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Biomedical subjects

Keela Herr

Publications and source records attributed to Keela Herr.

17 recordsLinked to original sources
PubMed2007

An interdisciplinary expert consensus statement on assessment of pain in older persons.

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

Age Factors↗
PubMed2006

Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review.

To improve assessment and management of pain in nonverbal older adults with dementia, an effective means of recognizing and evaluating pain in this vulnerable population is needed. The purpose of this review is to critically evaluate the existing tools used for pain assessment in this population to provide recommendations to clinicians. Ten pain assessment tools based on observation of behavioral indicators for use with nonverbal older adults with dementia were evaluated according to criteria and indicators in five areas: conceptualization, subjects, administration, reliability, and validity. Results indicate that although a number of tools demonstrate potential, existing tools are still in the early stages of development and testing. Currently, there is no standardized tool based on nonverbal behavioral pain indicators in English that may be recommended for broad adoption in clinical practice.

Aged↗
PubMed2006

Evaluation of the Revised Faces Pain Scale, Verbal Descriptor Scale, Numeric Rating Scale, and Iowa Pain Thermometer in older minority adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale Revised (FPS-R), Verbal Descriptor Scale (VDS), Numeric Rating Scale (NRS), and Iowa Pain Thermometer (IPT) with a cognitively impaired minority sample. A descriptive correlational design was used, and a convenience sample of 68 participants, admitted to acute care facilities in the South, with an average Mini Mental Status Exam score of 23 comprised the sample. Thirty-two percent of the participants were males, and 68% were females. The majority (74%) of the sample consisted of African-American participants with the exception that 16% were Hispanic and 10% were Asian. An overwhelming majority of participants were able to use all of the tools. Concurrent validity was supported with correlations ranging from 0.56 to 0.90. The lowest correlations were found between the FPS-R and the other scales, suggesting that the FPS-R may be measuring a broader construct incorporating pain. Test-retest reliability was supported with coefficients ranging from 0.77 to 0.89. In terms of pain scale preference, the Numeric Rating Scale (33%) was the preferred scale in the cognitively intact group and the FPS-R (54%) was the preferred scale in the cognitively impaired group. When race and cognitive status were considered, African-Americans and Hispanics preferred the FPS-R. Severely, moderately, and mildly impaired participants also preferred the FPS-R. The findings of this study support the use of these scales with older cognitively impaired minority adults.

Black or African American↗
PubMed2004

Assessment and treatment of postoperative pain in older adults.

Hospitals are experiencing an increase in surgical procedures aimed at improving function and quality of life for elders. However, recent reports of pain management practices of elder patients show that pain is underassessed and undertreated. High postoperative pain intensities have been associated with delayed ambulation, postoperative pulmonary complications, increased hospital length of stay, long-term functional impairment, and chronic pain syndromes in this age group. Aggressive pain control is needed, but challenges in assessing and treating pain in older adults make this difficult. The purpose of this article is to review strategies for assessing and treating postoperative pain in older adults. Attention is given to the challenges associated with mental and physical impairments experienced by elders and a review of assessment and pharmacologic and nonpharmacologic strategies are included.

Age Factors↗
PubMed2004

Neuropathic pain: a guide to comprehensive assessment.

Patients with neuropathic pain present a clinical challenge. Neuropathic pain, when chronic, often leads to disability. Diagnosis can be difficult because both positive and negative sensory and motor signs and symptoms may be present, as well as a variety of comorbid conditions. In addition, there may be a high degree of interpatient variability. Currently, clinical evaluation, rather than diagnostic tests, is one of the best available tools for assessment and diagnosis. As with all chronic pain conditions, the key to a thorough assessment is a thorough history that includes medical, functional, and psychosocial evaluations. Currently available pain assessment tools, which are widely used in nursing practice, are still inadequate for use in patients with neuropathic pain. The physical and neurologic examination remains a critical element for patient evaluation. This includes an assessment of spontaneous pain (continuous or intermittent), pain evoked by daily activities (allodynia), and other abnormal sensations that are not necessarily painful (paresthesias, dysesthesias). Sensitivity to pinprick, touch, pressure, cold, heat, and vibration are measured, often confirming the suspected diagnosis. Patients may be confused by the unusual sensations they are experiencing and unable to effectively describe or communicate their symptoms. This communication barrier may contribute to an inadequate physical examination. With improved skills in patient assessment and through enhanced communication with patients, nurses can make an important contribution to treatment outcomes in patients with neuropathic pain.

