The 50 most-cited articles in AJN American Journal of Nursing, 2016

In Brief Moral distress is a pervasive problem in the nursing profession. An inability to act in alignment with one's moral values is detrimental not only to the nurse's well-being but also to patient care and clinical practice as a whole. Moral distress has typically been seen as characterized by powerlessness and victimization; we offer an alternate view. Ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience. This article outlines the concept and prevalence of moral distress, describes its impact and precipitating factors, and discusses promising practices and interventions. This article details the concept and prevalence of moral distress in the nursing profession, describes its impact and precipitating factors, and discusses promising practices and interventions.

Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents’ sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent…

UNLABELLED: : BACKGROUND: Nurses who work the night shift often experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries, but has not had widespread acceptance in nursing. PURPOSE: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps. METHODS: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units for which the executive nursing leadership had given approval. Unit nurse managers' approval was sought, and where granted, further explanation was given to the unit's staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period. RESULTS: Successful implementation occurred on…

: To conduct a systematic review of the published research literature on end-of-life (EOL) care in prisons in order to determine the current state of the science and suggest implications for nursing practice and areas for future research.Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the literature using the following databases: CINAHL, Criminal Justice Abstracts, the National Criminal Justice Reference Service, PsycINFO, PubMed, and Sociological Abstracts. All databases were searched from the time of their inception through June 2014. All English-language articles that reported on original quantitative and qualitative research involving EOL or palliative care delivered to prisoners were included. We abstracted data, using the matrix method, and independently reviewed and graded the evidence on its level of strength and quality in accordance with the Johns Hopkins Nursing Evidence-Based Practice rating scales.Nineteen articles, all published between 2002 and 2014, met the inclusion criteria.…

In Brief More than 12% of women will be diagnosed with breast cancer at some point in their lives, and 78% of them can be expected to survive for at least 15 years. More than 2.8 million breast cancer survivors currently reside in the United States. After breast cancer treatment, as many as 90% of survivors report physical problems that can reduce functional ability, produce or exacerbate emotional problems, negatively affect body image, and diminish quality of life. Many survivors will seek care for late and long-term effects of treatment, which will not necessarily be recognized as such by health care providers and appropriately treated. In this article, the authors discuss the underlying causes of late and long-term sequelae of breast cancer treatment and describe effective assessment and management strategies. They focus specifically on the most common and potentially debilitating upper body effects of breast cancer surgery and external radiation therapy: lymphedema, axillary web syndrome, postmastectomy pain syndrome, rotator cuff syndrome, adhesive capsulitis, arthralgias,…

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library.

PURPOSE: The purpose of this study was to gather baseline data on the health-promoting lifestyle practices of RNs working in six major health care and educational institutions in a southeast Pennsylvania community. METHODS: A descriptive correlational study design was used. The 52-item Health-Promoting Lifestyle Profile II instrument was used to explore participants' self-reported health-promoting behaviors and measure the dimensions of health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management. RESULTS: Findings revealed that physical activity and stress management scores were low for the entire group of RNs. There were statistically significant differences between nurses 50 years of age and older and those 30 to 39 years of age for the subscales of health responsibility, nutrition, and stress management, suggesting that older nurses are more concerned about their health. There were also statistically significant differences between nurses 50 years of age and older and those 29 years of age and younger for the subscale of…

In Brief Although skin tears are common, particularly among older adults and neonates, they are often inadequately documented and poorly managed, resulting in complications, extended hospital stays, and negative patient outcomes. In this article, the first in a series on wound care in collaboration with the World Council of Enterostomal Therapists (www.wcetn.org), the authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears. In this first article in a series on wound care in collaboration with the World Council of Enterostomal Therapists, the authors describe the complications that developed in an elderly patient whose skin tear was improperly dressed and discuss best practices for preventing, assessing, documenting, and managing skin tears.

