Pub Date : 2016-05-01DOI: 10.1097/NUR.0000000000000210
J. Fulton
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Pub Date : 2016-05-01DOI: 10.1097/NUR.0000000000000200
J. Young-Mason
Anumber of years ago, as a consultant to a rural community hospital Healing Environment Committee, I recommended that TVs, piped-in music, and inappropriate magazines be removed from all waiting rooms. Most of the waiting rooms in the hospital opened out intomain corridors. The cacophony of the TVs andmusic combined was disconcerting, interrupting conversation and thought. Although committee members agreed that this was so, some thought that the community wanted and even needed the TV for distraction. They feared a backlash of anger. Discussions ensued, and it was pointed out by some that the choice of a TV program was usually made by one person and others present were expected to go along with that choice, even the level of sound. Another shared the fact that staff picked themusic in the laboratory waiting room, patients were never asked. It is important here to note ethnomusicologist Elizabeth Miles’ words on the implications of listening to other’s music choices. ‘‘Any time you listen to music that someone else has chosen you are allowing other people to color yourmood and control your body and mind.’’ The selection of magazines available was insensitive to the plight of thosewaiting, somewere an insult to their intelligence. None were in languages other than English. After lengthydiscussions, itwasdecided that itwould be a worthwhile endeavor to conduct a time-limited trial of media-free waiting rooms and the elimination of offensive magazines. Response boxes with blank page composition bookswere installed in eachwaiting room and commentary began to appear. The initial responseswere not overwhelmingly in favor of the proposal, but as timewent on, the peace and quiet began to be favored. It is always interesting to read invited ongoing commentary and to learn how thoughtful responses influence others in a way nothing else can. Some were surprised to be given a choice; others were grateful for the quiet. Some choice words and advice was shared about the problematic magazines. Then, the committee, in concert with patient and family representatives, began to introduce literature that spoke to this community’s citizens: books and magazines about nature, floral design, art, architecture, and photography; short story collections; and literary journals with poetry. In consultation with community teachers, intriguing, appropriate literature was selected for children and teenagers. Then one remarkable day, I encountered two teenage girls sitting in the Radiology Waiting Area, and wonder of wonders, they were reading poetry to one another from one of the journals in the waiting room. One said to the other, ‘‘Wait, listen to this!’’ And then she read an entire poem to her friend with full inflection and strong voice. Her friend listened intently to her. They never noticed me standing in the doorway. Today, entering a clinic or hospital waiting room, you will see people looking intently at their cell phones screensIscrolling up and down, reading and sendi
{"title":"Why Not Poems in the Waiting Room?","authors":"J. Young-Mason","doi":"10.1097/NUR.0000000000000200","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000200","url":null,"abstract":"Anumber of years ago, as a consultant to a rural community hospital Healing Environment Committee, I recommended that TVs, piped-in music, and inappropriate magazines be removed from all waiting rooms. Most of the waiting rooms in the hospital opened out intomain corridors. The cacophony of the TVs andmusic combined was disconcerting, interrupting conversation and thought. Although committee members agreed that this was so, some thought that the community wanted and even needed the TV for distraction. They feared a backlash of anger. Discussions ensued, and it was pointed out by some that the choice of a TV program was usually made by one person and others present were expected to go along with that choice, even the level of sound. Another shared the fact that staff picked themusic in the laboratory waiting room, patients were never asked. It is important here to note ethnomusicologist Elizabeth Miles’ words on the implications of listening to other’s music choices. ‘‘Any time you listen to music that someone else has chosen you are allowing other people to color yourmood and control your body and mind.’’ The selection of magazines available was insensitive to the plight of thosewaiting, somewere an insult to their intelligence. None were in languages other than English. After lengthydiscussions, itwasdecided that itwould be a worthwhile endeavor to conduct a time-limited trial of media-free waiting rooms and the elimination of offensive magazines. Response boxes with blank page composition bookswere installed in eachwaiting room and commentary began to appear. The initial responseswere not overwhelmingly in favor of the proposal, but as timewent on, the peace and quiet began to be favored. It is always interesting to read invited ongoing commentary and to learn how thoughtful responses influence others in a way nothing else can. Some were surprised to be given a choice; others were grateful for the quiet. Some choice words and advice was shared about the problematic magazines. Then, the committee, in concert with patient and family representatives, began to introduce literature that spoke to this community’s citizens: books and magazines about nature, floral design, art, architecture, and photography; short story collections; and literary journals with poetry. In consultation with community teachers, intriguing, appropriate literature was selected for children and teenagers. Then one remarkable day, I encountered two teenage girls sitting in the Radiology Waiting Area, and wonder of wonders, they were reading poetry to one another from one of the journals in the waiting room. One said to the other, ‘‘Wait, listen to this!’’ And then she read an entire poem to her friend with full inflection and strong voice. Her friend listened intently to her. They never noticed me standing in the doorway. Today, entering a clinic or hospital waiting room, you will see people looking intently at their cell phones screensIscrolling up and down, reading and sendi","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"390 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123196662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.1097/NUR.0000000000000199
C. J. Thompson
D isruptive innovation. It sounds messy, and rebellious. You may have run across this term in the leadership or business literature. Although disruptive innovation seems to be the new buzzword, the concept itself has been around a long time. For example, ‘‘creative destruction’’ defined businesses that took advantage of new technology and was coined by Schumpeter in the 1930s; in 1989, ‘‘permanent white water’’ denoted the turmoil and chaos in a changingworld, and the use of terms such as reengineering, reinvention, and healthcare reform in recent decades brings visions of change and chaos. However, the goal of disruptive innovation is not to bring chaos but to provide value to underservedmarkets. The innovation’s purpose is to transform an existingmarket or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo. Initially, a disruptive innovation is formed in a niche market that may appear unattractive or inconsequential to industry incumbents, but eventually the new product or idea completely redefines the industry.6({2) Personal computers, cellular phones, and the Internet are examples of disruptive innovation. In fact, the Internet has been identified as the number 1 disruptive force in recent history. The theory of disruptive innovation was created by Dr Clayton Christensen from Harvard University and posits that transformation in any industry occurs when small entities disrupt larger ones by focusing on efficient and economical processes and procedures as simpler solutions for complex problems; the disruptors also focus on a new or underserved market of consumers. It is important to note that the impetus behind the disruption is not to improve a product, but to meet consumers’ unmet needs. Because these innovations upset the status quo, they are resisted and frequently ignored by those stakeholders, as inconsequential. However, disruptions can also cause the larger entities to innovate to defend theirmarket sector. The goals of both types of innovations (disruptive and defensive), if successful, lead to positive outcomes for the consumer. Disruptive innovation is not confined to the business world, though; so let us talk about disruptive