Pain management outcomes for hospitalized Hispanic patients.

The purposes of the study were to describe outcomes of pain management and predictors of patient satisfaction in a minority sample. By using a survey design, 3 instruments were used to collect data: (1) The American Pain Society's Patient Outcome Questionnaire-Modified, a 16-item self-report tool about pain and patient satisfaction; (2) a demographic form; and (3) the Pain Management Index. The sample consisted of 104 hospitalized Hispanic inpatients in a Rio Grande Valley hospital. Mean ratings for current and average pain were moderate, whereas severe mean ratings were reported for worst pain. High interference caused by pain was found for walking and sleep. Patients were satisfied with pain management. However, a negative correlation was found between satisfaction and current pain intensity (r = -.49, p = .001). Pain Management Index scores revealed that 36% of the participants were inadequately treated for pain; also, negative correlations with age indicated less effective management for elders. Reliability estimates for tool subscales were greater than 0.70 except for the Beliefs subscale (0.63). By using logistic regression, satisfaction with pain management was predicted by general pain in the last 24 hours (odds ratio = 4.02), pain-related interference with mood (odds ratio = 7.31), and age (odds ratio = 1.8). Clinical implications include the need to apply standardized guidelines, such as those from the Agency for Health Care Policy and Research, and to educate patients, particularly minority elders, about pain management approaches. The emergence of Hispanics as the fastest growing minority group increases the need for research regarding pain management outcomes to plan more effective intervention.

Using collaborative research to facilitate student learning.

Developing research partnerships between academia and the service sector is an innovative way to meet the demand for high-quality, cost-effective, and clinically oriented research. Undergraduate student participation in clinical research is an educational strategy to facilitate positive mindsets toward research. This article outlines the methodological steps in recruiting and training undergraduate students for clinical research teams to benefit nurse educators, nurse researchers, students, and institutional partners. Student volunteers collected data for a study examining patient satisfaction with pain management practices. The research proposal was used to demonstrate principles of the research process and to familiarize the students with the study. A detailed study protocol guided the entire team through the project. Student sensitivity to pain assessment and management was enhanced. Learning the research process and the students' appreciation for the rigors of research were reinforced using this experiential model. Student evaluation of the research experience is presented.

Identifying and addressing medical errors in pain mismanagement.

BACKGROUND: There is strong evidence in the pain management literature that undertreatment of pain is pervasive despite several approaches, including use of national guidelines, to completely correct the problem. Although the concept of medical errors has primarily been concerned with adverse events, it is not unreasonable that mismanagement of pain could also be classified as a medical error. ERRORS OF PAIN MANAGEMENT: Error types can be classified as errors in assessment and documentation, errors in treatment and management, and errors in patient education. Within each of these categories, errors may be skill-, rule-, and/or knowledge-based, as suggested by evidence of mismanagement in various aspects of the pain management process as found in the literature. An examination of the root causes of medical errors may be used to detect system failures. At least ten steps can be identified in the process of pain management in the acute care setting, starting with admission, and errors can potentially occur at any step. A redesigned system could help improve error rates by incorporating use of skills, rules, and knowledge for effective management. CONCLUSION: A new approach to the unsolved problem of pain management in acute care settings is proposed; this approach uses the concept of mismanagement as a medical error.

Qualitative assessment of hospitalized patients' satisfaction with pain management.

Patient evaluations of effectiveness of care and satisfaction with care are useful outcome indicators of pain management. The subiective, multidimensional nature of pain is best evaluated when outcome measures include the richness of qualitative data to more fully capture the range of patient experiences. A descriptive qualitative component was added to the American Pain Society Patient Outcome Questionnaire--Modified (1995) to determine critical indicators in the pain experience affecting patient satisfaction. Four themes emerged from the data as factors affecting patient satisfaction or dissatisfaction: Patient Pain Experience, Patient Views of Health Care Providers, Patient Pain Management Experiences, and Pain Management Outcomes. The result is a typology of factors affecting patient reports of satisfaction. Satisfaction was most likely when providers effectively addressed pain control with the patient as an informed partner. Patients expressed dissatisfaction, even when pain was relieved, when providers appeared uncaring, were slow to respond, or lacked knowledge and skill. Our results offer clinicians new insights into how patients respond to pain, which could enable development of patient-oriented approaches to pain management improving quality and effectiveness of care and increasing patient satisfaction.

21st-century leadership in nursing education: the need for trifocals.

In this qualitative study, deans of top-ranked graduate nursing schools were interviewed to examine how they are approaching leadership issues into the next century. Discussion focused on managing change, handling problems, communication/leadership styles, models of governance, research productivity, and expectations of faculty. The picture that emerged suggested that deans must be able to see objects and events from different perspectives, analogous to wearing trifocal eyeglasses. Deans described current roles, which were labeled as Director, Sensor, and Negotiator. However, future roles will require a different set of skills and competencies. Deans described these roles as Consensus Builder, Risk Taker, and Interactive Empowerer. Deans will need to react based on multiple points of vision and accommodate rapidly to maintain excellence in all areas of the mission.

Assessing clinical outcomes: patient satisfaction with pain management.

