Journal of the American Medical Directors Association
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Multicenter Study
Nursing home resident barriers to effective pain management: why nursing home residents may not seek pain medication.
Multiple barriers to effective pain management are present in the nursing home setting. The purpose of this analysis was to determine the extent to which residents in pain declined to request pain medication from the staff, and the reasons provided by the residents to explain this behavior. ⋯ Interventions to reduce pain in nursing home residents need to be responsive to the concerns of the residents. It must be acknowledged that resident preferences and beliefs may lead to declined pain interventions regardless of the staff's motivation to make the resident more comfortable. Staff nurses also need to make a more concerted effort to systematically assess pain and offer pain medication to residents rather than rely on resident requests.
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Multicenter Study
A standardized quality assessment system to evaluate pain detection and management in the nursing home.
Assessment and management of pain for nursing home residents is frequently reported to be inadequate, yet few studies have used objective criteria to measure the quality of care related to pain. ⋯ Infrequent or incomplete physician pain assessment and treatment and inaccurate documentation by licensed nurses limits evaluation of pain care quality based on medical record review alone. A brief resident interview identified participants reporting symptoms of chronic pain not documented in the medical record and those with a preference for medication. Initial targeting of residents with self-reported pain maximizes the efficiency of the standardized scoring system described in this study. Focusing on explicit process measures clearly identifies areas for improvement and represents an important step in assessing the quality of pain care in the NH.
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To determine if an educational program can improve knowledge and attitude among ancillary staff on end-of-life care issues in a long-term care facility. ⋯ This pilot project demonstrates that a staff educational program on end-of-life care for dementia residents can improve end-of-life knowledge and attitudes among long-term care ancillary staff and that this improvement can be maintained for up to 1 year. This intervention is easily reproducible in the long-term care setting. This project is an important step in helping improve end-of-life care for dementia residents in long-term care settings by improving the knowledge and attitudes of their caregivers.
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The outcome of cardiopulmonary resuscitation of residents of long-term care facilities is poor. However, only about one half of residents of long term care facilities have a do not resuscitate (DNR) order. The remainder usually have resuscitation by order or by default policy. Understanding predictors of DNR may help clinicians address end-of-life issues with the older long-term care population. ⋯ Fewer than half of this sample of long-term care residents had a DNR order. Among seven factors studied, only age and race were independent predictors of DNR status in the nursing home.