Diane B. Monsivais

Developing and Evaluating Patient Education Materials.

Nurses should be involved in all aspects of patient education, including the development of print and web resources, but most nurses have not been educated in how to develop these resources. This article discusses the rationale for nurse involvement, describes guidelines for evaluating existing material for credibility and readability, and provides recommendations for rewriting material at an easier-to-read level.

“I’m Just Not That Sick” Pain Medication and Identity in Mexican American Women With Chronic Pain

Purpose: To describe the beliefs and attitudes about self-identity and pain medication in a sample of Mexican American women with chronic pain living in the El Paso, Texas, area. The findings are drawn from a larger qualitative study of 15 women describing the expression and communication of chronic pain symptoms, pain-related cultural beliefs, decision making, and treatment preferences of chronic pain. Methods: Participants who had chronic pain syndromes for at least 1 year were recruited from a pain clinic and fibromyalgia support group. In-depth, open-ended interviews, fieldwork, and participant observation were used to gather information using a focused clinical ethnographic approach. Interviews were audiotaped and transcribed verbatim. Findings: A shared central theme was controlling the use of pain medications to control perceived negative associations with pain medication. The negative associations resulted in women rejecting use of medication to preserve their legitimate identity. This perception can be destructive and can lead to poor pain control. Conclusion: Providing patients with anticipatory guidance about common barriers to taking pain medication may allow medication use consistent with improved pain control.

Decreasing barriers for nurse practitioner social entrepreneurship

Purpose To describe difficulties associated with the business-related aspects of practice in role transition of rural nurse practitioners (NPs), and to give practice implications. Data sources This focused ethnographic study derived data from semi-structured interviews. Participants provided information about rural NP practice ownership and barriers. The sample consisted of 24 rural NPs living throughout the United States. The majority were 51–60 years of age (45%) and females (93%) who had been in rural practice for 1 to over 20 years. Conclusions NP social entrepreneurs experience difficulties related to scope of practice, business skills, and role conflict. Implications for practice To decrease barriers for NP clinic ownership and management, NPs need to receive education related to financing a rural practice, legal/regulatory practices, strategic planning, leadership, and clinic management.Purpose To describe difficulties associated with the business‐related aspects of practice in role transition of rural nurse practitioners (NPs), and to give practice implications. Data sources This focused ethnographic study derived data from semi‐structured interviews. Participants provided information about rural NP practice ownership and barriers. The sample consisted of 24 rural NPs living throughout the United States. The majority were 51–60 years of age (45%) and females (93%) who had been in rural practice for 1 to over 20 years. Conclusions NP social entrepreneurs experience difficulties related to scope of practice, business skills, and role conflict. Implications for practice To decrease barriers for NP clinic ownership and management, NPs need to receive education related to financing a rural practice, legal/regulatory practices, strategic planning, leadership, and clinic management.

Nonsurgically treated carpal tunnel syndrome in the manual worker.

This study evaluates the course of carpal tunnel syndrome in a group of manual laborers who declined surgery for personal or social reasons. Thirty-five patients and 67 extremities with carpal tunnel syndrome were evaluated in a group of manual laborers. The carpal tunnel syndrome was classified as mild, moderate, or severe on the basis of initial evaluation data. Sensory batteries, motor and sensory conduction velocities, and electrical studies were performed on a scheduled basis. Follow-up ranged between 14 and 58 months, with an average of 34.3 months. Three patients became worse and one improved during the study period. All others remained unchanged. Six patients returned to work, but only three returned to their original jobs. Although carpal tunnel syndrome does not appear to be a progressive condition once the triggering cause is removed, nonsurgical treatment does not seem to be the treatment of choice for patients who must continue in a manual labor position.

Decreasing the stigma burden of chronic pain

Purpose: To describe stigmatizing experiences in a group of Mexican‐American women with chronic pain and provide clinical implications for decreasing stigma. Data sources: This focused ethnographic study derived data from semistructured interviews, participant observations, and fieldwork. Participants provided detailed descriptions of communicating about chronic pain symptoms, treatment, and management. The sample consisted of 15 English‐speaking Mexican‐American women 21–65 years old (average age = 45.6 years) who had nonmalignant chronic pain symptoms for 1 year or more. Conclusions: The cultural and social norm in the United States is the expectation for objective evidence (such as an injury) to be present if a pain condition exists. In this study, this norm created suspicion and subsequent stigmatization on the part of family, co‐workers, and even those with the pain syndromes, that the painful condition was imagined instead of real. Implications for practice: To decrease stigmatization of chronic pain, providers must understand their own misconceptions about chronic pain, possess the skills and resources to access and use the highest level of practice evidence available, and become an advocate for improved pain care at local, state, and national levels.