innovations in healthcare and education. The passage of the Patient Protection and Affordable Care Act in 2010 was, and remains, the impetus for much disruption in healthcare deliveryVand ultimately for nursingeducation. Theestablishmentof clinical nurse specialists (CNSs), nurse practitioners, and other advanced practice nurses to address unmet consumer needs has also been labeled as a disruptive innovation in healthcare delivery. Indeed, CNSs have been at the forefront of disruptive change by challenging the status quo and designing innovative processes and procedures to improve the delivery of healthcare and promote positive patient outcomes. The growth of independent primary care andurgent care clinics in retail establishments
D颠覆性创新。这听起来很混乱，很叛逆。你可能在领导力或商业文献中遇到过这个术语。虽然颠覆性创新似乎是一个新的流行语，但这个概念本身已经存在很长时间了。例如，熊彼特(Schumpeter)在上世纪30年代创造的“创造性破坏”(creative destruction)定义了利用新技术的企业;1989年，“永久白水”指的是不断变化的世界中的动荡和混乱，近几十年来，诸如再造、再发明和医疗改革等术语的使用带来了变革和混乱的愿景。然而，颠覆性创新的目标不是带来混乱，而是为服务不足的市场提供价值。创新的目的是通过引入简单、方便、可访问性和可负担性来改变现有的市场或行业，而现状是复杂和高成本。最初，颠覆性创新是在一个利基市场形成的，这个利基市场对行业现有者来说可能看起来没有吸引力或无关紧要，但最终，新的产品或想法完全重新定义了这个行业。个人电脑、手机和互联网都是颠覆性创新的例子。事实上，互联网已经被认为是近代历史上最具颠覆性的力量。颠覆性创新理论是由哈佛大学的克莱顿·克里斯滕森博士创立的，他认为任何行业的转型都是在小企业通过专注于高效、经济的流程和程序，作为复杂问题的简单解决方案，从而颠覆大型企业时发生的;这些颠覆者还专注于一个新的或服务不足的消费者市场。值得注意的是，颠覆背后的推动力不是为了改进产品，而是为了满足消费者未被满足的需求。由于这些创新颠覆了现状，它们受到了利益相关者的抵制，并经常被他们视为无关紧要。然而，破坏也可能导致较大的实体通过创新来捍卫自己的市场领域。两种类型的创新(破坏性和防御性)的目标，如果成功，会给消费者带来积极的结果。然而，颠覆性创新并不局限于商业世界;让我们来谈谈医疗和教育领域的颠覆性创新。2010年通过的《患者保护和平价医疗法案》(Patient Protection and Affordable Care Act)过去是，现在仍然是医疗保健服务中断的动力，并最终导致护理教育中断。临床专科护士(CNSs)、执业护士和其他高级执业护士的建立，以解决未满足的消费者需求，也被标记为医疗保健服务的颠覆性创新。事实上，通过挑战现状和设计创新流程和程序来改善医疗保健服务并促进积极的患者结果，CNSs一直处于颠覆性变革的前沿。零售机构中独立初级保健和紧急护理诊所的增长(越来越多地配备执业护士和/或医师助理)以及该国农村和偏远地区的远程保健应用是医疗保健领域颠覆性创新的其他例子。为了回应对这一现象日益增长的认识，《护理管理杂志》正在实施一个新的专栏，以确定医疗机构中发生的破坏性创新的过程和影响。作者单位:科罗拉多州南福克CJT咨询与教育公司总裁兼首席执行官。作者报告无利益冲突。通信:Cathy J. Thompson, PhD, RN, CCNS, CNE, CJT咨询与教育，邮政信箱1263,South Fork, CO 81154 (cathyj. Thompson)。thompson@hotmail.com)。DOI: 10.1097 / NUR.0000000000000199
{"title":"Disruptive Innovation in Graduate Nursing Education: Leading Change.","authors":"C. J. Thompson","doi":"10.1097/NUR.0000000000000199","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000199","url":null,"abstract":"D isruptive innovation. It sounds messy, and rebellious. You may have run across this term in the leadership or business literature. Although disruptive innovation seems to be the new buzzword, the concept itself has been around a long time. For example, ‘‘creative destruction’’ defined businesses that took advantage of new technology and was coined by Schumpeter in the 1930s; in 1989, ‘‘permanent white water’’ denoted the turmoil and chaos in a changingworld, and the use of terms such as reengineering, reinvention, and healthcare reform in recent decades brings visions of change and chaos. However, the goal of disruptive innovation is not to bring chaos but to provide value to underservedmarkets. The innovation’s purpose is to transform an existingmarket or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo. Initially, a disruptive innovation is formed in a niche market that may appear unattractive or inconsequential to industry incumbents, but eventually the new product or idea completely redefines the industry.6({2) Personal computers, cellular phones, and the Internet are examples of disruptive innovation. In fact, the Internet has been identified as the number 1 disruptive force in recent history. The theory of disruptive innovation was created by Dr Clayton Christensen from Harvard University and posits that transformation in any industry occurs when small entities disrupt larger ones by focusing on efficient and economical processes and procedures as simpler solutions for complex problems; the disruptors also focus on a new or underserved market of consumers. It is important to note that the impetus behind the disruption is not to improve a product, but to meet consumers’ unmet needs. Because these innovations upset the status quo, they are resisted and frequently ignored by those stakeholders, as inconsequential. However, disruptions can also cause the larger entities to innovate to defend theirmarket sector. The goals of both types of innovations (disruptive and defensive), if successful, lead to positive outcomes for the consumer. Disruptive innovation is not confined to the business world, though; so