Medication management in the older adult: A narrative exploration.

BACKGROUND AND PURPOSE: The purpose of this study was to characterize the meaning nurse practitioners (NPs) ascribed to personal experiences providing care to older adults who take multiple medications to manage complex conditions. The study illuminated the NP experience in caring for the older adult while addressing the complexities of medication management through narrative stories in practice. METHODS: NPs self-identifying as caring for older adults were interviewed (N=15). Narrative inquiry and the three-dimensional narrative inquiry space were used to guide the researcher during data collection and analysis. CONCLUSIONS: Three common themes emerged from the narratives. These themes illuminated the complexities NPs face in managing patients with multiple comorbidities, taking multiple medications, and seeing multiple providers. Identified themes were "mastering the art of the puzzle," "it takes a village," and "power in knowledge." Tools to assist NPs identify and manage polypharmacy were identified including the 2015 updated Beers Criteria, ARMOR (Assess, Review, Minimize, Optimize, and Reassess), STOPP (screening tool of older people's potentially inappropriate prescriptions), and START (screening tool to alert providers to the right treatment) tools.

Storied experiences of nurse practitioners managing prehypertension in primary care.

PURPOSE: The purpose of this study was to explore the nurse practitioner (NP) experience with caring for prehypertensive patients. Lifestyle modifications are the primary recommendation for management of prehypertension. Given the historical foundation of health promotion and disease prevention as a fundamental component of NP professional identity, gaining insight into the experience of caring for prehypertensive patients in the current healthcare environment is valuable to the profession, patients, and communities. Therefore, the NP role in health promotion and disease prevention related to prehypertension was explored as well. DATA SOURCES: Narrative inquiry was the chosen methodology to gather narrative accounts of eight NPs caring for prehypertensive patients in primary care. The three-dimensional narrative inquiry space was used to guide the researcher during data analysis. CONCLUSIONS: Three themes emerged from the NPs' narratives: realities of practice, ambiguous role identity, and bridging models. Time constraints, financial considerations, and bridging the nursing and medical models while adapting to practice environments were barriers identified as components of the NP experience caring for patients with prehypertension. IMPLICATIONS FOR PRACTICE: This study revealed that caring for prehypertensive patients is a complex and multilayered experience.

Perioperative pharmacology: patient-controlled analgesia.

Patient-controlled analgesia (PCA) is an effective treatment option for reducing pain, but PCA errors can be quite serious. Opioid analgesics are among the most effective pain relievers available, but all have contraindications and can have adverse effects, including respiratory depression and other effects on the central nervous system. Practitioners must weigh the potential benefits of PCA use against the risks. Errors associated with the PCA process have been documented in each phase of the medication-use process; therefore, practice improvements in prescribing, transcribing, dispensing, administering, and monitoring PCA may reduce the likelihood of errors. Perioperative nurses can make important contributions to safe PCA use by establishing standardized processes to help ensure positive patient outcomes in pain management.

Prehypertension: a literature-documented public health concern.

PURPOSE: To provide nurse practitioners (NPs) with an overview of prehypertension identification and management. Additionally, the article serves to highlight the prevalence and impact of prehypertension in the United States. DATA SOURCES: A comprehensive review of the literature was conducted using multiple databases, including PubMed, Medline, CINAHL, and SAGE Health Sciences databases. The review was not limited by discipline, year of publication, or type of research. Key words used to obtain relevant articles included prehypertension, nurse practitioner, health promotion, disease prevention, hypertension, and chronic disease. CONCLUSIONS: Approximately 70 million individuals have been recognized as prehypertensive in the United States, placing them at increased risk for hypertension and cardiovascular disease. Identifying and managing prehypertension has been recognized in national health policy as a priority to improve public health. Prehypertension is managed primarily by eliminating risk factors and implementing lifestyle modification. IMPLICATIONS FOR PRACTICE: Health promotion and disease prevention form the cornerstone of the NP role. The designation of prehypertension serves as an opportunity for NPs to assist in decreasing the burden on the health system from chronic disease and improve patient quality of life.

Perioperative pharmacology: a focus on vancomycin.

Given the increase in various drug-resistant organisms and in patients who are allergic to penicillin, perioperative nurses are likely to encounter patients who are receiving IV vancomycin, a tricyclic glycopeptide antibiotic. In general, vancomycin is not considered a first-line agent because of its possible adverse effects (e.g., hypotension, phlebitis, nephrotoxicity, ototoxicity); therefore, it is reserved for treating serious or severe infections caused by organisms that are unresponsive to other antimicrobial agents. Vancomycin is administered intravenously over a minimum of 60 minutes to avoid infusion-related reactions. Some considerations for nurses administering vancomycin include ensuring a patent IV line, planning for administration of the preoperative dose as much as two hours before the initial incision is made, and including information about the dose and timing of preoperative vancomycin administration in the surgical time out.

Perioperative pharmacology: pharmacotherapeutics, pharmacokinetics, and pharmacodynamics.

Results of current research into perioperative medication errors have revealed that more than half of medication errors occur during the administration phase of the medication-use process. The administration phase is the point at which the medication and the patient intersect and the medication imposes its pharmacological effect. During this phase, the only safety net between the patient and the medication is the health care provider's attention and care when administering the medication. To help mitigate these errors, perioperative nurses must understand pharmacotherapeutics: the use of medications to prevent, treat, cure, or alleviate symptoms of disease. Pharmacotherapeutics incorporates pharmacokinetics (ie, what the body does to a medication after it enters the system) and pharmacodynamics (ie, how a medication acts on the body to achieve a desired therapeutic effect).