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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


I heard it through the grapevine!

Updated: Aug 29, 2023

Have you heard the song made famous by Marvin Gaye, "I heard it through the grapevine"? This phrase is an "idiom" which means that you cannot determine the meaning by looking at the words. This phrase means that information has been passed from one person to another that is not proven or scholarly but is rumor or gossip. In the age of the internet this phrase takes on new meaning with information coming from Facebook, Instagram, Tik-Tok and many others. Just because it is on one of those internet sites it doesn’t mean it is true or proven.

Here is a perfect example. In 1993 NBC TV aired a public service announcement before airing the Super Bowl that year about the dangers of domestic violence during and following the Super Bowl. This day was referred to by women as the "day of the dread", This claim relied on studies done showing domestic violence increased on Super Bowl Sunday. However, there were no studies done to show a correlation (Ringle, 1993). This statistic was passed on by women's groups without any studies or factual information to back it up. In fact, when the data from police reports, women's shelters and hotlines were evaluated it was found that Super Bowl Sunday had less domestic violence than other days. Ironically, it was Christmas and children's time off from school that had the highest number of domestic violence reports. Yet the information continues to be passed on from women to women "through the grapevine!"

You may be wondering what in the world does this have to do with nursing? Because getting medical information from internet websites like Facebook, Instagram, Tik-Tok, Pinterest and others is not what a professional nurse does to learn new information or acquire knowledge. Without knowing about the studies and data that the information comes from, makes that information rumor and gossip. A "noble lie" is believing information that sounds true, could possibly be true, so it must be true. It's called Fake News! For years doctors and patients believed that Oxycontin was not addictive because the manufacturer, Purdue Pharma, said it in their package inserts. Thalidomide was sent all over the world in the 1950's and 60's with claims that it could be safely given to pregnant woman who were having problems with insomnia, nausea and vomiting. The German pharmaceutical company, Chemie Grunenthal, distributed the drug without performing animal studies. Even when the wives of the scientists in the company had deformed children after using Thalidomide during pregnancy the drug was not taken off the market. By 1962 over 10,000 babies had been born without arms and legs, ears and feet all over the world and the only common denominator in all of the pregnant woman was taking Thalidomide during pregnancy (Vanderbes, 2023). It was only because of extensive and dedicated work by a female physician and scientist at the FDA that Thalidomide was taken off the market.

You cannot believe everything you read, see or hear on the internet or because your best friend said it was true. So how do you trust what you read? You have to ask a series of questions.

Did you find the information in a trusted source? Did the information come from a peer-reviewed or scholarly source? Are the authors affiliated with a university or professional organization?

Is the topic treated in an unbiased way?

Are the results of the study valid, reliable and applicable?

Were the experiments and clinical trials done with blinded, or double-blinded groups? Were there randomized experimental and control groups?

Not only should the researchers not know who is getting the real "cure" and who is getting the placebo but there should be a process of who gets put into the experimental group; those subjects getting the "cure" and who gets put into the control group; those who get the placebo.

The bottom-line is don't believe everything you see or hear or read on the TV, news, or the internet. Make sure the information is reliable, trusted and applicable to the situation. Find out where the information is coming from and if there are studies to back up the information. Evidence-based practice means you are following scientifically based information guided by policies and procedures of the organization or facility where you work. The Institute of Medicine has set a goal that 90% of all health care decisions in the United States will be evidence based. This means the nurse is using interventions based on scientifically proven studies, their clinical expertise and are involving the patient in the decisions made. When these three parts work together there are high quality patient outcomes (Melnyk et al., 2009)

But how do we know if we are using the latest evidence-based practices, guidelines and interventions?

With so much information bombarding our inboxes, our social medica pages, newsletters, magazines, TV, YouTube, how do we know that we are using the best and the most effective treatments, medications, etc.? According to the amazing nurses who wrote the definitive book on evidence-based practice Melnyk et al (2009) in order to know if one is using EBP the first step is to ask why. Why do we wake patients up in the middle of the night to take their vitals? Why do we take blood pressures using the same size cuff for everyone? It was only when nurses asked why that studies were done to answer these and many other questions.

Let me give you an example from my own experience in hospice nursing. When a patient is getting near the end of their life, in the last 24-48 hours, the patient can develop increased respiratory secretions, better known as the "death rattle". I asked my preceptor what do we use to treat the death rattle. I was told to order eyedrops called Atropine that is administered sublingual (under the tongue).

"Wait, eyedrops under the tongue?" I asked several times. Atropine and scopolamine and hyoscyamine are anticholinergic medications that dry secretions. There was no other medication or effective treatment for this distressing noise at the end of life. I did some research and found the questions had already been asked and answered at Cochrane Library. The Cochrane Library is a collection of databases that contain high-quality, independent evidence to inform healthcare decision-making. Researchers compile every study or clinical trial that has been done to answer a question about treatments, medications, interventions and best practices. My question "do anticholinergics reduce the death rattle in patients at the end of their life?" The answer comes from the authors Wee and Hillier (2008):

In our original Cochrane review, we concluded that there was no evidence to show that any intervention, be it pharmacological or non‐pharmacological, was superior to placebo in the treatment of noisy breathing. This conclusion has not changed.

These medications have terrible side effects.

Anticholinergics were still being used even though over 10 years ago the studies showed that the medications do not work. But hospice organizations continue to use it because they think there is nothing else to use. The Cochrane Review showed that nonpharmacologic interventions worked better in many studies. Educating the family, friends and staff that this is a normal reaction to an inability to swallow one's secretions is so important. Educating them that the patient is not drowning in their secretions. The sound is mucus and sputum caught in the back of the throat and is noisy because of the close proximity to the vocal cords. Putting the head of the bed up or propping the patient up with pillows and keeping the mouth cleaned out helps to quiet the death rattle without all of the awful side effects. I made it my mission to educate the hospice organizations I worked for. Sometimes it worked, sometimes they continued to practice with their heads in the sand.

What question do you have about something that is being done at school or in your job?

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-Based practice: Step by step: Igniting a spirit of inquiry. AJN, American Journal of Nursing, 109(11), 49–52.

Ringle, K. (1993, January 31). Debunking the “Day of Dread” for women. Washington Post.

Vanderbes, J. (2023). Wonder drug. Random House.

Wee, B., & Hillier, R. (2008). Interventions for noisy breathing in patients near to death. Cochrane Database of Systematic Reviews, 1.

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