《今日美国护士》2016年9月总第11卷第9期
American Nurse Today
September 2016 Vol. 11 No. 9
Editorial
Multiple Studies reveal the benefits of assigning patients based on acuity rather than simply the census
众多研究显示基于敏锐度而非统计数字的患者评估好处更多
Continuing Education
Oral Chemotherapy: Not just an ordinary pill
口服化疗：不仅仅是一种普通的药丸
In recent years, the Food and Drug Administration has approved many new anticancer medications that are taken primarily by mouth. In fact, an estimated 30% of cancer drugs in development are oral, and the trend is increasing.
Some practitioners tout oral chemotherapies as more convenient and flexible. But are they really? The change from parenteral to oral cancer medications brings new challenges. Patients taking oral drugs may end up being seen by many different healthcare team members, some of whom may be unaware of the possible toxicities of these therapies—or even that the patient’s taking them.
Features
How to help patients live with liver failure
如何帮助患者度过肝衰
A life-threatening condition, liver failure results from liver damage. In many cases, the damage is gradual and silent, causing few symptoms until the organ loses all of its functions.
Liver failure can be acute or take the form of chronic liver disease (CLD), which leads to irreversible end-stage liver disease (ESLD).
Carbon monoxide poisoning: The silent killer
一氧化碳中毒：默默的杀手
In June 2013, a mother and her 11-year-old son drove to the North Carolina mountains for an overnight stay and checked into a nice hotel with an indoor pool. Shortly after their arrival, she went to the bathroom to remove her contacts while her son used his iPad on the bed. In the bathroom, she was overcome with nausea, prompting her to lie down on the floor. The last thing she remembered was reaching for the door and calling for her son.
Leading the Way
Three first steps for effective succession planning
有效的成功规划的前三步
In light of the predicted nursing shortage, nursing leaders need to take strategic action to prepare nurses to assume key leadership roles in the near future. Proactive succession planning programs are a key strategy for addressing the impending shortage of nurse leaders. Such planning involves identifying highpotential individuals and formally developing them to assume leadership roles. A primed pipeline of competent nurses prepared to step into leadership roles may reduce recruiting expenses, increase leadership continuity, and decrease role-transition stress.
Practice Matters
Risk-adjusted mortality rates: Why you should care about them
风险校正后的死亡率：你为什么要关注他们
Have you ever heard of risk-adjusted mortality? Maybe you’re thinking, “No! It sounds like something only a healthcare administrator or researcher would be interested in.”
Actually, every healthcare professional should know—and be concerned—about risk-adjusted mortality. Risk adjustment refers to methods of determining if a patient’s characteristics might warrant greater use of medical services. It takes into account illness severity and certain other patient demographics and characteristics. In effect, risk adjustment levels the playing field to allow comparisons of the quality and safety of hospitals and healthcare providers.
Inside ANA
Partnerships bring infection prevention practices to nurses
与护士建立感染预防执业伙伴关系
Spurred by the 2014 Ebola crisis and such emerging threats as Zika virus and antibiotic resistance, ANA is partnering with leading public health organizations to give registered nurses (RNs) in all practice settings effective training and tools for themselves and their patients against the hazards of infectious diseases.
Developing a leadership legacy
发杨领导传统
Leadership means different things to different people. For example, it might be a position of authority or perceived power. It might be a role on a team or a persona someone carries with them. However you define a leader, a personal element must be considered. As they say, with power comes responsibility. Leaders have a responsibility to uphold values and to clearly communicate and emulate those values.
Political advocacy: A passion for shaping health care and our practice
政治支持：对塑造健康保健和执业充满热情
We are engaged in a high-stakes profession—serving on the frontlines as essential players throughout our patients’ healthcare journeys, and invariably the first and last lines of defense for them and their families.
However, the stakes can be equally high on the broader political and policy-making fronts, where our critical thinking, judgment, and advocacy are just as vital. Nurses’ voices can make a crucial difference in crafting and moving policy measures that are essential to good nursing practice and quality health care, as well as in electing government leaders who share our goals.
The critical role of nurses in promoting immunization for adults
护士在推动成人免疫中的关键作用
Children aren’t the only ones who need vaccines. Older adults and those with chronic health conditions are particularly at risk for vaccine-preventable diseases. Yet immunization coverage levels for U.S. adults are low, leaving many vulnerable to illness, hospitalization, and deaths that could have been prevented.
Career Sphere
Evidence-based interview strategy for new nurses
新护士的循证基面试策略
For many nurses, job interviews induce fear. The competitive job market has made interview preparation more important than ever, especially for new graduate nurses. Competition for new graduate positions can be fierce; some employers get up to 1,000 applicants for a single new graduate opening.
