LET TER S EDITORIAL BOARD
The mystery of death > “Moving Toward the Light” (December, 2013)* provides a powerful and poignant account of an end-of-life incident that illustrates how nurses are often privileged to be permitted a peek, however fleeting, of the reality and mystery of death. The patient’s dying utterance causes the author to eloquently contemplate the phenomenon of death and the enigma of the next dimension. I think that a nurse who ponders such philosophical matters is a better nurse. —KELLY WELLS, RN Marquette, Miss.
Opioid mortality: Flawed analysis? > I felt the need to respond to “Chronic Pain: Opioid use soars but pain management lags” (Clinical Rounds, December, 2013).* The article begins by providing a summary of the impact of chronic pain and the increase in opioid abuse and overdose deaths in the United States, which suggests, to me, that the researchers already suspected an association. This research brief is accompanied by a quote from one of the authors that “efforts to improve the identification and treatment of pain have backfired, due to an overreliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike.” With all due respect, that conclusion can’t be drawn from this data, which didn’t account for any outcome measures that would suggest that anything backfired. Analgesics and nonpharmacologic therapies, such as heat and
cold, are interventions—they’re not outcomes. Also, the researchers didn’t have access to records that would indicate whether a prescribed treatment was appropriate for the individual patient or whether it was effective. In addition, data likely doesn’t contain an accurate account of the use of nonopioid medications or nonpharmacologic treatments because the vast majority of those interventions are available over-the-counter and don’t require an office visit. I’m concerned about the epidemic of drug overdose deaths in the United States; however, we should be cautious in associating these deaths with the assessment and treatment of pain. To try to reduce opioid mortality, we should examine factors associated with these deaths. I encourage clinicians to gather and analyze high-quality data that can provide the answers we need to reduce prescription drug abuse mortality. —SUSAN K. DECRANE, PhD, RN, ACNS-BC West Lafayette, Ind. ■
Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAAN, FAPWCA, President, Ayello, Harris & Associates, Inc.; Faculty, Excelsior College School of Nursing, Albany, N.Y.; Senior Adviser, The John A. Hartford Institute for Geriatric Nursing and Program Director, Education Essentials, New York, N.Y. Michael R. Cohen, ScD, MS, RPh, President, Institute for Safe Medication Practices, and Member of the Sentinel Event Advisory Group for The Joint Commission, Horsham, Pa. Yvonne D’Arcy, MS, CRNP, CNS, Pain Management and Palliative Care Nurse Practitioner, Suburban Hospital-Johns Hopkins Medicine, Bethesda, Md. Michael W. Day, MSN, RN, CCRN, Trauma Nurse-Coordinator, Sacred Heart Medical Center and Children’s Hospital, Spokane, Wash. Cheryl Dumont, PhD, RN, CRNI, Director, Nursing Research and Vascular Access Team, Winchester Medical Center, Winchester, Va. Martha M. Funnell, MS, RN, CDE, Codirector of the Behavioral, Clinical and Health Systems Intervention Research Core, Michigan Diabetes Research and Training Center; Research Investigator in the Department of Medical Education; and Adjunct Lecturer, School of Nursing, University of Michigan, Ann Arbor, Mich. Peg Gray-Vickrey, DNS, RN, Provost and VP for Academic and Student Affairs, Texas A&M University-Central Texas, Kileen, Texas. Elizabeth Heavey, PhD, RN, CNM, RN-BSN Program Director, Associate Professor of Nursing, The College at Brockport, State University of New York, Brockport, N.Y. Jeanne Held-Warmkessel, MSN, RN, ACNS-BC, AOCN, Clinical Nurse Specialist, Fox Chase Cancer Center, Philadelphia, Pa. Frank Edward Myers III, MA, CIC, Infection Preventionist III, UC San Diego Health System, San Diego, Calif. Bill Pruitt, MBA, RRT, AE-C, CPFT, FAARC, Senior Instructor and Director of Clinical Education, Cardiorespiratory Sciences, School of Allied Health, University of South Alabama, Mobile, Ala. Susan Simmons, PhD, RN, ARNP-BC, Family NP, College Park Family Care Center, Overland Park, Kan. Linda S. Smith, PhD, MS, RN, CLNC, Faculty Affiliate, Idaho State University, Pocatello, Idaho Kristopher T. Starr, JD, MSN, RN, Attorney at Law, Ferry, Joseph & Pearce, P.A., Wilmington, Del.; Staff RN, Emergency Department, Christiana Care Health System, Newark, Del.; Adjunct Nursing Faculty, Excelsior College, Albany, N.Y.; Supplemental Nursing Faculty, University of Delaware, Newark, Del. Jeff Strickler, MA, RN, CEN, CFRN, NE-BC, Director, Emergency Services, University of North Carolina Hospitals, Chapel Hill, N.C.
* Individual subscribers can access articles free online at http://www.nursing2014.com. Send comments by e-mail if possible to [email protected]. Please, no attachments. Or send them to Letters Editor, Nursing2014, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Please include your name, credentials, complete mailing address, e-mail address (if applicable), and daytime phone number. Letters are edited for content, length, and grammar. Submission of a letter will constitute the author’s permission to publish it, although it doesn’t guarantee publication. Letters become the property of Nursing journal and may be published in all media. DOI-10.1097/01.NURSE.0000443330.41945.11
N0314
8 l Nursing2014 l March
www.Nursing2013.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The mystery of death > “Moving Toward the Light” (December, 2013)* provides a powerful and poignant account of an end-of-life incident that illustrates how nurses are often privileged to be permitted a peek, however fleeting, of the reality and mystery of death. The patient’s dying utterance causes the author to eloquently contemplate the phenomenon of death and the enigma of the next dimension. I think that a nurse who ponders such philosophical matters is a better nurse. —KELLY WELLS, RN Marquette, Miss.