let us talk about disruptive innovations in healthcare and education. The passage of the Patient Protection and Affordable Care Act in 2010 was, and remains, the impetus for much disruption in healthcare deliveryVand ultimately for nursingeducation. Theestablishmentof clinical nurse specialists (CNSs), nurse practitioners, and other advanced practice nurses to address unmet consumer needs has also been labeled as a disruptive innovation in healthcare delivery. Indeed, CNSs have been at the forefront of disruptive change by challenging the status quo and designing innovative processes and procedures to improve the delivery of healthcare and promote positive patient outcomes. The growth of independent primary care andurgent care clinics in retail establishments ","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124278198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1097/NUR.0000000000000188
Marlena Seibert Primeau
Healthcare is organic. This fundamental aspect of healthcare was slowly recognized and acknowledged over my years of teaching a Global Health course and traveling abroadwith students. After interacting with nurses, medical personnel, and the general public in various countries, it became evident that a nation’s healthcare system is not just a static entity. Healthcare is created, then grows, develops, and changes according to the needs of anation and the culture, history, andpersonality of its citizens. Beginning in the late 1970s, a Public Broadcasting System documentary series entitled Connections (An Alternate View of Change) looked at science and inventions from both an interdisciplinary perspective and as a largely unintentional interaction of discrete events. As creator and science historian James Burke noted, the development of anything in our world cannot be viewed as a singular event, but rather as a network of interrelated events, with each of those events occurring for various individual reasons with no awareness of the possible future results. Burke suggested several corollaries to his theory: first, that the modern world has no ideawhere today’s ‘‘isolated’’ eventswill lead, second that the probable increase in both speed and complexity of these connections will impact individual freedom and privacy, and third, the probable consequences to the entire system in case of a breakup or collapse of one of the interconnected networks. In many ways, healthcare systems mimic Burke’s theory on how the world interconnects. Healthcare does not occur in isolation; it is developed and changed by people, events, and the connections between them. History, culture, education, politics, and geography all play an integral part in contemporary healthcare; comparisons of these topics add dimension and depth to the learning experienced and insight developed by the students in my Global Health course. What does historical perspective bring to understanding healthcare systems, and what role does a nation’s history play in current-day healthcare? The history of a nation illuminates that nation’s view of individual health and the development of its healthcare system. The aftermath of war, the immediacy of a national trauma, and the realities of public health concerns, such as infectious disease or a widespread disaster, all help determine the role that healthcare plays in the lives of a country’s citizens. Inmany parts of Europe, World War II is not just a distant memory; it is a remembrance that is integral to the national consciousness. With the influx of refugees, the damaged cities, and the necessary rebuilding of a society, systemic programs such as universal health coveragewere both an imperative and a reasonable solution for the postwar problems experienced by many European countries. William Beveridge, one of the creators of Britain’swelfare state, said in 1948 that ‘‘social security and world security were indissolubly linked.’’ Professional nursing
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Pub Date : 2016-03-01DOI: 10.1097/NUR.0000000000000185
S. Alexander
