Pain management at the end of life: A comparative study of cancer, dementia, and chronic obstructive pulmonary disease patients.

BACKGROUND: Limited data exist concerning the unique pain characteristics of patients with non-cancer terminal diseases referred for inpatient hospice care. AIMS: To define the unique pain characteristics of patients admitted to an acute inpatient hospice setting with end-stage dementia or chronic obstructive lung disease (or chronic obstructive pulmonary disease) and to compare them to patients with end-stage cancer. DESIGN: Retrospective patient chart review. Demographic, physiological, pain parameters, and medication utilization data were extracted. Associations between pain characteristics, medication utilization, and admission diagnoses were assessed. Analyses included descriptive statistics. SETTING/PARTICIPANTS: In total, 146 patients admitted to an acute inpatient hospice between 1 April 2011 and 31 March 2012 with an underlying primary diagnosis of chronic obstructive pulmonary disease (n = 51), dementia (n = 48), or cancer (n = 47). RESULTS: Pain was highly prevalent in all diagnostic groups, with cancer patients experiencing more severe pain on admission. Cancer patients received a significantly higher cumulative opioid dose compared with dementia and chronic obstructive pulmonary disease patients. Pain control within 24 h of pain onset was achieved in less than half of all patient groups with chronic obstructive pulmonary disease patients the least likely to achieve pain control. CONCLUSIONS: Despite the fact that pain is the most common complaint at the end of life, pain management may be suboptimal for some primary diagnoses. Admission diagnosis is the strongest predictor of pain control. Patient with cancer achieve the best pain control, and chronic obstructive pulmonary disease patients are the least likely to have their pain adequately treated.

Perceived social support, self esteem, and pregnancy status among Dominican adolescents.

UNLABELLED: Adolescent pregnancy is a major health concern among Dominicans in the U.S. and in the Dominican Republic (DR). Twenty three percent of adolescents age 15-19 have experienced pregnancy and this trend is rising. PURPOSE: The purpose of this study was to explore and compare social support, self-esteem and pregnancy between Dominican adolescents in the DR with those who have immigrated to the U.S. METHODS: This study used an exploratory, descriptive design including study samples from both the U.S. and DR. Findings showed that young women with stronger social support and higher self esteem experienced lower pregnancy rates in both the DR and U.S. RESULTS: Neither self esteem nor social support was found to be predictors of pregnancy. CONCLUSION: Important findings from this study will inform the development of interventions aimed at preventing pregnancy in adolescents.

Building collaborative capacity: promoting interdisciplinary teamwork in the absence of formal teams.

BACKGROUND: Contradictory findings about the effectiveness of health care teams may relate to the actual structure of teams-loose rather than formal-and the nature of decision making-hierarchical rather than egalitarian. We introduce the concept of collaborative capacity-the likelihood that providers, no matter how brief their exchange, will collaborate as if they were members of an egalitarian team even in the absence of a formal team structure. OBJECTIVE: To examine aspects and determinants of collaborative capacity, namely task interdependence, norms of working together, and egalitarian collaboration among interdisciplinary providers on health care units. RESEARCH DESIGN: We collected survey data from unit-based staff in 45 units across 9 hospitals and 7 health systems in upstate New York. One thousand five hundred twenty-seven surveys were returned for an overall response rate of 68.5%. RESULTS: Measures for team structure and collaboration do not vary significantly between hospitals, only by unit and occupational group, with higher status providers reporting greater interdependence, higher quality of interactions, and more collaborative influence in decision making. Clear task direction, namely an emphasis on patient-centered care, and organizational contexts supportive of work are both significantly associated with higher levels of task interdependence, quality of staff interactions, and collaborative influence. CONCLUSIONS: Collaborative capacity is somewhat constrained by a rigid hierarchy of health care occupations and division of labor that make teamwork more similar than different across hospitals. At the unit level, collaborative capacity may be improved, however, by an emphasis on patient-centered care and a context that supports providers' work.

Risk behaviors of Dominican adolescents in their homeland and in the United States.

