• Effectiveness of an Electronic Pain Notification System on Postoperative Pain

      Paranilam, Sheeba Ouseph; Johantgen, Mary E. (2013)
      Background: Pain management is an important responsibility of the entire health care team. A 2008 nursing documentation audit at the study hospital showed inadequate pain assessment. In response, an Electronic Notification System (ENS) for Registered Nurses (RNs) was implemented in one surgical unit of the study hospital in 2008-2009. Purpose: The purpose of this study was to determine the effectiveness of the ENS on postoperative pain measurements, pain intensity, and total narcotic analgesic use. Furthermore, the association between pain control and patient outcomes such as physical therapy participation, length of hospitalization, and discharge disposition was examined. Methods: A retrospective, descriptive-correlational design used medical record data to compare postoperative pain and related outcomes before and during the ENS implementation. Hospitalized inpatients undergoing hip or knee joint replacement, laminectomy, or spinal fusion were studied. The pre-ENS group included 95patients, whereas the ENS group had 113 patients. Linear mixed modeling was used to account for the repeated pain observations clustered within patients, while controlling for potential covariates. Results: There were no significant differences in frequency of pain measurement nor in pain intensity between the pre-ENS and ENS time periods. However, other important covariates were found to significantly influence pain intensity including history of mental illness (t=2.028, p=.045), pre-operative opioids (t=3.307, p<.001), and age (t= -3.383. p<.001). Only age (t=3.406, p<.001) and pain level on day 2 (t=2.306, p= .025) were significant predictors of length of stay. Conclusion: While the use of an electronic notification system reflects a widely used technology, the effectiveness was not demonstrated in this population and setting. The findings showing that patients with a history of mental illness and opioid use report higher pain intensity, confirm the findings of previous studies and should be incorporated in developing customized pain management plans. Innovative new devices such as ENS could be a valuable tool to assist nurses in pain assessment and documentation but current evidence does not support their use.
    • The Effects of Reiki on Stress and Pain in the Hospitalized Trauma Patient

      Foster, Dawn; Thomas, Sue Ann, 1947- (2010)
      Stress and pain can detrimentally impact the recovery of patients in the hospital setting. Complementary and Alternative Medicine (CAM) therapies have seen an upsurge in healthcare settings. The utilization of Reiki is increasingly employed in hospitals to assist in the alleviation of stress and pain for hospitalized patients. Although progressively used with hospitalized patients, little scientific evidence as to the efficacy of this practice has been established. This study examines the effects of Reiki on both physiological measures of stress and pain (blood pressure and heart rate) and subjective measures (pain scores, amount of pain medication utilized and the State Anxiety Inventory) in hospitalized trauma patients. A quasi-experimental repeated measures study was conducted in the trauma setting. Adults (8 males and 2 females) between 23 and 59 years participated in Reiki and Standard of Care (SOC) visits on 4 consecutive days. Subjects either received Reiki or Standard of Care on day 2 and the alternate on day 3. Blood pressure and heart rate were recorded 12 times, four times during each session, with pre and post pain scores. The amount of pain medication utilized in the previous 24 hours prior to each session was recorded, as well as, the post-session State Anxiety Inventory. No significant relationship was found between age and anxiety levels (p>.05). State anxiety at the final session was found to be significantly lower than at the baseline session (p<.05). Results offered no support that Reiki reduced the need for pain medication in this population (p>.10). No significant differences were found in heart rate and blood pressure either during sessions (p>.10) or between those receiving Reiki and those monitored for SOC (p>.10). While this study offers no support to the utilization of Reiki as an intervention for stress and pain in the hospitalized trauma patient, a discussion as to the problems and pitfalls of clinically-based research and the use of CAM is presented.
    • Optimizing Pain Management in Medically Complex Long-Term Care Residents

      Kuzucan, Aida; Simoni-Wastila, Linda; 0000-0003-0893-7028 (2021)
      Problem statement: While much needed clinical research has emphasized appropriate opioid stewardship in the general population, the needs of long-term nursing home care (LTC) residents remain largely ignored. Methods: This dissertation identified emerging trends in opioid therapy and initial opioid dosing patterns among LTC Medicare beneficiaries using Medicare Parts A, B and D claims, the Minimum Data Set 3.0 (MDS) and LTCFocus datasets. Aim 1 is a repeat cross-section study using resident and facility adjusted generalized estimating equations (GEE) to examine patterns of opioid use alone and in conjunction with pain-adjuvant medications among general, hospice, cancer, non-cancer chronic pain and dementia-related LTC stays from 2011 to 2015. Aim 2 identifies common patterns of average morphine equivalent daily dosing (MEDD) across six 30-day intervals starting with the first opioid prescription using latent class growth modeling (LCGM). Multivariate multinomial regression quantifies associations between different opioid use patterns over time and resident characteristics. Aim 3 accesses the odds of falls among residents with the highest probability of belonging to each of the commonly identified opioid dosing patterns with a facility clustered GEE model. Results: From 2011 to 2015, adjusted analyses found no constant significant changes in dose, duration, or frequency of opioid use. Increased use of anticonvulsant and skeletal muscle relaxants in opioid-related stays, particularly among residents with dementia, were found. LCGM identified four common opioid dosing patterns; extended high, short-term, intermittent and restart. Almost half of LTC residents received extended high opioid dosing. Multinomial regression found significant associations between sex, race, U.S. geographical region, pain diagnosis and receipt of other pain treatments with receipt of extended high dose therapy. Fall odds were found to be similar in the extended high and short-term groups. Models did find increased odds of falls in groups with less opportunity to develop tolerance (i.e., the restart and intermittent groups). Findings were not consistently significant in stratified analyses. Conclusions: Opioid use varies by resident characteristics. Opioid dosing varies over the course of therapy. More research on what factors lead to decisions regarding pain treatment and the impact of opioid dosing strategies on health-related outcomes are warranted.