Perspectives (Gerontological Nursing Association (Canada))
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Persistent pain is a significant problem for older hospitalized adults and their health care team. A better understanding of the approach to pain management in the clinical setting will provide guidance for the development of improvements in clinical management. ⋯ Findings revealed that 70% of older patients were in pain, nurses had limited awareness of their patients' pain, documentation of pain assessment and management was lacking, and pain was under-treated. Utilization of practice guidelines related to management of persistent pain in older adults in acute care settings is recommended, and an approach to their implementation, including identifying and overcoming the barriers to such best practices, is warranted.
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Nurses are in an excellent position to positively impact the quality of care for this group of patients. By developing a knowledge base of risk factors with a special emphasis on modifiable risks factors, nurses become pivotal in the development of an client focused plan of care. The value of the plan of care is to target intervention protocols to ameliorate the effect of the hospital environment on the at-risk patient with the goal of decreasing the incidence of delirium. ⋯ The care of older surgical patients requires a rigorous approach to prevention, detection and management. Close attention to ensure adequate oxygenation, perfusion, hydration, nutrition and stimulation is critical. Commitment to improve outcomes in a decidedly vulnerable patient population holds the potential to reduce morbidity and mortality as well as reducing costs and length of stay for the older surgical population who experience an episode of acute post-operative delirium.