Abdominal Assessment.

Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care.

Neurological Assessment.

Reasons for completing a neurological exam include: detecting life-threatening conditions, identifying nervous system dysfunction and the effects of this dysfunction on activities of daily living, comparing current data to previous exams to determine trends, and to provide a database upon which to base collaborative care across disciplines. In this third article of a four-part series, subjective and objective assessment of the neurological exam is reviewed.

Assessment of the Respiratory System.

This article on respiratory system assessment is the first of a four-part series. Future articles will include instructions on focused examinations of the cardiac, gastrointestinal, and neurological systems. A systematic method of collecting both subjective and objective data will guide the healthcare clinician to make accurate clinical judgments and develop interventions appropriate to the home healthcare environment.

Cardiac Assessment.

Heart disease remains the number one cause of mortality in both men and women in the United States and patients with heart failure are at high risk for hospitalization. Thirty-day readmission rates have become a benchmark for hospitals and home healthcare agency reimbursement. Physical exam and history taking are essential to evaluate patients with suspected or known heart disease, and to detect early symptoms of worsening heart failure. Home care clinicians have the opportunity to assess the patient in the home environment, identify significant changes in the patient's status, and form a plan of care for effective intervention to prevent the need for emergency department care or rehospitalization. In this second article of a four-part series, the subjective and objective assessment of the cardiovascular system exam is reviewed.

Avoiding emergency department visits for COPD, pneumonia, and heart failure: when should patients go to the emergency department?

Patients with pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure make frequent visits to the emergency department. Heart failure alone is the reason for more than 1 million emergency department visits annually in the United States. This article describes strategies home care clinicians can use to prevent unnecessary emergency department visits for patients with pneumonia, COPD and heart failure.

Evidence about the pharmacological management of constipation, part 2: implications for palliative care.

Constipation remains a challenging problem for patients and caregivers in home healthcare. Part 1 of this two-part series discussed the scope, physiology, and evidence-based practice for nonpharmacological interventions for constipation. This second article will focus on evidence-based pharmacological prevention and management of constipation, medication cost, and implications for palliative care.

The efficacy of auriculotherapy for smoking cessation: a randomized, placebo-controlled trial.

BACKGROUND: Quitting smoking remains a challenge for almost one-third of the military veteran population. Alternatives to pharmacological therapies such as acupuncture, acupressure, and electrical stimulation have received minimal attention in research but have been widely reported to be popular and safe interventions for smoking cessation. METHODS: This randomized, double-blind, placebo-controlled clinical trial of 125 veterans was conducted to determine whether aural electrical stimulation (auriculotherapy) once a week for 5 consecutive weeks is associated with a higher rate of smoking abstinence are than observed with sham stimulation. RESULTS: Auriculotherapy was found to be safe and largely free from significant side effects. However, there was no difference in the rate of smoking cessation between those participants who received true auriculotherapy and those who received sham auriculotherapy. The auriculotherapy group achieved a rate of 20.9% abstinence versus 17.9% for the placebo arm after 6 weeks. CONCLUSION: The results of this randomized, controlled clinical trial do not support the use of auriculotherapy to assist with smoking cessation. It is possible that a longer treatment duration, more frequent sessions, or other modifications of the intervention protocol used in this study may result in a different outcome. However, based on the results of this study, there is no evidence that auriculotherapy is superior to placebo when offered once a week for 5 weeks, as described in previous uncontrolled studies.

Evidence about the prevention and management of constipation: implications for comfort part 1.

Constipation remains a challenging problem for patients and caregivers in home health. In Part 1 of this 2-part series, the scope, physiology, and evidence-based practice for nonpharmacological interventions for constipation are discussed. Part 2 will focus on pharmacological management of constipation, including medication cost, prevention of occurrence, and implications for palliative care.

Establishing partnerships to recruit and retain critical care nurses.

