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Open Access Publications from the University of California

Scholarly Works (3 results)

  • Article
UCR Honors Capstones 2017-2018 (2018)
    Cover page: The Catacombs of Life and Other Romantic Thoughts
    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2018)

    Background: Pain is a problem for adults in nursing homes (NHs), especially those with pressure injuries (PrIs). Pain is the most distressing symptom associated with PrI, yet, specific data on the stability of pain over time, ulcer and NH resident characteristics associated with PrI pain, and best assessment methods do not exist. The purpose of this study was to examine severity, stability, and treatment of PrI pain among NH residents.

    Methods: Data were examined from 33 NH residents with 49 PrIs from four NHs who had a Minimum Data Set assessment completed. Resident characteristics (age, gender, ethnicity/race, Brief Interview for Mental Status score, cognitive status, functional status, urinary and fecal incontinence, and Body Mass Index) and ulcer characteristics (stage, size, location, duration, infection, and Bates-Jensen Wound Assessment Tool [BWAT] score) were obtained from the MDS, medical records and PrI assessments. PrI pain was assessed using a four-point Verbal Response Scale (VRS) and Pain Assessment in Advanced Dementia (PAINAD) three times a day for two days within one week. Data classified as: no, mild, moderate, or severe pain. Pearson correlations, independent t-tests, one-way analysis of variance and multiple linear regressions were used to analyze the data.

    Results: Twenty-seven participants (82%) reported PrI pain on at least one assessment. Of those reporting pain, 14 (42%) rated pain as moderate or severe. Twelve (40%) reported higher PrI pain levels in afternoon compared to morning and mid-day. Higher PrI pain levels were associated higher cognitive and functional impairment, advanced stage (stage 4, deep tissue injury) PrIs, higher infection and BWAT scores. Seven (21%) participants had analgesics ordered to treat PrI pain.

    Conclusions: PrI pain should be assessed at various times during the day regardless of PrI stage. PrI pain was reported by most participants and was greater in afternoon. The VRS and PAINAD were effective in PrI pain assessments among participants with varying cognition. Most who received general pain medications reported no PrI pain. Nurses can recognize PrI pain among NH residents with higher PrI BWAT scores, infection, cognitive and functional impairment, which should prompt PrI pain assessment.

      Cover page: Pressure Injury Pain Among Nursing Home Residents
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2016)

      Background

      Caregivers play a special role in the management and control of cancer-related pain. For American Indians with cancer, caregivers can contribute to patient education, medication compliance, and can facilitate communication between the patient and the provider and the patient and the family.

      Objective

      To identify the role(s) of caregivers of American Indian cancer survivors.

      Methods

      As a part of a large randomized intervention designed to improve barriers to cancer symptom management, 13 focus groups were held among American Indian cancer survivors and their caregivers at Southwest reservations and urban sites. Focus groups, audiotaped and transcribed, used constant comparative methods in the analysis of caregiver dialogues.

      Results

      Caregivers are patient educators and provider culture-brokers and their communication strategies use a combination of cultural and conventional strategies in their care of American Indian cancer patients. Cultural communication styles include "talk stories" (storytelling), group (talking circles), and dialogue to manage cancer pain, educate the patient and community, and to protect the patient from stigma, reduce barriers to care, and provide support to patients and families. Active discussion with providers "re-packaged" the patient's reporting/responses to specific clinical measures (pain measure scores) and identified the need for pain medication and compliance-related issues.

      Limitations

      Findings are not generalizable to the American Indian population outside of the sites and focus groups from which data were collected.

      Conclusions

      Caregivers are "cultural brokers" who inform providers of the cultural nuances associated with American Indian patient care. However, caregivers voiced that cultural restriction for not discussing illness openly was a sanction and an important barrier.
        Cover page: Culture-broker and medical decoder: contributions of caregivers in American Indian cancer trajectories.
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