: The perceived benefits of rapid response teams (RRTs) influence whether RRTs are used and sustained. Perceived benefits are particularly important to sustaining RRTs when limited RRT data are shared with organizational members. Nurse leaders' perceptions of the benefits of RRTs likely influence their support, which is crucial for sustained RRT use. The perceptions of RRT members and end users similarly will affect use. But little is known regarding the perceptions of nurse leaders, RRT members, and RRT users in this regard.This study sought to explore and compare the perceptions of nurse leaders, RRT members, and RRT users regarding the benefits of RRTs.A qualitative, multiple-case study design was used. Semistructured interviews were conducted with nurse leaders, RRT members, and RRT users at four community hospitals, as part of a larger mixed-methods study examining RRT sustainability. Purposive and snowball sampling were used. Recruitment strategies included e-mail and listserv announcements, on-site presentations, direct personal contact, and a study flyer.All participants…

Consolidated approaches are needed from employers, victims, and the political system.

In Brief When engaging in telemedicine, it is important for a nurse to understand legal and regulatory requirements. This article examines the legal and regulatory considerations surrounding the rapidly growing practice of remote health care delivery.

: Objective: The purpose of this project was to design, implement, and evaluate a safe sleep program for expectant mothers and the families of infants discharged from our hospital's neonatal intensive care unit (NICU). It was prompted by the sleep-related deaths of two infants in the community, both of whom had been discharged from our NICU. METHODS: A six-member interdisciplinary team comprising nurses, a physician, an occupational therapist, and a respiratory therapist developed a safe sleep program in an effort to identify and implement evidence-based safe sleep practices for infants in the NICU. The team examined the literature on sleep-related death and safe sleep practices, consulted with colleagues in NICUs at nearby hospitals and clinics, and conducted an audit of practices related to putting infants to sleep in the NICU. The initiative included the use of infant sleep sacks, the development of a clinical practice guideline to promote safe sleep, and the delivery of standardized discharge education for caregivers in the NICU and safe sleep classes for expectant mothers and…

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library.

In Brief With the growing popularity of integrative medicine, essential oils have found their way back into health care. Essential oils provide a simple way to alleviate certain physical symptoms, promote emotional well-being, and provide comfort. This article, the last in a five-part series on holistic nursing, discusses the administration and common uses of essential oils; their reported benefits, potential risks, and contraindications; and the current state of associated research. The authors focus specifically on the inhalation, both direct and by diffusion, as well as the topical application of essential oils, providing guidance for their use in acute care, self-care, community nursing, and long-term care that will enable readers to incorporate this modality into nursing practice. This final installment in a five-part series on holistic nursing presents an overview of the use of essential oils, with a focus on its benefits and risks, supportive research, and how to incorporate its use into practice.

A series of policy briefs on topics of interest to nurses.

This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes mentoring strategies clinical instructors and preceptors can use to help ease novice nurses' transition to practice.

In Brief Bullying in the workplace can create a dysfunctional environment that is associated with serious physical and psychological harm to the person being bullied. Nurses’ experience with bullying has gained considerable attention in recent years, and warrants further discussion. Nurse leaders need to develop and implement effective bullying prevention initiatives that will foster the functioning of a professional and productive staff in a healthy work environment. The aim of this article is to review workplace bullying as experienced by nurses, and describe how nurses at a Magnet-designated academic medical center developed and implemented a bullying task force to address the problem. The authors review workplace bullying among nurses—including its prevalence, manifestations, and consequences—and describe how one hospital implemented a nurse-led initiative to address bullying.

In Brief Background: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. Purpose: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults. Methods: The study site's adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and body mass index. Findings: Bivariate analysis revealed a statistically significant association between injurious falls and having a primary discharge diagnosis of “symptoms, signs, and…

The manufacturer of Zecuity, a transdermal formulation of sumatriptan, which is used to treat migraine headache, has temporarily suspended sales, marketing, and distribution while it works with the FDA to investigate the reports of burns and scarring associated with the patch. Clinicians should immediately stop prescribing Zecuity and provide patients with an alternative migraine medication.

This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes the benefits and challenges of using a "flipped" classroom to promote active engagement among learners and more meaningful interaction between learners and educators.

