A Cross-Sectional Study of the Characteristics Associated With Chronic Pain Documentation on the Problem List.

ABSTRACT: Chronic pain is often elusive because of its specific diagnosis and complex presentation, making it challenging for healthcare providers to develop safe and effective treatment plans. Experts recommend a multifaceted approach to managing chronic pain that requires interdisciplinary communication and coordination. Studies have found that patients with a complete problem list receive better follow-up care. This study aimed to determine the factors associated with chronic pain documentation in the problem list. This study included 126 clinics and 12,803 patients 18 years or older with a chronic pain diagnosis within 6 months before or during the study period. The findings revealed that 46.4% of the participants were older than 60 years, 68.3% were female, and 52.1% had chronic pain documented on their problem list. Chi-square tests revealed significant differences in demographics between those who did and did not have chronic pain documented on their problem list, with 55.2% of individuals younger than 60 years having chronic pain documented on their problem list, 55.0% of female patients, 60.3% of Black non-Hispanic people, and 64.8% of migraine sufferers. Logistic regression analysis revealed that age, sex, race/ethnicity, diagnosis type, and opioid prescriptions were significant predictors of chronic pain documentation on the problem list.

Innovation in Nursing Practice: A Scoping Review.

Conceptual clarity on nursing innovation is vital in educating and supporting innovative nurses. This analysis aimed to determine the state of innovation within nursing through a scoping review of the literature. Twenty-four articles were identified, and a constant comparison analysis discovered 3 components essential to the successful innovation: the innate characteristics of the nurse, teams, leader, workplace, and organization; the culture or environmental factors; and then the process components, which include the translation, assessment, outcome, and sustainability of an innovation. This review highlights the need to clarify what does or does not qualify something to be innovative. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A68 .

Nurse, Parent, and Nurse Leader Perspective on Adoption of iPads for Pediatric Preoperative Anxiety Reduction.

PURPOSE: The purpose of this study was to examine the use of an iPad to facilitate distraction and reduce anxiety with preoperative pediatric patients. DESIGN: The authors conducted a descriptive case study in a Pre-Anesthesia Surgical Suite. METHODS: Nurses were trained on the use of the iPad, which came preloaded with games. The research staff took detailed notes during training and implementation. Research staff conducted interviews with nurses, leaders, and patient guardians for the study. FINDINGS: The authors discovered different perspectives among the clinical nurse, parent, and nursing leadership. The clinical nurse felt the iPad afforded them more focused time with the parents before surgery, though there was some hesitation at the beginning due to ownership of the devices. The parents felt the iPads were helpful to distract their child but worried there were not enough games appropriate for various age ranges. Nursing leadership found the iPads helpful in building a connection with the patient and their parents. Still, they felt many obstacles made integrating the use of the iPads in the nurses' workflow very difficult. There were technological issues that also delayed and discouraged the use of iPads. Once these preliminary issues were resolved, the iPad appeared to reduce anxiety in both patients and their parents. CONCLUSIONS: The iPad is an evidence-based intervention used for preoperative anxiety reduction. This study identifies essential facilitators and barriers associated with adopting the technology from the perspective of key stakeholders (nurses, parents, and nursing leadership). Overall, the iPad was considered a valuable tool to help parents feel less stressed with their child, allowing them to interact more effectively with the clinician. However, additional work is indicated to address the limitations regarding sample size and actual measures of anxiety.

Interdisciplinary Optimization of Admission Documentation: Reducing the Bloat.

Moving toward the electronic health record increases the quality of information gathered. However, nurses argue that the electronic health record is an added burden. The aim of this study was to evaluate the removal of duplicative or unnecessary fields and reordering fields on the admission form to increase documentation that is meaningful to the patient story. A team of approximately 60 interdisciplinary clinicians engaged in document review to evaluate the importance of each field and removal or modification based on those findings. After a review of the 251 fields, the authors reduced the form to 124 fields, and the percentage of unfields by 31%. After outlier removal, the average time to complete the admission form decreased by 2.88 minutes. The new form showed a reduction of 36.71% of the use of the free text advance directive. Additionally, nurses' perceptions of the form significantly improved from pretest to posttest in terms of satisfaction with the form, time to complete, usability and usefulness, question flow, and length of the form. This study shows that an interdisciplinary team can effectively work together to optimize the Adult Admission History Form, increasing the quality of documentation while reducing the time to complete.

School-Based Telemedicine Interventions for Asthma: A Systematic Review.

