Inpatient pain assessment and decision-making in internal medicine and general surgery residents: A qualitative analysis.

Background: Understanding physician approaches to pain treatment is a critical component of opioid and analgesic stewardship. Practice patterns learned in residency often persist longitudinally into practice. Objective: This study sought to identify salient factors and themes in how resident physicians assess and manage pain. Methods: Video-recorded focus groups of internal medicine and general surgery residents were conducted via videoconferencing software. Data were analyzed using a ground theory approach and constant comparative method to identify themes and subthemes. Focus groups occurred in September and October 2020. Results: 10 focus groups including 35 subjects were conducted. Four general themes emerged: (1) Assessment considerations; (2) Education & Expectations; (3) Systems Factors; and (4) Management considerations. Participants indicated that while it is important to treat pain, its inherently subjective nature makes it difficult to objectively quantify it. The 0-10 numeric rating scale was problematic and infrequently utilized. Patient expectations of no pain following procedures was viewed as particularly challenging. The absence of formal best practices to guide pain assessment and management was noted in every group. Management approaches overall very highly variable, often relying on word-of-mouth relay of the preferences of specific attending physicians. Conclusions: Pain is highly nuanced and resident physicians struggle to balance pain's subjectivity with a desire to quantify and appropriately treat it. The 0-10 numeric rating pain scale, though ubiquitous, is problematic. Priority areas of improvement identified include education for both patients and physicians, functional pain scales, and expansion of existing effective resources like the nursing pain team.

Polypharmacy Interactions Impacting Methacholine Challenge Testing for Asthma Assessment in Older People.

Objective To investigate potential reasons for unusually high incidence of negative Methacholine Challenge Tests (MCT), following standardized MCT medication-hold protocol, in older people with physician-diagnosed asthma. Design An analysis of a longitudinal observational parent study of asthma. Setting Community-dwelling participants were evaluated in an outpatient clinic and at home. Participants Screening inclusion criteria for the parent study included 60 years of age or older, physician diagnosis of asthma, and a positive response to at least one of six asthma screening questions. Participants were enrolled in the study if they also demonstrate either: (1) a postbronchodilator administration response showing an increase of at least 12% and 200 mL in forced expiratory volume or an increase of at least 12% and 200 mL in forced vital capacity, or (2) an MCT result of PC20 ≤ 16 mg/mL (indicating bronchial hyper-responsiveness, MCT positive). Exclusion criteria included diagnosis of cognitive impairment or dementia, residing in a long-term care facility, more than 20 pack/ year smoking history or a history of smoking within the previous five years, inability to perform pulmonary function testing maneuvers, and a Prognostic Index score of greater than 10. Interventions Analysis of participant data for non-medication- and medication-exposure factors for association with negative MCT results. Results Anticholinergic burden and statin use were positively associated with negative MCT. Conclusion Medications not accounted for in medication-hold protocols, and concurrently in use, may impact clinical tests and outcomes.

Lessons from Fukushima: Potassium Iodide After a Nuclear Disaster.

ABSTRACT: The release of radioactive iodine after a nuclear disaster, such as those that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan 10 years ago and Three Mile Island in Pennsylvania in 1979, increases thyroid cancer risk among people who are exposed. Certain populations are especially vulnerable, including pregnant and breastfeeding women, children, and neonates. Potassium iodide (KI) can effectively block radioactive iodine from being absorbed by the thyroid gland if taken immediately after a radiation release. This article examines lessons learned from Fukushima to enhance disaster readiness and nursing actions. Nurses should be directly involved in vulnerability assessments, emergency planning, and in ensuring the availability, accessibility, and distribution of KI within U.S. nuclear power plant emergency planning zones before a crisis occurs.

Pain Management and Education for Ambulatory Surgery: A Qualitative Study of Perioperative Nurses.

BACKGROUND: Ambulatory surgery presents unique challenges regarding adequate pain management and education. Studies have documented issues with transfer of information and patient comfort. Our objective was to explore perioperative nurses' perspectives of current practices and challenges with pain management and education. MATERIALS AND METHODS: We used a qualitative descriptive design and conducted four focus group interviews, with 24 total participants from two perioperative areas of an academic medical center, using a standardized script. Using qualitative analysis software, two investigators reviewed the data and coded major themes and subthemes. The consolidated criteria for reporting qualitative studies guidelines were followed for reporting the data. RESULTS: We identified four major themes impacting current perioperative pain management and education practices: communication among the perioperative care team, sources of nurses' frustrations in the perioperative setting, patient expectations for pain, and nurse-driven pain management and education. Nurses highlighted their work became easier with adequate information transfer and trust from physicians. Frustrations stemmed from surgeon, system, and patient factors. Nurses often use their clinical experience and judgment in managing patients throughout the perioperative period. Furthermore, nurses felt patients have limited pain education and stressed education throughout the surgical care pathway could improve overall care. CONCLUSIONS: Perioperative pain management, assessment, and education practices are inconsistent, incomplete, and sources of frustrations according to participants. Participant experiences highlight the need for improved and standardized models. Patient pain education should use a multidisciplinary approach, beginning at the point of surgery scheduling and continuing through postoperative follow-up.

