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Biomedical subjects

Judith A Paice

Publications and source records attributed to Judith A Paice.

At least 19 recordsLinked to original sources
PubMed2006

Relieving symptoms in cancer: innovative use of art therapy.

Art therapy has been used in a variety of clinical settings and populations, although few studies have explored its use in cancer symptom control. The specific aim of this study was to determine the effect of a 1-hour art therapy session on pain and other symptoms common to adult cancer inpatients. A quasi-experimental design was used (n=50). The Edmonton Symptom Assessment Scale (ESAS) and the Spielberger State-Trait Anxiety Index (STAI-S) were used prior to and after the art therapy to quantify symptoms, while open-ended questions evaluated the subjects' perceptions of the experience. There were statistically significant reductions in eight of nine symptoms measured by the ESAS, including the global distress score, as well as significant differences in most of the domains measured by the STAI-S. Subjects overwhelmingly expressed comfort with the process and desire to continue with therapy. This study provides beginning evidence for the efficacy of art therapy in reducing a broad spectrum of symptoms in cancer inpatients.

Adult↗
PubMed2006

Creating organizational change through the Pain Resource Nurse program.

BACKGROUND: Unrelieved pain remains a critical problem in health care. Barriers to improving the state of pain control include lack of education of health care professionals. Traditional quality improvement (QI) strategies directed toward educational interventions are rarely sufficient to change pain-related practice. PAIN RESOURCE NURSE (PRN) PROGRAM: The PRN program consists of a two-day course, quarterly in-services, regular newsletters, a listserv, individual meetings with PRNs and their managers to plan and conduct quality initiatives appropriate to their unit, as well as an optional clinical experience. RESULTS: Significant improvements were seen in knowledge and attitude of the participants, along with reduced turnover, improved patient satisfaction with pain control, a reduction in the prevalence of pain, and a greater percentage of patients who remembered speaking with a doctor or nurse about their pain (93% versus 89%). DISCUSSION: Establishing a PRN program entails conquering a number of management challenges common to any organizationwide QI project. The single most important step is building a shared priority among all those who must participate for success-in this case, nursing management. SUMMARY: The PRN program is an effective strategy in creating organizational change to improve the state of pain control.

Humans↗
PubMed2006

Appraisal of the Graduate End-of-Life Nursing Education Consortium Training Program.

BACKGROUND: Advanced practice nurses (APNs) are crucial in the provision of quality end-oflife care. However, little attention is devoted to palliative care in most graduate nursing curricula, leaving advanced practice nurses poorly prepared to meet the needs of those approaching the end of their lives. OBJECTIVE: The purpose of the graduate version of the End-of-Life Nursing Education Consortium (ELNEC-Graduate) Training Program is to provide nursing faculty with the knowledge and materials necessary to include palliative care throughout the graduate nursing curriculum. DESIGN AND SETTINGS: Sixty graduate nursing faculty members attended the first ELNECGraduate training course. Prior to attending the course, each participant completed surveys regarding the adequacy of end-of-life (EOL) content within their curriculum, as well as overall perceptions of EOL education in their university. Participants were asked to respond to these same questions immediately and at 12 months after completion of the course. RESULTS: Respondents reported significant improvements in the adequacy of eight areas of EOL content taught within their settings. Participants noted improved effectiveness in their ability to teach EOL care, of their curriculum in including EOL care, and of their graduate nursing students in providing care to the dying. The total hours of EOL content added to graduate nursing curricula as a result of attending ELNEC-Graduate was 18.4 +/- 17.4 standard deviation (SD) hours. Additional unintended consequences were noted. CONCLUSION: The ELNEC-Graduate Program is a national initiative that effectively improves faculty expertise in EOL care and expands palliative care content within graduate nursing curricula.

Education, Nursing, Graduate↗
PubMed2005

American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.

