IU School of Nursing Works

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https://hdl.handle.net/1805/8325

Scholarship (articles, conference presentations, reports, posters and proceedings) by IU School of Nursing faculty, staff and students.

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Physicians' and nurses' perspectives on increased family reports of pain in dying hospitalized patients
(2000) Hickman, Susan E.; Tolle, Susan W.; Tilden, Virginia P.
Many indicators suggest that care of the dying in Oregon has been improving over the past decade. However, results from a recent study suggest that one aspect of care of the dying, pain management, may be worsening. In late 1997, family reports of moderate and severe pain in dying hospitalized patients increased from 33% to 57%. This occurred during a volatile time in the Oregon political climate associated with events surrounding a second vote on physician-assisted suicide. In order to better understand the observed increase better, a statewide sample of physicians and nurses was surveyed to obtain their opinions about factors that may have contributed to the increased family reports of moderate and severe pain in dying hospitalized patients. Seventy-nine percent of respondents endorsed two or more factors as partial explanations. These factors include an increase in family expectations about pain management (endorsed by 96%), decreased physician prescribing (endorsed by 66%), and reduced nurse administration of pain medication (endorsed by 59%). Physicians who thought reduced physician prescribing was a partial factor rated fears of the Board of Medical Examiners and the Drug Enforcement Administration as the most likely explanations for decreased prescribing. More research is needed to better understand family expectations for end-of-life care, fears of investigation, and pain medication practices.
Trends in opioid use over time: 1997 to 1999
(2004-02) Tolle, Susan W.; Hickman, Susan E.; Tilden, Virginia P.; Bubalo, Joseph S.; Fromme, Erik K.
Substantial resources have been spent to improve pain control for dying patients, and increased opioid administration has been presumed. Oregon has been a consistent leading state in per capita use for morphine for the past 10 years, as recorded by the Automation of Reports and Consolidated Orders System (ARCOS). Health policy experts, extrapolating from World Health Organization methods, have suggested these data are indicative of the quality of end-of-life care in Oregon. To determine whether trends in opioid prescription at the state and national levels reflect increased opioid use for inpatients during the final week of life, chart reviews were conducted to record all opioid medications administered in the last week of life to 877 adult inpatients who died from natural causes between January 1, 1997 and December 31, 1999. Inpatient morphine use did not increase significantly for dying patients from 1997 to 1999. However, overall morphine use for both Oregon and the United States as measured by ARCOS data increased significantly. Comparisons revealed no significant difference between linear trends for Oregon and U.S. morphine use, but both were significantly greater than the dying inpatients. This pattern was also found for all other opioids. These findings suggest that ARCOS data do not necessarily provide information about opioid use for specific subpopulations of patients and raise questions about the meaning of observed increases in ARCOS data.
Family Health Needs Study: Bi-National Community Participatory Research
(2006-04-07T18:56:57Z) Riner, ME
Third lecture in a series: International Research Ethics. March 29, 2006. Lecture I.
Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation
(2007-09) Johnson, Elizabeth A; Bakas, Tamilyn; Williams, Linda S.
Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation. Geriatrics & Aging. 10(8):492–6.
Administrators' perspectives on ethical issues in long-term care research
(2008) Hickman, Susan E.; Cartwright, Juliana C.; Young, Heather M.
ETHICAL ISSUES ARE A SIGNIFICANT potential barrier to much-needed research in long-term care settings. LTC stakeholder perspectives are largely absent from the development of regulation and guidelines. Fifteen long-term care administrators were interviewed as part of a study of ethical issues in community-based, long-term care research. Established qualitative procedures for conducting content analysis were used to organize the data. Findings suggest that existing mechanisms to protect human subjects do not take into account important differences between academic and long-term care settings. The full potential of LTC research will not be realized until supportive processes to enhance human subjects protections are developed in a way that is reflective of the LTC environment.
A Synergistic Dialogue: Clinical Nurses and Academic Researchers in Partnership
(Elsevier, 2008-02-01) Barnes, Y.J.; Hendricks-Ferguson, V.L.; Oakley, B.; Roll, L.; Stegenga, K.; Haase, J.E.; School of Nursing
A Randomized Trial of Two Print Interventions to Increase Colon Cancer Screening Among First-Degree Relatives
(2008-05) Rawl, Susan M.; Champion, Victoria L.; Scott, Linda L; Zhou, Honghong; Monahan, Patrick; Ding, Yan; Loehrer, Patrick; Skinner, Celette Sugg
First-degree relatives (FDRs) of people diagnosed with colorectal cancer (CRC) have a two- to threefold increased risk of developing the same disease. Tailored print interventions based on behavior change theories have demonstrated considerable promise in facilitating health-promoting behaviors. This study compared the impact of two mailed print interventions on CRC screening outcomes among FDRs. Methods This randomized trial compared effects of two mailed print interventions – one tailored and one nontailored – on participation in CRC screening among FDRs of CRC survivors. Data collected via phone interviews from 140 FDRs at baseline, 1 week post-intervention, and 3 months post-intervention. Results At 3 months, both the tailored and nontailored interventions yielded modest but statistically insignificant increases in adherence to any CRC screening test (14% vs. 21%, respectively; p = 0.30). While there were no main effects for tailored versus nontailored interventions, there were significant interactions that showed that the tailored print intervention had significantly greater effects on forward stage movement for CRC screening depending on stage of adoption at baseline, race, and objective CRC risk. Receipt of the tailored intervention was 2.5 times more likely to move baseline precontemplators and contemplators forward in stage of adoption for colonoscopy (95% CI: 1.10–5.68) and was three times more likely to move Caucasians forward in stage of adoption for FOBT (95% CI: 1.00–9.07). In addition, the tailored intervention was 7.7 times more likely to move people at average risk forward in stage of adoption for colonoscopy (95% CI: 1.25–47.75). Conclusion The tailored print intervention was more effective at moving Caucasians, those in precontemplation and contemplation at baseline, and those at average risk forward in their stage of adoption for CRC screening. Practice implications Both tailored and nontailored print interventions showed moderate effects for increasing CRC screening participation. Tailored print interventions may be more effective for certain subgroups.
