Laurie Jowers Ware

Ethnic wait time differences in analgesic administration in the emergency department.

Although many studies have documented ethnic disparities in analgesia administration, few have dealt with the wait time for analgesia in the emergency department, despite the fact that the provision of timely and appropriate analgesia should be a primary goal in caring for patients. Inadequate analgesia has been reported for patients presenting with long bone fractures, and a body of evidence exists indicating that ethnic and minority patients may be receiving inadequate pain care when presenting to the emergency department for treatment of long bone fractures. The purpose of the present research was to determine whether wait time differences in pain treatment existed for ethnic and minority adults (18 years old or older) who were admitted to the emergency department suffering from long bone fractures using a quantitative retrospective design. Purposive sampling of medical records of 234 European-American, African-American, and Hispanic patients presenting with long bone fractures from two small Georgia hospitals were analyzed. Although Hispanic, European-American, and African-American patients in this study all reported substantial pain, a significant (p = .005) overall wait time difference was found between Hispanic and European-American patients, with Hispanic patients waiting an average of 102 minutes for the first dose of analgesia, and the European-Americans waiting an average of 67 minutes. Significant (p = .011) wait time differences were also found between Hispanics and European Americans when opioids were ordered and when there was a nurse notation of pain in the record (p = .029).

Do Ethnic Differences Still Exist in Pain Assessment and Treatment in the Emergency Department

Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated and some evidence supports the existence of pain treatment disparities. Despite strong incentives from accreditation organizations, pain management in the ED may still be inconsistent and problematic. The purpose of this research study was to conduct a retrospective chart review to investigate pain assessment and treatment for 200 adults (≥18 years old) admitted to the ED suffering from long-bone fractures. An additional purpose was to investigate demographic variables, including ethnicity, to determine if they influenced pain assessment, pain treatment, and wait times in the ED. Although assessment and treatment of pain is universally recognized as being important and necessary to provide optimal patient care, only 52% of patients in this study were assessed using a pain intensity scale, with 43% of those assessed reporting pain as ≥5 on a 0-10 pain intensity instrument. Pain medication was administered to 75% of the patients, but 25% of the patients received no medication. Only 24% of those receiving a pain medication were reassessed to determine pain relief. Compounding these problems were wait times for analgesia of >1 hour. Although the influence on pain management related to ethnicity was not a factor in this study, other findings revealed that undertreatment of pain, inadequate assessment, lack of documentation of pain, and lengthy wait times persist in the ED.

Promoting Caring by Increasing Realism in the Simulated Environment

High-fidelity human patient simulators provide students learning opportunities for performing skills, attaining knowledge, critical thinking, and building self-confidence. Absent from this list is the essential component of learning caring in nursing. Simulation-based learning can present a challenge to students learning caring behaviors. The purpose of this paper is to address strategies helpful in creating realistic high-fidelity simulation-based learning experiences promoting learning caring during simulation. Simulation specialists who create a realistic clinical scenario and add the human component to the simulated experience were found to make the simulated environment more realistic and consequently more conducive to learning caring behaviors.