Esther I. Bernhofer

The Pain Experience of Patients Hospitalized With Inflammatory Bowel Disease: A Phenomenological Study.

Pain is personal, subjective, and best treated when the patients experience is fully understood. Hospitalization contributes to the physical and psychological complications of acute and chronic pain experienced by patients with inflammatory bowel disease (IBD). The purpose of this qualitative phenomenological study was to develop an understanding of the unique experience of pain in hospitalized patients with an admitting diagnosis of IBD and related care or surgery. Following institutional review board approval, purposeful sampling was used to recruit 16 patients (11 female, 5 male, mean age 41.8 years) from two 36-bed colorectal units of a large academic medical center in the Midwest. Individual, audio-recorded interviews were conducted by a researcher at each participants bedside. Recordings and transcripts were systematically reviewed by the research team using Van Manens approach to qualitative analysis. Subsequently, 5 major themes were identified among the data: feeling discredited and misunderstood, desire to dispel the stigma, frustration with constant pain, need for caregiver knowledge and understanding, and nurse as connector between patient and physician. Hospitalized patients with IBD have common issues with pain care. Nurses caring for them can provide better pain management when they understand these issues/themes. Further research into the themes discovered here is recommended.

Chronic Pain in Older Adults

Despite the sophisticated pharmaceutical agents and technologies available today, many people, including older adults, continue to experience chronic pain. Inadequately treated chronic pain can seriously affect ones quality of life. Health care providers are only beginning to understand the structural and functional changes that occur in older adults with chronic pain, but recent research suggests that nurses and other health professionals need to become aware of the unique needs of older adults who live with chronic pain. When health professionals lack specific knowledge of pain management in older adults, patients may suffer needlessly.

Investigating the concept of rest for research and practice

AIMS To report an analysis of the concept of rest; to determine the conceptual maturity (consistent use and meaning) of rest in the current scientific literature and to present a theoretical definition of rest, providing a strong basis for research and practice. BACKGROUND Rest is a physical, mental and spiritual human need, common to all humanity, and is frequently prescribed around the world as a treatment for many maladies. Yet the concept of rest remains subjective, is vaguely defined and is often confused with sleep, limiting its utility for research and practice. Without a clear definition and understanding of rest and its parameters, its restorative benefits may not be realized and the advice to rest, based on little evidence, has limited usefulness and unknown risks. DESIGN Concept analysis. DATA SOURCES The scientific, peer-reviewed literature of five healthcare disciplines whose practitioners recommend rest for their patients were queried: nursing, medicine, physical therapy, psychology and occupational therapy. Twenty-seven articles published between 1970-2015 were included. METHODS The Morse criterion-based method of concept investigation was used. RESULTS The epistemological, pragmatic, linguistic and logical descriptions of rest found in the literature revealed that the concept of rest remains immature, poorly defined, rarely operationalized and inconsistently used. Nevertheless, a cross-contextual definition of rest based on antecedents, attributes, boundaries and outcomes is emerging. CONCLUSION Based on the findings, a rudimentary understanding of rest emerged. Further research is necessary to develop an operational, evidence-based, definition of rest so it can be effectively studied and prescribed.

Nurses Managing Patients’ Pain May Experience Moral Distress

Bedside nurses care for patients with pain every day but the task is often challenging. A previous qualitative study that investigated nurses’ experiences as they treated patients with pain suggested that nurses may suffer from moral distress if they are unsuccessful in providing adequate pain relief. As 20 of the original 48 nurses interviewed described frustration and distress when constrained from doing the right thing to provide pain relief for their patients, the purpose of this secondary qualitative analysis was to answer new research questions on nurse moral distress related to managing pain. Findings indicated that difficulties in nurse/physician communication and lack of pain education were contributors to nurses’ frustrations and provided barriers to optimal pain management. Many participants indicated a need for interprofessional pain management education. Further investigation is needed to clarify the impact of moral distress on nurses managing hospitalized patients’ pain.

5E Development and Psychometric Evaluation of a New Clinical Pain Knowledge Test for Nurses

and minimizing risk factors for adverse events caused by pain management treatments. This presentation will provide background for the position paper and identify nursing, prescriber and institutional barriers to change. Presenters will discuss results of a survey that explored implementation of the recommendations in the position paper. Presenters will describe the development of a strategy for intentional implementation of range orders that includes identification of the current institutional state, necessary preliminary work, examples of implementation, and monitoring of safety strategies. Additionally, the presenters will give examples of successful range orders that participants may contemplate and plan for institutional change in prescribers’ practices, meets The Joint Commission standards, and improves the safety of all patients receiving opioid therapy in the hospital.

6A Pain Management Education for Nurses: Simulation vs. Traditional Lecture, a Comparative Parallel-Group Design Study

Managing pain requires a unique skill set combining knowledge and psycho-social skills not often taught to post-licensure nurses. Education using standardized patients (SPs) in simulation exercises to portray hospitalized patients with pain may fill this gap. The purpose of this mixed methods research was to compare SP simulation (experimental) versus traditional lecture/PowerPoint education (control) on nurses’ pain knowledge and patients’ pain experience, measuring differences between nurse groups on pain knowledge test scores and patients’ reported pain experience. Kolb’s Experiential Learning Theory informed this study. Method: comparative mixed methods, parallel-group design.

Hospital‐acquired pressure injuries: The significance of the advanced practice registered nurse's role in a community hospital

BACKGROUND AND PURPOSE Hospital-acquired pressure injuries (HAPIs) continue to be a persistent problem in the acute care arena. The purpose of this retrospective quality improvement study was to examine if the introduction of nurse practitioners (NPs), as wound care consultants (WCCs), without other interventions, impacted the HAPI rates in a community hospital. METHODS A retrospective, comparison design was used; 48 months of HAPI data (May 2010-2014) reported on the monthly National Database for Nursing Quality Indicators (NDNQI) survey was abstracted from hospital records. Data included the assessment of 10,752 patients and were divided into two groups for comparison: 24 months before and 24 months after NP hiring. CONCLUSIONS There was a strong, inverse correlation between the presence of NPs and number of patients with HAPIs (r = -0.73, p < .01), indicating that HAPI rates were significantly lower after NPs took on the role of WCCs. The odds of a HAPI occurring following introduction of the NP WCCs were 20% of the odds in the previous years. IMPLICATIONS FOR PRACTICE Study findings suggest that NPs assuming a leadership role as WCCs may be instrumental in decreasing HAPI rates.Background and purpose Hospital-acquired pressure injuries (HAPIs) continue to be a persistent problem in the acute care arena. The purpose of this retrospective quality improvement study was to examine if the introduction of nurse practitioners (NPs), as wound care consultants (WCCs), without other interventions, impacted the HAPI rates in a community hospital. Methods A retrospective, comparison design was used; 48 months of HAPI data (May 2010–2014) reported on the monthly National Database for Nursing Quality Indicators (NDNQI) survey was abstracted from hospital records. Data included the assessment of 10,752 patients and were divided into two groups for comparison: 24 months before and 24 months after NP hiring. Conclusions There was a strong, inverse correlation between the presence of NPs and number of patients with HAPIs (r = −0.73, p < .01), indicating that HAPI rates were significantly lower after NPs took on the role of WCCs. The odds of a HAPI occurring following introduction of the NP WCCs were 20% of the odds in the previous years. Implications for practice Study findings suggest that NPs assuming a leadership role as WCCs may be instrumental in decreasing HAPI rates.