The 50 most-cited articles in AJN American Journal of Nursing, 2017

In Brief Climate change is an enormous challenge for our communities, our country, and our world. Recently much attention has been paid to the physical impacts of climate change, including extreme heat events, droughts, extreme storms, and rising sea levels. However, much less attention has been paid to the psychological impacts. This article examines the likely psychological impacts of climate change, including anxiety, stress, and depression; increases in violence and aggression; and loss of community identity. Nurses can play a vital role in local and regional climate strategies by preparing their patients, health care facilities, and communities to effectively address the anticipated mental health impacts of climate change. The authors examine the evidence on the likely effects of climate change on mental health and well-being, and discuss these health impacts, their mechanisms of action, and the unique vulnerabilities of some populations, as well as the need to build resilience.

: Decades of research have documented the frequency, sources, and consequences of moral distress. However, few studies have focused on interventions designed to diminish its negative effects. The cultivation of moral resilience-the ability to respond positively to the distress and adversity caused by an ethically complex situation-is proposed as a method to transform moral distress.

Despite the promise of remote health care services, their operation faces hurdles.

In Brief Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal (GI) condition characterized by disturbances in bowel habits and abdominal pain in the absence of known organic pathology. IBS reduces quality of life and is costly to treat. It is diagnosed using the symptom-based Rome criteria for functional GI disorders, which was recently updated and released as Rome IV. Both physiologic and psychological variables play a role in the etiology of IBS and perpetuate symptoms. Although research has shed light on IBS pathophysiology, therapeutic interventions remain symptom driven, employing both pharmacologic and nonpharmacologic approaches. Here, the authors review the epidemiology and pathophysiology of IBS, summarize diagnostic and treatment strategies, and discuss implications for nursing practice. The authors review the epidemiology and pathophysiology of irritable bowel syndrome, summarize diagnostic and treatment strategies, and discuss implications for nursing practice.

In Brief This series on palliative care is developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; http://hpna.advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research. This article in a series on palliative care developed in collaboration with the Hospice and Palliative Nurses Association discusses how nurses can promote the practice of advance care planning in their facility and overcome the challenges associated with its implementation.

: Multimodal analgesia, which combines analgesic drugs from different classes and employs analgesic techniques that target different mechanisms of pain, is recommended in the treatment of acute postoperative and trauma-related pain because its synergistic effect maximizes pain relief at lower analgesic doses, thereby reducing the risk of adverse drug effects. Using a case-based approach, this article reviews various multimodal analgesic therapies used in the treatment of acute pain; discusses their benefits; and summarizes findings from related research, recommendations from evidence-based practice guidelines, and expert consensus reports.

: This article provides an overview of moral distress, including the existing research on the concept, and a discussion of ways to evolve our understanding of moral distress in order to meet current and future practice challenges.

In Brief The vast majority of medical errors occurring each year involve faulty communication. For this reason, it's essential that we identify skills that support accurate communication and information transfer as well as optimum patient-centered care, team function, and patient safety. Research in nursing and other disciplines has demonstrated that emotional intelligence abilities improve communication, support constructive conflict resolution, and improve individual and team performance. Although further studies are needed, these findings suggest emotional intelligence ability can positively affect patient safety. The authors address how emotional intelligence–which refers to our ability to recognize and manage both our emotions and the emotions of others–may be a skill that can help nurses to “error proof” communication in the health care setting.

In Brief At the April 2016 National Pressure Ulcer Advisory Panel (NPUAP) consensus conference, terminology and staging definitions were updated and two definitions were revised to describe pressure injuries (PIs) caused by medical devices or other items on the skin or mucosa. Here, the authors discuss the etiology and prevention of PIs resulting from medical and other devices, the frequency of such injuries, and the bodily sites at which they most often occur. They provide an overview of the current NPUAP guideline, highlight important risk factors, and explain why mucosal PIs cannot be staged. A review of the etiology, identification, and prevention of pressure injuries caused by medical and other devices, plus highlights from the current National Pressure Ulcer Advisory Panel clinical guidelines.