In Brief Clinical nurses often find writing a challenge, but it's important to disseminate clinical practice initiatives that result in notable patient outcomes. Nurses have a responsibility to share what they do to improve patient care. The increased emphasis on the development and evaluation of evidence-based practice has made it necessary for nurses to share best practices that are associated with improved patient outcomes. We developed a six-month Writing for Publication workshop series designed to teach clinical nurses about the writing process and mentor them through the stages of preparing a manuscript to submit for publication. This successful program helped novice nurse authors become published professionals and had a great impact on our organization. This article describes the initiation of a workshop series designed to teach clinical nurses about the writing process and mentor them through the stages of submitting a manuscript for publication.

Providing learners the experiences without the risks.

In Brief Objective: This study aims to provide demographic data on the 5.4% of U.S. RNs who are Latino in order to assist nursing educators in planning more effective engagement with the growing U.S. Latino population. Methods: Detailed data from the U.S. Census for the years 1980 to 2010 were used to identify the total U.S. population and the total number of RNs in four standard U.S. Census racial and ethnic groups: non-Latino white (NLW), Latino, African American, and Asian/Pacific Islander. Results: The number of RNs in each racial or ethnic group per 100,000 persons of that same group is reported for all four groups. Spanish-language ability and nativity were derived only for the NLW and Latino groups. Data are reported for the United States as a whole and for the five states with the largest Latino populations: California, Florida, Illinois, New York, and Texas. Of the four racial and ethnic groups, Latinos had the fewest number of RNs per 100,000 population in the period from 1980 to 2010. Compared with NLW RNs, Latino RNs were more likely to speak Spanish and to have been…

UNLABELLED: : BACKGROUND: Intimate partner violence (IPV) continues to be a pervasive health and social problem in the United States with serious short- and long-term consequences. Women in rural areas face particular challenges. Health care providers can play an important role in the lives of women who experience IPV; yet among providers, lack of knowledge, negative attitudes and beliefs, and low rates of screening are common. OBJECTIVE: Though a large body of research exists regarding health care providers' IPV-related knowledge, attitudes, beliefs, and behaviors, little is known specifically with regard to rural providers. Given the challenges faced by rural women and the potential influence of their providers, it's important to understand rural providers' IPV-related knowledge, attitudes, beliefs, and behaviors. We conducted a study to learn more. METHODS: Health care providers working in a large rural health network were asked to complete electronic surveys that examined their IPV-related knowledge, attitudes, beliefs, and behaviors. Descriptive and correlational statistical…

Research has shown that nurses who participate in shared decision making (SDM) have more control over their practice and greater job satisfaction, and hospitals that have instituted SDM have lower rates of nurse turnover and better patient outcomes. The purpose of this article is to describe the implementation of an SDM structure at a pediatric hospital. The hospital's chief nurse officer charged a group of nurses with developing SDM guidelines to outline the purpose, structure, and function of unit councils. A targeted, multifaceted approach to the implementation of these guidelines led to the successful standardization of nine existing unit councils and the expansion of the SDM unit council structure to all other hospital units. Work continues with guideline refinement in response to the real-life circumstances nurses encounter on the units, and the original group of nurses continues to review literature on SDM best practices. In addition, professions other than nursing, including multidisciplinary teams in dialysis, cardiovascular surgery, respiratory therapy, and child life,…

: Postoperative urinary retention (POUR) is the inability to void when the bladder is full after surgery. It is a common complication in postoperative patients, especially in patients undergoing spinal surgery. At our institution, patients who were discharged from the postanesthesia care unit (PACU) to the inpatient surgical unit typically had bladder distention and a bladder volume of more than 450 mL. In an effort to address this situation, an interprofessional group of advanced practice RNs and physicians formed a team, reviewed the existing literature, examined the PACU nursing practice guideline for evaluating and managing POUR, and devised a quality improvement (QI) project to raise the PACU nursing staff's awareness of the potential for POUR among postoperative patients and to develop an updated nursing practice algorithm for the evaluation and management of POUR in spinal surgery patients. A description of the QI process, including the revised algorithm and pre- and postintervention results, is reported here. In the preintervention group (n = 42), 19 indwelling urinary…

