SAFE Medication Management for Patients with Physical Impairments of Stroke, Part One.

PURPOSE: This article focuses on the extensive impairments of stroke and their influence on medication management. The impairments of motor skills due to paralysis-loss of mobility and balance, lack of hand-to-mouth coordination, and difficulty swallowing-are discussed. A future article will discuss sensory impairments of vision, hearing, cognition, comprehension, communication, and emotional disorders and how these impairments influence medication management. DESIGN: Each of the impairments are presented and discussed, and possible interventions are proposed. Every patient is an individual and requires variable care plans. METHOD: Intervention strategies that include tools for patient assessment, practice tips, and devices available to assist the patient and family in safe medication management are presented. FINDINGS: Patient outcomes and successes vary, but the strategies outlined will return the patient to as close to previous capabilities as possible. CONCLUSION AND CLINICAL RELEVANCE: Teaching SAFE (Systematic, Accurate, Functional, Effective) medication management to the patient, family, and caregivers will increase medication safety and decrease the number of adverse effects. The rehabilitation nurse is charged with evaluating the patients' needs and developing strategies to assist them to manage their medications.

Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy.

BACKGROUND: Self-management of complex medication regimens for chronic illness is challenging for many older adults. OBJECTIVES: The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. DESIGN: This study used a randomized controlled trial with three arms and longitudinal outcome measurement. SETTING: Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. METHODS: All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. RESULTS: After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. DISCUSSION: Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

Factores que influyen en la automedicación del personal de enfermería a nivel técnico y de estudiantes / Factors influencing self medication nursing staff and students technical level

La automedicación, es “el consumo de medicamentos, hierbas y remedios caseros por iniciativa o consejo de otra persona, sin consultar al médico”, considerada también como un fenómeno que se ha incrementado a través del tiempo, convirtiéndose en un serio problema de salud pública. En México no existen estudios o publicaciones que permitan valorar la real magnitud de esta práctica en la población. Objetivo: Conocer los factores que influyen en la automedicación del personal de enfermería a nivel técnico y estudiantes del Instituto Nacional de Neurología y Neurocirugía.

Self-medication, is “the use of drugs, herbs and home remedies or advice on the initiative of another person, without consulting a doctor”, also regarded as a phenomenon that has been increasing over time, becoming a serious public health problem. In Mexico, there are no studies or publications to assess the real magnitude of this practice in the population. Objective: Understanding the factors that influence self-medication nursing staff technical level, and students of the National Institute of Neurology and Neurosurgery.

Fatores predisponentes ao uso próprio de psicotrópicos por profissionais de enfermagem / Factores predisponentes al uso proprio de psicotrópicos por profesionales de enfermería / Factors favoring the use of psychotropics by nursing professionals

Este estudo trata como objeto a vulnerabilidade de profissionais de enfermagem ao envolvimento pessoal com substâncias psicotrópicas. Teve como objetivo analisar os fatores predisponentes ao envolvimento pessoal de trabalhadores de enfermagem com psicotrópicos. O referencial teórico estruturou-se a partir dos fundamentos farmacológicos de substâncias psicotrópicas e da promoção da saúde. Estudo descritivo, de abordagem qualitativa, realizado com 15 profissionais de enfermagem da unidade de terapia intensiva de um hospital universitário, situado no município do Rio de Janeiro, em 2008. Foi realizada análise de conteúdo temática dos depoimentos obtidos por entrevista semiestruturada. Os resultados mostraram que o envolvimento deles ocorre por elevado estresse e carga horária ocupacional, cobranças e insatisfação no ambiente de trabalho ou familiar. O enfrentamento do uso indevido de psicotrópicos por trabalhadores de enfermagem exige, principalmente, reflexões éticas e mudança de atitude visando o autocuidado, a responsabilidade profissional e a busca de condições dignas para um trabalho saudável.