The current need to increase numbers of critical care nurses presents an exciting opportunity for nurses in staff development. Partnerships forged between university faculty and nurses have potential to recruit students into critical care settings. This article describes a course taught by faculty and practicing nurses that encourages students to pursue careers in critical care. The success of this initiative provides evidence that academic and clinical partnerships can develop a critical care nurse workforce.

A computerized smoking cessation intervention for high school smokers.

This study evaluated a computerized intervention designed to assist high school-aged smokers to consider not smoking and move forward in the "Stages of Change." A pretest-posttest pilot was conducted with 121 high school students who completed self-reported questionnaires that provided information about smoking history and exposure, smoking dependence, stage of change, and social support. Following baseline assessment, the experimental group (n = 61) completed four, 30-minute computerized sessions known as the Computerized Adolescent Smoking Cessation Program (CASCP). Immediately following completion of the program and 1 month later, the experimental subjects were reassessed. Control subjects completed baseline assessment and were reassessed 4 to 5 weeks later. CASCP increased the number of quit attempts. At 1 month after the intervention, 20% of the experimental group quit smoking. Of those subjects who did not quit smoking, nicotine dependence and the number of cigarettes smoked daily decreased, which decreased their nicotine dependence. Overall, there was a forward movement in the experimental group's stage of change. CASCP was found to be an effective and inexpensive intervention that motivates adolescent smokers to consider smoking cessation, move forward in the stage of change, and decrease nicotine dependence.

Program strategies for adolescent smoking cessation.

School nurses who work with adolescents are in an ideal position to promote smoking cessation. This opportunity is important because research suggests teens who smoke are likely to become habitual smokers. This study characterizes adolescents' patterns and levels of smoking, describes adolescents' perceptions toward smoking, and delineates quit strategies that may prove helpful for adolescents who attempt smoking cessation. Results suggest adolescent smokers have highly variable patterns and levels of smoking. They fail to consider their future health and continue to be unaware of the harmful effects of smoking and the addictive nature of tobacco. Among adolescent smokers, there are few gender differences in perception of smoking. Therefore, gender specific cessation programs may not be necessary. The most effective quit strategy was the acquisition of information on contents of cigarettes and the health effects of smoking. Armed with these strategies, school nurses can provide leadership in the design and implementation of school based smoking cessation programs.

Family study of fibromyalgia.

OBJECTIVE: To assess for familial aggregation of fibromyalgia (FM) and measures of tenderness and pain, and for familial coaggregation of FM and major mood disorder (major depressive disorder or bipolar disorder). METHODS: Probands meeting the American College of Rheumatology criteria for FM and control probands with rheumatoid arthritis (RA) and no lifetime diagnosis of FM were recruited from consecutive referrals to 2 community-based rheumatology practices. Probands were ages 40-55 years and had at least 1 first-degree relative age 18 years or older who was available for interview and examination. All probands and interviewed relatives underwent a dolorimeter tender point examination and a structured clinical interview. Interviewed relatives were asked about first-degree relatives who were not available for interview, using a structured family interview. Logistic and linear regression models, adjusting for the correlation of observation within families, were applied to study the aggregation and coaggregation effects. RESULTS: Information was collected for 533 relatives of 78 probands with FM and 272 relatives of 40 probands with RA. FM aggregated strongly in families: the odds ratio (OR) measuring the odds of FM in a relative of a proband with FM versus the odds of FM in a relative of a proband with RA was 8.5 (95% confidence interval [95% CI] 2.8-26, P = 0.0002). The number of tender points was significantly higher, and the total myalgic score was significantly lower in the relatives of probands with FM compared with the relatives of probands with RA. FM coaggregated significantly with major mood disorder: the OR measuring the odds of major mood disorder in a relative of a proband with FM versus the odds of major mood disorder in a relative of a proband with RA was 1.8 (95% CI 1.1-2.9, P = 0.013). CONCLUSION: FM and reduced pressure pain thresholds aggregate in families, and FM coaggregates with major mood disorder in families. These findings have important clinical and theoretical implications, including the possibility that genetic factors are involved in the etiology of FM and in pain sensitivity. In addition, mood disorders and FM may share some of these inherited factors.