Geriatric nursing
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This study's objectives were twofold: to identify pain assessment methods used by caregivers of cognitively impaired older adults in long-term care, and to identify medications ordered and administered to them. Over 60% of RNs, with fewer LPNs and CNAs, used formal pain assessment tools. Patient records identified that 77.5% of cognitively impaired patients had a regularly ordered pain medication and 91% had a PRN pain medication order. ⋯ No one diagnosis was significantly associated with a greater tendency for PRN pain medications to be administered, with cancer a possible exception. Eighty-two percent of cognitively impaired patients had a PRN order for acetaminophen. Using minimum data set (MDS) criteria, this study found that patients with greater communication impairments received fewer pain medications.
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Review Case Reports
Anticipatory grief and chronicity: Elders and families in racial/ethnic minority groups.
This article provides some brief demographic data on aging, describes anticipatory grief, and presents two cases of anticipatory grief involving elders in racial/ethnic minority groups with some analysis including cultural values and beliefs and some practical guidelines. Melen McBride and Mycel JacobIrene Daniels and Lillian DavisIrene and Don Lewis The discussion ends with a useful process model for improving communications with elders in racial/ethnic groups and their families.
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As part of a multisite study funded by the Agency for Healthcare Research and Quality, the medical records of older adults with a hip fracture were abstracted for acute pain assessment and treatment practices. Of the 709 records reviewed, 8 patients did not have an opioid administered during the first 72 hours after admission to a non-intensive patient care unit. Using a case study approach, this article examines demographic characteristics, pain assessment, and analgesic administration for these 8 patients to illustrate specific practice problems that occur in managing acute pain in older adults. ⋯ The medical records of these hip fracture patients indicate that acute pain was underassessed and undertreated. Provision of quality pain management will require that nurses address the specific practice behaviors identified in the article and correct problems where they exist. Key strategies that can be used to improve pain management practices include implementation of standardized assessment tools and pain flow-sheets, audit and feedback of pain management data with staff, use of pain management opinion leaders and change champions, and incorporation of research-based pain management practices into performance-evaluation criteria.