More and more nurses are beginning businesses for many reasons: wound care, family therapy, in-home respite services, and acute/chronic patient management. Owning a business can be a fulfilling and flexible way to build a career, or it can be a professional nightmare. According to the US Department of Labor Statistics, half of all small businesses will fail within 5 years, and only a third survive 10 years or more. For nurses who want to start their own businesses, taking the time to plan a strategy of business design, implementation, and ownership can contribute to long-term success. Use your head. The first key investment is the timeneeded to create a solid business plan,which should begin asmuch as a year before the doors of a new company are ready to open. Think carefully about realistic short-, mid-, and longterm goals. The bottom line for any business is revenue generation, and this entails more complexity in the world of healthcare. For example, howmanypatientswill need to be seendaily to create the cash flowneeded to sustain daily operations, while building capital for other projects? Lending agencies will likely want to review this business plan as they work with potential borrowers to design the best financial strategies for new companies. In the beginning, an attorney, preferablywith a specialty in business law, will be needed to assist with creating the articles of incorporation for the company and obtaining tax identification numbers and to offer expertise on the intricacies of state and local business permits and licensing. To prepare the physical site of the business, the negotiation of building leases or purchases, repair and/or renovations contracts that may be necessary, and follow-up inspections to ensure that local building codes are met is needed. For many health-related businesses, having a location near the local hospital maximizes visibility for those patients whomay be unattached to providers and in need of care. An attractive building,with easy-to-access entrances, bright lighting, and lots of parking,may be especially appealing to patient populations such as older adults or familieswith small children. Manage the bottom line. The cycle of revenue generation is vitally important to a business; in healthcare, this begins with providers’ ability to produce cash flow. To bill third-party reimbursers, healthcare providersmust be credentialed with each insurer. The process of credentialing can be lengthy, taking 3 to 6 months or more with some reimbursers. Once the physical and mailing addresses of the business are established, the process of credentialing can begin. Retaining a billing agency that can comprehensively manage the credentialing process simultaneously for multiple insurers is a strategy that has been suggested by practice owners as a method to both initiate and maintain cash flow from day 1 of operations (C. Landrum, personal communication, October 8, 2015). Creating financial policies for the business, with rev
越来越多的护士开始创业，原因有很多:伤口护理、家庭治疗、居家休息服务、急慢性病人管理。拥有一家企业可以是一种充实而灵活的职业发展方式，也可以是一场职业噩梦。根据美国劳工统计局的数据，一半的小企业将在5年内倒闭，只有三分之一的小企业能存活10年或更长时间。对于想要自己创业的护士来说，花时间规划业务设计、实施和所有权的战略有助于取得长期成功。动动脑筋。第一个关键投资是制定一个可靠的商业计划所需的时间，它应该在新公司准备开业前一年开始。仔细考虑现实的短期、中期和长期目标。任何业务的底线都是创收，这在医疗保健领域带来了更多的复杂性。例如，每天需要多少病人来创造维持日常运营所需的现金流，同时为其他项目筹集资金?贷款机构在与潜在借款人合作，为新公司设计最佳财务策略时，可能会想要审查这份商业计划。一开始，最好是在商业法律方面有专长的律师，将需要协助创建公司章程，获得税务识别号码，并提供有关州和地方商业许可和执照的复杂专业知识。为了准备业务的实际场地，可能需要的建筑租赁或购买谈判，维修和/或翻新合同，以及后续检查以确保符合当地建筑规范。对于许多与健康相关的企业来说，在当地医院附近设有一个位置，可以最大限度地为那些可能与供应商无关但需要护理的患者提供服务。一个有吸引力的建筑，有易于进入的入口，明亮的照明和大量的停车场，可能特别吸引患者群体，如老年人或有小孩的家庭。管理底线。盈利周期对企业来说至关重要;在医疗保健领域，这始于供应商产生现金流的能力。要向第三方报销人开具账单，医疗保健提供者必须获得每个保险公司的认证。认证的过程可能很长，需要3到6个月甚至更长时间。一旦建立了企业的实体地址和邮寄地址，认证过程就可以开始了。聘请一家能够同时为多家保险公司全面管理认证流程的结算机构是一种策略，这是一种从运营第一天开始启动和维持现金流的方法(C. Landrum, personal communication, 2015年10月8日)。在业务开始之前，还需要在法律顾问的审查下为业务制定财务政策，以便在客户见到之前确定收入周期的关键步骤。这些政策也需要得到实践管理系统的支持。在计费系统中建立支付费用时间表可以消除随着患者数量增长而出现的错误。在21世纪，医疗保健实践的有效管理需要使用电子健康记录(EHRs)来管理患者就诊、日程安排和计费。许多(EHR)系统包含所有这3个功能。花时间研究这些系统以及如何将它们集成到日常工作流程中是很重要的。考虑生产效率目标，系统使用的便利性，对临床指南的依从性，以及系统将如何运行。作者报告无利益冲突。通信:SusanAlexander, DNP,ANP-BC, ADM-BC, 301 Sparkman Dr, Huntsville, AL 35899 (susan.alexander@uah.edu)。DOI: 10.1097 / NUR.0000000000000185