: Background: As it is in many other developed countries, obesity is a growing health concern in Taiwan, affecting nearly 20% of the adult population. Obesity can increase the risk of developing metabolic syndrome, diabetes, and cardiovascular disease. Recent data indicate that the prevalence of metabolic syndrome in Taiwan is 25.5%. Yet some overweight and obese individuals have normal metabolic profiles. It's not clear why some overweight or obese people remain metabolically healthy while others do not. PURPOSE: The purpose of this study was to examine lifestyle risk factors for metabolic syndrome in people who are overweight or obese. We were particularly interested in distinguishing those lifestyle factors associated with metabolic health in this population. METHODS: Data collected from community-based physical examinations in northern Taiwan were used for this cross-sectional study. A survey was conducted from 2013 to 2014. We collected data on demographic variables, clinically pertinent measures (weight; height; waist circumference; blood pressure; and levels of fasting blood…

Issues surround data entry, usability, and communication.

In Brief The last two decades have seen increasing numbers of women entering all branches of the U.S. armed forces. Now that women in the military are no longer prohibited from holding direct combat positions, they are often exposed to traumatic events that place them at higher risk for mental health conditions. Nurses working within the Veterans Affairs (VA) system and those working in non-VA settings are likely to encounter female veterans. It's essential for all nurses to be knowledgeable about the mental health issues commonly seen in this population, and to understand the importance of screening, not only for mental health issues but also for physical conditions that may be related to service. Numerous studies have focused on the mental health effects of deployment among military men, but very few have been conducted among military women. To learn more, the literature was searched for relevant articles published between January 2005 and December 2015. The research supports the contention that both active-duty and veteran women are at increased risk for postdeployment mental…

The FDA has revised the boxed warning for fluoroquinolone antibiotics to highlight the possibility that a cluster of adverse effects in the musculoskeletal system, peripheral nervous system, and/or central nervous system may occur suddenly during or after drug therapy. These adverse effects may produce permanent disability. A high risk of these severe adverse effects exists when fluoroquinolones are used to treat acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections; therefore, fluoroquinolones should not be used to treat these infections unless there are no alternative treatment options.

In Brief The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, birthing centers, and abortion facilities must file information on incidents and serious events. Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on “Patient Safety Advisories” and then “Advisory Library” in the left-hand navigation menu. This article examines the safety implications of health care worker fatigue and offers strategies for reducing the incidence of fatigue-related errors and patient injuries.

In Brief In the spring of 2012, a nurse in Washington State detected a cluster of babies born with anencephaly—a fatal condition in which infants are born without parts of the brain or skull. The resulting investigation initially confirmed a rate of anencephaly between January 2010 and January 2013 of 8.4 per 10,000 live births—more than four times the national average. As of November 2015, cases of anencephaly in Washington State have continued to increase, with the current rate estimated at 9.5 per 10,000 live births. While no distinct cause has yet been determined, neural tube defects—including anencephaly—are known to have multiple causes, including folic acid deficit, genetic variants in the folate pathway, and exposure to a variety of environmental and occupational toxins. This article describes many of these risk factors and explores the findings of Washington's ongoing investigation. The nurse who reported an alarming cluster of babies born with anencephaly in 2012, which triggered a still-ongoing investigation, reviews the many risk factors for neural tube defects and…

In Brief Since the introduction of HMG-CoA reductase inhibitors, also known as statins, as an adjunct to diet in the treatment of hyperlipidemia and the greater emphasis placed on reducing low-density lipoprotein (LDL) cholesterol levels in the prevention of atherosclerosis and cardiovascular disease (CVD), there has been less focus on the value of lowering serum triglyceride levels. Many patients are aware of their “good” and “bad” cholesterol levels, but they may not be aware of their triglyceride level or of the association between high triglycerides and the development of CVD. In recent years, however, in light of the increasing incidences of obesity, insulin resistance, and type 2 diabetes, lowering triglyceride levels has gained renewed interest. In addition to the focus on lowering LDL cholesterol levels in CVD prevention, clinicians need to be aware of the role of triglycerides—their contribution to CVD, and the causes and treatment of hypertriglyceridemia. The authors discuss the importance of lowering triglyceride levels in light of the increasing incidences of obesity,…

