Martha D. Buffum

A music intervention to reduce anxiety prior to gastrointestinal procedures.

Patients scheduled for gastrointestinal procedures such as colonoscopy or esophagogastroduodenoscopy are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported education, coping skills, relaxation techniques, and combinations of these including music, have decreased anxiety in patients across many settings. Self-selected music therapy for preprocedural anxiety has not been studied. A randomized controlled trial of 198 patients was undertaken to determine whether 15 minutes of self-selected music reduced preprocedure anxiety. The State Trait Anxiety Inventory was used to measure patients’ anxiety. One-hundred ninety-three men and 5 women comprised the sample with an average age of 61 (SD 10.5). Patients who listened to music (n = 100) reduced their anxiety score from 36.7 (SD 9.1) to 32.3 (SD 10.4), while those who did not listen to music (n = 98) reduced their anxiety score from 36.1 (SD 8.3) to 34.6 (SD 11.5). These differences were statistically significant (F = 7.5, p = .007) after controlling for trait anxiety. There were no significant vital sign changes premusic and postmusic. Music is a noninvasive nursing intervention that can significantly reduce patients’ anxiety prior to gastrointestinal procedures. Further research should address using music to reduce anxiety in other procedure areas and testing effectiveness of self-selected versus investigator-selected music in reducing anxiety.

Cognitive impairment and pain management: review of issues and challenges.

The assessment and treatment of pain in persons with cognitive impairments pose unique challenges. Disorders affecting cognition include neurodegenerative, vascular, toxic, anoxic, and infectious processes. Persons with memory, language, and speech deficits and consciousness alterations are often unable to communicate clearly about their pain and discomfort. Past research has documented that persons with cognitive impairments, particularly dementia, are less likely to ask for and receive analgesics. This article provides an overview of the assessment, treatment, and management of pain in adults with cognitive impairments. We review types of cognitive impairment; recent work specific to best practices for pain management in patients with dementia, including assessment-tool development and pharmacological treatment; challenges in patients with delirium and in medical intensive care and palliative care settings; and directions for future research.

A clinical trial of the effectiveness of regularly scheduled versus as-needed administration of acetaminophen in the management of discomfort in older adults with dementia.

Objectives: To determine in a sample of nursing home patients with dementia and a painful condition whether the regularly scheduled administration of acetaminophen (650 mg four times a day (qid)) was more or less effective than as‐needed (prn) administration of acetaminophen in reducing discomfort.

Humor and well-being in spouse caregivers of patients with Alzheimer's disease

The relationship between the use of humor and well-being was studied in a convenience sample of 96 elderly spouse caregivers of community-residing patients with Alzheimers disease (AD). Using hierarchical multiple regression analysis and controlling for severity of illness, caregiver education, and income, the use of humor accounted for 18.2% (p < .001) of variance in caregiver well-being. Caregivers of patients with advanced AD symptoms used less humor and had more psychological distress than those caregivers of patients who had mild symptoms. Because humor helps to maintain a sense of well-being, nurses should develop and encourage the use of humor in the spouse caregiver population.

Educating patients after conscious sedation for gastrointestinal procedures.

Medication for conscious sedation during gastrointestinal (GI) diagnostic procedures causes amnesia, thereby preventing patients from recalling postprocedure instructions or follow-up appointments. A serious complication after GI diagnostic procedures is bleeding, which can occur if patients take aspirin or nonsteroidal anti-inflammatory agents after the procedure. Past research revealed that 73% of patients did not remember instructions. The purpose of this randomized controlled trial was: (1) to determine if patients with wrist bands remember to read their postprocedure instructions, and (2) to determine what patient demographics are associated with failure to read postprocedure instructions. Sixty-one GI clinic outpatients participated in this Veterans Affairs Medical Center study, received routine written instructions before and after GI diagnostic procedures, and were randomly assigned to one of two groups: control group (standard care plus next-day phone call) or intervention group (wrist band plus standard care plus next-day phone call). A memory test evaluated patients’ knowledge of procedure results, date of follow-up appointment, and medications. Results indicated no significant differences in the memory test between the groups (t = 0.9, p = .36). Patients 65 years of age and older had scores indicating memory problems, regardless of the wrist band (r = 0.19, p = .06). The wrist band was ineffective as a reminder to read instructions; rather, the next-day phone call served as the reminder.

Posttraumatic stress disorder and the World War II veteran

Throughout history, soldiers have suffered the psychologic consequences of war. PTSD in the WWII combat veteran presents with physical, psychologic, and social manifestations. Specific physical problems, such as traumatic arthritis and digestive disorders, may be linked to POW experiences. Psychologic symptoms include denial, numbing, intrusive images and thoughts, and nightmares. The older combat veteran may experience long-delayed PTSD symptoms when facing the losses associated with aging, loss of loved ones and declining physical health. Nurses are challenged to discover which elderly patients are combat veterans, what their military experiences were, how the experiences are affecting their mental and physical health, and whether biopsychosocial factors are concurrently affecting the health of the patients known to have PTSD.