{"title":"Nurses in Business: The Time Is Now.","authors":"S. Alexander","doi":"10.1097/NUR.0000000000000185","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000185","url":null,"abstract":"More and more nurses are beginning businesses for many reasons: wound care, family therapy, in-home respite services, and acute/chronic patient management. Owning a business can be a fulfilling and flexible way to build a career, or it can be a professional nightmare. According to the US Department of Labor Statistics, half of all small businesses will fail within 5 years, and only a third survive 10 years or more. For nurses who want to start their own businesses, taking the time to plan a strategy of business design, implementation, and ownership can contribute to long-term success. Use your head. The first key investment is the timeneeded to create a solid business plan,which should begin asmuch as a year before the doors of a new company are ready to open. Think carefully about realistic short-, mid-, and longterm goals. The bottom line for any business is revenue generation, and this entails more complexity in the world of healthcare. For example, howmanypatientswill need to be seendaily to create the cash flowneeded to sustain daily operations, while building capital for other projects? Lending agencies will likely want to review this business plan as they work with potential borrowers to design the best financial strategies for new companies. In the beginning, an attorney, preferablywith a specialty in business law, will be needed to assist with creating the articles of incorporation for the company and obtaining tax identification numbers and to offer expertise on the intricacies of state and local business permits and licensing. To prepare the physical site of the business, the negotiation of building leases or purchases, repair and/or renovations contracts that may be necessary, and follow-up inspections to ensure that local building codes are met is needed. For many health-related businesses, having a location near the local hospital maximizes visibility for those patients whomay be unattached to providers and in need of care. An attractive building,with easy-to-access entrances, bright lighting, and lots of parking,may be especially appealing to patient populations such as older adults or familieswith small children. Manage the bottom line. The cycle of revenue generation is vitally important to a business; in healthcare, this begins with providers’ ability to produce cash flow. To bill third-party reimbursers, healthcare providersmust be credentialed with each insurer. The process of credentialing can be lengthy, taking 3 to 6 months or more with some reimbursers. Once the physical and mailing addresses of the business are established, the process of credentialing can begin. Retaining a billing agency that can comprehensively manage the credentialing process simultaneously for multiple insurers is a strategy that has been suggested by practice owners as a method to both initiate and maintain cash flow from day 1 of operations (C. Landrum, personal communication, October 8, 2015). Creating financial policies for the business, with rev","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129292919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1097/NUR.0000000000000180
J. Young-Mason
Ihave been haunted for a very long time by Greg Lum’s piercing narrative about the spiritual and psychological exile he descended into after an accident irrevocably altered his life. There was life before the accident and life after. His life before was full of promise and the enjoyment of the culture of theater and music with his friends. He was writing his PhD dissertation on dramatic adaptations of classical works of literature. His life after the accident was centeredon attempts to find relief from severe and constant pain. On his journey to find relief, he encountered healthcare providers who insisted that he was getting something out of being in pain, others who withheld medication until he ‘‘begged’’ essentially blaming him for his afflictions just as ‘‘Job’s friends blamed him for his.’’ He found somemeasure of control over his life when he began going to a pain clinic and exercising more regularly. ‘‘I see that I can have some say and can take a more active role in dealing with the symptoms even if no one else can determine what’s wrong with me. But what I don’t need is psychobabble on top of trying to cope with pain.’’ Lum describes the problematic effects of pain and antidepressantmedications on his cognition. He is angered by the burden of guilt imposed upon him by those who could not diagnose the sources of pain throughout his body. And then there is the sadness that he is unable to finish his dissertation. ‘‘I suspect thatwhat orwho I am is decided bywhat kind of pain, and howmuch pain I’m in. I can no longer remember a timewhen Iwasn’t in pain. The last 7 years have pretty muchbecome fused and fuzzy and haveoverwhelmed any memories of my life before this intense, chronic pain that has changed my life to an existence. I can recall only colorless memories of what I’ve done in the past, such as traveling, living, and studying abroad, but I can’t remember what they felt like because pain filters and interferes with even my memories. I can’t call up memories of physical activities. For instance, I can recall going to the Comédie Francaise, but I can’t remember actually sitting through Le Bourgeois Gentilhomme for however long it lasts and recalling how it felt to be so caught up in the play that I’d forget myself, because if I try, all I can call up is how painful it would be now to even go to such an event. (I angered my neighboring spectators at the last play I saw because I couldn’t sit still.).’’ Livingwith severe and chronic pain can be a life lived in exile. Greg Lum’s life after his accident echoes Sophocles’ Philoctetes, who was abandoned on an uninhabited island after being crippled by a wound that would not heal. His incessant cries of agony and complaint and the malodorous wound were unbearable to his comrades in the Greek Army. Certain encounters that Greg Lum experienced with healthcare ‘‘providers’’ left him overwhelmed with anger and sense of abandonment. At times it seemed as though no one knew what to do or how to help
{"title":"Greg Lum's \"Prisoner of Pain\".","authors":"J. Young-Mason","doi":"10.1097/NUR.0000000000000180","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000180","url":null,"abstract":"Ihave been haunted for a very long time by Greg Lum’s piercing narrative about the spiritual and psychological exile he descended into after an accident irrevocably altered his life. There was life before the accident and life after. His life before was full of promise and the enjoyment of the culture of theater and music with his friends. He was writing his PhD dissertation on dramatic adaptations of classical works of literature. His life after the accident was centeredon attempts to find relief from severe and constant pain. On his journey to find relief, he encountered healthcare providers who insisted that he was getting something out of being in pain, others who withheld medication until he ‘‘begged’’ essentially blaming him for his afflictions just as ‘‘Job’s friends blamed him for his.’’ He found somemeasure of control over his life when he began going to a pain clinic and exercising more regularly. ‘‘I see that I can have some say and can take a more active role in dealing with the symptoms even if no one else can determine what’s wrong with me. But what I don’t need is psychobabble on top of trying to cope with pain.’’ Lum describes the problematic effects of pain and antidepressantmedications on his cognition. He is angered by the burden of guilt imposed upon him by those who could not diagnose the sources of pain throughout his body. And then there is the sadness that he is unable to finish his dissertation. ‘‘I suspect thatwhat orwho I am is decided bywhat kind of pain, and howmuch pain I’m in. I can no longer remember a timewhen Iwasn’t in pain. The last 7 years have pretty muchbecome fused and fuzzy and haveoverwhelmed any memories of my life before this intense, chronic pain that has changed my life to an existence. I can recall only colorless memories of what I’ve done in the past, such as traveling, living, and studying abroad, but I can’t remember what they felt like because pain filters and interferes with even my memories. I can’t call up memories of physical activities. For instance, I can recall going to the Comédie Francaise, but I can’t remember actually sitting through Le Bourgeois Gentilhomme for however long it lasts and recalling how it felt to be so caught up in the play that I’d forget myself, because if I try, all I can call up is how painful it would be now to even go to such an event. (I angered my neighboring spectators at the last play I saw because I couldn’t sit still.).’’ Livingwith severe and chronic pain can be a life lived in exile. Greg Lum’s life after his accident echoes Sophocles’ Philoctetes, who was abandoned on an uninhabited island after being crippled by a wound that would not heal. His incessant cries of agony and complaint and the malodorous wound were unbearable to his comrades in the Greek Army. Certain encounters that Greg Lum experienced with healthcare ‘‘providers’’ left him overwhelmed with anger and sense of abandonment. At times it seemed as though no one knew what to do or how to help ","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115621311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1097/NUR.0000000000000192