Mind/Body/Spirit
What the mirror doesn’t tell you
镜子不会告诉你
If you’re like 97% of the American population, you’ve probably had thoughts like these at some point. According to a survey by Glamour magazine 30 years ago and updated in 2014, 54% of women are unhappy with their body and 80% claim the mirror makes them feel bad about themselves. Unhappiness about body image has been reported in girls as young as age 6. Even men admit to body-image angst; from 1997 to 2001, the number of men who had cosmetic surgery increased 256%. Clearly, we need to evaluate the messages the mirror is telling us.
Strictly Clinical
New kidney biomarkers: A faster way to detect acute kidney injury
新的肾生物标记：检查急性肾损伤的更快手段
It’s 7:30 am, and you’ve just received report on your patients. One of them, Anna Clark, age 77, is a postoperative patient who underwent an abdominal aortic aneurysm repair last evening. It was a difficult case, so instead of placing a minimally invasive stent in the aorta, surgeons performed an open repair that lasted several hours. During surgery, Mrs. Clark had a bleeding episode that caused her blood pressure to drop; she recovered after receiving three units of packed red blood cells and two units of fresh frozen plasma.
Drugs and Devices
FDA permits marketing of balloon device for Eustachian tube dysfunction
FDA允许咽鼓管机能障碍球囊装置上市销售
On Sept. 16, the Food and Drug Administration (FDA) permitted marketing of the Aera system, a device that uses a small balloon to treat persistent Eustachian tube dysfunction.Read more
FDA approves first drug for treating Duchenne muscular dystrophy
首种杜兴肌营养不良综合症治疗药物获FDA批准
On Sept. 19, the Food and Drug Administration (FDA) approved Exondys 51 (eteplirsen) injection, the first drug approved to treat patients with Duchenne muscular dystrophy (DMD). Read more
Take Note - Practice Updates
Children in U.S. have low aerobic fitness levels compared to other countries
与其他国家相比，美国儿童需氧健身水平较低
According to a study on aerobic fitness in youth aged 9-17, published in in the British Journal of Sports Medicine, the United States ranked 47 out of 50 countries. Read more andread the study abstract.
Editorial
Patient assignment vs. nurse staffing: More than just numbers
个案护理与护理编制：不仅仅是数字
For more than 15 years, I’ve been advocating for healthcare leaders to replace the term “opinion-based” with “evidence-based.” Too often, I’ve heard, “In my opinion, we should do the following.” Whether the speaker is referring to leadership or clinical practice, we hear “In my opinion” far too often.
When discussing staffing and staffing systems, we need to focus on “evidence-based” instead of “in my opinion.” Multiple well-designed research studies provide evidence that patient assignments should be based on patient acuity rather than simply the total number of patients.
Special Reports
Practical steps for applying acuity-based staffing
应用基于敏锐度的编制的实用步骤
In the healthcare arena, change happens at a rapid pace. Healthcare leaders face the continual challenge of delivering high-quality patient care while managing costs. A growing body of evidence shows that patient acuity-driven staffing is an effective way to optimize nurse staffing to improve patient outcomes and promote clinical and organizational excellence.
Patient Safety / Quality
Fall prevention: A contract with patients and families
预防摔倒：与患者和家人的协议
When hospital patients fall and suffer an injury, family members perceive that nurses and other hospital staff aren’t paying enough attention to their loved one. The Centers for Medicare & Medicaid Services (CMS) agree, deeming falls preventable events that should never happen in healthcare facilities. Consequently, falls with associated injuries can lower a hospital’s reimbursements.
Rapid Response
Sulfonylurea-induced hypoglycemia in an elderly patient
老年患者的磺酰诱发性低血糖
Myrna Klein, age 82, is admitted to the medical-surgical unit from the emergency department (ED) at 9 pm for an exacerbation of chronic obstructive pulmonary disease. She also has hypertension, diabetes type 2, and mild dementia. Ted, her nurse, obtains her initial vital signs: heart rate 89 beats per minute (bpm), blood pressure 145/71 mm Hg, respiratory rate 10 breaths/minute, oxygen saturation 95% on 2 L oxygen, and temperature 97.7° F (36.5° C). Her blood glucose (BG) level is 90 mg/dL.
Education Guide
American Nurse Today: Education Guide
今日美国护士：教育指南
Education is a valuable tool for advancing your nursing career. This special guide explains how to choose the right educational option for you, how to become a nurse educator or an advanced practice nurse, and how to land your dream job after completing your additional education.
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