BACKGROUND: The American Pain Society (APS) set out to revise and expand its 1995 Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain and to facilitate improvements in the quality of pain management in all care settings. METHODS: Eleven multidisciplinary members of the APS with expertise in quality improvement or measurement participated in the update. Five experts from organizations that focus on health care quality reviewed the final recommendations. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases were searched (1994-2004) to identify articles on pain quality measurement and quality improvement published after the development of the 1995 guidelines. The APS task force revised and expanded recommendations on the basis of the systematic review of published studies. The more than 3000 members of the APS were invited to provide input, and the 5 experts provided additional comments. The task force synthesized reviewers' comments into the final set of recommendations. RESULTS: The recommendations specify that all care settings formulate structured, multilevel systems approaches (sensitive to the type of pain, population served, and setting of care) that ensure prompt recognition and treatment of pain, involvement of patients and families in the pain management plan, improved treatment patterns, regular reassessment and adjustment of the pain management plan as needed, and measurement of processes and outcomes of pain management. CONCLUSION: Efforts to improve the quality of pain management must move beyond assessment and communication of pain to implementation and evaluation of improvements in pain treatment that are timely, safe, evidence based, and multimodal.

Acute Disease↗
PubMed2005

Efficacy and safety of scheduled dosing of opioid analgesics: a quality improvement study.

UNLABELLED: Scheduled dosing of opioids is believed to provide more effective analgesia when compared to as needed (PRN) administration of the drug; however, few studies have evaluated the value of this approach. Therefore, a quality improvement study was conducted to determine the efficacy and safety of scheduled dosing of opioid analgesics, using a 2-group parallel design. One medical unit in a large urban academic medical center employed scheduled dosing, whereas a comparable unit used PRN dosing. The primary outcome indicators included pain intensity ratings and opioid doses, along with adverse events. Scheduled dosing was associated with decreased pain intensity ratings. There were no statistically significant differences in the amount of opioid ordered, or the amount administered when comparing scheduled vs. PRN dosing. However, when the amount of opioid given was expressed as a percentage of the amount ordered, the difference between scheduled (70.8%) and PRN (38%) dosing was statistically significant (P = .0001). There was no difference in adverse events between the 2 groups. These findings suggest that scheduled dosing of opioids in an inpatient medical population provides improved analgesia with no increased risk of adverse events. PERSPECTIVE: Scheduled dosing of opioids in an inpatient medical population improves analgesia, theoretically by overcoming barriers to drug administration, as well as providing more stable plasma levels of the opioid.

Academic Medical Centers↗
PubMed2005

Use of herbal therapies to relieve pain: a review of efficacy and adverse effects.

To find holistic treatment with effective pain relief and few side effects, Americans spend billions of dollars annually on complementary and alternative medicine, including herbal therapies. Despite extensive use, the lack of regulatory scrutiny of these herbal supplements contributes to the paucity of reliable clinical data assessing their efficacy and safety. This review summarizes the existing studies investigating the efficacy of herbal therapies as a treatment for pain. Possible side effects, potential drug-herb interactions, and information about common herbal therapies are also summarized. MEDLINE, AMED, and the Cochrane Library databases were searched for the period from January 1966 to June 2005. Uses, dosages, routes of administration, and side effects were summarized. Strength of empirical evidence also was evaluated. This review found few well-controlled clinical studies. Furthermore, these studies documented limited efficacy of herbal therapies to treat pain. The information presented here may be used to further educate nurses and patients on the use of herbal therapies as well as direct future research efforts.

Clinical Trials as Topic↗
PubMed2005

Control of common, non-pain cancer symptoms.

Despite major advances in cancer biology and therapeutics, cancer and its treatment continue to cause devastating suffering. Patients with advanced cancer most often experience multiple physical and psychological symptom concurrently. We review here some of the common non-pain cancer symptoms, focusing on the assessment and treatment of fatigue, anorexia and cachexia, dyspnea, and symptoms common near the end of life.

Anorexia↗
PubMed2005

Spirituality and distress in palliative care consultation.