This study addresses the vulnerability of nursing professionals to personal involvement with psychotropic chemicals. It aims at analyzing the factors favoring the use of psychotropic drugs by nursing professionals. The theoretical framework was structured on the pharmacological fundamentals of psychotropic drugs as well as on health promotion. Descriptive study of qualitative approach undertaken with fifteen nursing professionals of the intensive care unit of a university hospital, located in Rio de Janeiro, RJ, Brazil, in 2008. Reports obtained with semi-structured interviews underwent a thematic content analysis. Results showed that involvement with psychotropics derive from high stress and long work hours, professional demands, and dissatisfaction at work or at home. Coping with undue use of psychotropic chemicals by nursing professionals requires ethical reflections as well as attitude change aiming at self-care, professional responsibility, and the search for basic and healthy working conditions.

Este estudio trata como objeto la vulnerabilidad de profesionales de enfermería al envolvimiento personal con substancias psicotrópicas. Tuvo como objetivo analizar los factores predisponentes al envolvimiento personal de trabajadores de enfermería con psicotrópicos. El referencial teórico se estructuró a partir de los fundamentos farmacológicos de substancias psicotrópicas y de la promoción de la salud. Estudio descriptivo, de enfoque cualitativo, realizado con 15 profesionales de enfermería de la unidad de terapia intensiva de un hospital universitario, sito en Rio de Janeiro-Brasil, en 2008. Fue cumplido análisis de contenido temático de las declaraciones obtenidas por entrevista semiestructurada. Los resultados revelaron que el envolvimiento de ellos acaece por estrés intenso y carga horaria laboral, cobranzas e insatisfacción en el ambiente de trabajo o familiar. El enfrentamiento del uso indebido de psicotrópicos por trabajadores de enfermería exige, principalmente, reflexiones éticas y cambio de actitud mirando al autocuidado, a la responsabilidad profesional y a la búsqueda de condiciones dignas para un labor saludable.

Vigilância em saúde na enfermagem: o caso das medicações sem prescrição em crianças / Surveillance at health in nursing: the case of medications without prescription in children

A automedicação é um hábito comum em nosso país e sempre foi um assunto muito discutido e controverso. Muitas mães recorrem à prática de medicar por conta própria suas crianças quando estas apresentam algum sintoma decorrente ou não de alguma patologia. Esta pesquisa teve como objetivo descrever os motivos que levaram as mães a administrarem medicações sem prescrição profissional a seus filhos. Foram entrevistadas 20 mães de crianças menores de 10 anos cadastradas no programa de Crescimento e Desenvolvimento da Unidade de Saúde da Família do município de Passagem, interior do Rio Grande do Norte. Entre as 20 mães entrevistadas, 30 por cento automedicaram seus filhos com antipirético, 50 por cento automedicaram devido à febre, 43 por cento foram motivadas pela experiência anterior e 90 por cento não relataram efeitos adversos. A automedicação na população infantil reforça a necessidade de um melhor esclarecimento às mães sobre os riscos da automedicação.

Automedicação: desvelando o descuidado de si dos profissionais de enfermagem / Automedicación: desvelando el descuidado de si de los profesionales de enfermería / Self-medication: showing self carelessness by nursing professionals

Este estudo é parte de uma dissertação de mestrado e objetivou compreender o significado do (des)cuidado de si dos profissionais de enfermagem, a partir da prática da automedicação. Foi utilizado o método exploratório descritivo de abordagem qualitativa. Os participantes são 12 auxiliares e técnicos de enfermagem e enfermeiros atuantes em rede pública e particular de saúde, no interior do Estado do Rio Grande do Sul. Os dados foram coletados, em 2004, por meio de entrevista semiestruturada para a caracterização dos sujeitos e para conhecer os posicionamentos individuais sobre o tema em questão. O registro dos dados foi audiogravado, sendo os mesmos, posteriormente, transcritos, conferidos e submetidos à análise de conteúdo. A automedicação, baseada na formação e prática dos sujeitos, desvela o descuidado de si dos profissionais de enfermagem que buscam minimizar sintomas físicos ou psíquicos sem a recomendação médica adequada. O estudo mostrou que as drogas usualmente consumidas na automedicação são: analgésicos, anti-inflamatórios e psicotrópicos.

