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Ethical dilemmas in dealing with difficult families

Obstacles can occur when providing treatment to a patient. When the obstacle is the patient’s family crossing boundaries in an attempt to influence a treatment plan, the situation can spiral out of control. This can negatively impact patient care, as well as the work environment of caregivers.

In the March/April 2005 issue of MEDSURG Nursing, Katrina A. Bramstedt, PhD, and co-authors use the case study approach to explore ethical dilemmas that occurred when a family member attempted to dictate the course of treatment for her sick daughter. The mother’s difficult behavior resulted in hospital staff calling for an ethics consult. The mother was required to sign a contract that set limits on her behavior and established consequences for breaking the agreement.

Bramstedt and co-authors offer signs of ethical dilemmas and guidelines to deal with difficult families to help prevent such cases from occurring. An abstract of the study is available on PubMed.

Nursing students provide health care to migrant workers

In June, more than 1,000 migrant farm workers and their families received health care through the Farm Worker Family Health Project, an annual program coordinated by Emory University’s Nell Hodgson Woodruff School of Nursing and a rural health clinic.

For the past 12 years, the two-week program has delivered health care to Georgia’s migrant farm workers, who spend as many as 18 hours a day picking and sorting vegetables by hand. Due to harvest patterns, these workers and their families travel from farm to farm and state to state to find work, allowing little time to tend to their health needs, let alone have a primary care physician or health insurance.

Health concerns of migrant workers include muscle strains, back problems, foot fungus, urinary tract infections, skin rashes, eye infections and diabetes. The addition this year of family nurse-midwives and women’s health practitioners allowed for expanded services for women, including Pap smears and sexual health education.

Judith Wold, RN, PhD, has directed the Emory program since 2002. “Agriculture is one of the most dangerous occupations in the United States,” she said, “and the migrant farm workers are terribly at risk.”

Wold works with Cynthia Hernandez, director of the Ellenton Rural Health Clinic, to ensure the program complements year-round services that the clinic provides. “Over the last 12 years, we’ve been able to reach an additional 12,000 people through the Farm Worker Family Health Project that we could not have seen on our own,” Hernandez said.

Web site offers resources for patient safety

The Joint Commission International Center for Patient Safety has launched a new Web site to serve as a central repository of resources and information related to all aspects of patient safety. Content is relevant for nurses, patients, employers, physicians and pharmacists, as well as health care organizations.

A monthly newsletter, Patient Safety Link, is available for no charge at the site. The newsletter features journal articles, book excerpts and other resources from the Joint Commission on Accreditation of Healthcare Organizations and Joint Commission Resources. Click here to subscribe.

The site will ultimately provide a wide array of practical solutions to improve the safety and quality of patient care in a variety of environments, such as hospitals, outpatient clinics, physician offices, nursing homes, home care settings, behavioral health centers and assisted living facilities.

The International Center for Patient Safety, established in 2005, advocates for patient safety through research and education.

Problems linger for patients with lymphedema

Patients diagnosed with lymphedema as a result of treatment for breast cancer face a much different battle than patients with breast cancer alone, according to a study led by Sheila Ridner, RN, PhD, research associate in nursing at Vanderbilt University.

Lymphedema is the accumulation of fluid in the arm on the same side in which a patient was treated for breast cancer. The problem is caused by damage to the lymphatic system that can happen as a consequence of standard breast cancer treatment.

Ridner examined and interviewed 149 breast cancer patients; 74 participants had previously been diagnosed with lymphedema, and the other 75 did not have the condition.

When looking at differences in physical symptoms, Ridner noticed that women with a larger body mass index (BMI) who had lymphedema had more difficulty keeping the arm size under control medically and experienced more complications.

Psychological symptoms among patients with lymphedema were also measurably different. If women perceived a larger size difference between the lymphedema arm and their other arm, they reported more symptoms, even if the lymphedema was medically controlled. Other psychological issues ranged from a loss of confidence in body image to overall psychological distress.

Although there is no known preventive measure, the risk of developing lymphedema increases with more aggressive treatment in cases of advanced disease, Ridner said. Women who have sentinel node biopsy and do not have radiation to the axilla have a decreased risk of developing lymphedema.