Opioid mortality: Flawed analysis? > I felt the need to respond to “Chronic Pain: Opioid use soars but pain management lags” (Clinical Rounds, December, 2013).* The article begins by providing a summary of the impact of chronic pain and the increase in opioid abuse and overdose deaths in the United States, which suggests, to me, that the researchers already suspected an association. This research brief is accompanied by a quote from one of the authors that “efforts to improve the identification and treatment of pain have backfired, due to an overreliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike.” With all due respect, that conclusion can’t be drawn from this data, which didn’t account for any outcome measures that would suggest that anything backfired. Analgesics and nonpharmacologic therapies, such as heat and
cold, are interventions—they’re not outcomes. Also, the researchers didn’t have access to records that would indicate whether a prescribed treatment was appropriate for the individual patient or whether it was effective. In addition, data likely doesn’t contain an accurate account of the use of nonopioid medications or nonpharmacologic treatments because the vast majority of those interventions are available over-the-counter and don’t require an office visit. I’m concerned about the epidemic of drug overdose deaths in the United States; however, we should be cautious in associating these deaths with the assessment and treatment of pain. To try to reduce opioid mortality, we should examine factors associated with these deaths. I encourage clinicians to gather and analyze high-quality data that can provide the answers we need to reduce prescription drug abuse mortality. —SUSAN K. DECRANE, PhD, RN, ACNS-BC West Lafayette, Ind. ■
Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAAN, FAPWCA, President, Ayello, Harris & Associates, Inc.; Faculty, Excelsior College School of Nursing, Albany, N.Y.; Senior Adviser, The John A. Hartford Institute for Geriatric Nursing and Program Director, Education Essentials, New York, N.Y. Michael R. Cohen, ScD, MS, RPh, President, Institute for Safe Medication Practices, and Member of the Sentinel Event Advisory Group for The Joint Commission, Horsham, Pa. Yvonne D’Arcy, MS, CRNP, CNS, Pain Management and Palliative Care Nurse Practitioner, Suburban Hospital-Johns Hopkins Medicine, Bethesda, Md. Michael W. Day, MSN, RN, CCRN, Trauma Nurse-Coordinator, Sacred Heart Medical Center and Children’s Hospital, Spokane, Wash. Cheryl Dumont, PhD, RN, CRNI, Director, Nursing Research and Vascular Access Team, Winchester Medical Center, Winchester, Va. Martha M. Funnell, MS, RN, CDE, Codirector of the Behavioral, Clinical and Health Systems Intervention Research Core, Michigan Diabetes Research and Training Center; Research Investigator in the Department of Medical Education; and Adjunct Lecturer, School of Nursing, University of Michigan, Ann Arbor, Mich. Peg Gray-Vickrey, DNS, RN, Provost and VP for Academic and Student Affairs, Texas A&M University-Central Texas, Kileen, Texas. Elizabeth Heavey, PhD, RN, CNM, RN-BSN Program Director, Associate Professor of Nursing, The College at Brockport, State University of New York, Brockport, N.Y. Jeanne Held-Warmkessel, MSN, RN, ACNS-BC, AOCN, Clinical Nurse Specialist, Fox Chase Cancer Center, Philadelphia, Pa. Frank Edward Myers III, MA, CIC, Infection Preventionist III, UC San Diego Health System, San Diego, Calif. Bill Pruitt, MBA, RRT, AE-C, CPFT, FAARC, Senior Instructor and Director of Clinical Education, Cardiorespiratory Sciences, School of Allied Health, University of South Alabama, Mobile, Ala. Susan Simmons, PhD, RN, ARNP-BC, Family NP, College Park Family Care Center, Overland Park, Kan. Linda S. Smith, PhD, MS, RN, CLNC, Faculty Affiliate, Idaho State University, Pocatello, Idaho Kristopher T. Starr, JD, MSN, RN, Attorney at Law, Ferry, Joseph & Pearce, P.A., Wilmington, Del.; Staff RN, Emergency Department, Christiana Care Health System, Newark, Del.; Adjunct Nursing Faculty, Excelsior College, Albany, N.Y.; Supplemental Nursing Faculty, University of Delaware, Newark, Del. Jeff Strickler, MA, RN, CEN, CFRN, NE-BC, Director, Emergency Services, University of North Carolina Hospitals, Chapel Hill, N.C.
* Individual subscribers can access articles free online at http://www.nursing2014.com. Send comments by e-mail if possible to [email protected]. Please, no attachments. Or send them to Letters Editor, Nursing2014, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Please include your name, credentials, complete mailing address, e-mail address (if applicable), and daytime phone number. Letters are edited for content, length, and grammar. Submission of a letter will constitute the author’s permission to publish it, although it doesn’t guarantee publication. Letters become the property of Nursing journal and may be published in all media. DOI-10.1097/01.NURSE.0000443330.41945.11
N0314
8 l Nursing2014 l March
www.Nursing2013.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
