AJN, American Journal of Nursing

Journal Information
ISSN / EISSN : 0002-936X / 1538-7488
Total articles ≅ 106,863
Current Coverage
Archived in

Latest articles in this journal

, Essie P. Mathews, Faith Newton
AJN, American Journal of Nursing; https://doi.org/10.1097/01.naj.0000794104.21262.86

While acute blood pressure elevations are commonly seen in the ED, not all require emergency treatment. True hypertensive emergencies are characterized by a rapid elevation in blood pressure to a level above 180/120 mmHg and are associated with acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and iv pharmacotherapy. Recognizing the clinical signs and symptoms of hypertensive emergency, which may vary widely depending on the target organ involved, is critical. High blood pressure levels that produce no signs or symptoms of target organ damage may be treated without hospitalization through an increase in or reestablishment of previously prescribed oral antihypertensive medication. However, all patients presenting with blood pressure this high should undergo evaluation to confirm or rule out impending target organ damage, which differentiates hypertensive emergency from other hypertensive crises and is vital in facilitating appropriate emergency treatment. Drug therapy for hypertensive emergency is influenced by endorgan involvement, pharmacokinetics, potential adverse drug effects, and patient comorbidities. Frequent nursing intervention and close monitoring are crucial to recuperation. Here, the authors define the spectrum of uncontrolled hypertension; discuss the importance of distinguishing hypertensive emergencies from hypertensive urgencies; and describe the pathophysiology, clinical manifestations, and management of hypertensive emergencies.
, Lynn G. Mackinson, Lauge Sokol-Hessner, Anica C. Law, Susan DeSanto-Madeya
AJN, American Journal of Nursing; https://doi.org/10.1097/01.naj.0000794108.07908.54

Prone positioning of critically ill patients with acute respiratory distress syndrome is an accepted therapy done to improve oxygenation and promote weaning from mechanical ventilation. But there is limited information regarding its use outside of the ICU. At one Boston hospital, the influx of patients with suspected or confirmed COVID-19 strained its resources, requiring sweeping systems changes and inspiring innovations in clinical care. This article describes how an interdisciplinary team of clinicians developed a prone positioning protocol for use with awake, nonintubated, oxygen-dependent patients with suspected or confirmed COVID-19 on medical–surgical units, with the hope of hastening their recovery and avoiding deterioration and ICU transfer. A protocol implementation plan and staff educational materials were disseminated via the hospital incident command system and supported through daily leadership huddles. Patient eligibility criteria, including indications and contraindications, and a clear nursing procedure for the implementation of prone positioning with a given patient, were key elements. Nurses' feedback of their experiences with the protocol was elicited through an e-mailed survey. Nearly all respondents reported improvements in patients' oxygen saturation levels, while few respondents reported barriers to protocol implementation. The prone positioning protocol was found to be both feasible for and well tolerated by awake, nonintubated patients on medical–surgical units, and can serve as an example for other hospitals during this pandemic.
Charlotte Clements, Jennifer Barsamian, Nicolette Burnham, Claire Cruz, Ann Marie Grillo Darcy, Lindsay Duphiney, Jacqueline FitzGerald, Susan Holland, Christine Joyce, Susan DeSanto-Madeya
AJN, American Journal of Nursing, Volume 121, pp 46-55; https://doi.org/10.1097/01.naj.0000790632.18077.c1

The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.
Karen Rosenberg
AJN, American Journal of Nursing, Volume 121, pp 57-57; https://doi.org/10.1097/01.naj.0000790644.96356.96

According to this study: Minimum nurse-to-patient staffing ratios not only improve nurse staffing and patient outcomes but also yield a good return on investment. Staffing improvements of one fewer patient per nurse led to improvements in mortality, readmissions, and length of stay.
AJN, American Journal of Nursing, Volume 121, pp 15-15; https://doi.org/10.1097/01.naj.0000790572.28489.82

Nurse leaders call for more diversity in nursing school students and faculty.
AJN, American Journal of Nursing, Volume 121, pp 25-25; https://doi.org/10.1097/01.naj.0000790624.30479.00

Dapagliflozin (Farxiga) is now approved to reduce the risk of declining kidney function, kidney failure, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease with or without type 2 diabetes.
Heather H. Washington, Kimberly R. Glaser,
AJN, American Journal of Nursing, Volume 121, pp 26-33; https://doi.org/10.1097/01.naj.0000790184.66496.1d

Stroke, the most common form of cerebrovascular disease, is a leading cause of death and disability throughout the world. There have been no significant advances in the development of effective therapeutics for hemorrhagic stroke, and for ischemic stroke highly effective, evidence-based therapies such as alteplase and mechanical thrombectomy are widely underutilized. Improving outcomes for patients experiencing ischemic stroke requires faster recognition and appropriate intervention within the treatment window (the first 24 hours after symptom onset). This article discusses the pathophysiology underlying the various types of ischemic stroke; the risk factors for ischemic stroke; stroke presentation; and the evidence-based treatments, nursing assessments, and monitoring protocols that are critical to patient recovery.
AJN, American Journal of Nursing, Volume 121, pp 18-18; https://doi.org/10.1097/01.naj.0000790596.03613.0e

Resolutions include strengthening access to nurse midwives in underserved areas.
AJN, American Journal of Nursing, Volume 121, pp 11-11; https://doi.org/10.1097/01.naj.0000790556.33467.7b

Health care providers remain ill prepared to recognize these conditions and support patients and their families.
Back to Top Top