Nurse-sensitive patient outcomes: an annotated bibliography.

This article is an annotated bibliography on the topic of nurse staffing and patient care outcomes in the acute care setting. The authors have been involved in the developmental and pilot phase of the Veterans Affairs Nursing Outcomes Database project to build a database of acute care nursing-sensitive quality indicators. In the section preceding the annotated bibliography, a context for the development of this literature review is explained and a summary synthesizing key issues is presented.

Bowel preparation comparison: flavored versus unflavored colyte.

Patients undergoing colonoscopy who have poor bowel cleansing must undergo repeated colon lavage and procedure, resulting in the possibility of additional discomfort and risk. Patient compliance with the necessary 4 liters of colon lavage fluid is essential. At our facility, the current colon lavage solution is unflavored and most patients complain about the taste. These are the patients who are likely to have poorly cleansed bowels. Patient preference for flavor of lavage is not known. A randomized controlled trial of 130 patients was undertaken to learn whether Colyte flavor made a difference in bowel cleansing. Results showed flavor made no difference in bowel cleansing (χ2 = 0.064, p = .96, NS); successful cleansing occurred in 75% (n = 45) of patients who received flavored and 76% (n = 53) who received unflavored Colyte. Results suggest flavor is not a factor in patients’ completion of the prep nor cleansing effectiveness. As unflavored Colyte costs less than flavored, cost savings can result from continuing use of unflavored Colyte. While this clinical trial did not answer the dilemma about how to improve colon preparation, the staff’s process of conducting nursing research inspired critical thinking and innovative problem-solving. Patients who are undergoing a colonoscopy are required to do a bowel cleansing the day before the procedure. Without proper bowel cleansing, colonic lesions such as polyps, neoplasms, and arteriovenous malformations (AVMs) may go undetected by being covered with small particles of stool (Cohen et al., 1994). Poor bowel cleansing results in the need for repeat colon preparation and repeat procedure, which pose risk and discomfort for the patient and cost for the staff and institution. Done under moderate sedation, colonoscopy poses potential cardiac risks and respiratory problems for the patient. In addition, the endoscopy procedure itself could cause perforation and bleeding. Avoiding repeat procedures because of failed colonic preparation is, therefore, essential for patient safety and organization cost. Optimally, completing the colon prep solution results in adequate bowel cleansing. Prep flavor was theorized to be a possible cause of noncompliance. The purposes of this study were to determine whether patients’ preferred prep solution would yield better compliance with the colon lavage solution and whether the improved compliance results in an adequately prepared bowel.

Diabetic colon preparation comparison study.

The purpose of the present study was to establish an optimal colon preparation for persons with diabetes who are undergoing colonoscopies. Specifically, the aim was to compare the difference between an experimental and standard preparation. Adequacy of bowel preparation is critical for good bowel visualization. Compared with nondiabetic patients, persons with diabetes have slower gastric emptying, colonic transit, and colon evacuation. Inadequate preparations may lead to suboptimal colonoscopy resulting in overlooked pathology, repeated examinations with associated risks, and organizational inefficiencies. Using a single-blind experimental design, 198 persons with diabetes who were scheduled to receive colonoscopies were randomly assigned to either the experimental (diabetic colon preparation) or the control (standard colon preparation) group. Patients in the diabetic colon preparation group had 70% good colon preparations compared with 54% in the standard group, and this finding was significant (&khgr;2 = 5.14, p = 0.02). Results indicate that diabetic patients receiving 10 ounces of magnesium citrate 2 days prior to their colonoscopies followed by 10 ounces of magnesium citrate and 4-L polyethylene glycol the day prior to the procedure had cleaner colons than those receiving standard preparation of 10 ounces of magnesium citrate and 4-L polyethylene glycol the day prior to procedure. This colon preparation is safe, feasible, well-tolerated, and effective.

Handoffs and Patient Safety Grasping the Story and Painting a Full Picture

Effective handoff communication is critical for patient safety. Research is needed to understand how information processes occurring intra-shift impact handoff effectiveness. The purpose of this qualitative study was to examine medical-surgical nurses’ (n = 21) perspectives about processes that promote and hinder patient safety intra-shift and during handoff. Results indicated that offgoing nurses’ ability to grasp the story intra-shift was essential to convey the full picture during handoff. When oncoming nurses understood the picture being conveyed at the handoff, nurses jointly painted a full picture. Arriving and leaving the handoff with this level of information promoted patient safety. However, intra-shift disruptions often impeded nurses in their processes to grasp the story thus posing risks to patient safety. Improvement efforts need to target the different processes involved in grasping the story and painting a full picture. Future research needs to examine handoff practices and outcomes on units with good and poor practice environments.