Cultural Cues: Review of Qualitative Evidence of Patient‐Centered Care in Patients with Nonmalignant Chronic Pain

&NA; The purpose of this paper was to examine published qualitative studies that explored the beliefs, values, and behaviors of patients with nonmalignant chronic pain during their interactions with the healthcare system. The findings were used as “cultural cues” to create patient‐centered care. A literature review of primary qualitative studies that focused on beliefs, values, or behaviors of patients with chronic nonmalignant pain in the formal healthcare setting was conducted. CINAHL, Medline, Pubmed, PsychInfo, Sociology Abstracts, Cochrane Library Database, Proquest Dissertation and Thesis, and EmBase served as the database for the research. The findings from the studies fell into two categories: beliefs and expectations about appropriate treatment and the behaviors patients may exhibit if they perceive they are not receiving appropriate treatment. Qualitative findings showed that the beliefs, values, and behaviors of patients with nonmalignant chronic pain exhibited during their interactions with the healthcare system created a set of “cultural cues” for providers.

Supporting faculty proposal development and publication.

The Hispanic Health Disparities Research Center, a collaborative venture between the University of Texas at El Paso and the University of Texas at Houston Health Sciences Center, supports the research capabilities of junior faculty through a variety of programs. Novice researchers often need practical help in conducting literature reviews, extracting data, evaluating the evidence, and formulating a research question of significant importance to be funded yet narrow enough to fit within the scope of the proposal. The authors discuss a successful proposal development program that includes mentoring by more senior faculty and structured sessions with a medical writer and editor.

The long-term safety and efficacy of intrathecal therapy using sufentanil in chronic intractable non-malignant pain

This report describes the long term safety and efficacy of intrathecal therapy using Sufentanil for the management of chronic intractable neuropathic pain in 12 chronic pain patients. Standardized psychological screening was used to determine treatment suitability. Evaluation data included the Visual Analog Scale (VAS), Wong-Baker Faces Scale, Brief Pain Inventory (BPI), Disability of Arm, Shoulder, and Hand (DASH), McGill Quality of Life Questionnaire, and complications (granulomas, toxicity, withdrawal, or deaths). SPSS version 18 was used for data analysis. Pre- and post- treatment BPI measures and pain scale scores showed a statistically significant difference. There were no complications directly related to drug toxicity, nor drug withdrawals, granulomas, or deaths. Intrathecal therapy with Sufentanil therapy offers a good treatment alternative for those cases that have failed both surgery and standard pain treatment. Strict patient selection based on psychological screening, control of co-morbidities, a proper pain management may contribute to successful outcome.

Promoting culturally competent chronic pain management using the clinically relevant continuum model.

This article reviews the culture of biomedicine and current practices in pain management education, which often merge to create a hostile environment for effective chronic pain care. Areas of cultural tensions in chronic pain frequently involve the struggle to achieve credibility regarding ones complaints of pain (or being believed that the pain is real) and complying with pain medication protocols. The clinically relevant continuum model is presented as a framework allowing providers to approach care from an evidence-based, culturally appropriate (patient centered) perspective that takes into account the highest level of evidence available, provider expertise, and patient preferences and values.

From Dissertation Defense to Dissemination: Jump Start Your Academic Career With a Scholar Mentor Group.

Problem The dissertation provides an excellent source of scholarly productivity for new doctoral faculty, yet is often neglected because of the demands inherent in the faculty role. Methods The purpose of this paper is to present a case study of a scholar mentor group composed of three graduates of a PhD nursing program and their shared dissertation chair, who acted as a senior scholar mentor to the group. Findings By working together, we have been able to enhance our scholarly productivity by disseminating our dissertations through presentations and publications. The paper will present the evolving process of this working group, summarize outcomes, analyze the challenges, and provide suggestions for future doctoral students and faculty who are working with them. Conclusions Our experience and scholar mentor model captures the best of both worlds—the benefits of interaction with academic peers and the benefits of having a senior scholar mentor. This was accomplished while all members were at different schools in different cities and states. Although other literatures that document successful collaborations using a peer-mentorship model are available, we were unable to locate any that documents a post-doctoral group with a senior scholar mentor who continued working together after graduation.PROBLEM The dissertation provides an excellent source of scholarly productivity for new doctoral faculty, yet is often neglected because of the demands inherent in the faculty role. METHODS The purpose of this paper is to present a case study of a scholar mentor group composed of three graduates of a PhD nursing program and their shared dissertation chair, who acted as a senior scholar mentor to the group. FINDINGS By working together, we have been able to enhance our scholarly productivity by disseminating our dissertations through presentations and publications. The paper will present the evolving process of this working group, summarize outcomes, analyze the challenges, and provide suggestions for future doctoral students and faculty who are working with them. CONCLUSIONS Our experience and scholar mentor model captures the best of both worlds-the benefits of interaction with academic peers and the benefits of having a senior scholar mentor. This was accomplished while all members were at different schools in different cities and states. Although other literatures that document successful collaborations using a peer-mentorship model are available, we were unable to locate any that documents a post-doctoral group with a senior scholar mentor who continued working together after graduation.