INTRODUCTION: Adolescence is a time of developmental change. The major task of adolescence is to become an independent individual capable of functioning as a contributing adult within culturally expected norms. It is often accompanied by frustration and difficulties with adjustments. One typical response of adolescents to these changes is engaging in high-risk behaviors. The purpose of this study was to compare self-reported high risk behaviors that may lead to unintentional and intentional injuries among adolescents living in the Dominican Republic and Dominican adolescents living in the United States. METHOD: This study used a cross-sectional, comparative design with data collection sites in Las Matas de Farfan, Dominican Republic, and Boston, MA, United States. Data were collected using the 99-item 1999 Youth Risk Behavior Survey. RESULTS: Findings indicated that adolescents in both groups reported similar risk behaviors in all areas; however, there were few differences between the two groups that did exist. DISCUSSION: To educate youth regarding outcomes of high-risk behaviors, it is necessary for providers to engage in discussion with adolescents regarding specific risk behaviors that are commonly practiced in their homeland or in their cultural groups.

Adult-health/medical-surgical nurses' perceptions of students' contributions to clinical agencies.

The nursing shortage and accompanying increase in nurses' workloads could suggest that the presence of nursing students on clinical units would further increase nurses' responsibilities. Counterbalancing this concern is the need to adequately prepare the next generation of dedicated and skilled nurses. The question arises as to whether nursing students are an asset or liability to clinical agencies.

Past, present, and future trends of master's education in nursing.

Nurses interested in pursuing careers in advanced practice are now being educated at the doctoral level through new doctorate of nursing practice degree programs. In light of this shift, master's programs for advanced practice nurses are in a tenuous position, and it is questionable whether the remaining master's level educational programs are meeting the needs of consumers, health care institutions, and students. Given the great need for clinical leadership in health care, it is essential to reexamine master's nursing education to ensure that educational institutions are meeting the needs of graduate nursing students, consumers, and health care systems. Research supports that the master's-prepared nurse of the future must be proficient in the development and management of accountable care systems using state-of-the-art technology. In addition, interprofessional models show improvement in health care delivery and health outcomes. The current demands in health care that impact nursing education will be discussed, including the movement toward interprofessional education and the broadened expertise, required of master's-prepared nurses working in an era of health care reform. While academic medical centers are actively advancing toward an interprofessional model, the majority of nurses in this country are educated in private and community settings. This article will examine the move toward interprofessional education at a private university, utilizing clinical partnerships to revise the master's program. The goal of this revision is to empower students with the expertise required in today's health care environment to improve the delivery of care.

Understanding child feeding practices of Vietnamese mothers.

PURPOSE: To understand the feeding practices, knowledge, and nutritional beliefs of Vietnamese mothers with young children who are recent immigrants to the United States. STUDY DESIGN AND METHODS: Exploratory, descriptive study using a focus group design to provide qualitative data. Twelve Vietnamese mothers of children under the age of 5 years participated in a 1-hour focus group discussion (in Vietnamese) facilitated by a Vietnamese nutritionist and the principal investigator. RESULTS: The study participants identified that breastfeeding is healthier for babies than formula but reported the difficulty in maintaining breastfeeding due to work and family constraints. A traditional Vietnamese diet of meat or fish with soup broth, vegetables, and rice was the preferred and healthiest diet for children under the age of 6 years. There was consensus in the group that "junk food" and inactivity were unhealthy for children and led to overweight and obesity. Several of the group participants verbalized difficulty in maintaining a healthy diet for their children because the children demanded unhealthy food choices, and their work schedules made it difficult to make sure their children were getting adequate exercise. CLINICAL IMPLICATIONS: This knowledge can be used by nurses to develop culturally appropriate interventions for immigrants from Vietnam aimed at preventing childhood obesity. Interventions that consider the effects of acculturation could be more effective when targeted to parents of young children than interventions focused on treatment of obesity in later years.

Comparing child-feeding practices of Dominican mothers.

The purpose of this study was to compare similarities and differences between two samples - mothers of children under the age of 6 years living in the Dominican Republic (D.R.) and recent immigrants from the D.R. to the United States - on their (a) feeding practices for infants and young children, (b) knowledge regarding healthy size and weight and ideal diet for young children, and (c) knowledge regarding the causes and health implications of childhood obesity. An exploratory descriptive design was used, and qualitative data were collected through focus groups.