LET TER S EDITORIAL BOARD
Feelings about moral courage and palliative care I appreciated the article emphasizing the quality of moral courage and the need for palliative care referrals (“Moral Courage: A Step Beyond Patient Advocacy,” Transitions, June 2015).* Providing palliative care and alleviating suffering are both positive actions. Yet something about the article concerned me. On rereading it, I noted that the nurse “felt,” “believed,” and “connected” with patient MJ. Now what could be missing? The author has skillfully drawn us in and, speaking for myself, elicited agreement. But, as I thought this over, I realized that his nurse apparently hadn’t asked MJ what he wanted, although he wasn’t described as confused. She did speak to the medical team about palliative care, but why not talk directly with MJ? The implied acceptance of feelings and beliefs as inherently positive attributes worries me. Certainly they were in this situation. But consider alternative situations, such as a pro-life nurse dealing with a patient considering an abortion. If she “felt,” “believed,” and “connected” with the patient, would it be appropriate for her to urge the patient to consider a referral to a pregnancy support center? Some nurses might agree; others would say no. Having worked in an ICU and seen many patients like MJ there, I’m grateful that palliative care is now an option. But I’d like to raise an alert about relying on feelings, beliefs, and connections as markers for moral courage. —JANET DEL ROSARIO, RN Peekskill, N.Y.
Teamwork helps to prevent CAUTIs I was very interested to read your article “Preventing Urinary Tract Infections with a Two-Person Catheter Insertion Procedure” (March 2015)* because this is how I inserted urinary catheters when I became a nurse 4 years ago. Inserting urinary catheters can be challenging, especially with female patients, because everyone’s anatomy is a little different. Sometimes having an extra set of eyes can be helpful; for example, to catch breaks in sterile technique. Reducing healthcare-acquired infections is a goal of every hospital
facility. At the hospital where I first worked, a urinary catheter buddy system was implemented to help reduce catheter-associated urinary tract infections (CAUTIs). With this system, two nurses assisted each other with the insertion of a urinary catheter. This technique gave me, then a graduate nurse, the confidence and experience I needed to properly insert urinary catheters. Even though I no longer work at that hospital, I still use the buddy system every time I insert a urinary catheter. I’m so glad to know that other hospitals have implemented this system as well. —ERIKA DE’BATO, BSN, RN Spring, Tex. ■
Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAAN, FAPWCA, President, Ayello, Harris & Associates, Inc.; Faculty, Excelsior College School of Nursing, Albany, N.Y.; Senior Adviser, The John A. Hartford Institute for Geriatric Nursing and Program Director, Education Essentials, New York, N.Y. Michael R. Cohen, ScD, MS, RPh, President, Institute for Safe Medication Practices, and Member of the Sentinel Event Advisory Group for The Joint Commission, Horsham, Pa. Yvonne D’Arcy, MS, RN, CRNP, CNS, Pain Management and Palliative Care Nurse Practitioner, formerly at Suburban HospitalJohns Hopkins Medicine, Bethesda, Md. Michael W. Day, MSN, RN, CCRN, Clinical Practice Specialist, Trauma & Acute Surgery, Northeast Georgia Medical Center, Gainesville, Ga. Cheryl Dumont, PhD, RN, CRNI, Director, Nursing Research and Vascular Access Team, Winchester Medical Center, Winchester, Va. Martha M. Funnell, MS, RN, CDE, Codirector of the Behavioral, Clinical and Health Systems Intervention Research Core, Michigan Diabetes Research and Training Center; Research Investigator in the Department of Medical Education; and Adjunct Lecturer, School of Nursing, University of Michigan, Ann Arbor, Mich. Peg