Activities of Daily Living↗
PubMed2003

Acute pain treatment for older adults hospitalized with hip fracture: current nursing practices and perceived barriers.

This article examines acute pain management practices for patients 65 years of age and older who were hospitalized during 1999 for hip fracture. Data were collected from the medical records of patients (N = 709) admitted to 12 hospitals in the Midwest and from questionnaires on pain practices completed by nurses (N = 172) caring for these patients. The major variables examined were (1). pharmacological and nonpharmacological treatments for acute pain in hospitalized elders, (2). nurses' perceived stage of adoption for avoiding meperidine use and for administering analgesics around-the-clock, and (3). nurses' perceived barriers to optimal treatment of acute pain in elders. Acetaminophen was the most frequently administered analgesic, but administered doses were far less than the maximum daily recommended dose. More than one third (39%) of the nurses reported that they always avoided the use of meperidine, and over half reporting avoiding its use sometimes. However, the majority of patients (56.8%) received at least one dose of meperidine, even though evidence suggests that other analgesic agents are more appropriate for treatment of acute pain in elders. Only 27% of patients received patient-controlled analgesia, and only 22.3% of patients received around-the-clock administration during the first 24 hours after admission of analgesics that had been ordered on a prn basis. The majority of nurses were aware that around-the-clock administration of analgesics was preferable, but only 33.7% were persuaded (believed) that this method should be used. Intramuscular injection was used for 52.2% of patients, even though this route is not recommended for older adults. The most frequently used nonpharmacological intervention was repositioning, followed by use of pressure relief devices and cold application. Nurses reported difficulty contacting physicians and difficulty communicating with them about type and/or dose of analgesics as the greatest barriers to pain management. Findings from this multi-site study show that active and focused "translation" interventions are needed to promote adoption of evidence-based acute pain management practices by health care providers.

Acute Disease↗
PubMed2003

Pain intensity assessment: a comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale (FPS), the Verbal Description Scale, the Numeric Rating Scale, and the Iowa Pain Thermometer to assess pain in cognitively impaired minority older adults. A descriptive correlational design was used, and a convenience sample of 57 volunteers age 58 and older residing in the South was recruited for this study. The sample consisted of 8 males and 49 females with a mean age of 76. Fifty-nine percent of the sample completed an 11th grade education or less, and 59% completed high school or college. Seventy-seven percent (n = 44) of the sample scored 24 or less on the mental status exam, indicating some degree of cognitive impairment. The remaining 23% (n = 13) were cognitively intact. All of the participants were able to use each of the scales to rate their pain. Concurrent validity of the scales was supported with Spearman rank correlation coefficients ranging from.74 to.83 in the cognitively impaired group and.81 to.96 in the cognitively intact group. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from.73 to.83) and to a lesser degree in the cognitively impaired group (correlations ranged from.52 to.79). When asked about scale preference, both the cognitively impaired and the intact group indicated a preference for the FPS. Findings from this study suggest that cognitive impairment did not inhibit older minority participants' ability to use a variety of pain intensity scales. Additionally, options should be provided that address individual needs of older adults considering specific cognitive level and disability, education, gender, ethnicity, and cultural influences concerning perceptions of the various pain intensity scales.

Black or African American↗
PubMed2002

Chronic pain: challenges and assessment strategies.

Older adults are a rapidly growing segment of the world population, and long-term care will continue to be a major concern for most health care institutions in this century. Pain management remains at the forefront of long-term care issues, with older patients more subject than younger patients to chronic disease states that predispose them to pain. Assessment and management of chronic pain, however, are impeded by a lack of patient and caregiver education regarding pain, widespread misconceptions about pain in older patients, and special concerns and cautions for appropriate analgesic use in this population. This is the first of a two-part series highlighting issues and strategies related to pain assessment in older adults.

Aged↗
PubMed2002

Chronic pain in the older patient: management strategies. 2.

This is the second of a two-part series, which highlights issues and strategies related to pain assessment in older adults and current problems of pain management in older adults and analgesic regimens pertinent to this population. The complexities of assessing pain in older adults and assessment techniques for accomplishing a careful evaluation of pain were presented in the first part of this series, which was published in the January issue of the Journal of Gerontological Nursing (Vol. 28, No. 1). This article addresses issues and strategies related to management of pain, particularly analgesic use, in this challenging population.

