Poor Assessment of Nursing Home Residents’ Pain — What Can Be Done?

A recent study sought to find out whether relatives and caregivers (proxies) understood residents’ pain well enough to assist in pain assessment and to discover what factors affected their judgments of pain. The findings showed, however, that their reports didn’t consistently match the pain ratings of nursing home residents themselves.

It’s particularly difficult to assess pain in cognitively impaired nursing home residents. This means that there’s a lot of suffering that goes untreated. This AJN article in the December issue discusses the findings of a new study on the topic and offers some recommendations we obtained from the study authors. Here’s another excerpt:

The authors suggest that pain management in nursing homes could be improved through caregiver education, including the implementation of pain assessment education in combination with treatment. They recommend basic training for nurses and nursing assistants on pain, pain behavior, and pharmacologic and nonpharmacologic pain treatment, such as “massage, applying warmth, mobility[, and] distractions with music or story telling.” They also suggest that “treatment effects could be determined more easily using a pain observation scale.”

So check out the article, and also let us know what else can we do to more accurately assess the pain of nursing home residents.

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Required Reading: Nurses as Champions of Patient Safety

Photo from otisarchives4, via Flickr

By Diana J. Mason, PhD, RN, FAAN, editor-in-chief emeritus of AJN. Mason is a member of the National Advisory Committee of Kaiser Health News.

I was delighted to see Kaiser Health News publish a superb commentary by nurse researcher Mary Naylor and health economist Mark Pauly on why nurses are the key to patient safety and quality, the barriers that interfere with nurses being these sentinels, and what can be done to address these barriers. It should be required reading by all policymakers, CEOs of health care organizations, and trustees.

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2018-03-13T10:44:44-04:00December 11th, 2009|career, nursing perspective, nursing research|1 Comment

National Forum to Focus on Role of Nursing in Community, Public Health, Primary Care, and Long-Term Care Settings


Below is a press release we received for an important and timely December 3rd event on the future of nursing, including links to attend the forum by live Webcast or to follow it on Twitter.

Initiative Exploring the Future of Nursing Convenes National Forum in Philadelphia

The Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (www.iom.edu/nursing) will hold the second of three national forums on December 3 in Philadelphia. Participants including committee chair Donna Shalala discuss how to improve the delivery of medical treatment for Americans in Community Health, Public Health, Primary Care, and Long-Term Care settings across the country. This forum will look at opportunities in which nurses – who are key front-line providers of care – can play a role in ensuring patients in all settings receive the best possible care.

**A live webcast of the meeting will be available via www.thefutureofnursing.org**

**Follow the forum live on Twitter at http://twitter.com/FutureofNursing**

[…]

If You Think ‘Evidence-Based Practice’ Is Just Another Buzzword, Think Again

Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes. In many hospital EDs across the country, children with asthma are treated with albuterol delivered with a nebulizer, even though substantial evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. Nurses even disrupt patients’ sleep, which is important for restorative healing, to document blood pressure and pulse rate because it’s hospital policy to take vital signs every two or four hours, even though no evidence supports that doing so improves the identification of potential complications.

That’s from the start of an article in the November issue of AJN, the first in a new series we are running to highlight the way’s evidence-based practice (EBP) changes what nurses do at the bedside—and saves lives. The authors point out that every day nurses perform dozens of actions and procedures without ever really asking whether the way they are doing them is the best way, or whether or not they are even helping patients by performing these actions.

While […]

Overcoming Barriers to Kidney Transplantation

By Genevieve Coorey, BSN, MA(Ed.). Coorey is the quality assurance and program director at the National Kidney Foundation and was the lead author of “Barriers to Preemptive Kidney Transplantation,” published in the November issue of AJN.

 

DadTransplantTattoo

Talk with any nursing colleague who cares for people with a chronic, complex disease and you will hear about the resilience and patience with which they accept—even triumph over—the effects of their illness.  

Cheryl learned nine years ago that her kidneys were failing. “At one point, I was so weak from anemia and malnutrition I could barely lift a dinner plate. Walking through a grocery store was a struggle. I used a wheelchair briefly because my legs were so filled with fluid. My husband . . . had to carry me at times, because I was too weak to walk.” 

A long-time school friend gave Cheryl one of his kidneys. She took up biking when her recovery allowed and the next summer she rode a 69-mile segment of a huge annual bike ride across Iowa; two years later she rode all 500 miles. Now Cheryl is a seven-time gold medal winner at three separate National Kidney Foundation U.S. Transplant Games events and a two-time bronze medal winner at the World Transplant Games. Extraordinary.

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