Publications (42)183.97 Total impact
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Article: How do emergency department patients store and dispose of opioids after discharge? A pilot study.
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ABSTRACT: Opioid abuse and overdose have increased drastically in recent years. Diversion of opioids used to treat pain, either through theft or sharing, is increasing and may contribute to this misuse. Based on these trends, we designed a study to investigate opioid storage and disposal practices of patients who were prescribed these agents in the emergency department. A prospective cohort pilot study was conducted. All adults (aged ≥18 years) with a chief complaint of either minor musculoskeletal trauma, renal colic, or acute back pain who were discharged home with an opioid prescription were eligible for inclusion; persons with chronic pain were excluded. Patients were asked to participate in two home interviews in which the research assistant viewed the storage location of the opioid prescription. Safe storage was defined as being stored in a locked container or cabinet. Safe disposal was defined as returning the drugs to a designated location or mixing unused pills with an undesirable substance, placing in a sealable container, and then in the trash. Patients self-reported disposal methods. Feasibility of study methods evaluated the ability to conduct home interviews after the ED visit. Descriptive statistics were used to analyze the data. Twenty-five subjects consented to participate; 20 patients completed both home interviews. None of the medications were safely stored. Only 1 patient disposed of the medication, yet did so improperly. This pilot study revealed widespread improper storage and disposal of opioids. The study has major implications for education for ED physicians, nurses, and residents.Journal of emergency nursing: JEN: official publication of the Emergency Department Nurses Association 12/2011; 38(3):273-9. · 0.36 Impact Factor -
Article: Managing cancer-related pain in critical care settings.
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ABSTRACT: Pain is a common symptom experienced by individuals who are in treatment for cancer and becomes more prevalent for those with more advanced stages of malignancy. Critical care nurses are essential in the management of cancer-related pain, which is a challenging problem when individuals who have a cancer diagnosis are admitted to the intensive care unit for emergent conditions. Regular, thorough, and patient-appropriate assessments by experienced critical care nurses guide selection of treatment modalities, including pharmacologic and nonpharmacologic techniques. In addition, existential pain necessitates spiritual care intervention, and involvement of other appropriate interdisciplinary team members can result in improved management of all types of pain experienced by critically ill individuals with cancer.AACN Advanced Critical Care 10/2011; 22(4):365-78. -
Article: Statewide efforts to improve palliative care in critical care settings.
Critical Care Nurse 12/2010; 30(6):40-5. · 1.08 Impact Factor -
Article: Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for quality improvement of pain management in hospitalized adults: preliminary psychometric evaluation.
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ABSTRACT: Quality improvement (QI) is a compilation of methods adapted from psychology, statistics, and operations research to identify factors that contribute to poor treatment outcomes and to design solutions for improvement. Valid and reliable measurement is essential to QI using rigorously developed and tested instruments. The purpose of this article is to describe the evolution of the American Pain Society Patient Outcome Questionnaire (APS-POQ) for QI purposes and present a revised version (R) including instrument psychometrics. An interdisciplinary task force of the APS used a step-wise, empiric approach to revise, test, and examine psychometric properties of the society's original POQ. The APS-POQ-R is designed for use in adult hospital pain management QI activities and measures 6 aspects of quality, including (1) pain severity and relief; (2) impact of pain on activity, sleep, and negative emotions; (3) side effects of treatment; (4) helpfulness of information about pain treatment; (5) ability to participate in pain treatment decisions; and (6) use of nonpharmacological strategies. Adult medical-surgical inpatients (n = 299) from 2 hospitals in different parts of the United States participated in this study. Results provide support for the internal consistency of the instrument subscales, construct validity and clinical feasibility. PERSPECTIVE: This article presents the initial psychometric properties of the APS-POQ-R for quality improvement purposes of hospitalized adult patients. Validation in additional groups of patients will be needed to demonstrate its generalizability.The journal of pain: official journal of the American Pain Society 11/2010; 11(11):1172-86. · 3.78 Impact Factor -
Article: Adult cancer pain.