Acetaminophen↗
PubMedDate not supplied

Psychometric evaluation of selected pain intensity scales for use with cognitively impaired and cognitively intact older adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales such as the Faces Pain Scale (FPS), the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) to assess pain in cognitively impaired older adults. A descriptive correlational design was used, and a convenience sample of 66 volunteers age 60 and older residing in assisted living facilities in the South was recruited for this study. The sample included 22 (33%) men and 44 (67%) women, with a mean age of 76. Ninety-eight percent (65) of the sample comprised Caucasian participants, with the exception of 1 African-American man. Seventy percent (47) completed high school and/or college. The mean Mini Mental State Exam (MMSE) score was 16, with a range of 1 to 29. Eighty-five percent scored 24 or lower, indicating some degree of cognitive impairment. The remaining 15% were cognitively intact. All but one participant could use each scale to rate their pain. Concurrent validity of the VDS, NRS, and IPT was supported with Spearman rank correlation coefficients ranging from .78 to .86 in the cognitively impaired group. The FPS, however, demonstrated weak correlations with other scales when used with the impaired group, ranging from .48 to .53. In the cognitively intact group, strong correlations ranging from .96 to .97 were found among all of the scales. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from .67 to .85) and unacceptable for most scales in the cognitively impaired group (correlations ranged from .26 to .67). When asked about scale preference, both the cognitively impaired and the intact groups preferred the IPT and the VDS. This study revealed that cognitive impairment did not inhibit participants' ability to use a variety of pain intensity scales, but the stability issue must be considered.

Aged↗
PubMedDate not supplied

Lack of opioid administration in older hip fracture patients (CE).

As part of a multisite study funded by the Agency for Healthcare Research and Quality, the medical records of older adults with a hip fracture were abstracted for acute pain assessment and treatment practices. Of the 709 records reviewed, 8 patients did not have an opioid administered during the first 72 hours after admission to a non-intensive patient care unit. Using a case study approach, this article examines demographic characteristics, pain assessment, and analgesic administration for these 8 patients to illustrate specific practice problems that occur in managing acute pain in older adults. Pain intensity was documented infrequently. All 8 patients had a physician order for some type of analgesic, and 7 of the 8 had an order for an opioid analgesic. Yet none received an opioid during the first 72 hours of care on a general medical-surgical unit, and one patient received no analgesia of any kind. The medical records of these hip fracture patients indicate that acute pain was underassessed and undertreated. Provision of quality pain management will require that nurses address the specific practice behaviors identified in the article and correct problems where they exist. Key strategies that can be used to improve pain management practices include implementation of standardized assessment tools and pain flow-sheets, audit and feedback of pain management data with staff, use of pain management opinion leaders and change champions, and incorporation of research-based pain management practices into performance-evaluation criteria.

Acute Disease↗
PubMedDate not supplied

Evidence-based assessment of acute pain in older adults: current nursing practices and perceived barriers.

OBJECTIVES: To report data on current nurse practice behaviors related to evidence-based assessment of acute pain in older adults, perceived stage of adoption of pain assessment practices, and perceptions of barriers to optimal assessment in this population. METHODS: Medical records from 709 older adult patients hospitalized with hip fractures from 12 acute care settings were abstracted for nurse assessment practices during the first 72 hours after admission. Questionnaires sent to nurses on study units regarding perceived stage of adoption and barriers to assessment in older adults. RESULTS: Data revealed several areas in which pain assessment practices were not optimal. Pain was not routinely assessed every 4 hours, and pain location was assessed even less frequently. Pain behaviors were assessed more in patients with a diagnosis of dementia compared to those without dementia, but the frequency of pain behavior assessments was low. Pain was not routinely assessed within 60 minutes of administering an analgesic. Nurses reported not using optimal pain assessment practices even when they were aware of and persuaded that those practices were desirable. In addition, nurses reported that difficulty communicating with patients created the greatest challenge in managing pain. CONCLUSIONS: Our data suggest that pain is not being assessed and reassessed in a manner that is consistent with current practice recommendations in older adult patients with pathologic processes that highly suggest the presence of acute pain.

Aged↗