This study is part of a master’s thesis which aimed at shedding light on the meaning of self care(less)ness by nursing professionals as far as self-medication is concerned. It used the exploratory descriptive method of qualitative approach. The informants are twelve assistant nurses and nursing technicians acting both in the public and private health network, in the backlands of Rio Grande do Sul state, Brazil. Semi-structured interviews organized data collection in 2004, meant to characterize the subjects and to learn about their stand on the theme in question. Data registration was audio-recorded, transcribed, double-checked, and submitted content analysis. Self-medication, based on the informants’ training and practice, points to self carelessness by nursing professionals, who seek alleviation of physical and psychic symptoms without adequate medical recommendation. The study showed that analgesics, anti-inflammatory drugs, and psychotropic substances are usually consumed in self-medication.

Este estudio es parte de una tesis de maestría que tuvo como objetivo entender el significado del (des)cuidado de si de los profesionales de enfermería, a partir de la práctica de la automedicación. Se utilizó el método exploratorio descriptivo de enfoque cualitativo. Los participantes son auxiliares de enfermería y técnicos de enfermería y enfermeros que trabajan en los sectores público y privado de atención de salud, en el interior del Estado de Rio Grande do Sul-Brasil, totalizando 12 sujetos. Los datos fueron recolectados, en 2004, a través de entrevista semiestructurada para la caracterización de los sujetos y para conocer las posiciones individuales sobre el tema en cuestión. El registro de los datos fue audiogravado, y luego transcritos, conferidos y sometidos al análisis de contenido. La automedicación, basada en la formación y en la práctica, desvela el descuidado de si de los profesionales de enfermería que buscan el alivio de los síntomas físicos o psicológicos sin recomendación médica adecuada. El estudio mostró que las drogas normalmente consumidas en la automedicación son: analgésicos, antiinflamatorios y psicotrópicos.

Over-the-counter medication use in older adults.

Use of over-the-counter (OTC) medications is becoming more of a problem in the older adult population as the push to deregulate prescription medications grows. This article summarizes the side effects, adverse reactions, and medication interactions older adults face when using some common OTC medications.

Factors influencing women's decisions to self-treat vaginal symptoms.

PURPOSE: To review the research on women's self-treatment of vaginal symptoms, describe factors influencing this phenomenon, identify evidence-based interventions, and suggest strategies for nurse practitioners (NPs) to promote safe and effective self-treatment decisions by women. DATA SOURCES: Research articles identified through Medline and CINAHL databases. CONCLUSIONS: The primary factors influencing women's decisions to self-treat vaginal symptoms were personal (attitudes, beliefs, values, knowledge and experience, and emotions) and environmental (culture, social networks and norms, media, and life context). IMPLICATIONS FOR PRACTICE: Women's self-diagnostic skills and decision making for self-treatment can be improved through education and support from NPs. The traditional office visit may not provide an opportunity to teach women appropriate self-care because many women do not access providers for advice or information. Different methods of providing information to large numbers of women through consumer publications need to be developed and evaluated.

Using computers to reduce medication misuse of community-based seniors: results of a pilot intervention program.

Persons over the age of 65 are at high risk for conditions related to medication misuse. Addressing this issue is important to prevent serious outcomes such as falls, drug interactions, rehospitalization, and addiction. The role of community-based organizations, such as senior centers, in preventing medication misuse can be enhanced by the use of standardized interventions. This article reports a pilot project implementing laptop computer interventions for medication misuse by seniors. The study was conducted in Cleveland, Ohio, with 412 seniors participating in Area Agency on Aging programs. Seniors completed a computerized simple screening for medication misuse and watched short video clips related to their own potential misuse. Seniors also received a medication reminder checklist and a 7-day pill-dispensing box. Results of a 2-month follow-up interview revealed promising results, with 55% of participants using the medication reminder checklist. One-third of participants visited their doctor to discuss the medication misuse feedback. Almost all of the participants found the computerized administration of the intervention to be easy and helpful. The study supports the further development of community-based interventions for seniors using computerized administration.