Afghanistan and Iraq war veterans' health care needs and their underuse of health care resources: implications for psychiatric-mental health nurses.

U.S. Veterans who have served in the Afghanistan and Iraq wars have combat-related medical and mental health issues, notably posttraumatic stress disorder and traumatic brain injury, but underuse health care resources. To better understand their health care needs, resource use, and facilitators and barriers to seeking health care, a literature review was conducted. The results suggest high prevalence of mental and medical health issues and disproportionate use of quantitative research design that lacked approaches to understanding the psychosocial, cultural, and contextual factors that affect help-seeking by Veterans. Strategies to increase the likelihood that Veterans will seek needed health care, gaps in the literature, and the need for further research are discussed.

From documentation to the problem: controlling postoperative pain.

PROBLEM: Adequate pain control continues to be an enigma in the face of the Joint Commission (TJC) well-intended pain management standards. Notable in the pain standards is the mandate to make pain the fifth vital sign to increase pain visibility and awareness. METHOD: The following databases were searched: EBSCOHost, CINHAL, PubMed Central, Medline, and government/societies sites for guidelines on pain control. Various search terms used included pain, post operative pain, pain control, pain as the 5th vital sign, pain documentation, pain assessment, Joint Commission Pain Standard, PRN effectiveness, and pay-for-performance. FINDINGS: Accredited facilities are mandated to have plans to assess for pain and evaluate pain management effectiveness. These mandates have necessitated a flurry of initiatives and programs by hospitals and healthcare facilities focusing on documentation processes to meet TJC compliance. Notable programs include Pain as the 5th Vital Sign and PRN (as needed) effectiveness documentation. Many facilities have programs to assess and document pain but lack programs that effectively control patient's pain. CONCLUSION: This article is a call for facilities to refocus on pain control. A need to evaluate current programs by facilities is evident. Studies show that Pain as the 5(th) Vital Sign and PRN effectiveness documentation are not effective and invariably have not met the goals of TJC pain standard--adequate and effective pain control.