In Brief To examine practices for addressing moral distress, a collaborative project was developed by the Johns Hopkins Berman Institute of Bioethics, the Johns Hopkins School of Nursing, the American Journal of Nursing, and the Journal of Christian Nursing, along with the American Association of Critical-Care Nurses and the American Nurses Association. Its purpose was to identify strategies that individuals and systems can use to mitigate the detrimental effects of moral distress and foster moral resilience. On August 11 and 12, 2016, an invitational symposium, State of the Science: Transforming Moral Distress into Moral Resilience in Nursing, was held at the Johns Hopkins School of Nursing in Baltimore, Maryland. Forty-five nurse clinicians, researchers, ethicists, organization representatives, and other stakeholders took part. The result of the symposium was group consensus on recommendations for addressing moral distress and building moral resilience in four areas: practice, education, research, and policy. Participants and the organizations represented were energized and…

Nurse-led interventions can prepare a vulnerable population.

: To examine practices for addressing moral distress, a collaborative project was developed by the Johns Hopkins Berman Institute of Bioethics, the Johns Hopkins School of Nursing, the American Journal of Nursing, and the Journal of Christian Nursing, along with the American Association of Critical-Care Nurses and the American Nurses Association. Its purpose was to identify strategies that individuals and systems can use to mitigate the detrimental effects of moral distress and foster moral resilience. On August 11 and 12, 2016, an invitational symposium, State of the Science: Transforming Moral Distress into Moral Resilience in Nursing, was held at the Johns Hopkins School of Nursing in Baltimore, Maryland. Forty-five nurse clinicians, researchers, ethicists, organization representatives, and other stakeholders took part. The result of the symposium was group consensus on recommendations for addressing moral distress and building moral resilience in four areas: practice, education, research, and policy. Participants and the organizations represented were energized and committed to…

This column is designed to provide a nursing perspective on 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.

This updates the 1999 original, published before formal evidence-based guidelines were in routine use.

In Brief Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The most promising approach to this national crisis is a new understanding of the need for the careful and responsible use of antibiotics, both for the benefit of society and for the optimal care of each patient. This multidisciplinary approach, called antimicrobial stewardship, has typically involved specialists but not necessarily nurses, who perform numerous antibiotic-related activities daily and should be an integral part of antimicrobial stewardship programs. In this article, we use patient examples to review several stewardship activities and illustrate how nurses are essential to the appropriate use of antibiotics. In light of the dramatic increase in antibiotic resistance in the United States, this article reviews antimicrobial stewardship activities that can be performed by nurses and illustrates how nurses are essential to the appropriate use of antibiotics.

: Opioid analgesics are commonly administered to hospitalized patients to treat acute pain, but these drugs put patients at risk for serious adverse events, such as unintended advancing sedation, respiratory depression, and death. Nurses play an important role in keeping patients safe by making clinical decisions about the frequency and intensity with which patients receiving IV and epidural opioids should be monitored. To make sound clinical judgments, nurses must be aware of the factors that place patients at elevated risk for adverse opioid-related effects and know how to screen and assess patients for these risks. The authors review the literature on unintended advancing sedation and respiratory depression associated with opioid administration and present evidence-based recommendations for clinical decision making and patient monitoring, using both nursing assessments and electronic technologies.

: In recent years, health care organizations have been moving away from a culture that responds to errors and near misses with "shame and blame" and toward a fair and just culture. Such a culture encourages and rewards people for speaking up about safety-related concerns, thus allowing the information to be used for system improvement. In part 1 of this series, we reported on findings from a study that examined how nursing schools handled student errors and near misses. We found that few nursing schools had a policy or a reporting tool concerning these events; and that when policies did exist, the majority did not reflect the principles of a fair and just culture. This article, part 2 of the series, describes several strategies that nursing schools can use for creating such a culture.

In Brief Nurses are becoming increasingly involved in conducting clinical research in which feasibility studies are often the first steps. Understanding why and how these studies are conducted may encourage clinical nurses to engage with researchers and take advantage of opportunities to participate in advancing nursing science. This article provides an overview of feasibility studies, including pilot studies, and explains the type of preliminary data they seek to provide in order to make larger, future studies more efficient and successful. By way of example, the authors discuss a feasibility study they conducted that illustrates the key components and necessary steps involved in such work. This article provides an overview of feasibility studies, including pilot studies, and explains the type of preliminary data they seek to provide in order to make larger, future studies more efficient and successful. As an example, the authors discuss a feasibility study they conducted.