P. O'Malley
Despite the availability, safety, and efficacy of novel oral anticoagulants (NOACs) compared with warfarin, acceptance and use have been hampered by lack of a specific reversal agent. Thismay be part of the reasonwhy anticoagulants remainwidely underprescribed for stroke prevention in atrial fibrillation. The lack of an antidote to reverse NOACs in emergent situations such as lifethreatening bleeding or emergentmajor surgery has been a significant clinical issue until now. The recent approval of idarucizumab (Praxbind; Boehringer Ingelheim, Ridgefield, Connecticut) to reverse the anticoagulant effects of dabigatran (Pradaxa; Boehringer Ingelheim) has resulted in the first and only NOAC with a specific reversal agent. Pradaxa was approved in 2010 to prevent stroke and systemic blood clots in patients with atrial fibrillation and for the treatment and prevention of deep venous thrombosis and pulmonary embolism without a specific reversal agent. Now, Praxbind has been approved specifically for Pradaxa under the FDA’s accelerated approval program (http://www.fda.gov/ForPatients/Approvals/Fast/ucm405447 .htm), which permits drug approval for serious conditions that is likely to provide a clinical benefit.
{"title":"The Antidote Is Finally Here! Idarucizumab, A Specific Reversal Agent for the Anticoagulant Effects of Dabigatran.","authors":"P. O'Malley","doi":"10.1097/NUR.0000000000000192","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000192","url":null,"abstract":"Despite the availability, safety, and efficacy of novel oral anticoagulants (NOACs) compared with warfarin, acceptance and use have been hampered by lack of a specific reversal agent. Thismay be part of the reasonwhy anticoagulants remainwidely underprescribed for stroke prevention in atrial fibrillation. The lack of an antidote to reverse NOACs in emergent situations such as lifethreatening bleeding or emergentmajor surgery has been a significant clinical issue until now. The recent approval of idarucizumab (Praxbind; Boehringer Ingelheim, Ridgefield, Connecticut) to reverse the anticoagulant effects of dabigatran (Pradaxa; Boehringer Ingelheim) has resulted in the first and only NOAC with a specific reversal agent. Pradaxa was approved in 2010 to prevent stroke and systemic blood clots in patients with atrial fibrillation and for the treatment and prevention of deep venous thrombosis and pulmonary embolism without a specific reversal agent. Now, Praxbind has been approved specifically for Pradaxa under the FDA’s accelerated approval program (http://www.fda.gov/ForPatients/Approvals/Fast/ucm405447 .htm), which permits drug approval for serious conditions that is likely to provide a clinical benefit.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129270923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-09-01DOI: 10.1097/01.NUR.0000289749.77866.7c
Deborah L Volker, Michael Limerick
Purpose: The purpose of this study was to explore the concept of dignified dying from the perspective of oncology advanced practice nurses.
Methodology: A naturalistic, hermeneutic approach was used to interview the study participants. A sample of 19 oncology advanced practice nurses was obtained by combining data sets from 2 larger studies of patient control and end-of-life care. Audiotaped interviews of the nurses were transcribed verbatim and were analyzed using a phenomenological approach.
Results: The analysis revealed that dignified dying is an experience that includes the following themes: going in peace, maintaining bodily integrity, and dying on their own terms.
Conclusions: Advanced practice nurses lend an important perspective that expands understanding of the concept of dignified dying. Future studies of patient and family perceptions will enhance knowledge of their needs and lead to intervention studies to promote an end-of-life experience that is consistent with patient priorities and values.
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