of nurse practitioners—typically, registered nurses who have completed a master's degree in nursing—tack on up to a year of clinical and other training, often in primary care.
Celebrating a life of faith and service at the century mark
In 2013, Sister Mary Maurita Sengelaub was inducted into Modern Healthcare's Health Care Hall of Fame. This year, she'll be celebrating another milestone as a testament to a lifetime of good health; June 28 will mark Sister Mary Maurita's 100th...
Intermountain piloting app to manage the ebb and flow of nurse staffing
Taking a cue from Uber, Airbnb and other on-demand companies, leaders at Intermountain Healthcare think a mobile app for scheduling nurses and other healthcare workers might help solve their staffing challenges.
Nurses want to delete Zuckerberg name from San Francisco General Hospital
SEIU nurses in San Francisco want to delete the Zuckerberg name from Zuckerberg San Francisco General Hospital
Too much nurse overtime can hinder collaboration
Overtime among nurses is relatively common, but the practice can lead to decreased collaboration with other nurses or physicians even if it's just an hour over the nurse's shift, according to new research.
Week Ahead: Hospital execs swoop into D.C.
Hospital execs and lobbyists will flood the Washington Hilton for the American Hospital Association's annual membership meeting. HHS Secretary Alexa Azar, CMS Administrator Seema Verma, and Sen. Susan Collins (R-Maine) are among the D.C. dignitaries...
Arizona nurse stuns running world at Boston Marathon
A nurse from Banner-University Medical Center in Tucson, Ariz., captured second place at the Boston Marathon, only her second marathon.
Bill would give Virginia nurse practitioners more autonomy
A measure passed by Virginia's General Assembly would allow most types of nurse practitioners with five years of full-time clinical experience to earn approval to practice without maintaining a contract with a physician who oversees them.
Workplace violence prevention plans now required at California hospitals
Starting this week, healthcare facilities in California must have comprehensive plans in place to protect clinicians from workplace violence.
Detroit Medical Center charity care levels questioned by union nurses
Union nurses at a Detroit Medical Center hospital charge that Tenet Healthcare Corp. has violated the terms of its 2013 purchase of DMC. They say charity care has dropped 98% since 2013 at four DMC hospitals.
Hundreds of Quebec doctors say they don't want pay raise
When offered a raise, hundreds of physicians in Quebec just said no. Or at least they've signed a petition protesting the recently negotiated pay hikes.
CMS urged to scrap policy letting nurses evaluate lab tests
Hospital lab personnel are asking the CMS to roll back a 2016 policy that allows nurses to analyze lab tests. The request comes as such tests become more complex and widely used.

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