: Background: Little attention has been paid to how nursing students learn about quality and safety, and to the tools and policies that guide nursing schools in helping students respond to errors and near misses. PURPOSE: This study sought to determine whether prelicensure nursing programs have a policy for reporting and following up on student clinical errors and near misses, a tool for such reporting, a tool or process (or both) for identifying trends, strategies for follow-up with students after errors and near misses, and strategies for follow-up with clinical agencies and individual faculty members. METHODS: A national electronic survey of 1,667 schools of nursing with a prelicensure registered nursing program was conducted. Data from 494 responding schools (30%) were analyzed. RESULTS: Of the responding schools, 245 (50%) reported having no policy for managing students following a clinical error or near miss, and 272 (55%) reported having no tool for reporting student errors or near misses. CONCLUSIONS: Significant work is needed if the principles of a fair and just culture…

In Brief Insertion of peripheral iv catheters is a common practice in medical–surgical care settings. The frequency with which attempts are made to insert catheters causes rapid peripheral vessel depletion (a reduction in the number of usable veins), leading to the overuse of unnecessary central line catheters. Reducing central line–associated bloodstream infections is a national health care priority. In this quality improvement report, the authors describe the implementation of a nurse-led vascular access preservation program using ultrasound technology as a method to reduce the use of nonessential peripherally inserted central catheters. How one institution reduced its catheter failure rate and use of nonessential peripherally inserted central catheters by initiating a practice change involving an ultrasound-guided insertion technique.

A call to action for research, education, and collaboration.

: Acute pain, which is usually sudden in onset and time limited, serves a biological protective function, warning the body of impending danger. However, while acute pain often resolves over time with normal healing, unrelieved acute pain can disrupt activities of daily living and transition to chronic pain. This article describes the effects of unrelieved acute pain on patients and clinical outcomes. The authors call on nurses to assess and manage acute pain in accordance with evidence-based guidelines, expert consensus reports, and position statements from professional nursing organizations in order to minimize the likelihood of its becoming chronic.

: Purpose: Red yeast rice (RYR) supplementation has become a popular alternative to statin therapy in treating hypercholesterolemia. This state-of-the-science review seeks to explore the most recent evidence on the effectiveness and safety of RYR supplementation in treating dyslipidemic adults. METHODS: This review extends the time frame of a meta-analysis performed by Li and colleagues in 2014; specifically, we looked at the literature published between September 2013 and April 2016. We conducted a search of four electronic databases-PsycINFO, CINAHL, PubMed, and Scopus-using the terms red yeast rice and cholesterol. We excluded studies that included berberine or lovastatin. RESULTS: Fifteen articles met the inclusion criteria. Eleven articles reported on randomized controlled trials, one reported on an open-label pilot study, and one reported on an open-label clinical trial. Two articles were meta-analyses. The 13 studies involved a total of 1,246 participants, with an additional 7,467 participants reported in the two meta-analyses. Significant reductions in low-density…

In Brief Acute postoperative pain remains undertreated despite the dramatic increase in opioid prescribing in the United States over the past 20 years. Inadequately relieved postoperative pain may be a risk factor for persistent postoperative pain, chronic pain, and disability. In an effort to promote evidence-based strategies for optimal postoperative pain management, the American Pain Society published a new postoperative pain management guideline in 2016. Its 32 recommendations for interdisciplinary and multimodal postoperative pain management are stratified according to risks and benefits, based on varying levels of evidence. This article aims to help nurses translate the recommendations into clinical practice, while providing the historical context in which the guidelines emerged and describing current events that may affect guideline implementation. This article reviews the recommendations of the American Pain Society's postoperative pain management guideline, and discusses its historical context and the current events that may affect its implementation in clinical practice.

In Brief Nurses regularly circumvent work systems they perceive to be flawed to provide more efficient or better care. If kept secret, however, such workarounds become ethically questionable, even when the nurse is trying to do the right thing. In this article, the author discusses how nurses can be creative problem solvers without resorting to practices that may be ethical in intent yet potentially harmful in their consequences. How nurses can be creative problem solvers without resorting to workarounds that may be ethical in intent yet potentially harmful in their consequences.