Oncology Outpatient and Provider Responses to a Computerized Symptom Assessment System
(2008-07) Carpenter, Janet S.; Rawl, Susan M.; Porter, Jennifer; Schmidt, Karen; Tornatta, Jennifer; Ojewole, Foluso; Helft, Paul; Potter, David A; Sweeney, Christopher; Giesler, R. Brian
Purpose/Objectives: To assess patient and provider responses to a computerized symptom assessment system. Design: Descriptive, longitudinal study with retrospective, longitudinal medical records review. Setting: University-based National Cancer Institute-designated outpatient cancer center. Sample: 80 oncology outpatients receiving chemotherapy, 8 providers, and 30 medical records. Methods: Patients completed the computerized assessment during three chemotherapy follow-up clinic appointments (times 1, 2, and 3). Patient usability was recorded via an observer checklist (ease of use) and the computer (completion time). Patient satisfaction and impact were assessed during telephone interviews two to three days after times 1 and 3 only. Provider usability and impact were assessed at the end of the study using a questionnaire and focus groups, whereas effect on provider documentation was assessed through chart audits. Main Research Variables: Patient usability (ease of use, completion time), satisfaction, and impact; provider usability and impact. Findings: Patients reported good usability, high satisfaction, and modest impact on discussions with their providers. Providers reported modest usability, modest impact on discussions with patients, and had varied reactions as to how the system affected practice. Documentation of symptoms was largely absent before and after implementation. Conclusions: This system demonstrated good usability and satisfaction but had only a modest impact on symptom-related discussions and no impact on documentation. Implications for Nursing: A computerized system can help address barriers to symptom assessment but may not improve documentation unless it can be integrated into existing medical records systems.
Content Validity and Satisfaction With a Stroke Caregiver Intervention Program
(Wiley, 2009) Bakas, Tamilyn; Farran, Carol J.; Austin, Joan K.; Given, Barbara A.; Johnson, Elizabeth A.; Williams, Linda S.; School of Nursing
Background and Purpose Establishing evidence of content validity and satisfaction is an integral part of intervention research. The purpose of this article is to describe content validity and satisfaction relative to the Telephone Assessment and Skill-Building Kit (TASK), an 8-week follow-up program based on individualized assessment of stroke caregiver needs. Design and Methods The TASK intervention enables caregivers to develop skills based on assessment of their own needs. During the development of the TASK program, 10 experts rated the validity of the TASK intervention components for accuracy, feasibility, acceptability, and problem relevance. After incorporating feedback from the experts, a randomized controlled clinical trial was instituted using a convenience sample of 40 stroke caregivers to determine satisfaction (usefulness, case of use, and acceptability) with the TASK intervention (n=21) compared with an attention control group (n=19). Data collection occurred between March 2005 and June 2006. Data were analyzed using descriptive statistics, independent sample t tests, and content analysis. Findings Expert ratings on a 1 to 5 scale, with 5 being strongly agree, provided evidence of content validity (accuracy 4.71, feasibility 4.46, acceptability 4.40, problem relevance 4.67). Caregivers in the TASK group scored significantly higher than the attention control group on all satisfaction measures (usefulness p=.02; ease of use p=.02; acceptability p=.05). Qualitative comments from caregivers provided further evidence of satisfaction. Conclusions Evidence of content validity and user satisfaction for the TASK intervention relative to an attention control group was found. Clinical Relevance The TASK program may be a viable telephone-based program that can be implemented by nurses to support family caregivers during the first few months after stroke survivors are discharged home.
Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting
(2009-02) Hickman, Susan E.; Nelson, Christine A.; Moss, Alvin H.; Hammes, Bernard J.; Terwilliger, Allison; Jackson, Ann; Tolle, Susan W.
Background The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program was designed to ensure the full range of patient treatment preferences are honored throughout the health care system. Data are lacking about the use of POLST in the hospice setting. Objective To assess use of the POLST by hospice programs, attitudes of hospice personnel toward POLST, the effect of POLST on the use of life-sustaining treatments, and the types of treatments options selected by hospice patients. Design A telephone survey was conducted of all hospice programs in three states (Oregon, Wisconsin, and West Virginia) to assess POLST use. Staff at hospices reporting POLST use (n = 71) were asked additional questions about their attitudes toward the POLST. Chart reviews were conducted at a subsample of POLST-using programs in Oregon (n = 8), West Virginia (n = 5), and Wisconsin (n = 2). Results The POLST is used widely in hospices in Oregon (100%) and West Virginia (85%) but only regionally in Wisconsin (6%). A majority of hospice staff interviewed believe the POLST is useful at preventing unwanted resuscitation (97%) and at initiating conversations about treatment preferences (96%). Preferences for treatment limitations were respected in 98% of cases and no one received unwanted cardiopulmonary resuscitation (CPR), intubation, intensive care, or feeding tubes. A majority of hospice patients (78%) with do-not-resuscitate (DNR) orders wanted more than the lowest level of treatment in at least one other category such as antibiotics or hospitalization. Conclusions The POLST is viewed by hospice personnel as useful, helpful, and reliable. It is effective at ensuring preferences for limitations are honored. When given a choice, most hospice patients want the option for more aggressive treatments in selected situations.

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