Nurses may soon have to learn a new set of practice guidelines when it comes to all their patients. The Endocrine Society has issued new clinical practice guidelines concerning inpatient monitoring of blood glucose levels. Whether or not patients have been diagnosed as diabetics, patients admitted to a facility should receive blood glucose monitoring as long as they are not receiving intensive nursing care. The January 2012 issues of Journal of Clinical Endocrinology & Metabolism published the new standards.

Citing observational studies which found that hyperglycemia affects 32 to 38 percent of inpatients in community hospitals regardless of a pre-existing diagnosis of diabetes, the eight-person task force – all experts in the field of endocrinology – developed new evidence-based guidelines and designed protocols, system improvements and glycemic targets in order to facilitate better blood glycemic control. Dr. Guillermo Umpierrez of Emory University, the task force chair, stated that long hospital stays, higher infection rates and death in non-critical patients were all linked to hyperglycemia.

The new guidelines for acute care facilities include:

– Blood glucose testing upon admission for all patients admitted to the hospital whether they are a known diabetic or not. Diabetic patients will automatically receive A1c level testing if none has been done in the last two to three months.

– For the majority of hospitalized patients, the target premeal glucose level should not exceed 140 mg/dl; random testing should not reveal more than a 180 mg/dl level. If glucose levels fall under 100 mg/dl or 70 mg/dl, treatment should be reevaluated or modified.

– Closer monitoring should be implemented for patients not at risk for hypoglycemia, and for terminally ill or end-of-life patients and patients who are more likely to develop hypoglycemia.

– Diabetics on injectable insulin should continue to receive insulin as long as they are inpatients.

– As a preventive measure to perioperative complications, all type 1 diabetics and the majority of type 2 diabetics should receive a continuous IV insulin infusion or “sub-q” insulin with bolus insulin used as needed.

– Patients admitted with a higher than 140 mg/dl glucose level and patients receiving enteral or parenteral nutrition should be monitored with bedside glucose testing, whether the patient is diabetic or not. Patients on corticosteroids or octreotide should also receive bedside glucose testing.

– One to two hours after completion of continuous IV insulin, patients should be transitioned to “sub-q” insulin.

The new guidelines were reviewed by Endocrine Society members, the American Diabetes Association, the American Heart Association, the American Association of Diabetes Educators, the European Society of Endocrinology and the Society of Hospital Medicine.

While the new guidelines will likely increase the workload of nurses, better guidelines may decrease the risk of infection and save patients’ lives.

The Jackson Sun has a story about a retired African-American nurse who was one of the very first people to desegregate the Jackson General Hospital in Jackson, Tennessee.

Vernice Dixon, 93, was in her 30’s when she decided to quit her job as a dishwasher and try to become a nurse.

In 1952, she became part of a small group of minority nurses — patients were still segregated at that time, and some of the white patients didn’t want anyone but white nurses helping them. (An issue that unfortunately still persists today.)

“I remember one man, who was white, who spoke real bad to me,” Dixon said. “I came into his room and I said, ‘Hello’ and told him that I was there to take his temperature. He cussed so bad and used words that no one around me had used before.”

Dixon told a white colleague who came to her defense.

“I had to learn how to get over things like that,” Dixon said. “As a nurse, whether you’re black or white, you have to deal with patients. Sometimes you just have to grin and bear it.”

One of the most challenging examples of integrating a once-segregated hospital, Dixon said, was the separation of rooms for white and black people.

“There were times when the first floor, where they kept all of the black patients, was overcrowded when the rooms on the third floor were empty,” Dixon said. “There were empty beds, but they were not for black people.”

As a nurse, Dixon earned $300 every two weeks, which was a large pay increase from $1.10 she made cleaning houses.

“I always knew how to stretch a dollar,” Dixon said.

Her ability to make her money last helped improve the lives of her parents and her only daughter Clementine, who she hoped would follow in her footsteps as a nurse.

“She became a teacher instead,” Dixon said.

“Mama loved nursing with a passion; it’s her calling,” said Clementine Spencer, Dixon’s daughter.

Dixon worked in the hospital for 28 years before she retired.

“I saw a lot of changes,” she said. “We (black nurses) broke up a lot of segregation that was going on.”

In one of Dixon’s stories, she asked nursing supervisors about why black nurses didn’t know about training inservice opportunities.

“After that, they posted the inservice trainings,” Dixon said.