BACKGROUND: One's spirituality or religious beliefs and practices may have a profound impact on how the individual copes with the suffering that so often accompanies advanced disease. Several previous studies suggest that negative religious coping can significantly affect health outcomes. OBJECTIVE: The primary aim of this study was to explore the relationship between spirituality, religious coping, and symptoms of distress among a group of inpatients referred to the palliative care consult service. DESIGN: Pilot study. SETTING: The study was conducted in a large academic medical center with a comprehensive Palliative Care and Home Hospice Program. MEASUREMENT: (1) National Comprehensive Cancer Network Distress Management Assessment Tool; (2) Pargament Brief Religious Coping Scale (Brief RCOPE); (3) Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp); (4) Puchalski's FICA; and (5) Profile of Mood States-Short Form (POMS-SF). RESULTS: The 31 subjects surveyed experienced moderate distress (5.8 +/- 2.7), major physical and psychosocial symptom burden, along with reduced function and significant caregiving needs. The majority (87.2%) perceived themselves to be at least somewhat spiritual, with 77.4% admitting to being at least somewhat religious. Negative religious coping (i.e., statements regarding punishment or abandonment by God) was positively associated with distress, confusion, depression, and negatively associated with physical and emotional well-being, as well as quality of life. CONCLUSIONS: Palliative care clinicians should be alert to symptoms of spiritual distress and intervene accordingly. Future research is needed to identify optimal techniques to address negative religious coping.

Adaptation, Psychological↗
PubMed2005

Life's final journey: the oncology nurse's role.

Despite advances in technology and science, many people diagnosed with cancer are likely to die from the disease. Because of the long-term relationships that oncology nurses develop with patients and their families during lengthy treatment periods, they are the most appropriate clinicians to provide care across the continuum and through the final journey. Care of patients in the final days of life requires a comprehensive knowledge of common syndromes, skillful assessment, and adept clinical management. Nurses cannot focus solely on the needs of patients; family members often are unaware of the dying process. Oncology nurses are uniquely qualified to provide education and support to families at the bedside witnessing the final days and hours of their loved ones. Finally, oncology nurses involved in the care of dying patients are at risk for burnout and need to provide care for their own needs to find balance between their professional and personal lives.

Adaptation, Psychological↗
PubMed2004

Pain assessment and management in aging.

Pain in the absence of disease is not a normal part of aging, yet it is experienced daily by a majority of older adults in the United States. Older adults are at high risk for undertreatment of pain due to a variety of barriers. These include lack of adequate education of health care professionals, cost concerns and other obstacles related to the health care system, and patient related barriers, such as reluctance to report pain or take analgesics. Unrelieved pain in the older adult has significant functional, cognitive, emotional, and societal consequences. Pain control begins with a thorough assessment, including an extensive history and physical examination. This information guides the plan of care, including both pharmacologic and nonpharmacologic therapies. Pharmacologic therapies include non-opioids, opioids, and adjuvant analgesics. Nonpharmacologic techniques include cognitive-behavioral strategies, such as distraction, guided imagery, education, and prayer, and physical measures, including heat, massage, bracing, and assistive devices. Health care professionals must be cognizant of the special pain-related needs of this fastest growing segment of the population.

Aged↗
PubMed2004

Assessment of symptom clusters in people with cancer.

The control, and ideally prevention, of symptoms such as pain, depression, and fatigue is dependent on a comprehensive clinical assessment. Furthermore, to advance the science of this field, symptom research requires the use of multidimensional instruments with proven validity and reliability in a cancer population across the lifespan. Studies demonstrate a significant correlation among pain, depression, fatigue, and other symptoms commonly seen throughout the course of cancer. Therefore, multidimensional scales incorporating the most common symptoms would ensure systematic assessment. Optimally, valid and reliable tools that measure symptom clusters would be feasible for use in both clinical and research settings. Currently available instruments that measure symptom clusters include the Edmonton Symptom Assessment Scale, the M.D. Anderson Symptom Inventory, the Memorial Symptom Assessment Scale, the Rotterdam Symptom Checklist, the Symptom Distress Scale, and others. Special populations include cancer patients with advanced disease, where symptom prevalence is expected to increase. Newer tools that attempt to address these populations are the Brief Hospice Inventory and the Hospice Quality of Life Index, appropriate for cancer patients with more advanced disease. Each of these tools has demonstrated utility in measuring symptom severity and quality of life. Few scales have been validated in the measurement of symptom clusters in children, in cognitively impaired adults, or in non-English speaking patients from various cultural backgrounds. The strengths and limitations presented in the clinical and research uses of each these instruments will be presented, as will be areas for future investigation.

Comorbidity↗
PubMed2002

A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.

Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting.

Activities of Daily Living↗