LETTERS , etc.
BETTER END-OF-LIFE CARE
The balancing act described
in Julie Anne Millers Reflections
(March), in which a nurse tries
to advocate for her patient while
maintaining the physicians ordered
plan of care, is a challenge nurses
face every day. Perhaps this situa-
tion could be avoided.
A study published in the Janu-
ary 19 JAMA1 looked at family
members perceptions of the end-
of-life care their loved ones with
advanced-stage cancer received
in relation to how aggressive the
treatment was. The authors found
that the majority of family mem-
bers reported better end-of-life
care when nonaggressive care
was administered.
Physicians and nurses should be
up front regarding the reality of the
patients outcome and encourage
palliative care more often than ag-
gressive end-of-life treatment. This
would improve the patients quality
of life and allow nurses to focus on
providing better end-of-life care for
their patients and support for their
patients families.
Vanessa Marzilli, RN
Cameron, NC
REFERENCE
1. Wright AA, et al. Family perspectives
on aggressive cancer care near the end
of life. JAMA 2016;315(3): 284-92.
PATIENTS WITH OUD
All clinicians in the hospital setting
should read Acute Pain Manage-
ment for Inpatients with Opioid
Use Disorder (September 2015),
which dispels some of the myths
about patients with opioid use dis-
order (OUD) and suggests how
to properly care for these patients
while in the hospital.
For example, on admission a
patient with OUD typically has a
cocktail of pain medications on
the home medication list. Unfor-
tunately, the admitting physician
may be unwilling to order all of
these medications, making it very
hard for the nurse to control the
ajn@wolterskluwer.com
patients acute pain on top of the
chronic pain. The article states that
methadone shouldnt be used as
acute pain relief; however, I see
this all the time. If a patient takes
methadone at home, the physician
thinks it will relieve both acute and
chronic pain. Methadone, how-
ever, is typically prescribed every
24 hours, and its analgesic action
lasts only four to eight. This article
illustrates the knowledge deficit
physicians and nurses have when
caring for patients with OUD, and
could help them change the way
they practice and care for these pa-
tients.
Jessica Redmond, RN
Pisgah Forest, NC
CLINICAL PLACEMENTS AND HEALTH
I enjoyed Maureen Shawn
Kennedys editorial on healthy
behaviors for nurses (April); how-
ever, it seems hypocritical to call
out health care facilities when we
have the same problem within
our profession. Im currently in
an RN-to-BSN program and have
read about the Commission on
Collegiate Nursing Educations
clinical practice experience re-
quirements (www.aacn.nche.edu/
ccne-accreditation/Clinical-Practice-
FAQs.pdf), which I believe could
contribute to nurses problems
taking care of their health and
well-being. On the surface clini-
cal placements are an excellent
idea, until one thinks about how
many nurses in RN-to-BSN pro-
grams are already working full-
timesome also caring for their
homes, children, and even parents.
RN-to-BSN students will now
have the added responsibility of
locating clinical placements (a
problem NP students have had
for years). Many colleges do not
arrange placements and the com-
petition is fierce. Also, nurses must
take whatever placement they can
get and be available any hours a
facility offers. This can be difficult
for nurses who work, especially
those who work nights and must
sleep during the day. Nurses need
two days per week away from the
workplace to do chores and er-
rands and hopefully exercise and
rest their bodies and minds.
I would like nursing groups and
health care facilities to consider the
health, safety, and well-being of
nurses. Colleges that offer RN-to-
BSN programs must be creative
and offer students ways to prac-
tice BSN skills that blend well with
their busy lives and work sched-
ules and dont cause undue stress.
Yes, nurses need wellness programs
and the time to use them. But as
Kennedy points out, this is easier
said than done.
Lisa McDonald, RN
GLUCOSE TESTING IN THE ICU
Im concerned that nurses are us-
ing a device in a way that is con-
sidered off label by the Food and
Drug Administration (FDA), but
which is written policy in their
ICUs (Blood Glucose Meters in
ICUs, Diabetes Under Control,
April). When strict glycemic con-
trol of surgical patients via insu-
lin drip began on my unit, which
required hourly monitoring using
blood glucose monitors, I had con-
cerns about the accuracy in rela-
tion to the coverage. Is the error
range of the machine small enough
to manage strict control? How ac-
curate is a finger-stick sample on
a norepinephrine drip or a patient
with edema? Is it injurious to stick
fingers every hour for many days?
Is using blood from arterial lines
accurate compared with capil-
lary blood? I never got answers.
I honestly did not know the sta-
tus of the use of these devices in
critical care. Before we lobby the
FDA and the Centers for Medicare
and Medicaid Services to change
their policy, we should demand
that research be done to guaran-
tee the safety of the devices and
strict guidelines be established on
how and where they can be safely
used.
Betsy M., RN, via ajnoffthecharts.com
AJN July 2016 Vol. 116, No. 7 13