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Biomedical subjects

Regina Fink

Publications and source records attributed to Regina Fink.

12 recordsLinked to original sources
PubMed2006

Nurses' reflections on pain management in a nursing home setting.

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Analgesia↗
PubMed2006

Assessing the appropriateness of pain medication prescribing practices in nursing homes.

OBJECTIVES: To test a tool for screening the quality of nursing home (NH) pain medication prescribing. DESIGN: Validity and reliability of measurement tool developed for a pre/postintervention with untreated comparison group. SETTING: Six treatment NHs and six comparison NHs in rural and urban Colorado. PARTICIPANTS: NH staff, physicians, and repeated 20% random sample of each home's residents (N = 2,031). INTERVENTION: Nurse and physician education; NH internal pain team to champion better pain management using a pain vital sign, consultations, and rounds. MEASUREMENTS: An expert panel reviewed the Pain Medication Appropriateness Scale (PMAS) for content validity. Research assistants interviewed NH residents, assessed them for pain using standardized instruments, and reviewed their medical records for prescriptions and use of pain and adjuvant medication. Construct validity was assessed by comparing the PMAS of residents in pain with the PMAS of those not in pain and comparing scores in homes in which the intervention was more effective with those in which it was less effective, using the Fisher exact and Student t tests. Interrater and test-retest reliability were measured. RESULTS: The mean total PMAS was 64% of optimal. Fewer than half of residents with predictably recurrent pain were prescribed scheduled pain medication; 23% received at least one high-risk medication. PMAS scores were better for residents not in pain (68% vs 60%, P = .004) and in homes where nurses' knowledge of pain assessment and management improved or stayed the same during the intervention (69% vs 61%, P = .03). CONCLUSION: The PMAS is useful for assessing pain medication prescribing in NHs and elucidates why so many residents have poorly controlled pain.

Adult↗
PubMed2005

Measuring pain intensity in nursing home residents.

Assessing pain intensity in nursing home residents remains a challenge. As part of a multifaceted intervention study to improve pain practices in nursing homes, quarterly pain assessments were conducted in 12 Colorado nursing homes. Residents who reported pain or discomfort of any kind in the past 24 hours were asked to choose one of three pain intensity scales to quantify their current and highest level of pain intensity. They were also observed for pain behaviors using Feldt's Checklist of Nonverbal Pain Indicators. Residents preferred the Verbal Descriptor Scale almost 2:1 over the 11-point Verbal Numeric Rating Scale and the Faces Pain Scale. Sex and ethnicity were associated with differences in scale preference. More than one-half of residents reporting pain had an observable pain indicator. There was a monotonic relationship between reported pain intensity and number of observed pain indicators. To improve pain assessment and management in nursing homes, residents should be given a choice of pain intensity scales and observed for possible pain behaviors.

Aged, 80 and over↗
PubMed2005

Overcoming barriers and promoting the use of research in practice.

OBJECTIVES: To identify changes in nurse attitudes toward research utilization and the organization's research environment preimplementation and postimplementation of a multifaceted intervention to promote the use of research in practice. BACKGROUND: Nursing practice based on research evidence has been shown to promote positive patient outcomes. Personal characteristics such as positive attitudes and involvement have been positively correlated with research utilization. Organizational culture is a determinant of nurses' use of research in practice. Healthcare organizations must develop a supportive environment in an effort to attract nurses who share a similar philosophy to positively influence the organization's research culture and ultimately the care patients receive. METHODS: A descriptive, cross-sectional, presurvey and postsurvey design was used to identify inpatient nurses' personal and professional characteristics, perceptions of organizational culture, and the effectiveness of organizational strategies. Baseline and post implementation data were collected using the BARRIERS to Research Utilization Scale and the Research Factor Questionnaire. RESULTS: There was improvement in nurses' perception of barriers and organizational culture postimplementation of the multifaceted intervention. Journal club participation was one of the key strategies that facilitated research utilization. CONCLUSIONS: Moving research findings into practice is important for the nursing profession. Barriers to the use of research findings in practice must be modified. A dialogue between administration and staff about how to remove the barriers is critical.

Adult↗
PubMed2005

Postoperative pain management in elderly patients: correlation between adherence to treatment guidelines and patient satisfaction.

