《美国护理杂志》2016年10月总第116卷第10期
American Journal of Nursing
October 2016 - Volume 116 - Issue 10
pp: 7-72
Editorial
Choosing a President
Viewpoint
Should Health Care Providers Support Electronic Cigarettes for Smoking Cessation?
医疗保健人员应否支持用电子香烟戒烟
Electronic cigarettes (ECs) are battery-powered vaporizing devices that heat liquid containing nicotine and other ingredients into an aerosol for inhalation. Since the introduction of ECs in the mid-2000s, there has been a steady increase in their use among cigarette smokers intending to quit. However, there is ongoing debate concerning the use of ECs in smoking cessation. Until sufficient long-term evidence shows that ECs are a safe and effective smoking cessation aid, health care providers should not support their use.
Letters, etc
Mentoring New Nurses
新护士的蒙导
“Effective Mentoring in the Clinical Setting” (Teaching for Practice, April) provided excellent information on mentoring new nurses. As an experienced nurse, I've seen new nurses struggle during their transition to the clinical setting. The biggest obstacle I've seen is the giving and receiving of feedback.
Palliative Nursing
姑息性护理
My brother battled stage IV malignant melanoma for 18 months; a battle he lost on July 1. I was very involved over the course of his disease process. As my first nursing job had been on an oncology–-hematology unit, I felt I had something to offer. What I saw at his cancer center was that no one was willing to suggest that my brother wasn't responding to treatment and that maybe we should consider helping him and his wife prepare for his imminent death. What I saw was a cancer center more interested in giving chemotherapy (probably because my brother had good insurance) until he took his last breath, rather than helping him deal with his fear and pain.
许可验尸的死亡
Even with improved laboratory testing, imaging, and technology, there remains an important role for the autopsy in clinical medicine. Autopsies can enhance our understanding of disease and how we die. They may also provide legal evidence, as well as relieve the stress of the unknown. However, consented autopsy is on the verge of extinction. The rate of autopsies has plummeted over the decades. It is estimated that an increasing number of the 2.5 million Americans who die each year do so without being examined at all.
In the News
Improving Safety in Older Drivers
提高老年驾驶的安全性
The aging of the U.S. population has created an important public health issue: safety and the older driver. Nearly half of all drivers today are older than 65 years, a proportion expected to increase significantly. This group has the highest accident rate per mile among all age groups. Moreover, drivers with dementia have double the risk of an accident compared with people their age without dementia.
NewsCAP: State prescription drug monitoring programs prevent about one death from opioid overdoses per 100,000 people
新闻头条：州处方药监控计划预防1/100000的阿片过量死亡
State prescription drug monitoring programs prevent about one death from opioid overdoses per 100,000 people, reports Health Affairs in its July issue. The greatest reduction in overdose deaths occurs in states that monitor four or more drugs and update their data at least weekly. States with more effective programs could have 1.55 fewer deaths per 100,000 people, compared with those with less effective programs. Overall opioid overdose deaths rose from 1.4 per 100,000 people in 1999 to 6.2 per 100,000 people in 2013. All states but Missouri have prescription drug monitoring programs.
Five Variables Predict Whether Newly Licensed Nurses Stay on a Unit or Transfer
五个变量可预测新护士是否留下或转岗
High job turnover among RNs who leave one hospital for another can be costly for employers and society as a whole, but less is known about the impact of nurse transfers between units of a single health care organization.
NewsCAP: Deaths in EDs fell 48% between 1997 and 2011
新闻头条：1997-2011急诊室死亡下降48%
Deaths in EDs fell 48% between 1997 and 2011. The study, reported in the July Health Affairs, found that 63% of ED visits that resulted in deaths involved patients who were either dead on arrival, had cardiopulmonary arrest, or were unconscious. Shortness of breath accounted for 8%, injuries for 5%, and chest pain for 4% of ED visits that resulted in deaths. An increase in palliative care partly explains the decline in ED deaths, since more patients now die in hospices or at home. For example, from 1989 to 2007, the proportion of home deaths increased 50%, while hospital deaths decreased 20%. Some cities also allow paramedics to forgo resuscitation for cardiac arrest under certain conditions. Better treatments for stroke, trauma, sepsis, and other traumatic conditions also may be factors in the decline in ED deaths
NewsCAP: Several prescription and nonprescription drugs may exacerbate heart failure
新闻头条：几种处方和非处方药可能加重心衰
Several prescription and nonprescription drugs may exacerbate heart failure. Many patients 65 years and older have heart failure, and the diagnosis is becoming more common. These patients typically see several health care providers, not all of whom communicate adequately about treatment plans, resulting in potentially harmful polypharmacy. To address these issues and provide guidance for clinicians, the American Heart Association has published a comprehensive list of the agents—prescription and nonprescription—that can exacerbate heart failure in this population. Categories addressed include analgesics, anesthetics, and disease-specific drugs such as antidiabetic and chemotherapy agents.
