Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement

Background: Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. Objectives: The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Methods: Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. Setting: The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Results: Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). Conclusion: By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences.     

Community Health Nurses' AIDS Information Needs

Community health nurses (CHNs) provide direct nursing care to acquired immunodeficiency syndrome (AIDS) clients in their homes and in community settings such as clinics, long-term care facilities, and hospice facilities. Direct-care needs are exemplified in the case management of the client in the community. The case management of the AIDS client in the community can include direct care to prevent and control infections, to maintain nutrition and fluid status, to manage pain, to manage alterations in bowel and bladder elimination, to treat circulatory impairment, to treat the consequences of decreased activity and immobility, and to provide psychosocial and bereavement support and counseling. In addition, CHNs provide indirect care to clients and their families through such services as education, referral, and counseling. As part of case management, they provide education on the disease; financial, housing, and health resources; and referral to community AIDS services, centers, and support groups. CHNs are involved in AIDS prevention through public health education, counseling the public about sexual practices, counseling persons who have human immunodeficiency virus (HIV) infections, and AIDS-related complex (ARC), and making referrals to community resources for education, testing, and support. Prevention and education activities take place in health settings, social settings, and occupational or work settings.     

Building a Community‐Academic Partnership to Improve Health Outcomes in an Underserved Community

ABSTRACT East Garfield Park, IL, is an impoverished community with 59.7% of residents falling below twice the poverty level and 42.6% of its children in poverty. In 2001, the leading causes of hospitalizations were heart disease (10.3%), diabetes (2%), and asthma (3.9%), all of which occur at frequencies 33% greater than the Chicago average. Finally, a review of the health care facilities in the community suggests that there is a need for accessible primary health care services in the area. The purpose of this project was to improve health outcomes in an impoverished, underserved community with documented health care needs and lack of adequate health care services by creating a community‐academic partnership to provide on‐site, interdisciplinary, health care services within an established and trusted community‐based social service agency, Marillac House. The short‐term objectives for this project included creating a community‐academic partnership between Marillac House and Colleges of Nursing, Medicine, and Health Sciences; providing comprehensive health care services; and developing an innovative clinical education model for interdisciplinary care across specialties. Long‐term objectives included providing preventative services; evidenced‐based management of acute and chronic illness; evaluating client's health outcomes; and creating a sustainability plan for the long‐term success of the health center.     

Leveraging Parent Pain Perspectives to Improve Pain Practices for Children with Medical Complexity

PurposeChildren with medical complexity (MC) must rely on others to notice and address pain. Parents are aware of child pain behaviors and can serve as reliable proxy reporters. Thus, there is a critical need to understand parent perspectives to improve pain practices.DesignIndividual interviews were used as a data collection method in this qualitative study.MethodsParticipants were recruited via mail and social media postings. Interviews were audio-recorded and transcribed verbatim. Transcribed documents were imported to NVIVO for qualitative analysis. Conventional and directed approaches to qualitative content analysis were used.ResultsFrom the data analysis, major themes included: pain experiences, confidence in caregivers, parents are partners, proactive communication, and a spontaneous theme, “they can hear us.” Emotional pain and challenges identifying the source pain were identified as sub-themes of pain experiences.ConclusionsParents in this study shared methods helpful to identifying pain in their children, as well as suggestions for discussing pain with caregivers. Priorities for future research include identifying methods for sharing pain information that are thorough, but do not burden parents or providers. Researchers should also determine how parents and caregivers can partner to identify and address pain in children with MC. Going forward, conversations about pain should be a key part of any admission assessment or first encounter. As pain episodes among children with MC can be complex and may not always be re-created in front of a provider, nurses may advise parents to take photos or videos to share with caregivers.     

Leveraging the Electronic Health Record to Address the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic continues its global spread. Coordinated effort on a vast scale is required to halt its progression and to save lives. Electronic health record (EHR) data are a valuable resource to mitigate the COVID-19 pandemic. We review how the EHR could be used for disease surveillance and contact tracing. When linked to “omics” data, the EHR could facilitate identification of genetic susceptibility variants, leading to insights into risk factors, disease complications, and drug repurposing. Real-time monitoring of patients could enable early detection of potential complications, informing appropriate interventions and therapy. We reviewed relevant articles from PubMed, MEDLINE, and Google Scholar searches as well as preprint servers, given the rapidly evolving understanding of the COVID-19 pandemic.     

