Evidence-Based Practice Guideline : Acute Pain Management in Older Adults.

Acute pain is a prevalent problem in a growing segment of the older adult population and is often ineffectively managed despite the accumulation of evidence to guide assessment and support interventions in managing pain. Improvements in acute pain management in older adults are needed to provide consistent and quality pain assessment techniques and treatment therapies consistent with patient and/or family preferences. The current article briefly discusses ways to improve the pain experience and outcomes for older patients and families. [Journal of Gerontological Nursing, 43(2), 18-27.].

Lessons learned from a study of a complementary therapy for self-managing hypertension and stress in women.

This report evaluates a Hawaiian-based, self-management intervention for reducing blood pressure (BP) and stress in women. It highlights lessons learned when using nonpharmacologic, complementary and alternative medicine (CAM) therapies. Specific participant characteristics and preferences should be considered for optimizing health outcomes in CAM research in nursing practice.

Initial antihypertensive prescriptions, switching patterns and adherence among insured patients in Hawai'i.

PURPOSE: Practice patterns were investigated for an insured population to determine if prescribing patterns, switching, and relative adherence by drug class for first-line antihypertensive medications adhered to national guidelines. PROCEDURES: Drug use was obtained from pharmaceutical claims. Prescriptions were categorized into 6 drug classes for analyses. Adherence with antihypertensive medications was based on a medication possession ratio or 0.8 or greater. For the analyses, 28,073 patients were categorized into groups: hypertension alone, hypertension plus diabetes, and hypertension plus congestive heart failure. Patient and physician characteristics affecting prescribing, switching, and adherence were analyzed using multivariable logistic regression analysis. FINDINGS: Thiazide diuretics were used and adhered to less often, despite national guideline recommendations. New drug classes were used more highly. CONCLUSIONS: Inconsistency exists between guidelines and practice as older, cheaper drugs were used less and more expensive drugs were used more often with better adherence.

Self identity through Ho'oponopono as adjunctive therapy for hypertension management.

OBJECTIVE: Self Identity through Ho'oponopono is a step-by-step problem-solving approach to identify and relieve stress. The objective of this study was to determine if Self Identity through Ho'oponopono along with standard medical therapy might better control hypertension than standard therapy alone. DESIGN, SETTING, PARTICIPANTS: Twenty-three Asian, Hawaiian, and other Pacific Islanders from a local community in Hawaii participated in a longitudinal design comparing pre- and post-intervention measures of blood pressure. INTERVENTION: Participants attended a half-day class on Self Identity through Ho'oponopono to learn ways to create balance and correct stress through an understanding of their own self identity. Participants learned processes to care for themselves through repentance, forgiveness, and transmutation and how to apply the processes in their daily lives. MAIN OUTCOME MEASURES: Repeated blood pressure measurements were compared before and after the intervention using generalized estimating equations; two spirituality questionnaires were administered before and after the intervention and analyzed with paired RESULTS: Systolic blood pressure decreased after the intervention, averaging 11.86 mm Hg below pre-intervention levels. Diastolic blood pressure decreased by 5.44 mm Hg. Spirituality scores significantly increased after the intervention. CONCLUSIONS: Self Identity through Ho'oponopono was associated with a statistically and clinically significant reduction in mean blood pressure. Spirituality scores increased after the intervention. We conclude that Self Identity through Ho'oponopono may be an effective adjunctive therapy for hypertension. Further research is needed to validate these preliminary findings.

Integrating a CAM Therapeutic Strategy for Hypertension.

Traditional approaches used to manage the complexities of hypertension (HTN) have achieved modest success. Most persons with HTN in the United States have blood pressure that is uncontrolled or inadequately controlled on medications, or they are unaware that they even have HTN. Because so many US adults with uncontrolled HTN are at risk for developing heart disease and stroke, an innovative therapeutic approach is needed. One such approach, a complementary and alternative medicine strategy called IZI LLC sponsors Self I-Dentity through Ho'oponopono® (SITH®), shows promise in the management of HTN and other chronic health conditions. The goal of this article is to describe the SITH® process and how this therapeutic strategy can be used in practice.