LETTERS , etc.

BETTER END-OF-LIFE CARE patient’s acute pain on top of the sleep during the day. Nurses need
The “balancing act” described chronic pain. The article states that two days per week away from the
in Julie Anne Miller’s Reflections methadone shouldn’t be used as workplace to do chores and er-
(March), in which a nurse tries acute pain relief; however, I see rands and hopefully exercise and
to advocate for her patient while this all the time. If a patient takes rest their bodies and minds.
maintaining the physician’s ordered methadone at home, the physician I would like nursing groups and
plan of care, is a challenge nurses thinks it will relieve both acute and health care facilities to consider the
face every day. Perhaps this situa- chronic pain. Methadone, how- health, safety, and well-being of
tion could be avoided. ever, is typically prescribed every nurses. Colleges that offer RN-to-
A study published in the Janu- 24 hours, and its analgesic action BSN programs must be creative
ary 19 JAMA1 looked at family lasts only four to eight. This article and offer students ways to prac-
members’ perceptions of the end- illustrates the knowledge deficit tice BSN skills that blend well with
of-life care their loved ones with physicians and nurses have when their busy lives and work sched-
advanced-stage cancer received caring for patients with OUD, and ules and don’t cause undue stress.
in relation to how aggressive the could help them change the way Yes, nurses need wellness programs
treatment was. The authors found they practice and care for these pa- and the time to use them. But as
that the majority of family mem- tients. Kennedy points out, this is easier
bers reported better end-of-life Jessica Redmond, RN said than done.
care when nonaggressive care Pisgah Forest, NC Lisa McDonald, RN
was administered.
up front regarding the reality of the I enjoyed Maureen Shawn I’m concerned that nurses are us-
patient’s outcome and encourage Kennedy’s editorial on healthy ing a device in a way that is con-
palliative care more often than ag- behaviors for nurses (April); how- sidered off label by the Food and
gressive end-of-life treatment. This ever, it seems hypocritical to call Drug Administration (FDA), but
would improve the patient’s quality out health care facilities when we which is written policy in their
of life and allow nurses to focus on have the same problem within ICUs (“Blood Glucose Meters in
providing better end-of-life care for our profession. I’m currently in ICUs,” Diabetes Under Control,
their patients and support for their an RN-to-BSN program and have April). When strict glycemic con-
patients’ families. read about the Commission on trol of surgical patients via insu-
Vanessa Marzilli, RN Collegiate Nursing Education’s lin drip began on my unit, which
Cameron, NC clinical practice experience re- required hourly monitoring using
quirements (www.aacn.nche.edu/ blood glucose monitors, I had con-
REFERENCE ccne-accreditation/Clinical-Practice- cerns about the accuracy in rela-
1. Wright AA, et al. Family perspectives FAQs.pdf), which I believe could tion to the coverage. Is the error
on aggressive cancer care near the end contribute to nurses’ problems range of the machine small enough
of life. JAMA 2016;315(3): 284-92.
taking care of their health and to manage strict control? How ac-
well-being. On the surface clini- curate is a finger-stick sample on
PATIENTS WITH OUD cal placements are an excellent a norepinephrine drip or a patient
All clinicians in the hospital setting idea, until one thinks about how with edema? Is it injurious to stick
should read “Acute Pain Manage- many nurses in RN-to-BSN pro- fingers every hour for many days?
ment for Inpatients with Opioid grams are already working full- Is using blood from arterial lines
Use Disorder” (September 2015), time—some also caring for their accurate compared with capil-
which dispels some of the myths homes, children, and even parents. lary blood? I never got answers.
about patients with opioid use dis- RN-to-BSN students will now I honestly did not know the sta-
order (OUD) and suggests how have the added responsibility of tus of the use of these devices in
to properly care for these patients locating clinical placements (a critical care. Before we lobby the
while in the hospital. problem NP students have had FDA and the Centers for Medicare
For example, on admission a for years). Many colleges do not and Medicaid Services to change
patient with OUD typically has a arrange placements and the com- their policy, we should demand
cocktail of pain medications on petition is fierce. Also, nurses must that research be done to guaran-
the home medication list. Unfor- take whatever placement they can tee the safety of the devices and
tunately, the admitting physician get and be available any hours a strict guidelines be established on
may be unwilling to order all of facility offers. This can be difficult how and where they can be safely
these medications, making it very for nurses who work, especially used.
hard for the nurse to control the those who work nights and must Betsy M., RN, via ajnoffthecharts.com ▼

ajn@wolterskluwer.com AJN ▼ July 2016 ▼ Vol. 116, No. 7 13