In Brief The prevalence of human papillomavirus (HPV)–related oral cancers has been rising, the cancers occurring in adults at a younger age than HPV-negative oral cancers typically do and in men more often than women. Patients who are diagnosed often don't understand the disease's etiology. Because HPV is sexually transmitted, diagnosis with an HPV-related oral cancer may prompt feelings of shame, embarrassment, and guilt. There are currently three vaccines for HPV. It's essential for nurses to educate patients on HPV transmission and HPV-related oral cancer, thus helping to mitigate the stigma and dispel myths, and to promote vaccination in at-risk populations, including children and young adults. This article describes the risk factors, clinical features, and treatment of human papillomavirus (HPV)–related oral cancers, and suggests ways for nurses to educate patients on and correct misconceptions about HPV transmission.

As part of its Raise the Voice campaign to showcase nurses who are key players in transforming health care, the American Academy of Nursing has identified nurses they call edge runners-"practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges." This is the seventh in AJN's series of profiles of these nursing innovators. Read and be proud of what nurses can accomplish.

In Brief In the acute care setting, pain, agitation, and delirium (PAD) often occur as interrelated parts of a syndrome rather than as separate entities. Because the three facets of PAD may be similar in presentation, it is often difficult for clinicians to recognize the syndrome and to assess and treat it. The challenge is particularly great in older patients, who are more likely than their younger counterparts to have such comorbid conditions as dementia, which may impair the ability to report pain, or age-related physiologic changes that may affect the metabolism and clearance of certain medications. This article provides an overview of each aspect of PAD, discusses clinical considerations related to the assessment and treatment of the syndrome in older adults receiving acute care, and illustrates the application of published PAD guidelines through the use of a hypothetical patient scenario. This article provides a review of clinical considerations related to the assessment and treatment of pain, agitation, and delirium, which often occur together as parts of a syndrome that may…

In Brief This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes teaching strategies as well as the importance of the learning environment. Emphasizing the importance of creating a positive learning environment, this article offers strategies for instructors who teach in the clinical setting.

According to this study: Intake of 500 mg/day of dietary long-chain omega-3 polyunsaturated fatty acids (found in at least two servings of fatty fish a week) is associated with a reduced incidence of severe diabetic retinopathy in older adults. Higher reductions in risk of diabetic retinopathy were seen in participants with hypertension and in those who had diabetes for more than five years; thus, intake of long-chain omega-3 polyunsaturated fatty acids were shown to be beneficial in these critical populations.

Modifiable risk factors emerge as leading contributors.

In Brief The author presents the case of a 52-year-old woman who experienced symptoms of myocardial infarction (MI) over many months; neither her clinicians nor the patient—herself a nurse—recognized them. The author discusses the signs and symptoms of MI in women and highlights how failure to recognize them may lead to misdiagnosis and even death. This case illustrates how important it is that health care providers consider the possibility of heart disease in any woman whose symptoms could be cardiac in origin, even when the cause appears to be something else. The author provides an overview of the signs and symptoms of myocardial infarction in women and highlights how the failure to recognize them in the case of one woman—herself a nurse—led to misdiagnosis and could have resulted in death.