Patients who have lost significant amounts of weight, especially for health reasons, need a stronger support system than someone who simply lost five pounds for swimsuit season. Often a little cheating or relaxation of the new diet habits causes a quick backslide to old habits, which can lead patients back to their starting point with a few extra pounds tacked onto their middle. By helping patients identify possible weight gain triggers, nurses can provide a strong foundation of support to mitigate the chances of a substantial weight regain in their patients.

The Journal of the American Academy of Nurse Practitioners recently reported eight categories of potential factors leading to a weight regain in patients after a successful weight loss, which may provide talking points to a nurse counseling a patient who is struggling to maintain the loss: (more…)

A study from nurse researchers at the University of Pennsylvania school of nursing has found that while pain is undertreated in general in the United States, low-income and minority patients are even less likely to receive adequate pain treatment. This result holds up across virtually all healthcare settings.

Minority patients are more likely to have dangerous jobs and often suffer more severe pain and physical impairments than non-minority patients, according to this article on Nurse.com.

Poor and minority patients often experience pain for many years before being seen by a specialist in pain treatment, possibly because health providers are more likely to underassess pain in minorities, the reviewers said. Minority and low-income patients also are more likely to live in geographic areas that restrict their access to healthcare, while pharmacies in minority zip codes are significantly less likely to have sufficient supplies of pain medications than pharmacies in predominantly white zip codes.

“There is no question that pain treatment disparities matter in many significant ways,” Penn Nursing professor and lead study author Salimah Meghani, RN, PhD, said in a news release. “The most important are the tremendous burdens placed on patients, health systems and society when the most effective pain care is not accessible, affordable and delivered to those in need.

“Until the prevailing issues of inequitable healthcare are realized and confronted through focused and systematic strategies for education, research and healthcare reform, it is unlikely that progress will occur in reducing and ultimately eliminating pain disparities.”

According to recent estimates, chronic pain affects 116 million American adults and remains the most common reason people seek medical care. The burden of pain on Americans in direct and indirect costs can reach $635 billion annually. This expenditure includes disability, poor quality of life, relational problems, lost income and productivity, and higher healthcare utilization including longer hospital stays, ED visits and unplanned clinic visits.

Meghani and colleagues, including Penn Nursing professor Rosemary Polomano, RN, PhD, FAAN, also proposed broad advocacy initiatives such as “Look at the Data Campaigns,” especially targeted at providers to sensitize them to their blind spots that contribute to inequitable pain care — emphasizing the need for targeted education in pain disparities as part of graduate and continuing medical education, and in licensure, accreditation and certification programs for medicine, nursing and allied health professionals.

Although the Patient Protection and Affordable Care Act mandates federally funded programs to consistently collect data to track trends in healthcare disparities, the authors urged the creation of public-private partnerships in promoting standardized reporting of race and ethnicity data to allow researchers to track disparities, monitor efforts to reduce them and compare findings across studies regardless of the source of funding.

Job stress and long, irregular hours are two of the reasons that 55% of all nurses are obese, according to a study at the University of Maryland School of Nursing.

Over two thousand nurses were surveyed in the study.

An article on ABCNews.com quotes medical professionals who say that nurses are just as susceptible to health problems as the rest of society, and that “Nurses need to understand the importance of taking care of themselves before patients or their families.”

To combat the high obesity rate among nurses, Kihye Han, the author of the study, proposed more education on good sleep habits, and better strategies for adapting work schedules. She also called for napping at work to curb sleep deprivation, reduce fatigue and increase energy.

The 2004 National Sample Survey of Registered Nurses found that more than 40 percent of nurses who left nursing said they did so because of irregular and long hours, indicating that better scheduling could help nurse retention.

Han also proposed increasing making healthy food more available, and allowing enough time to consume it.

For instance, Han recommends on-site farmer’s markets to serve health care workers who work nonstandard hours, healthier vending machine choices or having food delivered to the work unit.

“There’s an awful lot conspiring against weight control in nurses. The solutions are … giving the nurses the knowledge and skills they need to manage their weight, and environmental reforms, like having opportunities for physical activity breaks in hospitals, and having nutritious food options readily available 24 hours a day,” Katz said.

“Nurses, who dedicate themselves to helping others,” said Katz, “deserve that support from us.”

A registered nurse named Theresa Brown has written an article for The New York Times’ “Cases” feature about the strain of taking care of a patient who is violent.

She had to deal with a tall, muscular 300-pound man who would act in a threatening way and then say things like “Look at you, standing there with that stupid look on your face.”

He was scary, and it turned out that he had threatened to kill a nurse on another floor. (more…)