Doug Olsen discusses how military nurses at Guantanamo Bay face conflicting ethical imperatives and potential real world consequences over force-feeding Guantánamo Bay detainees. Military nurses are bound by the Oath of Commissioned Officers to protect their country and not simply to follow orders—in this way, their oath differs from the one taken by enlisted personnel. While officers are legally bound by the Uniform Code of Military Justice to follow orders, they are also expected to use sound judgment in assessing them—and to sometimes refuse those that are not in the best interests of the country, even if doing so means they will be held morally and legally responsible for the exceptional act of refusal. In some situations, the moral expectation to assess orders can present a conflict of fundamental values with a high potential for moral distress for the nurses involved.

Sufferers of mild traumatic brain injuries (mTBI) often have no physical symptoms and this injury may be undetected at first, yet it often has a profound negative effect on quality of life, including functional abilities and interpersonal relationships. AJN editor-in-chief Shawn Kennedy speaks with author Hyatt about her work with these patients and what all nurses need to know to recognize mTBI injuries.

Editor-in-chief Shawn Kennedy and Clinical Editor Betsy Todd, present the highlights of the November issue of the American Journal of Nursing. The photo on our cover of a father with his daughter, who had a traumatic brain injury, highlights our CE article on mild traumatic brain injury and how often patients don’t realize they’ve suffered an injury. Our second CE is about early implementation of palliative care for hospitalized older adults. Our Cultivating Quality column discusses the preparation of medications and how safety interventions can reduce errors. And we have an ethical piece about nurses’ moral distress at Guantanamo Bay. Our Archives column reflects on historical force-feeding of women in British prisons as well. Our Legal Clinic describes the nurse’s duty to protect, asking, did nurses unreasonably ignore a patient’s risk of harm? In addition, there’s News, Reflections, Drug Watch, Art of Nursing, and more.

Author Maureen Cavanagh shares her experience treating a pregnant woman with terminal ovarian cancer, and how the patient inspired in staff a commitment to patient-centered care.

Authors Kathleen McCauley and Karen B. Hirschman discuss the identification and management of cognitive impairment in hospitalized older adults. They stress that research involving this population must actively engage clinicians, patients, and family caregivers, as well as address the complex process of managing postdischarge care.

This is a story of how a team of nurses restored a patient’s hope. Editor-in-chief Shawn Kennedy speaks with the lead author of the team at the Mayo Clinic in Rochester about how they helped this patient with an unusual and painful illness to begin a journey towards recovery. Their attention to basic nursing care with a holistic approach is an exemplar of what care should be.

Editor-in-chief Shawn Kennedy presents the highlights of the October issue of the American Journal of Nursing. The photo on our cover of a nurse and patient ambulating in the halls of Mount Sinai Hospital, highlights our CE article on how a mobility program on an acute care medical unit improved patient outcomes. Our second CE is about calciphylaxis – a case study of how excellent nursing care can change a patient’s life. Our clinical feature describes research into nursing interventions on hospitalized older adults with cognitive deficits. And we have a special feature about a pregnant patient with ovarian cancer, her philosophy about birth and death, and how nurses focused on what the patient needed. Our Disaster Care column focuses on lessons learned by visiting nurses through their response to Hurricane Sandy. In addition, there’s News, Reflections, Drug Watch, Art of Nursing, and more.

Dr. Kathleen Murphy is the author of this month’s In Our Community, “Emergency Anaphylaxis at School.” She discusses how as the health services director for the Milwaukee Public Schools, she witnessed children having symptoms of anaphylaxis who lacked the first response they needed. As a result, Dr. Murphy helped to develop and initiate an emergency anaphylaxis response protocol so nurses would have access to stock epinephrine autoinjectors.

Seth Reed is the lead author on this month’s CE, “Champions for Central Line Care.” He discusses his work as a nurse in the acuity adaptable critical care unit at Geisinger Medical Center in Danville, Pennsylvania, where he and colleagues developed a quality improvement project for reducing central line associated blood stream infections.