Pain assessment and management in critically ill older adults.

Older adults comprise approximately 50% of patients admitted to critical care units in the United States. This population is particularly susceptible to multiple morbidities that can be exacerbated by confounding factors like age-related safety risks, polypharmacy, poor nutrition, and social isolation. The elderly are particularly vulnerable to health conditions (heart disease, stroke, and diabetes) that put them at greater risk of morbidity and mortality. When an older adult presents to the emergency department with 1 or more of these life-altering diagnoses, an admission to the intensive care unit is often inevitable. Pain is one of the most pervasive manifestations exhibited by intensive care unit patients. There are myriad challenges for critical care nurses in caring for patients experiencing pain-inadequate communication (cognitively impaired or intubated patients), addressing the concerns of family members, or gaps in patients' knowledge. The purpose of this article was to discuss the multidimensional nature of pain and identify concepts innate to pain homeostenosis for elderly patients in the critical care setting. Evidence-based strategies, including an interprofessional team approach and best practice recommendations regarding pharmacological and nonpharmacological pain management, are presented.

Exploring violence against women and adverse health outcomes in middle age to promote women's health.

A history of intimate partner violence (IPV) is linked to cardiovascular disorders among women. Static autonomic nervous system (ANS) imbalance may result from chronic stress associated with exposure to IPV. Autonomic nervous system imbalance is associated with an excessive proinflammatory response that may increase the risk for inflammatory diseases, including atherosclerosis. To better understand the process from IPV to poorer health outcomes in women diagnosed with acute coronary syndrome (ACS) we developed and tested a biobehavioral model of the psychological and biological pathway from IPV to chronic illness. We hypothesized that among women hospitalized for ACS, those who reported sexual abuse, with or without physical abuse, would have greater alterations in their serum levels of neuroendocrine markers, proinflammatory cytokines, and cell adhesion molecules and a chemotactic cytokine, at time of hospitalization for ACS, and 3 and 6 months later, than do women with physical abuse only. Participants were 45 women, primarily African American, admitted to a county hospital with a diagnosis of ACS. We evaluated 11 biomarkers and found a moderate group effect size for vascular cell adhesion molecule-1. All others had a small effect size.

Connecting the dots of heart disease, poor mental health, and abuse to understand gender disparities and promote women's health: a prospective cohort analysis.

Heart disease, poor mental health, and abuse are epidemic among women worldwide. Our purpose was to identify a group of women with heart disease and explore the relationship between a history of abuse and existing symptoms of depression and post-traumatic stress disorder (PTSD) and analyze the relationships over time. A prospective cohort analysis design with mental health measures repeated at 3 and 6 months postintake was followed. Abused women (n = 25) reported significantly more symptoms of depression (p = .004) and PTSD (p = .003) compared with nonabused women (n = 14). To promote global mental health among women with heart disease, interventions must address a history of abuse.

Does caring for displaced specialty unit patients affect the critical care nurse's perceptions of ability and job satisfaction?

Trauma centers are challenged to share beds with a larger hospital population of critical care patients. Often, this means that patients may be shifted between units when beds are not immediately available in the specialty unit that fits their diagnosis. They are admitted to the first intensive care unit bed that becomes available. This practice results in patients with special care needs being cared for by nursing staff who do not perceive themselves as trained to provide those needs. This practice is referred to as displaced specialty unit (DSU) admission. A review of 2-year data from one large trauma center revealed a total of 1072 DSU patients, of whom 50% were medical patients. A questionnaire given to intensive care unit nurses found that caring for DSU patients did affect their perceptions of their ability to care for such patients and affected their sense of job satisfaction. Strategies to improve nurses' comfort level and competency in treating diverse critical care patients were recommended and implemented.