A Nurse-Led Population-Based Health Education Project to Improve Infant Care Knowledge for an Old Order Mennonite Community

Population health is changing the focus of nursing practice as nurses are challenged to focus on health promotion and education for communities rather than limiting their practice to restorative care for individual acute care patients. This new focus is necessary to improve knowledge of maternal and infant health among vulnerable populations. One particularly vulnerable population is members of Old Order Mennonite communities, who frequently rely on self-trained local midwives in the community for home births and home remedies when caring for their infants. Providing evidence-based education to members of this isolated population can be a challenge because they do not typically access information outside of the community. The purpose of this article is to share the process of developing, publishing, and disseminating a culturally sensitive infant care manual for an Old Order Mennonite community using a community-based participatory model and to highlight the impact nursing outreach can have on improving health knowledge.     

Utilizing Innovative Technology to Improve Health Care

Staff expectations of leaders to recruit and retain nonexistent nursing personnel is an impossible task. In an effort to ease the burdens of an increasingly complex health care environment, caring, transformational nurse leaders can harness the power of innovative technology to improve health care. This article provides examples of several technological innovations as solutions to each of the Institute for Health Care Improvement’s Quintuple aims. Consideration is given to the importance of envisioning, inspiring, and supporting environments of curiosity, adaptation, and creativity necessary to advance the vision of sustainable, quality health care.     

Implementing Telemental Health to Improve Access to Mental Health Care in Rural Vermont

Mental health care shortages in the United States are most pronounced in rural areas. This practice-change project aimed to increase access to quality mental health care in rural areas for the treatment of depression and anxiety via telemental health delivery of care. The project yielded improvements across project aims, including an increased percent of enrolled patients from Healthcare Provider Shortage Areas; a decrease in quality measures for depression, anxiety, and disability; and increased patient satisfaction with care. The project can serve as a template for other practices wishing to increase access to mental health care in rural areas.     

Health Care Provider in Triage to Improve Outcomes

ProblemEmergency departments throughout the nation are experiencing crowding related to increased patient volumes and decreased hospital inpatient bed capacity. As a result of lengthy wait times, patients are leaving without having medical treatment, and satisfaction is poor. The purpose of this quality improvement initiative was placing a provider in triage to complement the existing split-flow process aimed to decrease wait times to see a provider, length of stay (LOS), left without being seen (LWBS) rates, and improve patient satisfaction.MethodsA multiprofessional team was established. Nurses, advanced practice providers, and physicians collaborated on a project to place a provider in triage to assist in seeing patients as soon as possible and begin care or treatment.ResultsThe outcomes of the initiative were positive for ED LOS metrics and patient satisfaction. Door-to-provider time decreased from a high of 56 minutes to a low of 13 minutes. The percentage of patients LWBS decreased from a high of 12% to a low of 1.62%.DiscussionThe project showed that the evidence-based practice of a combined split-flow and provider-in-triage model resulted in improvements in throughput for patients who were treated and released from the emergency department.     

Emergency Department Initiatives to Improve the Public Health

Each year, the Society for Academic Emergency Medicine, the American College of Emergency Physicians, and the American Board of Emergency Medicine co-sponsor an educational session at the Association of American Medical Colleges Annual Meeting. The 1997 session was entitled “Emergency Department Initiatives to Improve the Public Health,” and included presentations by 4 invited speakers: Dr. Lewis Goldfrank, Director of Emergency Medicine at Bellevue Hospital Center and New York University Medical Center; Dr. Dennis Andrulis, Director of the Office of Urban Populations at the New York Academy of Medicine; Dr. Robert D'Alessandri, Vice President for Health Sciences and Dean of the School of Medicine at West Virginia University; and Dr. Arthur Kellermann, Acting Chief of Emergency Medicine at Emory University. Each speaker focused on a particular aspect of emergency medicine and the health of the public. The following article summarizes some of the session's ideas and themes.