I'm an RN with 32 years of experience in hospital nursing, but I learned the effects of poor communication during transfer of care for my mother (“Could Emotional Intelligence Make Patients Safer?,” July). During a transfer from inpatient care to rehab, her seizure meds were ordered at three times the correct dose. My repeated questioning of nursing staff as to why she was confused and paranoid resulted in defensiveness and shrugs. Only after she was readmitted to a different hospital, at my insistence, was the error found. I agree with the authors that improved emotional intelligence skills can improve nurses’ performance and communication, as well as quality of care. I would suggest that these skills be utilized not only with staff members, but also when gathering information from patients and families. Having emotional intelligence means being able to facilitate reasoning, and that includes gathering information from all sources for improved patient care. Engaging patients and families during health care delivery is an important part of ensuring patient safety and of improving…

: Background: In its 1999 report To Err Is Human: Building a Safer Health System, the Institute of Medicine (IOM) suggested that between 44,000 and 98,000 Americans die annually as a result of medical errors. The report urged health care institutions to break the silence surrounding such errors and to implement changes that would promote a culture of safety. OBJECTIVE: Our aim in conducting this content analysis of AJN articles was to explore the nurse's historical and contemporary role in promoting patient safety. We chose to focus on AJN because, as the oldest continuously published nursing journal, it provided a unique opportunity for us to view trends in nursing practice over more than 100 years. METHODS: We reviewed all AJN tables of contents from 1900 through 2015, identifying for inclusion articles with titles that suggested a focus on nursing care, patient safety, or clinical content. We then read and analyzed each of the final 1,086 articles over a period of nine months. FINDINGS: Our content analysis indicates that the early articles (from 1900 through 1920) focused on…

In Brief Background: Alzheimer's disease is a chronic, debilitating disease that currently affects an estimated 5.5 million Americans. The majority are being cared for at home by family caregivers, who are known to have higher levels of burden than any other group of caregivers. Purpose: The purpose of this phenomenological study was to explore the lived experiences of people who transition to the role of caregiver for a family member with Alzheimer's disease or a related dementia. Methods: The study used purposeful sampling. Eight women and two men (mean age, 66.3 years) participated. Data were collected through in-depth semistructured interviews, along with observational field notes. Data were analyzed using a hermeneutic phenomenological approach. Results: The average duration of caregiving reported by participants was five years. Seven themes were uncovered: something is wrong; journey to diagnosis: ambiguity and negative emotions; shifting roles and relationships: losses and challenges; seeking knowledge and support: solutions and frustrations; adapting to the topsy-turvy world…

: Objective: RNs are adopting an ever-larger role in health care models designed to reduce costs, increase patient satisfaction, and improve patient outcomes. Most research exploring such models has focused on those involving physicians or advanced practice nurses rather than RNs. This study explored the perspectives of patients, RNs, and other providers regarding a new prenatal connected care model for low-risk patients aimed at reducing in-office visits and creating virtual patient-RN connections. METHODS: This qualitative evaluation was performed as part of a larger randomized controlled trial of the new care model. Individual interviews and asynchronous online focus groups were conducted with a total of 41 patients, up to 10 unit and connected care RNs, and up to 17 other providers (up to eight physicians and nine certified nurse midwives [CNMs]). RESULTS: Thematic analysis indicated that patients in the new care model valued connectedness and relationships with the connected care RNs, including the ability to contact them as needed outside the office setting. Patients also…

In Brief Nurses play a critical role in the diagnosis and treatment of tuberculosis and in the prevention of tuberculosis transmission through infection control practices. To eliminate tuberculosis in the United States, however, an expanded approach to testing and treating people with latent tuberculosis infection must be implemented. Recently, the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation statement on latent tuberculosis infection testing that expands nurses’ opportunities to identify at-risk populations for tuberculosis prevention. In combination with newer testing methodologies and shorter treatment regimens, implementation of the USPSTF recommendation has the potential to remove previously existing barriers to screening and treatment of both patients and health care providers. This article provides a general overview of tuberculosis transmission, pathogenesis, and epidemiology; presents preventive care recommendations for targeted testing among high-risk groups; and discusses the USPSTF recommendation's applicability to public health and primary…

: A deep tissue pressure injury (DTPI) is a serious type of pressure injury that begins in the muscle closest to the bone and may not be visible in its early stages. Its hallmark is rapid deterioration despite the use of appropriate preventive interventions. In 2007, the National Pressure Ulcer Advisory Panel added suspected deep tissue injuries to the traditional classification system, and by 2010 DTPIs had accounted for about 9% of all pressure injuries and were for the first time more prevalent than stage 3 or 4 pressure injuries. On average, patients who develop these injuries are older and have a lower body mass index than patients who develop other pressure injuries. Most commonly, DTPIs appear on the skin over the coccyx or sacrum, the buttocks, and the heels. This article discusses the pathophysiology; risk factors; and assessment, prevention, and treatment of DTPIs, using a composite case to illustrate the progression of this serious type of pressure injury.