Britain Honors Mary Seacole with a Memorial
英国隆重纪念Mary Seacole
Affectionately called “Mother Seacole” by the British soldiers she tended during the Crimean War, Mary Seacole—a Jamaican woman born in 1805 to a Scottish father and a Jamaican mother—has been recognized with a statue erected outside St Thomas’ Hospital in London. The statue—realized after 12 years of campaigning by the Mary Seacole Memorial Statue Appeal—was unveiled on June 30. It is the first UK statue dedicated to a named black woman.
Analysis Finds About 20 Veterans Died Daily from Suicide Between 2001 and 2014
分析发现2001-2014年老兵自杀率为平均20位/天
The U.S. Department of Veterans Affairs (VA) has released its most comprehensive report to date on veteran suicide, revealing that veterans have a 21% greater risk of committing suicide than civilians, after adjustment for age and gender. Researchers analyzed over 55 million records from all 50 states for the period 1979 to 2014, but concentrated on records from 2001 to 2014. Among their findings:
NewsCAP: Critical care associations issue a collaborative statement on ICU burnout
新闻头条：重症监护协会发布ICU职业倦怠合作声明
Critical care associations issue a collaborative statement on ICU burnout. Nurses have known the risks of burnout for decades, particularly in critical care areas like the ICU, where patient morbidity and mortality are especially high. The physical demands of care, staffing issues that affect workload, and the moral distress that often accompany this environment compound the situation. Now four major organizations—the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine—have jointly published a call to action to increase awareness and, ultimately, to reduce burnout syndrome in providers. The statement defines the syndrome and its risk factors and consequences and suggests interventions to prevent and treat it. Read more at
http://ajcc.aacnjournals.org/content/25/4/368.full.pdf.
Little Evidence for Routine Visual Screening for Skin Cancer, Says the USPSTF
USPSTF称，常规皮肤癌目视筛查证据不足
In an update of its 2009 recommendation on screening for skin cancer, the U.S. Preventive Services Task Force (USPSTF) echoes its previous conclusion that there is insufficient evidence for primary care clinicians to conduct routine visual screening for skin cancers in asymptomatic adults. Although this seems to fly in the face of current data—statistics from the Centers for Disease Control and Prevention show increased incidence rates of melanoma, particularly in white men and women—no randomized controlled trials definitively establish the benefits of visual screening for skin cancer in the primary care setting.
AJN Reports
Helping Elders ‘Age in Place’
帮助老人“就地养老”
About 10,000 people a day are reaching the age of 65 in the United States—a trend that is expected to continue for the next decade and beyond. As these baby boomers approach their later years, inevitable age-related changes may affect their ability to remain healthy and live independently at home—commonly referred to as “aging in place.” Unsurprisingly, the desire to spend older adulthood in one's current residence is the norm: a 2005 public policy report by AARP found that almost 90% of adults older than age 50 would prefer to age in their own homes.
AJN On the Cover
AJN On the Cover
AJN On the Web
Policy & Politics
Nursing, Health Care, and the 2016 Presidential Race
护理、健康保健与2016总统选举
Ever since Florence Nightingale used her influence to change health care delivery and health systems, nurses have engaged in forms of advocacy and grassroots politics. A presidential election year is a time when individual nurses should consider engaging in political activities with the party of their choice. In the past, grassroots political participation has allowed nurses not only to influence party positions and priorities but also to be visible enough to ultimately work in administrations and within federal agencies, both in career civil servant positions and in politically appointed and Senate-confirmed service.
Drug Watch
Stronger Warning for Two Diabetes Drugs
两种糖尿病药提升预警等级
The labeling of two drugs used in the treatment of type 2 diabetes—canagliflozin and dapagliflozin—has been revised to strengthen the warning concerning possible kidney damage. The labels now state that acute kidney injury is possible with use of the drugs.
* The labeling revision is based on a Food and Drug Administration review of 101 case reports of patients who developed acute renal injury while taking one of these drugs. The majority of patients required hospitalization and four died.
Loperamide Abuse or Misuse Triggers Cardiac Events
洛哌丁胺滥用或误用触发心脏事件
Loperamide, an antidiarrheal agent available over the counter and also by prescription, may produce serious cardiac effects, including changes in heart rhythm. The risk of adverse effects is more likely if the drug is taken at higher than recommended doses.
Cardiac events such as QT interval prolongation, torsades de pointes, ventricular tachycardia, syncope, and cardiac arrest were documented in 48 case reports evaluated by the Food and Drug Administration. Abnormal cardiac rhythms secondary to loperamide may not respond to typical antiarrhythmic drug therapy.
Drug Watch
New Drug Treats All Genotypes of Chronic HCV
新药治疗所有的基因型慢性HCV
Epclusa, an oral, fixed-dose combination drug containing sofosbuvir and velpatasvir, is the first agent approved to treat all six variants of the hepatitis C genotype.
It is prescribed as monotherapy if the patient has compensated (mild) cirrhosis or no cirrhosis and as combination therapy with ribavirin if the patient has decompensated cirrhosis.
Art of Nursing
Autumn Day.