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ABSTRACT: Overview Pain, defined as "a sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage,"(1) is one of the most common symptoms associated with cancer. Cancer pain or cancer-related pain is distinct from pain experienced by patients without malignancies. Pain occurs in approximately one quarter of patients with newly diagnosed malignancies, one third of patients undergoing treatment, and three quarters of patients with advanced disease,(2-4) and is one of the symptoms patients fear most. Unrelieved pain denies patients comfort and greatly affects their activities, motivation, interactions with family and friends, and overall quality of life. The importance of relieving pain and availability of effective therapies make it imperative that physicians and nurses caring for these patients be adept at the assessment and treatment of cancer pain.(5-7) This requires familiarity with the pathogenesis of cancer pain; pain assessment techniques; common barriers to the delivery of appropriate analgesia; and pertinent pharmacologic, anesthetic, neurosurgical, and behavioral approaches to the treatment of cancer pain. The most widely accepted algorithm for the treatment of cancer pain was developed by the WHO.(8,9) It suggests that patients with pain be started on acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). If this is not sufficient, patients should be escalated to a weak opioid, such as codeine, and then to a strong opioid, such as morphine. Although this algorithm has served as an excellent teaching tool, the management of cancer pain is considerably more complex than this 3-tiered "cancer pain ladder"...Journal of the National Comprehensive Cancer Network: JNCCN 10/2010; 8(9):1046-86. · 4.41 Impact Factor -
Article: Chronic treatment-related pain in cancer survivors.
Pain 10/2010; 152(3 Suppl):S84-9. · 5.78 Impact Factor -
Article: Advancing palliative care in Kenya.
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ABSTRACT: Life-threatening illnesses such as HIV/AIDS, malaria, tuberculosis, and other disorders are prevalent in the developing world, including Kenya. The aim of this project was to assist in the development of palliative care throughout Kenya by enhancing the knowledge and skill of faculty members in palliative care so they could integrate this content into existing nursing curricula. In an effort to develop palliative care throughout the country, experts from the Kenya Hospices and Palliative Care Association and the Kenyatta National Hospital invited faculty from the End-of-Life Nursing Education Consortium with the United States to adopt the content of its training program to address the needs of nurses and other health care professionals in Kenya. This curriculum was delivered to nursing faculty from throughout Kenya during a 5-day training course that incorporated presentations, case studies, exercises, and other teaching methods. The course participants completed daily course evaluations in which they rated each session on a scale of 0 = not helpful to 5 = very helpful. All of the sessions were rated very favorably, with scores for all sessions across the 5 days ranging from 4.57 to 4.91. End-of-Life Nursing Education Consortium provided educational and other support to faculty teaching in nursing schools in Kenya so they could advance palliative care efforts in this country. Nurses working in the United States can share their expertise and learn immense lessons from colleagues in developing worlds.Cancer nursing 10/2010; 34(1):E10-3. · 1.88 Impact Factor -
Article: Living and dying in East Africa: implementing the End-of-Life Nursing Education Consortium curriculum in Tanzania.
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ABSTRACT: Education about palliative care is crucial for oncology nurses, particularly in the developing world, where most patients present with advanced disease and heavy symptom burden. The End-of-Life Nursing Education Consortium-International training program was implemented in Tanzania to provide nurses with the knowledge, expertise, and tools to better care for the dying and to educate others. The curriculum was presented to 39 participants over three days, including didactic presentations, small group discussions, and role play. None of the participants had received previous formal palliative care training. The participants rated their impression of the course as excellent. Follow-up at eight months yielded similar findings regarding the effectiveness of the curriculum. International education regarding palliative care for those with cancer requires an understanding of different disease patterns and clinical practices, along with cultural humility and empathy. These experiences are extraordinarily enriching, giving nurses a unique perspective on palliative care that ultimately informs their own practice.Clinical Journal of Oncology Nursing 04/2010; 14(2):161-6. -
Article: Evaluation of palliative care nursing education seminars.