: Background: The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Using an evidence-based approach and building on the competencies identified by the IOM and QSEN, a team of experts at an academic health system developed eight competency domains and 186 related knowledge, skills, and attitudes (KSAs) for professional nursing practice. PURPOSE: The aim of our study was to validate the eight identified competencies and 186 related KSAs and determine their developmental progression within a clinical advancement program. METHODS: Using the Delphi technique, nursing leadership validated the newly identified competency domains and KSAs as essential to practice. Clinical experts from 13 Magnet-designated hospitals with clinical…

“Monitoring Hospitalized Adult Patients for Opioid-Induced Sedation and Respiratory Depression” (March supplement) offered helpful information. As an RN working in a neurosurgery ICU, I've seen patients experience respiratory depression from opioids. Recently I had a patient who was extubated and weaned off fentanyl without incident. For two days, the patient breathed normally without any form of oxygenation. However, on the third day, after receiving IV dilaudid 1 mg for pain, the patient began to show signs of breathing irregularities and had an oxygen saturation level of 89%. Continuous monitoring meant the patient's saturation and respiration were readily available to be interpreted and acted on. I agree with the authors that patients receiving opioids need to have continuous monitoring so nurses can respond and provide effective interventions. The authors also indicated that capnography is a great tool for assessing the respiratory status of patients receiving opioids. In the ICU, capnography is only available to patients during the 24 hours after extubation to monitor their…

: Background: Most veterans have the option of receiving their health care from the Veterans Health Administration or through primary care providers in the private sector. However, there is some evidence that fewer than half of community-based, private sector primary care and mental health providers screen their patients for military service, particularly in rural areas, leaving these veterans less likely to be screened for posttraumatic stress disorder (PTSD) and other military service-related conditions. PURPOSE: To determine whether primary care providers in the private sector are screening patients for military service and subsequent PTSD. METHODS: We designed and piloted a survey to determine whether primary care providers in a rural Pennsylvania region routinely screen for military service and service-related PTSD. We distributed the survey to a convenience sample of more than 250 primary care providers in central and western Pennsylvania through the U.S. Postal Service, via Facebook, and via work e-mails for those who worked in a local health system. RESULTS: Among 50…

: Background: Nurses developing a poster presentation for the first time who look for guidance in the literature will find many articles offering recommendations on format and style, but these are based on opinion rather than evidence. PURPOSE: The purpose of this study was to identify the attributes of a poster that improved the chance that nursing conference attendees would read it. METHODS: A mixed-methods descriptive study employing survey methodology was used to assess the perceptions of nurses attending poster sessions at a two-day nursing conference. The survey consisted of basic demographic questions, 25 items asking respondents to identify and rate the importance of variables that influenced their decision to read a poster, and several open-ended questions. Both a qualitative and quantitative analysis of the responses was performed. RESULTS: The two major themes that emerged from the qualitative analysis were that poster-viewing decisions were based first on aesthetics and then on relevance. The quantitative analysis identified aesthetic characteristics that were most…

In Brief Preeclampsia, one of four hypertensive disorders of pregnancy, has traditionally been characterized as new-onset hypertension and proteinuria developing after 20 weeks’ gestation. It is, however, now understood to be a complex, progressive, multisystem disorder with a highly variable presentation and a number of potentially life-threatening complications. The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy has refined preeclampsia diagnostic criteria accordingly, and as the disorder's pathogenesis has been more clearly defined, new targets for screening, diagnosis, prevention, and treatment have emerged. This clinical update provides a review of current practice related to preeclampsia risk assessment, prediction, and management. It discusses preeclampsia pathophysiology and points readers to valuable health care resources on the topic. A clinical review of current practice related to preeclampsia risk assessment, prediction, and management, plus updated diagnostic criteria from the American College of Obstetricians and…

A proactive approach may prevent inappropriate behaviors, sexual victimization.