BACKGROUND: School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism. OBJECTIVE: Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes. DATA SOURCES: PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar. STUDY ELIGIBILITY CRITERIA: Original research, including quasi-experimental studies, without restriction on the type of telemedicine. PARTICIPANTS: School-aged pediatric patients with asthma and their families. INTERVENTIONS: School-based telemedicine. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements. RESULTS: Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality of life, health care utilization, school absences, and spirometry. Four of 7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. Five of 6 reported increases in at least one quality-of-life metric, 2 of 7 reported a decrease in at least 1 health care utilization metric, 1 of 3 showed reductions in school absences, and 1 of 2 reported improvements in spirometry measures. LIMITATIONS: Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2 of 7 studies were randomized controlled trials. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only 2 comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear.

Unmet Needs for Information and Support Among Military Caregivers.

INTRODUCTION: In the United States, there are 5.5 million military caregivers, defined as family members, friends, or other acquaintances who provide essential care and support to current or former military service members. This study describes the prevalence and predictors of unmet information and support needs in this unique group of caregivers. Until recently, little research has focused on military caregivers. In 2014, a comprehensive RAND report underscored the specific challenges experienced by military caregivers including greater physical, financial, and emotional strain when compared with civilian caregivers. Of note, compared to civilian caregivers, military caregivers provide care and support for care recipients who are more likely to have complex illness. While this recent research improved our understanding of the increased burden associated with military caregiving, it also identified gaps for future work, including the need for additional studies to better understand unmet information and support needs to inform future interventions. The current study was designed to address this gap. MATERIALS AND METHODS: We examined data collected in the Caregiving in the U.S. Survey, a cross-sectional online survey fielded in 2014, by the National Alliance for Caregiving and the American Association of Retired Persons (AARP) for primary caregivers who had been in the role for at least six months. Four outcomes representing unmet caregiver needs were examined measuring caregiver report of needing more help or information to: (1) keep the care recipient safe at home; (2) manage challenging behaviors such as wandering; (3) manage their own emotional and physical stress; and (4) make end-of-life decisions. Survey-weighted logistic regression was used to test associations between military caregiver status (military/civilian) and unmet needs while controlling for key socio-demographic, caregiving and care recipient health variables, with nationally generalizable results. RESULTS: Compared to their civilian counterparts, military caregivers had significantly higher odds of reporting need for information or support to make end-of-life decisions (OR = 2.22; 95% CI: 1.24, 3.97; p = 0.01) and marginally higher odds of reporting need for more information or support to manage physical and emotional stress (OR = 1.64; 95% CI: 0.93, 2.88; p = 0.08). In contrast, military caregivers had significantly lower odds of reporting need for more information or support to keep the care recipient safe compared to civilian caregivers (OR = 0.54; 95% CI: 0.30, 0.95; p = 0.03). Reports of unmet needs related to managing challenging behaviors were similar between military and civilian caregivers. CONCLUSIONS: Needs for information and support differ for civilian and military caregivers and may reflect direct or indirect impacts on caregivers arising from differences in TRICARE and Veterans Affairs health insurance coverage and related benefits, services and systems or access to resources that address the unique needs of military populations. Future research is needed to better understand the unique concerns of military caregivers and inform interventions that support end-of-life care decision-making for military service members and their caregivers.

Using Interactive Patient Engagement Technology in Clinical Practice: A Qualitative Assessment of Nurses' Perceptions.

BACKGROUND: Research has shown patients who are more engaged in their care are likely to have better health outcomes and reduced health care costs. Health care organizations are now focusing their efforts in finding ways to improve patient engagement. At the forefront of this movement are patient engagement technology systems. In this paper, these emerging systems are described as interactive patient engagement technologies (iPET). OBJECTIVE: The objective of this descriptive study was to gain an understanding of the perceptions of nurses who are integrating these iPET systems into their daily clinical practice. METHODS: The research team interviewed 38 nurses from 2 California-based hospitals using a focused rapid ethnographic evaluation methodology to gather data. RESULTS: The study participants reported that using iPET systems may enhance clinical nursing practice. The 4 key findings of iPET were that it (1) is effective for distraction therapy, (2) has functionality that affects both patients and nurses, (3) has implications for clinical practice, and (4) may require additional training to improve usage. CONCLUSIONS: With sufficient training on the iPET system, nurses believed they could use these technologies as an enhancement to their clinical practice. Additionally, nurses perceived these systems served as distraction therapy for patients. Initial findings suggest that iPET is beneficial, but more research is required to examine the usefulness of iPET systems in the inpatient settings.