A Feasibility Study of Muslim Cancer Survivors' Experience in the United States: Recruitment and Data Collection.

BACKGROUND: Studies with U.S. Muslims have had difficulty recruiting participants. METHOD: This article, which was part of a larger qualitative study, aimed to describe the effectiveness of targeted recruitment and data collection strategies in Muslim cancer survivors. The purpose of the larger qualitative study was to gain an understanding of the experiences of Muslim cancer survivors in the United States. Four recruitment approaches were implemented to determine timeliness, diversity in respondents, and success in completing the interview. RESULTS: Eighteen Muslim cancer survivors participated (12 males, 6 females). Ten Muslim participants were identified by community leaders, two by posted flyers, four using social media, and two by a physician. No burden was voiced by participants related to length, time, or location of interviews. DISCUSSION: We demonstrated the feasibility of recruiting and interviewing Muslim cancer survivors. Using culturally sensitive approaches is important to encourage recruitment and participation in studies of Muslim cancer survivors.

Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results.

Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are ≥60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.

Student nurses' risk perceptions of home environmental hazards.

OBJECTIVE: This study described nursing students' perceptions of home health risks. DESIGN AND SAMPLE: Nursing students (N = 254) at two large urban universities completed a cross-sectional survey during the 2011-2013 academic years. MEASURES: From a list of 22 common home health hazards, students identified what they perceived as the three: (a) most dangerous hazards, (b) most common hazards in their state, (c) hazards most likely to be present in their current home, and (d) hazards they would most afraid to find in their home. Students also rated perceived dangerousness of the hazards, how healthy they perceived their home to be, and the perceived effect of their home on their own health. RESULTS: Tobacco smoke, asbestos, and cleaning products were the most commonly identified home hazards. Individual characteristics, hazard experiences in personal homes, and university geographic location (state) were associated with perceptions of home hazards. Students who identified hazards in their own homes were more likely to identify them as hazards in general and for their own state. CONCLUSIONS: These results fill a foundational knowledge gap by describing the risk perceptions of near-future health care providers about home environmental hazards.

Facilitating factors and barriers to BMI screening in schools.

The National Association of School Nurses advocates for body mass index (BMI) screening. Little research describes school nurse practice of BMI screening. In this descriptive study, 25 Ohio school nurses participated in three focus groups. An adapted Healthy People 2010 Determinants of Health Model guided the research questions. School nurses engaged in multiphasic data collection which was contingent on physical environment, workload, and referrals. Lack of system policy was key barrier in terms of data collection, referral, and follow-up. A key facilitating factor was physical education teachers in terms of reinforcing health. School size and privacy were components of school physical environment that influenced screening. Recommendations on securing adequate resources are presented. Implications for policy included a salient need for reduced SN workload.

Comparison of parental report of blood lead testing in children enrolled in Medicaid with Medicaid claims data and blood lead surveillance reports.

The purposes of this study were to identify the congruence of blood lead testing based on parental self-reports with Medicaid claims and blood lead surveillance records, and to determine factors associated with agreement between parental reports of blood lead tests and Medicaid claims or blood lead surveillance records. Data were obtained from a cross-sectional mailed survey of a randomly selected sample of parents of children 1-2 years old enrolled in Medicaid (n=532) and from existing Medicaid claims and blood lead surveillance records. Fifty-six percent of survey respondents reported their child had a blood lead test completed. Of these, only 56% could be confirmed with Medicaid claims/blood lead surveillance data. Logistic regression analysis revealed the odds of blood lead testing per parental report confirmed with Medicaid claims/blood lead surveillance data were 2.6 times greater if the child had > or =3 provider visits, 2.5 times greater if parents reported receiving a reminder about blood lead testing, 2.2 times greater if parents reported receiving information about lead poisoning, 1.6 times greater if residing in an urban county, and 1.5 times greater if the child was more than 2 years old. In conclusion, parents are not always aware if their child had a blood lead test. Information and reminders about blood lead testing should be distributed to parents of young children enrolled in Medicaid and frequently reviewed by healthcare providers.

Parental perceptions of barriers to blood lead testing.

INTRODUCTION: This study identified barriers to blood lead testing from the perspective of parents of young children eligible for Medicaid. METHOD: Data were gathered from three focus groups. Participants were asked if they were familiar with the dangers of high blood lead levels, rationale for not having a child tested for blood lead, what would facilitate having blood lead testing, and how they wanted to learn about blood lead poisoning. RESULTS: Most parents (n=30) were unfamiliar with the causes and effects of lead poisoning. While many reported their child had been tested for lead, others were unsure because they were not told the purpose of blood draws. Participants suggested that having all services in one facility would decrease travel and thus facilitate blood lead testing; others wanted the discomfort associated with phlebotomy minimized. Participants preferred to learn about lead poisoning from low-literacy brochures, videos, and television ads. DISCUSSION: Nurses should institute measures in their practice sites to improve blood lead poisoning prevention education and blood lead testing rates and to reduce the pain and anxiety associated with this procedure.