OBJECTIVES: To evaluate pain management satisfaction in elderly postoperative patients; to define pain management strategies documented in the medical record (MR) that predict patient satisfaction. DESIGN: Prospective cohort. SETTING: Eight urban hospitals. PARTICIPANTS: Three hundred twenty-two postsurgical patients aged 65 and older. MEASUREMENTS: Patients were surveyed regarding satisfaction with pain management in the first 24 hours postsurgery and the survey results summarized in a score. Pain management variables (patient education, pharmacological and nonpharmacological interventions, demographic variables, and surgery and anesthesia information) were abstracted from their MR. The correlation between the satisfaction score and MR variables was assessed using linear regression. RESULTS: Sixty-two percent of patients experienced severe postoperative pain, yet 87% reported being satisfied with the treatment. The mean satisfaction score+/-standard deviation was 59.3+/-10.8 (range 10.6-84.3; potential range 0-100, higher score=higher satisfaction). MR variables explained 14% of the satisfaction score variation. The worst pain intensity in the first 24 hours postsurgery as documented in the MR was the most powerful predictor of satisfaction. Other predictors associated with satisfaction were younger age, male sex, preoperative education, surgery type (laparotomy/thoracotomy patients were more satisfied than orthopedic patients), shorter recovery room stay, analgesic given through oral route, and morphine (compared with other opioids). CONCLUSION: Pain in elderly surgical patients remains undermanaged. Simple strategies such as emphasizing preoperative education may have a large effect in pain management. This study developed a validated patient satisfaction score and a MR instrument to assist in monitoring pain management quality.

Aged↗
PubMed2004

Improving nursing home staff knowledge and attitudes about pain.

PURPOSE: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. DESIGN AND METHODS: Twelve nursing homes participated in this intervention study: six treatment homes and six control homes, divided evenly between urban and rural locations. Three hundred licensed and unlicensed nursing home staff members completed written knowledge and attitude surveys at baseline, and 378 staff members completed the surveys after intervention implementation. RESULTS: Baseline results revealed notable knowledge deficits in the areas of pharmacology, drug addiction and dependence, side effect management, and nonpharmacologic management-strategy effectiveness. Significant differences were noted by job title (registered nurse/licensed practical nurse/certified nursing assistant). Case studies displayed a knowledge application problem, with nurses often filtering resident pain reports through observed resident behaviors. The intervention led to significant improvement in knowledge scores in some, but not all, the treatment homes. Perceived barriers to effective pain management showed a significant decline across all study nursing homes. IMPLICATIONS: Knowledge deficits related to pain management persist in nursing homes. An interactive multifaceted educational program was only partially successful in improving knowledge across settings and job categories. Attitudes and beliefs appear more difficult to change, whereas environmental and contextual factors appeared to be reducing perceived barriers to effective pain management across all participating nursing homes.

Adult↗
PubMed2004

The graduate nurse experience.

Graduate nurses experience stress transitioning from student to practicing professional nurse, moving from a familiar educational environment into the workforce, where expectations are to rapidly function as a competent nurse. This study identified the stresses and challenges experienced by cohorts of graduate nurses working in 6 acute care hospitals, during specific timed data periods, to better understand factors that may influence graduate nurse retention. Results report graduate nurses do not feel skilled, comfortable, and confident for as long as 1 year after being hired, highlighting the need for healthcare organizations to provide extended orientation and support programs to facilitate successful entry into practice.

Adult↗
PubMed2004

Translation research in long-term care: improving pain management in nursing homes.

BACKGROUND: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. AIMS: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. METHODS: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. FINDINGS: The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. DISCUSSION: Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. IMPLICATIONS: Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. CONCLUSIONS: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.

Aged↗
PubMedDate not supplied

Timing of the newborn first bath: a replication.

PURPOSE: To evaluate the effects on thermoregulation of bathing a healthy newborn within the first hour of life compared to bathing four to six hours after birth. DESIGN: Quasi-experimental. SETTING: Newborn nursery of a 30-bed obstetric unit in an urban university hospital. SAMPLE: Fifty-one healthy term newborns with a minimum axillary temperature of 36.5 degrees C (97.7 degrees F). INTERVENTION: Newborns in an experimental group were bathed within the first hour of birth; those in a control group were bathed at the standard four to six hours of age. MAIN OUTCOME VARIABLE: Axillary temperatures were measured before the bath, immediately after the bath, one hour later, and two hours later. RESULTS: Axillary temperatures as measured at four different times did not differ significantly between infants bathed within one hour of birth and those bathed four to six hours after birth. CONCLUSIONS: A flexible bathing time is recommended according to the characteristics and stability of the newborn and to family desires.

Baths↗