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ABSTRACT: More than 50 million people die each year around the world. Nurses are crucial in providing care to these individuals and their families as they spend the most time at the bedside with patients and families. Yet many nurses have received little or no education about palliative care. METHODS/SAMPLE: The Open Society Institute (OSI) and the Open Medical Institute (OMI) partnered with End-of-Life Nursing Education Consortium (ELNEC) to develop an international nursing palliative care curriculum. This international curriculum was implemented with two training courses held in Salzburg, Austria in October 2006 (n=38) and April 2008 (n=39) representing 22 Eastern European/Central Asian countries. Participants were asked to establish goals in disseminating the palliative care information when they returned to their country. The participants were mentored/followed for a 12-month period to evaluate their palliative care knowledge as well as challenges encountered. The participants provided excellent ratings for the training courses indicating that the courses were stimulating and met their expectations. The 12-month follow-up demonstrated many challenges (i.e., lack of funds, institutional support, fear of death), in advancing palliative care within each participant's setting/country as well as many examples of successful implementation. There is an urgent need for improved palliative care throughout the world. The ELNEC-International curriculum is designed to address the need for increased palliative care education in nursing. In order to improve the quality of life for those facing life-threatening illnesses around the world, ongoing support is needed for world-wide palliative care educational efforts.European journal of oncology nursing: the official journal of European Oncology Nursing Society 10/2009; 14(1):74-9. · 1.13 Impact Factor -
Article: Feasibility and effectiveness of the NEST13+ as a screening tool for advanced illness care needs.
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ABSTRACT: A comprehensive whole-person approach might improve processes and outcomes of care for patients with cancer. To assess the ability of NEST13+ (Needs of a social nature; Existential concerns; Symptoms; and Therapeutic interaction), a screening and assessment tool, to identify social, emotional, physical, and care-system needs and to improve clinical outcomes for cancer patients in tertiary care. A controlled trial involving 451 patients hospitalized for cancer care at a comprehensive cancer center. Patients responded to 13 screening questions regarding possible care needs. When an individual response exceeded threshold levels, additional in-depth questions for the relevant need were asked. For patients in the intervention arm, clinical recommendations for each dimension of need were generated based on a previously developed NEST-response-driven menu, and were reported to the clinical team. Documented needs, clinician response, patient perception of goals alignment, and overall quality of palliative care. Using the NEST13+ tool in the clinical setting facilitated greater documentation of illness-related needs than routine clinical assessment. Improvement in secondary outcomes was attenuated: changes in the clinician response were modest; changes in outcomes were not significant. The NEST13+ tool facilitated identification of a wider range of important needs than traditional evaluation, while care outcomes were not improved. Traditional evaluation may need improvement. Future trials of the NEST13+ should focus on more intensive clinician-directed interventions.Journal of palliative medicine 10/2009; 13(2):161-9. · 1.84 Impact Factor -
Article: NCCN task force report: management of neuropathy in cancer.
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ABSTRACT: Neuropathy is a common, often debilitating complication of cancer and its treatment. Effective management of this disorder depends on early diagnosis and an understanding of its underlying causes in the individual patient. In January 2009, NCCN gathered a multidisciplinary group to review the literature and discuss intervention strategies currently available to patients as well as areas that require research efforts. The task force, which comprised experts in anesthesiology, medical oncology, neurology, neuro-oncology, neurophysiology, nursing, pain management, and rehabilitation, was charged with the goal of outlining recommendations for the possible prevention, diagnosis, and management of neuropathy. This report documents the proceedings of this meeting with a general background on neuropathy and neuropathy in oncology, followed by discussions on challenges and research issues, evaluation criteria, and management of different symptoms associated with this disorder.Journal of the National Comprehensive Cancer Network: JNCCN 09/2009; 7 Suppl 5:S1-S26; quiz S27-8. · 4.41 Impact Factor -
Article: Clinical challenges: chemotherapy-induced peripheral neuropathy.
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ABSTRACT: To discuss the challenges associated with treating pain and altered sensations due to chemotherapy-induced peripheral neuropathy (CIPN). Published research articles and clinical experience. Although there are still great challenges associated with preventing and treating pain and altered sensations due to CIPN, there are preventative strategies and therapeutic options that can certainly improve the quality of life of patients who have cancer. Oncology nurses can gain a better understanding of the available pharmacologic and nonpharmacologic strategies that can prevent and reduce pain associated with chemotherapy-induced neuropathy.Seminars in Oncology Nursing 05/2009; 25(2 Suppl 1):S8-19. -
Article: Morphine bioavailability from a topical gel formulation in volunteers.