In Brief The experience of military sexual trauma (MST), which can result from assault, battery, or harassment of a sexual nature, may jeopardize the mental health of service members as well as that of their family members, colleagues, and community members. Although a greater proportion of female than male service members are subjected to MST, the Department of Defense estimates that the absolute numbers of affected men and women, across all ranks and branches of military service, are nearly equal because roughly 85% of military members are men. Little research has explored the effects of MST on men. This article discusses the unique ways in which men may experience MST, and examines how social stereotypes of masculinity, myths surrounding sexual assault, and military culture and structure often influence a man's interpretation of an attack and his likelihood of reporting the incident or seeking treatment. It describes current treatments for MST-related mental health conditions and addresses implications for nurses and other health care professionals. This article examines the…

The Food and Drug Administration is requiring manufacturers of metformin and metformin-containing drugs to revise their labeling to indicate that metformin may be safely used in some patients with mild-to-moderate renal dysfunction. Nurses should regularly assess patients’ estimated glomerular filtration rate to confirm that renal function remains adequate to support metformin therapy.

UNLABELLED: : PURPOSE: Young adult burn survivors who were burned before they reached young adulthood (before the age of 18) face particular challenges in meeting their needs for socialization. Social media are widely used by adolescents and young adults, and permit socialization without face-to-face communication. This qualitative, phenomenological study was conducted in order to explore and describe the lived experience of social media by young adult burn survivors. METHODS: Five women and four men between the ages of 20 and 25 years were interviewed; before the age of 18 years, each had sustained burns over more than 25% of their total body surface area. Van Manen's phenomenological methodology provided the study framework. RESULTS: Five essential themes emerged: identity, connectivity, social support, making meaning, and privacy. The participants used social media as a way to express their identity while safeguarding their privacy, and as a way to make meaning out of their traumatic experiences. Connecting with others facilitated a flow of social support and information, which…

This column is designed to provide a nursing perspective on new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs.

In Brief Controversies surround potential restrictions on their off-label use. This article details the controversies surrounding restrictions on the use of point-of-care blood glucose meters in critically ill, hospitalized patients.

In Brief The American Cancer Society estimates that in 2014 nearly 16,000 U.S. children and adolescents developed cancer, and in roughly 1,200 of these cases the cancer was Hodgkin lymphoma (HL). The great majority of these patients will survive, joining the thousands who have been diagnosed and treated successfully in decades past. Nurses’ familiarity with and attention to the late effects of the chemotherapy and radiation therapy used to treat HL, which include breast cancer as well as cardiotoxicity and its sequelae, are essential in helping these patients maintain their overall health. The author of this second article in a series on cancer survivorship care from Memorial Sloan Kettering Cancer Center reviews the late adverse effects associated with the management of Hodgkin lymphoma.

In Brief Child sexual abuse is a global issue that nurses must be aware of and knowledgeable about as they care for children in various care settings. This article focuses on the prevalence, potential risk factors, and possible signs and symptoms of child sexual abuse. It also provides information about what nurses can do should they suspect that a child has been or is being abused. Because consequences can be far reaching and exist for many years after the abuse, this article also addresses the possible long-term issues faced by survivors and provides resources that nurses can share with patients. The author discusses the prevalence, risk factors, and possible signs and symptoms of child sexual abuse, explains how to take action if abuse is suspected, and provides resources nurses can share with patients.

In Brief What if a patient doesn't want to be cared for by a provider against whom the patient harbors a personal bias? Nurses cannot refuse to care for a patient based on an individual bias, but what if it's the patient who doesn't want to be cared for by a certain provider? Can or should an accommodation be made to indulge a patient's bigotry?

Objective To conduct a systematic review of the published research literature on end-of-life (EOL) care in prisons in order to determine the current state of the science and suggest implications for nursing practice and areas for future research. Methods Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the literature using the following databases: CINAHL, Criminal Justice Abstracts, the National Criminal Justice Reference Service, PsycINFO, PubMed, and Sociological Abstracts. All databases were searched from the time of their inception through June 2014. All English-language articles that reported on original quantitative and qualitative research involving EOL or palliative care delivered to prisoners were included. We abstracted data, using the matrix method, and independently reviewed and graded the evidence on its level of strength and quality in accordance with the Johns Hopkins Nursing Evidence-Based Practice rating scales. Results Nineteen articles, all published between 2002 and 2014,…

With community commitment, older adults can remain healthy, independent, and in their own homes.