Gray-Vickrey, DNS, RN, Provost and VP for Academic and Student Affairs, Texas A&M University-Central Texas, Kileen, Texas. Elizabeth Heavey, PhD, RN, CNM, Associate Professor of Nursing, The College at Brockport, State University of New York, Brockport, N.Y. Jeanne Held-Warmkessel, MSN, RN, ACNS-BC, AOCN, Clinical Nurse Specialist, Fox Chase Cancer Center, Philadelphia, Pa. Frank Edward Myers III, MA, CIC, Infection Preventionist III, UC San Diego Health System, San Diego, Calif. Bill Pruitt, MBA, RRT, AE-C, CPFT, FAARC, Senior Instructor and Director of Clinical Education, Cardiorespiratory Sciences, School of Allied Health, University of South Alabama, Mobile, Ala. Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, Vice President of Informatics Healthcare Information and Management Systems Society, Chicago, Ill. Susan Simmons, PhD, RN, ARNP-BC, Family NP, College Park Family Care Center, Overland Park, Kan. R. Bryan Simon, RN, CNOR, FAWM, DiMM, Partner, Vertical Medicine Resources; Director, Appalachian Mountain Rescue Team; Contract RN, Perioperative Services, AMN Healthcare; Fayetteville, W.V. Linda S. Smith, PhD, MS, RN, CLNC, Vice President for Research, Data Design, Inc., Horseshoe Bend, Ark. Kristopher T. Starr, JD, MSN, RN, FNP-C, CEN, CPEN, Attorney at Law, Ferry Joseph, P.A., Wilmington, Del.; Nurse Manager, Wilmington Hospital Emergency Department, Christiana Care Health System, Wilmington, Del.; Supplemental Nursing Faculty, University of Delaware, Newark, Del. Jeff Strickler, MA, RN, CEN, CFRN, NE-BC, Director, Emergency Services, University of North Carolina Hospitals, Chapel Hill, N.C.
* Individual subscribers can access articles free online at http://www.nursing2015.com. Send comments by e-mail if possible to [email protected]. Please, no attachments. Or send them to Letters Editor, Nursing2015, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Please include your name, credentials, complete mailing address, e-mail address (if applicable), and daytime phone number. Letters are edited for content, length, and grammar. Submission of a letter will constitute the author’s permission to publish it, although it doesn’t guarantee publication. Letters become the property of Nursing journal and may be published in all media. DOI-10.1097/01.NURSE.0000469250.19718.bb
N0815
8 l Nursing2015 l Volume 45, Number 8
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Feelings about moral courage and palliative care I appreciated the article emphasizing the quality of moral courage and the need for palliative care referrals (“Moral Courage: A Step Beyond Patient Advocacy,” Transitions, June 2015).* Providing palliative care and alleviating suffering are both positive actions. Yet something about the article concerned me. On rereading it, I noted that the nurse “felt,” “believed,” and “connected” with patient MJ. Now what could be missing? The author has skillfully drawn us in and, speaking for myself, elicited agreement. But, as I thought this over, I realized that his nurse apparently hadn’t asked MJ what he wanted, although he wasn’t described as confused. She did speak to the medical team about palliative care, but why not talk directly with MJ? The implied acceptance of feelings and beliefs as inherently positive attributes worries me. Certainly they were in this situation. But consider alternative situations, such as a pro-life nurse dealing with a patient considering an abortion. If she “felt,” “believed,” and “connected” with the patient, would it be appropriate for her to urge the patient to consider a referral to a pregnancy support center? Some nurses might agree; others would say no. Having worked in an ICU and seen many patients like MJ there, I’m grateful that palliative care is now an option. But I’d like to raise an alert about relying on feelings, beliefs, and connections as markers for moral courage. —JANET DEL ROSARIO, RN Peekskill, N.Y.