The problem of unresolved pain in hospitalized patients is costly both in monetary terms and in patient comfort. Concern about patients' satisfaction and well-being led to a study to determine the characteristics of the pain experience as reported by the hospitalized patients. This study also examined the recently revised American Pain Society Patient Outcome Questionnaire (APS-POQ), particularly in regard to results from newly added items and overall reliability and validity. The data provide a cross-sectional description of patients' experience with pain in a large, urban teaching hospital. One hundred fifty-seven adult subjects reported moderate to high levels of current pain intensity, worst pain, and general level of pain in the last 24 hr, as well as moderate to high rates of pain-related interference with care activities. While patients indicated that they were satisfied with their pain management and with the responses of physicians and nurses to complaints of pain, patient satisfaction was inversely and significantly correlated with pain now and general level of pain in the last 24 hr. When patients with high pain intensity (> 7) were separated into satisfied and dissatisfied groups for analysis, no significant differences were found regarding pain-related interference with various activities including mood, relationships, sleep, etc. The majority of patients indicated that they were still in pain, but 41% did not wish to receive a stronger dose of pain medication. Significant differences between those who did and did not want more pain medication were found in that younger patients were more likely to want more pain medication. Additionally, analysis of these two groups found that patients who were still in pain and desired more pain medication reported significantly higher levels of pain-related interference with activity and sleep. The inverse correlation of current pain intensity and general level of pain with overall satisfaction with pain management differs from findings of previous studies. One added item queried patients regarding approaches they had used to manage pain in the last 24 hr. Oral pain medications, prayer, intravenous and intramuscular injections were the top-ranked methods. The findings guide further analysis of the APS-POQ questionnaire. Recommendations of items to be retained in the questionnaire are made based on data analysis. Refining the questionnaire will allow health-care providers to increase their understanding of issues related to pain management. The findings provoke several questions for further study, such as what are age and ethnic differences regarding pain intensity and satisfaction, as well as the predictors of aversion of receiving more pain medication when pain persists.

Development of a pain management report card for an acute care setting.

The article describes a pain management report card developed as a result of a study on pain satisfaction. The report card presented the actual results of the study and compared them with the institution's predetermined goals. Comparison items included adherence to national pain guidelines for pain management, various measures of the pain experience, and satisfaction with nurse and physician caregivers related to pain management. Recommendations were made to the institution based on the findings.

Boyer's multidimensional nature of scholarship: a new framework for schools of nursing.

This article compares Boyer's concept of four dimensions of scholarship with nursing's traditional definition of scholarship. A case is made that Boyer's concept is congruent with nursing's present and future direction of scholarship. An example is given of how one school of nursing has used Boyer's concept as a framework to develop policies and practices to promote and reward the scholarship of discovery, integration, application, and teaching.

The budget process in schools of nursing: a primer for the novice administrator.

All administrators are expected to be competent in budget and financial management. Novice administrators of schools of nursing are expected to know about the budgetary process, budgeting techniques, and the various types of budgets that can be used, such as the open-ended budget, incremental budget, alternate-level budget, quota budget, formula budget, intramural budget, zero-based budget, and cost center budget. In addition, administrators are expected to know what key questions need to be asked about how the budget is structured and revenue sources and how to manage and evaluate their budgets.

Nurse-managed clinics: a blueprint for success using the Covey framework.

This article describes the process from inception to successful operation of a university-based nurse managed clinic. The article includes information regarding the planning process, method of financing, political strategies for gaining approval, and on-going development of services. Covey's seven habits of highly effective people are used as a framework on which the development and evolution of the clinic are based. The habits are illustrated by relating how services/operation were enhanced and barriers and obstacles were overcome.

The Houston Linkage Model 1992; an update.

The authors provide an update on the development of an innovative model to promote faculty practice. Since its inception, the model has become more sophisticated and has more than tripled its revenues to the school of nursing. Faculty practice is an integral part of the teaching programs and has been the impetus for increased research productivity among faculty members. The authors discuss model changes, including the management of revenues and decentralized control of funds.

Developing a nursing doctorate for the 21st century.

Nursing in the next century will reflect changes in the health care system, and although the profession has made great strides in preparing nurse researchers, the current system has a serious gap that must be addressed; that of preparing clinical leaders. The article describes the need for a practice-focused doctoral curriculum that will produce a new type of senior clinician or expert practitioner to fill this gap. The envisioned graduates will be skilled in clinical decision making and information processing and will effect changes at both the micro- and macro-levels of the system. There is a clear future need to expand the number of primary care providers. The faculty required for their education must be doctorally prepared nurses who are themselves clinically proficient. The research and practice doctorates should be differentiated by faculty, the program of studies, resources, and placement/expectation of graduates. The article includes a model curriculum plan.

Nursing faculty practice in the Houston Linkage Model: administrative and faculty perspectives.

The authors describe a model for the development and implementation of faculty practice, focusing on administrative and faculty parameters of concern in its establishment. Administrative parameters include mission and purpose, benefits to nursing education and nursing service, contractual arrangements, legal issues, use of revenues, and evaluation. The case example illustrates faculty concerns and mentorship, maintenance of clinical skills, patient care, facilitation of research for promotion/tenure, and benefits.

The role of the university.

The role of the university, and particularly the health sciences university, in promoting positive health for women is twofold. First, the dissemination of existing knowledge raises awareness of special health needs and identifies gaps in the present research and literature base. Second, universities must project future needs of women in a rapidly changing society where such things as space travel may become commonplace. Reduction of the risk of debilitating disease and promotion of positive attitudes will enhance the quality of life for women. A logotherapeutic approach to choosing one's own attitudes toward life's challenges promotes successful coping in a dynamic society.