秋日
Feature Articles
CE: A Review of Common Oral Treatments for Breast Cancer: Improving Patient Safety in Nononcology Settings
CE：乳腺癌常用口服疗法复习：提高非肿瘤环境的患者安全性
Breast cancer patients are living longer with the disease than ever before. According to the National Cancer Institute, more than 3 million women in the United States are currently living with a breast cancer diagnosis, and many seek care in nononcology settings, whether for treatment, acute symptoms and complaints related to their cancer diagnosis, or unrelated concerns. Yet many nononcology providers are unfamiliar with the various oral agents used to treat breast cancer, and their possible adverse effects and drug interactions. It is imperative that all providers be aware of these agents and know when a patient is currently taking or has taken them. This article provides an overview of the most common oral treatments for breast cancer and discusses common adverse effects and management.
2.5 CE Test Hours: A Review of Common Oral Treatments for Breast Cancer: Improving Patient Safety in Nononcology Settings
2.5CE测验小时：乳腺癌常用口服疗法复习：提高非肿瘤环境的患者安全性
CE: Assessing and Managing Pain, Agitation, and Delirium in Hospitalized Older Adults
CE:住院老人疼痛、激越、瞻望的评估与管理
In the acute care setting, pain, agitation, and delirium (PAD) often occur as interrelated parts of a syndrome rather than as separate entities. Because the three facets of PAD may be similar in presentation, it is often difficult for clinicians to recognize the syndrome and to assess and treat it. The challenge is particularly great in older patients, who are more likely than their younger counterparts to have such comorbid conditions as dementia, which may impair the ability to report pain, or age-related physiologic changes that may affect the metabolism and clearance of certain medications. This article provides an overview of each aspect of PAD, discusses clinical considerations related to the assessment and treatment of the syndrome in older adults receiving acute care, and illustrates the application of published PAD guidelines through the use of a hypothetical patient scenario.
2 CE Test Hours: Assessing and Managing Pain, Agitation, and Delirium in Hospitalized Older Adults
2CE测验小时：住院老人疼痛、激越、瞻望的评估与管理
Perspectives on Palliative Nursing
For Advanced Cancer, What Treatment Is Next?
晚期癌症的下一步治疗是什么？
This article is the second in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; http://hpna.advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research.
Off the Charts
Seeing Potential: The Joys of Teaching Nursing
发掘潜力：上护理课的喜悦
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 bringAJN readers recent posts that we think deserve a wider audience. To read more, please visit:www.ajnoffthecharts.com.
Ethical Issues
Determining When an Activity Is or Is Not Research
确定什么情况下工作就等于研究
Practical and ethical considerations for nurses engaged in QI and other projects.
Journal Watch
Nurse-Led Intervention Helps Improve Infant Sleep
护士主导干预有助于改善婴儿睡眠
A “responsive parenting” intervention delivered by nurses during home visits to first-time mothers improved their newborns’ bedtime routines, sleep duration, and sleep-related problems.
Sleep-related behavior is modifiable during infancy.
Acupressure Reduces Breast Cancer−Related Fatigue
穴位按压减轻乳腺癌相关疲劳
Self-administered “relaxing” acupressure reduces persistent fatigue in breast cancer survivors and improves sleep and quality of life.
Undiagnosed Valvular Heart Disease is Common in Older Adults
老年人非诊断性瓣膜性心脏病常见
Previously undetected valvular heart disease (VHD) is present in more than half of older adults, especially those in lower socioeconomic groups.
Clinically significant VHD is three times more common in patients with atrial fibrillation; therefore atrial fibrillation may be a potential early marker.
Rotating Night-Shift Work is Associated With Increased CHD Risk in Female RNS
夜班轮班与RNS女性CHD增加相关
Among female RNs, a longer duration of rotating night-shift work is associated with a small, but significant increased risk of coronary heart disease.
Cochrane Corner
Adjuvant Corticosteroid Therapy for Acute Bacterial Meningitis
辅助性类皮质甾酮疗法治疗急诊细菌性脑膜炎
Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library.
In the Community
Teaching Children to Be Health Educators
教育儿童成为健康老师
A nursing school, an elementary school, and several local organizations initiated a pilot project to address hypertension in rural Hawaii. Their goal was to help increase awareness of hypertension in the community by partnering with sixth-grade students as health educators. As part of their pediatric clinical rotation, nursing students developed a curriculum and taught the elementary school students to take and record blood pressures. The sixth graders learned to use blood pressure monitors and took and recorded over 1,500 of their friends’ and family members’ blood pressures. The students were also able to correctly identify elevated findings. This pilot project is an example of how children can be taught to participate in a community collaboration to promote health care in their community.
Profiles
Speaking Up to Save a Life
大胆主张挽救生命
A nurse's advocacy alters the path of a patient with locked-in syndrome.
Reflections
The Traumatized Patient
受伤的患者
An irredeemable pain lies beneath some patients’ nonspecific symptoms.
Podcasts
October 2016 Highlights
2016．10亮点
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