: Background: The U.S. Department of Health and Human Services' initiative Healthy People 2020 targets tobacco use, including smoking during pregnancy, as a continuing major health concern in this country. Yet bringing the U.S. Public Health Service's 2008 clinical practice guideline, Treating Tobacco Use and Dependence, into routine prenatal care remains challenging. Our previous nurse-managed intervention study of rural pregnant women found no significant cessation effect and significant discordance between self-reported smoker status and urinary cotinine levels. PURPOSE: The overall purpose of this follow-up study was to increase our understanding of the experiences of pregnant smokers and their providers. No qualitative studies could be found that simultaneously explored the experiences of both groups. DESIGN AND METHODS: This qualitative descriptive study used focus group methodology. Nine focus groups were held in two counties in upper New York State; six groups consisted of providers and three consisted of pregnant women. Four semistructured questions guided the group…

: This article is the fourth in a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The fourth video can be accessed at http://links.lww.com/AJN/A78.

: Proper nutrition is an important but often overlooked component of preventive care and disease management. Following a plant-based diet in particular has been shown to have dramatic effects on health and well-being in a relatively short period of time. For this reason, nurses at three faculty-led community health clinics participated in a nutrition educational program, following a plant-based diet for 21 days. They sought to improve their knowledge of plant-based nutrition and experience firsthand the benefits of such a diet. The authors conclude that this type of program, with its experiential component and beneficial personal health results, has the potential to influence a larger nursing audience as participants apply their knowledge and experience to patient care and to classroom discussions with nursing students.

In Brief An evidence-based practice change at a radiation oncology center in a large academic medical center was designed to reduce the severity of oral mucositis in adults receiving radiation treatment for head and neck cancer. In the intervention described, patients were given newly created oral care kits and educational materials to improve their oral hygiene. Evaluations were conducted at three points during the project (before radiation treatment, during week 4 to 5 of treatment, and one month after treatment). At week 4 to 5—when the severity of oral mucositis is expected to peak—patients reported improved oral hygiene practices and reduced oral mucositis severity. The authors conclude that the use of these oral care kits and educational materials lessened the effects of oral mucositis during and after radiation treatment. The authors describe an evidence-based practice change at a radiation oncology center designed to reduce the severity of oral mucositis in adults receiving radiation treatment for head and neck cancer.

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. In this article, the author discusses ways to promote learning among adjunct clinical faculty as well as strategies for creating closer connections between these teachers and the schools of nursing that employ them.

In Brief Editor's note: To the surprise of many, a Canadian nurse's Facebook post complaining about the medical care a family member had received resulted in disciplinary action by the licensing board. We asked our legal and ethical contributing editors to provide some insight on the issues of this case. AJN's legal and ethical contributing editors offer insight on the issues raised by a case in which a Canadian nurse's Facebook post complaining about a family member's medical care resulted in disciplinary action by the licensing board.

Helping post-op patients move as soon as possible should be a clinical priority.

A new pathogen is making its presence known.

Multilevel approaches to address the problem are needed.

In Brief The Baby-Friendly Hospital Initiative (BFHI) is a program developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to promote breastfeeding in hospitals and birthing facilities worldwide. Since the program was launched in 1991, breastfeeding initiation, duration, and exclusivity have increased globally, a trend largely attributed to changes in hospital policies and practices brought about by the BFHI. This article provides an overview of these practices and policies, the institutional benefits of achieving BFHI certification, and the process through which health care facilities can do so. All nurses—whether they work in maternity care or another nursing specialty in a hospital, ambulatory, or community setting—can play a role in promoting societal health through their support of long-term breastfeeding as recommended by the WHO and UNICEF. The author describes the practices and policies of the Baby-Friendly Hospital Initiative (BFHI)—a program developed by the World Health Organization and the United Nations Children's Fund to promote…

The Food and Drug Administration has requested that manufacturers of over-the-counter topical products containing chlorhexidine gluconate add a warning to the drugs’ labeling about the risk of a rare but potentially lethal allergic reaction to the antiseptic. If patients develop an allergic response to a product containing chlorhexidine gluconate, they should discontinue its use and wash any remaining product off their skin. Nurses should monitor patients and be prepared to treat anaphylaxis.

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. In this article, the author discusses how nursing instructors influence the ethical development of students in the clinical setting.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.