Teamwork helps to prevent CAUTIs I was very interested to read your article “Preventing Urinary Tract Infections with a Two-Person Catheter Insertion Procedure” (March 2015)* because this is how I inserted urinary catheters when I became a nurse 4 years ago. Inserting urinary catheters can be challenging, especially with female patients, because everyone’s anatomy is a little different. Sometimes having an extra set of eyes can be helpful; for example, to catch breaks in sterile technique. Reducing healthcare-acquired infections is a goal of every hospital
facility. At the hospital where I first worked, a urinary catheter buddy system was implemented to help reduce catheter-associated urinary tract infections (CAUTIs). With this system, two nurses assisted each other with the insertion of a urinary catheter. This technique gave me, then a graduate nurse, the confidence and experience I needed to properly insert urinary catheters. Even though I no longer work at that hospital, I still use the buddy system every time I insert a urinary catheter. I’m so glad to know that other hospitals have implemented this system as well. —ERIKA DE’BATO, BSN, RN Spring, Tex. ■
Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAAN, FAPWCA, President, Ayello, Harris & Associates, Inc.; Faculty, Excelsior College School of Nursing, Albany, N.Y.; Senior Adviser, The John A. Hartford Institute for Geriatric Nursing and Program Director, Education Essentials, New York, N.Y. Michael R. Cohen, ScD, MS, RPh, President, Institute for Safe Medication Practices, and Member of the Sentinel Event Advisory Group for The Joint Commission, Horsham, Pa. Yvonne D’Arcy, MS, RN, CRNP, CNS, Pain Management and Palliative Care Nurse Practitioner, formerly at Suburban HospitalJohns Hopkins Medicine, Bethesda, Md. Michael W. Day, MSN, RN, CCRN, Clinical Practice Specialist, Trauma & Acute Surgery, Northeast Georgia Medical Center, Gainesville, Ga. Cheryl Dumont, PhD, RN, CRNI, Director, Nursing Research and Vascular Access Team, Winchester Medical Center, Winchester, Va. Martha M. Funnell, MS, RN, CDE, Codirector of the Behavioral, Clinical and Health Systems Intervention Research Core, Michigan Diabetes Research and Training Center; Research Investigator in the Department of Medical Education; and Adjunct Lecturer, School of Nursing, University of Michigan, Ann Arbor, Mich. Peg Gray-Vickrey, DNS, RN, Provost and VP for Academic and Student Affairs, Texas A&M University-Central Texas, Kileen, Texas. Elizabeth Heavey, PhD, RN, CNM, Associate Professor of Nursing, The College at Brockport, State University of New York, Brockport, N.Y. Jeanne Held-Warmkessel, MSN, RN, ACNS-BC, AOCN, Clinical Nurse Specialist, Fox Chase Cancer Center, Philadelphia, Pa. Frank Edward Myers III, MA, CIC, Infection Preventionist III, UC San Diego Health System, San Diego, Calif. Bill Pruitt, MBA, RRT, AE-C, CPFT, FAARC, Senior Instructor and Director of Clinical Education, Cardiorespiratory Sciences, School of Allied Health, University of South Alabama, Mobile, Ala. Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, Vice President of Informatics Healthcare Information and Management Systems Society, Chicago, Ill. Susan Simmons, PhD, RN, ARNP-BC, Family NP, College Park Family Care Center, Overland Park, Kan. R. Bryan Simon, RN, CNOR, FAWM, DiMM, Partner, Vertical Medicine Resources; Director, Appalachian Mountain Rescue Team; Contract RN, Perioperative Services, AMN Healthcare; Fayetteville, W.V. Linda S. Smith, PhD, MS, RN, CLNC, Vice President for Research, Data Design, Inc., Horseshoe Bend, Ark. Kristopher T. Starr, JD, MSN, RN, FNP-C, CEN, CPEN, Attorney at Law, Ferry Joseph, P.A., Wilmington, Del.; Nurse Manager, Wilmington Hospital Emergency Department, Christiana Care Health System, Wilmington, Del.; Supplemental Nursing Faculty, University of Delaware, Newark, Del. Jeff Strickler, MA, RN, CEN, CFRN, NE-BC, Director, Emergency Services, University of North Carolina Hospitals, Chapel Hill, N.C.
* Individual subscribers can access articles free online at http://www.nursing2015.com. Send comments by e-mail if possible to [email protected]. Please, no attachments. Or send them to Letters Editor, Nursing2015, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Please include your name, credentials, complete mailing address, e-mail address (if applicable), and daytime phone number. Letters are edited for content, length, and grammar. Submission of a letter will constitute the author’s permission to publish it, although it doesn’t guarantee publication. Letters become the property of Nursing journal and may be published in all media. DOI-10.1097/01.NURSE.0000469250.19718.bb
N0815
8 l Nursing2015 l Volume 45, Number 8
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