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ABSTRACT: Although available therapies provide relief to many patients with cancer-related pain, swallowing difficulties or intestinal obstruction may preclude oral analgesic delivery in some. Topical morphine might provide an alternate delivery form but morphine bioavailability from a topical gel formulation has not been reported in humans. We conducted a randomized, placebo-controlled, double-blind, crossover study of five volunteers after they provided institutionally-approved, written, informed consent. They were admitted to the Northwestern University General Clinical Research Center twice, being randomly assigned to receive either 1mL of morphine compounded at 10mg/mL in pluronic lecithin organogel (PLO) base applied to the wrist and 1mL of normal saline administered subcutaneously, or 1mL of topical drug-free PLO base and 1mL of subcutaneous morphine, 3mg/mL, the first time and the opposite combination the second. Seventeen blood samples were collected from 5minutes to 10hours after dose administration for morphine concentration determination. Plasma samples were prepared by solid-phase extraction and morphine concentrations measured by a mass spectrometric technique with a linear range of 0.5-500ng/mL. Bioavailability of the topical formulation relative to the subcutaneous dose was to be estimated from doses and the plasma morphine concentration versus time relationships. Because morphine was seldom detected in plasma samples after topical administration and was unquantifiable when it was, the low bioavailability of topical morphine was unquantifiable. These results suggest that topical administration of morphine compounded in a PLO base for transdermal drug delivery is unlikely to provide relief of cancer-related pain.Journal of Pain and Symptom Management 04/2008; 35(3):314-20. · 2.50 Impact Factor -
Article: Longitudinal screening and management of fatigue, pain, and emotional distress associated with cancer therapy.
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ABSTRACT: Fatigue, pain, and emotional distress are common symptoms among patients with cancer. We sought to learn about patient perceptions of these symptoms and their treatment. At a baseline assessment and two monthly follow-up assessments, we asked a diverse sample of patients with solid tumor or lymphoma (N = 99) about their fatigue, pain and distress, their treatment for these symptoms, and their satisfaction with treatment via standardized questionnaires and semistructured interviews. In this observational study, patients reported fatigue, pain, emotional distress, and general quality of life at expected levels. Across all assessments, at least half of our sample experienced at least some fatigue, pain, or distress. On the whole, patients and providers do communicate about these concerns, and at least 75% of patients found these discussions helpful when they occurred. Improved symptom identification and communication may optimize the detection of those at risk of morbidity and decreased quality of life because of excess symptom burden.Supportive Care Cancer 03/2008; 16(2):151-9. · 2.60 Impact Factor -
Article: Global efforts to improve palliative care: the International End-of-Life Nursing Education Consortium Training Programme.
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ABSTRACT: This paper is a report of an evaluation study to determine the feasibility and effectiveness of the End-of-Life Nursing Education Consortium-International training conference in providing education and support materials to participants so they might return to their home countries and disseminate palliative care information. More than 50 million people die each year, many without access to adequate pain control or palliative care. Numerous barriers to implementation of palliative care exist, including lack of education provided to healthcare professionals regarding these principles. Because they spend the most time with patients and their families, nurses have the greatest potential to change the way palliative care is provided. A Course Evaluation Form and a Postcourse Activity Evaluation was completed by a convenience sample of 38 nurses from 14 Eastern and Central European, former Soviet, and Central Asian countries. The data were collected in 2006 using Likert scales and open-ended questions. Evaluations of speakers ranged from a mean of 4.4 to 4.9 on the 5-point scale, with five denoting the highest level. The mean rating of the conference overall was 4.9. Strengths included the professional level of presentations, practical, clinically based content, extensive resources and availability of the educators. The first End-of-Life Nursing Education Consortium-International training programme demonstrated the feasibility of providing high-quality, essential education to nurses from a variety of countries. Because End-of-Life Nursing Education Consortium is designed as a train-the-trainer programme, assistance with translation to native languages, along with textbooks and other resources, is needed to allow participants to fully implement this curriculum.Journal of Advanced Nursing 02/2008; 61(2):173-80. · 1.48 Impact Factor -
Article: Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice.
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ABSTRACT: Fatigue, pain, distress, and anorexia are four commonly encountered symptoms in cancer. To evaluate the usefulness of a single-item screening for these symptoms, 597 ambulatory outpatients with solid tumors were administered a self-report screening instrument within the first 12 weeks of chemotherapy. Patients rated the severity of each symptom on a 0-10 scale, at its worst over the past three days, with higher ratings associated with higher symptom levels. From this sample, 148 patients also completed a more comprehensive assessment of these symptoms. Two criteria were used to determine optimal cut-off scores on the screening items: 1) the sensitivity and specificity of each screening item to predict clinical cases using receiver-operating characteristics analysis and 2) the proportion of patients at each screening score who reported that some relief of the target symptom would significantly improve their life. Optimal cut-off scores ranged from 4 to 6 depending on the target symptom (area under the curve range=0.68-0.88). Use of single-item screening instruments for fatigue, pain, distress, and anorexia may assist routine clinical assessment in ambulatory oncology practice. In turn, such assessments may improve identification of those at risk of morbidity and decreased quality of life due to excess symptom burden.Journal of Pain and Symptom Management 02/2008; 35(1):20-30. · 2.50 Impact Factor -
Article: Oncology End-of-Life Nursing Education Consortium training program: improving palliative care in cancer.
