JCAHO: meeting the standards for pain management

Chronic, unrelieved pain costs approximately $100 billion per year. The impact of unrelieved pain has yet to be determined. Postoperatively, an individual has a 50-80% chance of having unrelieved moderately severe to severe pain sometime during the surgical period. In spite of knowing how to manage pain, we still have a long way to go. New and updated guidelines will assist in providing a basis for standardization in the future. This article focuses on the newly adopted JCAHO guidelines on pain management and their impact on the management of pain in the operative period.     

The Pain Game: pain assessment, management, and related JCAHO standards. Joint Commission on Accreditation of Health Care Organizations

BACKGROUND: It is a challenge to educators to assist nursing staff in maintaining up-to-date knowledge of pain assessment and management. METHOD: A learning game, "The Pain Game," was developed to deliver information on current practices and standards related to patient pain assessment and management. RESULTS: The advantages of using this gaming technique included minimal instructor preparation time, low cost materials, inclusion of participants as peer teachers, and a high level of participant involvement in the learning process. CONCLUSIONS: The Pain Game has been a well-received educational activity. Not only did knowledge acquisition occur, but the game also provided an enjoyable alternative to more traditional content delivery methods.     

新入职护士班级管理模式的建立与实践

目的探讨新入职护士班级管理模式的建立及实践效果。方法在新入职护士培训中使用班级管理方法,即选拔优秀护士长为班主任;选拔教育护士及临床带教教师负责教学培训;新入职护士竞选担任班干部,共同参与管理。培训1年后,对核心胜任力及工作满意度进行评价。结果护士核心胜任力及工作满意度优于前1年入职的护士(P<0.05)。结论应用班级管理模式,可提升新入职护士培训效果,提高其核心胜任力及工作满意度。     

Recent advances in angina management: implications for nurses

This article describes the physiology of the heart and the pathophysiology of angina. Diagnosis and treatment options, including pharmacological therapies, are outlined. The authors also discuss cardiac rehabilitation programmes and the extended role of nurses in managing patients with angina.     

Poststroke dysphagia: implications for nurses.

It is important for nurses to increase their understanding of poststroke dysphagia because nurses are often the first to observe the signs and symptoms of dysphagia. An increased awareness of dysphagia and its complications should help prepare nurses to assess high-risk clients, advocate for prompt diagnosis, use compensatory interventions, and educate clients and their family members. Dysphagia is common after clients have had a stroke, and it places them at risk for numerous complications. Prompt assessment and intervention are required and may decrease clients' problems. This article presents an overview of the normal swallowing reflex to facilitate readers' understanding of dysphagia and discusses the assessment, diagnosis, and treatment of dysphagia as well as related nursing implications. An individualized plan of care for a dysphagic client requires input from the entire interdisciplinary team, and nurses must ensure adherence to this plan on a 24-hour-per-day basis.     

A 'new' psychological contract for nurses: some management implications

Changes within the health services are raising a number of employment issues for nurses. The idea that a professional qualification and a job will lead to security of employment and career development is rapidly changing. These assumptions, the 'old' psychological contract, is giving way to new expectations from employers and employees; the emergence of a 'new' psychological contract. A psychological contract is an implicit agreement between employer and employee that each party will treat the other fairly. Such contracts are maintained by virtue of all parties wanting to seek agreement on issues where possible and to maintain trust. While such a contract is not a legally binding agreement it is nonetheless a binding understanding between people. Changes to this psychological contract can have important implications for individuals and their employer in terms of work and organizational commitment. This paper will discuss some of the issues surrounding psychological contracts and the impact of violating them. It will also discuss, from a management perspective, how psychological contracts develop between employer and employee, and how to form a 'new' psychological contract based upon mutual benefit and shared values.     

Chronic post-surgical pain: Epidemiology and clinical implications for acute pain management

Chronic post-surgical pain (CPSP) is an under-recognised and prevalent healthcare problem associated with significant morbidity and potential economic costs. Risk factors include the type of surgery, pre-existing pain, re-operation, nerve damage, moderate-to-severe acute post-operative pain, neurotoxic radio or chemotherapy and psycho-social factors.CPSP has a multifactorial aetiology, principally nerve injury and wound inflammatory response, leading to peripheral and central sensitisation. The extent of wound hyperalgesia following abdominal surgery correlates with the incidence of CPSP but not with acute pain outcomes, reflecting the relative importance of central sensitisation in the development of CPSP. The contributions of genetics, gender, age, opioid-induced hyperalgesia, pre-existing pain disorders and psycho-social factors to the pathogenesis of CPSP have yet to be clarified.The prevention of CPSP includes limiting nerve and tissue injury at the time of surgery and in some cases using preventive analgesia techniques such as regional neural blockade or low-dose ketamine infusion. Other strategies such as education, patient surveillance, management of psycho-social factors and functional rehabilitation may also be beneficial, although there are no data to support this. Further research is required to develop ‘predictive tools’ and to examine the effects of multimodal “protective” analgesia and multidisciplinary approaches in the prevention and treatment of CPSP.     

Meeting the JCAHO standards for patient and family education

Although preparing for your next JCAHO review may be an arduous task, it ultimately yields a foundation for patient and family education that is a lasting resource. In this article, practical suggestions for meeting the patient and family education standards are discussed. These suggestions not only help to assure a successful review, they promote effective delivery of patient and family education. Such teaching contributes to good health outcomes and provides clinicians with unique opportunities to involve patients and family members in care and related decisions.