CaringBridge provides high-tech comfort

CaringBridge, a nonprofit organization, offers a free online service that helps families and friends stay connected during medical treatment and other challenging times. More than 25,000 personalized Web pages have been created at http://www.caringbridge.org.

Nurses can recommend this resource to patients and families as a way to keep loved ones informed.

“Families are quickly discovering the profound human connections CaringBridge helps facilitate, and they spread the word,” said Sona Mehring, founder and executive director. “We’ve become a word-of-mouth phenomenon, especially in hospitals.”

Families can create a secure Web page to post journal entries and photographs for their caring community. Visitors who are given the Web page address and password can read updates and post messages of support and encouragement to the family. Nearly 4 million messages have been written.

New software was recently installed to accommodate increased use of the site. The upgrade makes it easier for individuals to build their CaringBridge sites and allows more options in appearance, design and function.

Urology fact sheets available free online

The Society of Urologic Nurses and Associates (SUNA) has posted fact sheets for free download on its Web site, http://www.suna.org. Nurses and urologic health care providers can access these educational materials and place reliable information directly into their patients’ hands.

Topics include male infertility, pessaries, bladder health, kidney stones, overactive bladder, interstitial cystitis and urinary tract infections.

Once in the “Resources” section of the Web site, visitors click on the “Patient Education Fact Sheets” link and select the documents they want to download. SUNA members may access the materials directly; nonmembers are asked to fill out a short form and also may choose to receive e-mail updates when fact sheets are released in the future.

Travel nurse reality show planned

A new reality show, “13 Weeks,” will focus on the lives of six travel nurses relocated to Southern California from all over the United States. The nurses will live in an Orange County mansion and will experience the attractions of a Southern California lifestyle. Some of the nurses also will have personal development goals.

Filming will occur inside hospitals, inside the mansion and on pre-planned events. The show will be comprised of 13 weeks of episodes, as well as a background piece on each of the six nurses.

“As a primary provider of patient care, nurses are unsung heroes,” said Alan Braynin, chief executive officer of Access Nurses, a national travel nurse company. “‘13 Weeks’ will highlight the many exciting facets of the travel nursing profession and showcase nurses as caregivers who change the lives of many.”

New documentary to focus on men in nursing

Davis Gray Productions has begun shooting scenes and interviews for a documentary, “Career Encounters: Men in Nursing,” produced under the auspices of the American Assembly for Men in Nursing (AAMN).

Men represent a largely untapped resource to help alleviate the critical nursing shortage. By most estimates, less than 7 percent of U.S. nurses are men. This program will feature about 10 men, all RNs, who will tell why they chose nursing, what difficulties they encountered entering a traditionally female profession and what they think could be done to attract more men to nursing.

The documentary will be available for broadcast by public television stations and will be distributed in video and DVD formats to high schools, colleges, libraries and career counseling centers.

“We are delighted to be sponsoring this program,” said Jim Raper, RN, JD, president of AAMN. “[We] expect that it will go a long way toward changing some of the stereotyping and misplaced perceptions that can discourage males who might otherwise become professional nurses.”

Creating a culture of nurse retention in home care agencies

Home care administrators should implement strategies that create a culture of nurse retention, according to a study by Linda Flynn, assistant professor at Rutgers College of Nursing. “The Importance of Work Environment: Evidence-Based Strategies for Enhancing Nurse Retention” is featured in the June issue of Home Healthcare Nurse (volume 23, issue 5).

Research over nearly two decades, based on the Nursing Work Index-Revised, indicates that organizational traits such as professional autonomy, collaborative relationships with physicians and access to resources needed to provide quality care are associated with higher nurse retention and lower inpatient mortality in hospitals. Little is known, however, about the impact of these same organizational traits on nurses and patients in other settings, such as home health care agencies.

According to the survey, the most important work environment attributes include working with nurses who are clinically competent, establishing a good orientation program for newly employed nurses, having a plan of care that is accessible and up-to-date for all patients, and employing enough registered nurses to provide quality care.

This study is the third phase of a multifaceted investigation. Subsequent studies will investigate the effects of these traits on the outcomes of patient care in home health care services. An abstract of the study is available on PubMed.