2.50
Hdl Handle:
http://hdl.handle.net/10755/163750
Category:
Abstract
Type:
Presentation
Title:
Making Decisions About the Nursing Home Resident With Pain
Author(s):
Kenefick, Amy
Author Details:
Amy Kenefick, University of Connecticut, School of Nursing, Storrs, Connecticut, USA, email: amy.kenefick@uconn.edu
Abstract:
SPECIFIC AIM: To describe how nurses make decisions related to administering pain medications to elderly nursing home residents. FRAMEWORK: Pain is a frequently occurring phenomenon in nursing homes. Most analgesics are ordered on an as-needed basis. Nurses are responsible for deciding when to administer pain medication. The prevalence of cognitive impairment hampers use of conventional pain assessment methods. Undertreatment of pain in nursing homes is a significant public health problem. METHOD: Focused ethnography. Three key informants were head nurses in a large, non-profit nursing home in suburban New England. The researcher had worked as a nurse practitioner with these nurses for eight years and benefited from rapport developed over that time. Face-to-face, semi-structured interviews were audiotaped, transcribed, and analyzed by the constant comparative method. RESULTS/CONCLUSION: Nurses believed that quality of decision-making is based on the personal characteristics of the nurse. These include his or her experience, skill, motivation, and understanding of the role. Nurses rely more on "nursing judgment" than on any behavior or characteristic of the resident or on information gained from family members. Nurses are guided by the documented medical history and their previous experience with the resident. The decision-making process in increasingly difficult and complex when the resident is verbally impaired. Three models are proposed to describe the process of decision-making. (1) Exploring change in status is multifactorial. It includes comparing the resident's behavior to baseline, looking for a physical explanation for changes, obtaining orders for diagnostic studies, mental status testing, and consultation; (2) Identifying Pain consists of two pathways differentiated by the extent to which the resident is verbal. Verbalization is the preferred cue; assessment of behavior requires the nurse to be creative and proactive.; (3) Making a Decision includes the following four components: (a) Believing that conditions that are painful to others are also painful to those with dementia; (b) Awareness includes accepting the possibility that a resident may have pain; (c) Recognizing includes distinguishing pain behavior from behavioral manifestations of other problems, and (d) Understanding occurs when the nurse considers both the individual and the context in which the behavior is taking place. IMPLICATIONS FOR NURSING PRACTICE AND KNOWLEDGE DEVELOPMENT: Further research should identify triggers for awareness, recognition, understanding and believing that the resident has pain. What characteristics of the nurse, the resident, the situation, are associated with variation in achievement of the steps? Which aspects of the models are associated with effective pain management in nursing homes? Can the models be used to teach pain management of nursing home residents?
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
ENRS 13th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Atlantic City, New Jersey, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleMaking Decisions About the Nursing Home Resident With Painen_GB
dc.contributor.authorKenefick, Amyen_US
dc.author.detailsAmy Kenefick, University of Connecticut, School of Nursing, Storrs, Connecticut, USA, email: amy.kenefick@uconn.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163750-
dc.description.abstractSPECIFIC AIM: To describe how nurses make decisions related to administering pain medications to elderly nursing home residents. FRAMEWORK: Pain is a frequently occurring phenomenon in nursing homes. Most analgesics are ordered on an as-needed basis. Nurses are responsible for deciding when to administer pain medication. The prevalence of cognitive impairment hampers use of conventional pain assessment methods. Undertreatment of pain in nursing homes is a significant public health problem. METHOD: Focused ethnography. Three key informants were head nurses in a large, non-profit nursing home in suburban New England. The researcher had worked as a nurse practitioner with these nurses for eight years and benefited from rapport developed over that time. Face-to-face, semi-structured interviews were audiotaped, transcribed, and analyzed by the constant comparative method. RESULTS/CONCLUSION: Nurses believed that quality of decision-making is based on the personal characteristics of the nurse. These include his or her experience, skill, motivation, and understanding of the role. Nurses rely more on "nursing judgment" than on any behavior or characteristic of the resident or on information gained from family members. Nurses are guided by the documented medical history and their previous experience with the resident. The decision-making process in increasingly difficult and complex when the resident is verbally impaired. Three models are proposed to describe the process of decision-making. (1) Exploring change in status is multifactorial. It includes comparing the resident's behavior to baseline, looking for a physical explanation for changes, obtaining orders for diagnostic studies, mental status testing, and consultation; (2) Identifying Pain consists of two pathways differentiated by the extent to which the resident is verbal. Verbalization is the preferred cue; assessment of behavior requires the nurse to be creative and proactive.; (3) Making a Decision includes the following four components: (a) Believing that conditions that are painful to others are also painful to those with dementia; (b) Awareness includes accepting the possibility that a resident may have pain; (c) Recognizing includes distinguishing pain behavior from behavioral manifestations of other problems, and (d) Understanding occurs when the nurse considers both the individual and the context in which the behavior is taking place. IMPLICATIONS FOR NURSING PRACTICE AND KNOWLEDGE DEVELOPMENT: Further research should identify triggers for awareness, recognition, understanding and believing that the resident has pain. What characteristics of the nurse, the resident, the situation, are associated with variation in achievement of the steps? Which aspects of the models are associated with effective pain management in nursing homes? Can the models be used to teach pain management of nursing home residents?en_GB
dc.date.available2011-10-27T11:13:10Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:13:10Z-
dc.conference.date2001en_US
dc.conference.nameENRS 13th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationAtlantic City, New Jersey, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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