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Biomedical subjects

B R Ferrell

Publications and source records attributed to B R Ferrell.

At least 109 records · Page 6Linked to original sources
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Strengthening nursing education to improve end-of-life care.

The survey results provide future direction for nursing education. Results indicate an awareness in the nursing profession of the need for improved EOL care and identification of resources to achieve that goal. Many activities have been initiated within the nursing community, and the results of this project hopefully will stimulate additional activities. The imperative for improved EOL care will escalate in the future as our elderly population grows and a burdened health care system confronts the costs of chronic and terminal illness. Palliative care, which has traditionally been limited to hospice programs, must extend to other settings and be incorporated into the trajectory of care. The IOM report and other palliative care literature asserts that improved care for the dying will necessitate change at many levels. Patients and the general public must be educated to expect a higher standard of care at the EOL. Health care system changes are needed to improve access to care and to eliminate barriers such as regulatory constraints on prescribing opioids. However, central to all health care reform is the need for educated professionals to direct this change. As professionals dedicated to patient comfort and quality of life--even at the EOL, nurses should begin the revolution in EOL care by attending to the education of nurses.

Clinical Competence↗
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Easing the pain.

Explore the source record for details and available documents.

Aged↗
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HOPE. Home Care Outreach for Palliative Care Education.

PURPOSE: The goal of this project was to develop and test an educational program to extend the principles of palliative care into home-care agencies. The specific aims were: 1) to assess current practices within select home-care agencies regarding care of the dying; 2) to design the educational program, the HOPE (Home Care Outreach for Palliative Care Education) curriculum, to include relevant content for realistic implementation in home-care agencies; 3) to implement the HOPE project in two home-care agencies; and 4) to assess outcomes of the project and plan for future dissemination to home-care agencies and organizations. DESCRIPTION OF PROGRAM: A pilot project developed and tested five training modules including overview of end-of-life care, pain management, symptom management, communicating with patients and families, and the death event. A needs assessment survey completed by 134 home-care agencies provided input for the training course development. The five-part curriculum was developed by an interdisciplinary team of investigators and consultants and implemented in two agencies with 52 staff members participating. Two agencies then were selected to participate in pilot testing the curriculum. Precourse and postcourse surveys provided evaluation of the program content. RESULTS: Results from the home-care agency survey demonstrated the need for improving end-of-life care. Only 32% of nonhospice agencies reporting the availability of specially trained nurses for care of the terminally ill, and only 16% of the agencies reported providing such training. Pilot testing of the HOPE curriculum suggested that it was well received by staff members. Assessment of both self-effectiveness and agency effectiveness revealed greater comfort with content such as communication and other symptom management followed by the areas of pain management, managing the death at home, and cultural issues in end-of-life care. The overall rating of end-of-life care increased from a mean rating of 5.97 to 7.42 for self-assessment and from 6.59 to 7.94 for agency assessment (on a scale of 0 to 10, with 0 = not at all effective to 10 = very effective). This project identified areas of education needed to improve care at the end of life. The HOPE curriculum will be refined and extended to reach other home-care agencies to benefit their staffs and the patients they serve. CLINICAL IMPLICATIONS: Home care agencies provide extensive care to patients and families facing many physical and psychosocial demands at the end of life. Palliative care education is important to support home-care professionals across all disciplines in optimum end-of-life care. This education should focus on aspects of physical care, such as treatment of pain, dyspnea, confusion, and fatigue, and also to address decisions about physical care, such as hydration/nutrition at the end of life. Psychosocial dimensions of care at home can be improved by attention to issues such as communication with dying patients and families, cultural considerations, and the special care required at the time of the actual death at home.

Community Health Nursing↗
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Analgesic administration via rectum or stoma.

The rectal and stomal routes for administering analgesics are discussed as alternatives to invasive, parenteral routes when a patient is unable to take medication by mouth. The ET nurse has an important role in reminding members of the health care team about these routes and in teaching patients and family members (i.e., caregivers) to use them properly.

Administration, Rectal↗
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Influence of professional vs. personal role on pain assessment and use of opioids.

Previous surveys have revealed that patient characteristics such as behavior may influence nurses decisions about pain assessment and analgesic use. This survey suggested that the role assumed by the nurse, professional versus personal, also influences these decisions. The findings further suggested that continuing education aimed at improving pain management needs to include not only knowledge about pain assessment and safety in the use of opioid analgesics, but also teaching methods that increase empathy.

Adult↗
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Use of routine and breakthrough analgesia in home care.

PURPOSE/OBJECTIVES: To describe current use of routine analgesics in home care and the treatment of breakthrough pain. DESIGN: Descriptive, companion study. SETTING: Homecare agencies in southern California. SAMPLE: Convenience sample of 369 patients with cancer participating in a pain-education study. METHODS: Data regarding breakthrough pain were derived from the homecare medical records and patient interviews. MAIN RESEARCH VARIABLES: Analgesic medications prescribed and used for treatment of routine and breakthrough cancer pain. FINDINGS: Results demonstrate discrepancy between recommended pain management in clinical practice guidelines and the actual practice of pain management at home. Deficiencies were found in medications prescribed as well as in actual use by patients. CONCLUSIONS: Optimum relief of cancer pain is contingent on adequate treatment of routine and breakthrough pain, including greater use of recommended analgesics in adequate doses and clinical care consistent with clinical practice guidelines. IMPLICATIONS FOR NURSING PRACTICE: Breakthrough pain is a common problem affecting the quality of life of patients with cancer. Improved management of breakthrough pain is contingent on accurate pain assessment, optimum use of analgesics, and patient education. Nurses should address the important topic of breakthrough pain as new analgesic drugs and methods of delivery become available.

Adult↗
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The marriage: geriatrics and oncology.

Cancer always has been a disease of greater incidence and morbidity in the elderly, and sociodemographic trends predict this fact to escalate in the decades ahead. Optimum care of older adults with cancer can be enhanced through the marriage of two disciplines that have matured in recent years: geriatrics and oncology. This article reviews issues of cancer care for the elderly, including the strengths and challenges of this special population, quality of life considerations, and future directions.

Aged↗
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Opioid analgesics: nurses' knowledge of doses and psychological dependence.

Lack of education of health professionals, including nurses, is frequently cited as a major reason for undertreatment of pain. Very recent surveys have revealed an urgent need for basic and continuing nursing education to address this problem. For example, little time is spent on the topic of pain in many baccalaureate nursing programs, nursing textbooks lack correct information about opioid addiction, and most practicing nurses currently do not possess knowledge about opioid analgesics that would enable them to administer opioids effectively. The authors report on a survey of 1,781 practicing nurses' specific knowledge deficits regarding opioid analgesics and propose some solutions.

Adult↗