Perianesthesia challenges in geriatric pain management

The perianesthesia nurse is continually challenged to provide safe and effective pain management. This task becomes more difficult when working with an aging population. Success begins with understanding the challenges in controlling surgical pain and in communicating information regarding pain management prior to the surgery. Sharing of information between the patient, nurse, and other members of the health care team is essential. To provide quality pain care for geriatric patients, who are at greater risk for developing potentially life-threatening side effects of commonly used analgesics, the perianesthesia nurse must be knowledgeable about factors that affect pain management in this population. Common factors affecting pain control in the older adult patient include misconceptions regarding use and effects of analgesics, preexisting cognitive impairment, impaired communication, cultural differences between the nurse and the patient, and physiologic changes in aging that affect how drugs are metabolized.     

How One School-Based Clinic is Meeting the Challenge of Adolescent Health Care

Today's adolescent confronts a host of medical, social, and economic problems that have a significant impact on their lives as well as on society. The teenage population of the North Side area of the city of Pittsburgh is no exception. To address the needs of these teens a school-based clinic was established in one of the city's middle schools. It became known as the Allegheny Middle School/Allegheny General Hospital Wellness Center (AMS/AGH Wellness Center). Located on the school grounds, this clinic remained in operation during school hours. Student interest was obvious as they began using the services provided by the clinic immediately after its establishment. After only 1 school year of operation, nearly 60% of the student body was enrolled. The number of patient visits totaled 1086. Evidence from the literature attesting to the advanced skills, cost effectiveness, and holistic approach to patient care of nurse practitioners led to the selection of a family nurse practitioner as the primary health care provider for the middle school students. Other clinic staff include a part-time physician, ambulatory technician, secretary, and part-time psychiatric social worker. The establishment and operation of the Wellness Center is discussed in this article.     

Group B Streptococcal Disease: A Life-Threatening Infection in the Newborn

Group B streptococcal (GBS) disease, a life-threatening infection in newborns in the United States, causes considerable neonatal morbidity and mortality. GBS is also a major source of maternal infection. Screening during pregnancy leads to early identification. Intrapartal treatment of affected mothers can prevent harmful neonatal effects. Implementation of screening and treatment protocols is recommended for the protection of all obstetric and neonatal patients.     

Giving Up: Shelter Experiences of Battered Women

Abstract Within the last decade intrafamilial violence has been identified as a major health and social problem. Women in particular are at high risk for battering and often seek refuge in shelters. Empirical evidence is required regarding the experiences of battered women who use these shelters. Therefore, we collected qualitative data from interviews with seven battered women and by observation in ten group counseling sessions at a shelter in the Southeast. Using grounded theory methodology, the core concept that emerged was “giving up.” Supporting concepts were helplessness and fear of the unknown. The participants found it easier to give up and return to the abusive relationship than to seek alternatives.     

Nurse Practitioners' Use of Nursing Diagnosis

The role of the nurse practitioner (NP) represents a unique blend of nursing and medical functions. Few studies exist that address the nursing component of the NP role and no literature is available to document the extent to which nurse practitioners utilize nursing diagnoses in their clinical practice. Thus, the author reports findings of a study that sought to describe the use of nursing diagnosis in current NP practice and to identify advantages and barriers to the use of nursing diagnoses by NPs. Fifteen percent of nurses surveyed used nursing diagnoses in their practice. The diagnoses most commonly used reflected attention to clients' lifestyles and daily living problems.