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Jewish World Review Oct. 25, 2002 / 19 Mar-Cheshvan, 5763
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com |
Almost every hospital in the United States is struggling to recruit new
nurses. The nursing profession has seen its ranks decline substantially
over the past 10 years due to ever decreasing numbers of nursing student
applicants, as well as the increasing numbers of trained nurses who are
fleeing the profession. Long shifts, low pay, and excessive patient loads
all contribute to the very high burnout rate among hospital nurses these
days.
The impact of inadequate nurse staffing is evident to many physicians (and
patients), including myself. The dispensing of important medications is
often delayed, patients who require assistance often must wait a very long
time before their nurses are available to respond to a call for help, and
important cues relating to early complications are often missed by harried
nurses who are simultaneously caring for more patients than they can safely
handle.
A study in this week's Journal of the American Medical Association
puts this problem into sobering perspective. The authors reviewed patient
outcome at 168 hospitals in Pennsylvania, and studied more than 230,000
surgical patients and more than 10,000 nurses at these hospitals. The study
determined that for each additional patient assigned to a hospital ward
nurse, there was a corresponding 7 percent increase in the risk of death
among patients assigned to the same nurse.
The risk that a nurse would fail
to respond promptly when a patient signaled that a serious problem was
occurring also increased by 7 percent for each patient added to his or her
care. Doubling a nurse's patient caseload from 4 to 8 patients resulted in
a a very significant 31 percent increase in the risk of patient death.
This study merely confirms what most health care professionals already know:
inadequate staffing of hospitals with nurses seriously degrades patient
care, and results in a higher risk of complications, including patient
death. At the same time, overwhelming caseloads of seriously ill patients
increase the likelihood that nurses will develop job-related burnout. As it
stands now, there are not enough new graduating nurses from American nursing
colleges to fill all of the empty nursing slots.
Therefore, hospitals are
recruiting large numbers of nurses from other countries. (The Philippines
is a particularly rich source of foreign-trained nurses for hospitals
throughout the United States.) This study adds further evidence that the
chronic shortage of trained nurses in the United States is having a
deleterious effect on the health of hospital patients. More needs to be
done to transform Nursing into a better-paying and more highly respected
profession. As anyone who has ever been a patient in the hospital knows,
few things are more comforting in the middle of the night than a concerned
and well-trained nurse who is readily available if the need arises. Now,
according to this new study, it appears that One's recovery from surgery or
a major illness hinges upon patient access to a nurse who is not constantly
overwhelmed by an excessive number of patients under his or her charge.
GLUCOSAMINE SULFATE & PROGRESSION OF KNEE ARTHRITIS
In the current issue of the Archives of
Internal Medicine, 202 patients with known knee osteoarthritis were
randomized to receive either glucosamine sulfate (1500 mg per day) or a
placebo ("sugar pill"). The patients were all followed for three years, and
underwent periodic knee joint x-rays and symptom questionnaires. The study
found that the patients who took the placebo pill experienced a gradual and
sustained reduction in the thickness of the cartilage lining the knee join,
while the patients taking the glucosamine sulfate pills experienced
virtually no loss of protective cartilage in the joint during the 3-year
study.
Moreover, the symptoms associated with arthritis of the knee
improved by 20 to 25 percent among the patients taking glucosamine. Knee
joint pain, function, and stiffness all improved significantly among the
group of patients who took glucosamine.
Based upon this new information, I think that I'll continue taking
glucosamine on a daily basis!
ASPIRIN & CORONARY ARTERY BYPASS SURGERY
A total of 5,065 patients who were
scheduled to undergo CABG participated in an international study that
involved 70 medical centers in 17 countries, the results of which are
reported in this week's issue of the New England Journal of Medicine. Among
the patients who received aspirin within 48 hours of their CABG surgery, 1.3
percent of such patients died during the course of the study. On the other
hand, mortality was 4.0 percent after surgery among the patients receiving a
placebo pill. Postoperative aspirin therapy was associated with 48 percent
reduction in the incidence of heart attack, a 50 percent reduction in the
risk of stroke, a 74 percent reduction in the risk of developing kidney
failure, and a 62 percent reduction in the risk of a loss of blood supply to
the intestines ("intestinal stroke"). Based upon this study, it appears
that aspirin therapy following CABG surgery may significantly reduce the
risk of serious post-CABG complications, including death.
JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at
the John Wayne Cancer Institute in Santa Monica, CA.
Comment by clicking here.
Hospital nurse staffing & patient mortality
Like many avid runners, I occasionally develop knee pain associated with
osteoarthritis and soft tissue strain. After several episodes of severe
knee pain occurred about two years ago, as well as two herniated discs in my
spine, I started taking glucosamine sulfate on a daily basis. While I
cannot attest that all of my joint pain has miraculously resolved since I
started taking glucosamine, I have experienced a gradual but significant
improvement in my symptoms.
Heart surgeons have been relatively shy about prescribing aspirin to
patients who have just undergone coronary artery bypass grafting (CABG).
Aspirin shuts down the function of platelets in the blood, increasing the
risk of abnormal bleeding after surgery.
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