Clinical nurse specialist CNS
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The purpose of the study was to describe nurses' perceptions regarding the assessment and treatment of pain in patients with late-stage dementia. Thirty nurses from six long-term care facilities were interviewed using a semistructured format for this qualitative study. Initial results were presented to a second group for validation and refinement of findings. ⋯ Psychotropic drugs were perceived to be commonly misused because behavior changes were seen as a psychiatric problem rather than a representation of the patient's unmet need. Nurses had positive feelings about using both narcotics and nonnarcotic analgesics with this population but believed both types of analgesics were underused. The most common concerns regarding the administration of narcotic analgesics to this population were falls, sedation, and constipation.
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Advances in healthcare have improved the survival rates of children with serious health problems. Parents, relieved that their child is alive, often face the challenge of caring for a child with a chronic illness and must make healthcare decisions that have life-long consequences. ⋯ This "Handful of Questions" was created using a patient-oriented decision-making model by Pierce and the work of other decision-making researchers. The literature reviewed includes the topics of surrogate parental decision making and an examination of the relationship between the decision-maker and healthcare providers.
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As advanced practitioners, clinical nurse specialists and nurse practitioners have a leadership role in integrating and promoting nursing research in clinical settings. In this quasi-experimental study, the role of the advanced practice nurse in developing and implementing an intervention that improved delirium screening by staff nurses is described. ⋯ Control nurses failed to detect any cases of delirium. A discussion of study findings and their relevance to advanced practice nursing are discussed.
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Clinical Trial Controlled Clinical Trial
Pain during insertion of peripheral intravenous catheters with and without intradermal lidocaine.
Phase 1 of this study evaluated the perception of pain in 50 patients undergoing peripheral venous catheter insertion without the use of a local anesthetic. Phase 2 evaluated perceived pain in 50 patients who received intradermal lidocaine before the i.v. catheter was inserted. ⋯ No additional time (determined in intervals of 15 minutes) was required for the study group. Based on these findings, the hospital policy was modified so that intradermal lidocaine would be offered to all patients requiring peripherally inserted i.v. catheters.
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This article provides the reader with a historical perspective of advance directives, the role of surrogate decision making, and the difficulties families encounter surrounding end-of-life decisions. Illustrated with a case study, it includes a framework for advanced practice nurses (APNs) and other health care professionals to assist families in reaching decisions. ⋯ The APN can strive to make Do Not Resuscitate (DNR) discussions a consistent part of the hospital experience. It is hoped that the use of such a framework will improve care at the end of life.