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ABSTRACT: To describe an evaluation of the oncology version of the End-of-Life Nursing Education Consortium (ELNEC-Oncology) training program, which is designed to provide oncology nurses with the knowledge and materials necessary to disseminate palliative care information to their colleagues in local chapters of the Oncology Nursing Society (ONS). Participant reports. 124 nurses representing 74 ONS chapters attended the first two courses. Dyads of ONS members from local chapters applied to attend ELNEC and completed surveys regarding their goals and expectations for implementing end-of-life (EOL) education and training after completion of the program. Participants educated more than 26,000 nurses after attending the program, including 7,593 nurses within their ONS chapters and 18,517 colleagues within their workplaces. Barriers to implementation included a lack of funding and time constraints. Participants sought additional palliative care learning opportunities, including attending other workshops, subscribing to palliative care journals, and becoming involved in committees focused on palliative care. The ELNEC-Oncology program is a national collaboration with ONS that provides oncology nurses with the tools and expertise to effectively disseminate palliative care content to colleagues within their local chapters and work settings. EOL care information remains critical to the science of oncology nursing, and ELNEC-Oncology provides an effective strategy for disseminating the information.Oncology Nursing Forum 08/2007; 34(4):801-7. · 1.91 Impact Factor -
Article: Emergency department management of acute pain episodes in sickle cell disease.
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ABSTRACT: To characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic. This was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann-Whitney U test or Kruskal-Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups. There were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54-159 minutes). During 87% of visits, patients received the recommended agent (morphine or hydromorphone); 92% received the recommended dose, and 55% received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95% confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95% confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays. Patients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic.Academic Emergency Medicine 06/2007; 14(5):419-25. · 1.86 Impact Factor -
Article: Chemotherapy-induced peripheral neuropathy: A need for standardization in measurement.
The journal of supportive oncology 10/2006; 4(8):398-9. -
Article: Appraisal of the Graduate End-of-Life Nursing Education Consortium Training Program.
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ABSTRACT: Advanced practice nurses (APNs) are crucial in the provision of quality end-oflife care. However, little attention is devoted to palliative care in most graduate nursing curricula, leaving advanced practice nurses poorly prepared to meet the needs of those approaching the end of their lives. The purpose of the graduate version of the End-of-Life Nursing Education Consortium (ELNEC-Graduate) Training Program is to provide nursing faculty with the knowledge and materials necessary to include palliative care throughout the graduate nursing curriculum. Sixty graduate nursing faculty members attended the first ELNECGraduate training course. Prior to attending the course, each participant completed surveys regarding the adequacy of end-of-life (EOL) content within their curriculum, as well as overall perceptions of EOL education in their university. Participants were asked to respond to these same questions immediately and at 12 months after completion of the course. Respondents reported significant improvements in the adequacy of eight areas of EOL content taught within their settings. Participants noted improved effectiveness in their ability to teach EOL care, of their curriculum in including EOL care, and of their graduate nursing students in providing care to the dying. The total hours of EOL content added to graduate nursing curricula as a result of attending ELNEC-Graduate was 18.4 +/- 17.4 standard deviation (SD) hours. Additional unintended consequences were noted. The ELNEC-Graduate Program is a national initiative that effectively improves faculty expertise in EOL care and expands palliative care content within graduate nursing curricula.Journal of Palliative Medicine 05/2006; 9(2):353-60. · 1.85 Impact Factor
Top co-authors
Top Journals
Institutions
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2002–2010
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Northwestern University
- • Division of Hematology/Oncology
- • Department of Emergency Medicine
- • Feinberg School of Medicine
Evanston, IL, USA
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2006
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Purdue University
West Lafayette, IN, USA
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2002–2006
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Northwestern Memorial Hospital
Chicago, IL, USA
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