What are some questionable/controversial/old-fashioned Nursing actions currently in use right now? I need to find a topic to write about. I don't have a lot of clinical experiences and really don't have the ability to tell if something is old or incorrect.
The examples that I was given to help direct my search are:
1. The use of chlorahexadine vs. betadine
2. Saline flushes vs. herparin for IV locks
3. The use of saline bullets for trach/ET suctioning
As you can see, the kind of topics I need are "this vs. that" or "do vs. do not". I'm having a very hard time with my private searching and thought I would ask more experienced nurses.
The theory, I believe, behind that one, is that it will help to maintain bladder tone. If the bladder is overdistended, the theory (OLD ONE) was that it may keep from reducing the bladder's tone by not emptying it all at once.
This discussion came up just yesterday in my ER... one of the PA's said the most he has ever seen come from a cath at a time was three liters.
I had a patient many years ago who came in after passing out from a standing position. HR was in the 20's but he was still (miraculously) perfusing such that he was A&Ox3... as long as he did not stand up. He needed a Foley, and I was called to place a Coude as nobody could get past his prostate. I could not even get a Coude in, so we called in the Uro, who placed a suprapubic catheter. After a brief episode of "Old Faithful", we took off almost two liters; as we did so, his HR gradually came up to the 80's - he said the pain went away, too.
At the time, the question of how much to release came up; the response was simple: a HR in the 20's trumps "bladder tone".
As always, mileage may vary from one case to another.
The theory, I believe, behind that one, is that it will help to maintain bladder tone. If the bladder is overdistended, the theory (OLD ONE) was that it may keep from reducing the bladder's tone by not emptying it all at once.
I thought the limit was to limit the possibility of bladders spasms.
there are loads of good examples in obstetrics/l&d nursing, and you'll find the research evidence easily on the net. so much has/can change when nurses follow evidence-based nursing practice! starting her pushing at 10 cm despite no desire to vs 1-2hr passive stage when fully dilated with/without epidural; telling her to push w/breath held (valsalva; purple pushing); counting to 10 during pushing; moms in semi-fowlers vs getting them off their backs; letting her eat/drink as desired (if normal patient) vs ice chips only, or even npo/nbm in labour; assisting/holding her perineum vs hands poised/off; baby taken to warmer at birth vs skin-to-skin & breastfeeding before any procedures; telling moms to breastfeed every 3 or 4hrs vs encouraging closer frequency - different from artificial milk feedings. i know some of these are physician-led in the states (where i worked for many years) but nurses can initiate changes in their own practices that can influence all of these examples. good luck with your project!
we used to tell gastric ulcer patients they could not drink milk or use dairy products. the joke is on us as we finally learned it was the heliobacter that caused the ulcer irregardless of your dairy intake.
yes, and years before that, we gave them the 'sippy' diet which was milk and full cream together several times a day!
although i do love that my post is sparking such interest and getting people talking, remember that in my case, i need to be able to find evidence-based nursing journal articles and write a paper on the subject. i don't mind if you continue to discuss all of the various questionable actions you've seen, but if you're trying to answer my question, it needs to be something that somebody might have actually researched and written about, and i can write a 6-page paper on.
thanks guys! keep up the discussion!
yes, i actually researched much of the stuff i wrote above in getting my midwifery degree after being an l&d nurse, and it is all out there. and i have incorporated them into my practice. do you have access to the databases needed? your school must provide it through their library, right? are you familiar with the cochrane database?
This is really old timey, I can't even find anyone who remembers this, but when patients had difficulty voiding, we used to put a few drops of spirit of peppermint in the bedpan or urinal to stimulate voiding. It actually worked a lot of the time.
this is really old timey, i can't even find anyone who remembers this, but when patients had difficulty voiding, we used to put a few drops of spirit of peppermint in the bedpan or urinal to stimulate voiding. it actually worked a lot of the time.
yes, and it's still done with new moms. the mild fumes do something to stimulate voiding.
I'm a nursing student, and I recently learned in a lecture on immunology that one of the reasons chlorahexadine is now used more than betadine is because betadine was being used incorrectly. According to my lecturer (an Adult Health NP at Hopkins), nurses applying the betadine would slather it on, and either a) not allow it to dry entirely or b) wipe it off when it didn't dry fast enough . This is ineffective because betadine must be allowed to dry 100% in order to maximize its antimicrobial properties. Not allowing it to dry entirely compromises its effects, and wiping it off just recontaminates the area. I'm not sure if this is something you've seen in practice, but maybe there's some literature out there on it.
i find that for decubitus ulcers, plain old saline works tid than all the fancy products that they have on the market now, i am talking stage 4 after debriding, an old fashioned doctor used and it worked.
-Rectal temps in NICU & neonates (now often avoided because it can cause perforated orifice, axillary temps are done unless temp is abnormal or pt has hx of seizures)
-daily baths for patients. It is the standard of care at many if not most facilities, but studies show most patients only need to be bathed a few times per week if they are not sweaty or soiled.
-Visitation policies. It used to be that there were limited visiting hours for all patients, especially those in peds and NICU populations, then there was a push for "family centered care." But some units are now moving to a spot more in the middle, saying the family centered care is getting in the way of the medical care.
-stool cultures versus probiotics (eg lactobacillus/ florastor/ etc) as a first response to patients with diarrhea.
I love this thread! It's very interesting.. A lot of these examples are still debated at the hospital where I work.. I think I'll do some research of my own and see what change I can affect..
Injecting air into an NG tube to check for placement. I was taught in school that this is no longer evidence-based - check the pH of the aspirate instead. However, when my uncle was in the hospital recently, everyone checked via air injection & stethoscope.
This is the first thing that came to my mind when I saw the thread topic. I read a scary article about this a while back, called "Inadvertent Intracranial Nasogastric Tube Placement." I wish I could add attachments on here because I still have the article.. In the article, a nurse and her supervisor both tested the placement of a newly inserted NG tube with air injection & auscultation, and they both believed they heard it. The nurse also withdrew serosanguinous fluid and concluded that the NG tube was well-placed. Well, it wasn't because the tube was in her brain!!!
I love this thread! It's very interesting.. A lot of these examples are still debated at the hospital where I work.. I think I'll do some research of my own and see what change I can affect..
This is the first thing that came to my mind when I saw the thread topic. I read a scary article about this a while back, called "Inadvertent Intracranial Nasogastric Tube Placement." I wish I could add attachments on here because I still have the article.. In the article, a nurse and her supervisor both tested the placement of a newly inserted NG tube with air injection & auscultation, and they both believed they heard it. The nurse also withdrew serosanguinous fluid and concluded that the NG tube was well-placed. Well, it wasn't because the tube was in her brain!!!
Holy cow! I just googles "intracranial nasogastric tube placement"... the first site on the list had x-rays of this! I think it said that there were 35 cases reported internationally, and it has a mortality rate of 64%!
Overland1, RN
465 Posts
This discussion came up just yesterday in my ER... one of the PA's said the most he has ever seen come from a cath at a time was three liters.
I had a patient many years ago who came in after passing out from a standing position. HR was in the 20's but he was still (miraculously) perfusing such that he was A&Ox3... as long as he did not stand up.
He needed a Foley, and I was called to place a Coude as nobody could get past his prostate. I could not even get a Coude in, so we called in the Uro, who placed a suprapubic catheter. After a brief episode of "Old Faithful", we took off almost two liters; as we did so, his HR gradually came up to the 80's - he said the pain went away, too. 
At the time, the question of how much to release came up; the response was simple: a HR in the 20's trumps "bladder tone".
As always, mileage may vary from one case to another.