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To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02274.x Byline: Kristen Lynne Swafford (*), Lois Lachmann Miller (*), Pao-Feng Tsai ([dagger]), Keela Ann Herr ([double dagger]), Mary Ersek (s.) Keywords: pain; nursing home; process interventions Abstract: Regulatory agencies, researchers, and clinicians have identified improving pain assessment and management in nursing homes as a high priority, but there is no consensus regarding the best strategies to change pain management practices in nursing homes. The goal of this article is to present a synthesis of published literature of process-level pain management improvement projects in nursing homes and identify and describe the role and necessary skills of various clinicians and nursing leaders in successful interventions. This literature synthesis is limited to research in nursing homes. Reports of research or reports of evaluation of quality improvement programs and descriptions of process interventions that targeted pain assessment and management were reviewed. Studies that focused primarily on the efficacy of pain treatment (e.g., analgesic trials or nonpharmacological therapies) were excluded. Of the original 472 articles, 53 were kept for a full text review. Of these, 10 were included in the final synthesis. Findings from this synthesis suggest that pain management practices may improve with the adoption of systematic implementation models, clinical decision-making algorithms, an interdisciplinary approach, continuous evaluation of outcomes, and use of on-site resource consultants. Clinician leaders in nursing homes require adept pain assessment and management skills and working knowledge of organizational change practices, including quality improvement processes, team building, collaborative decision-making, and assessing and solving system-level problems. Author Affiliation: (*)School of Nursing, Oregon Health & Science University, Portland, Oregon ([dagger])College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas ([double dagger])College of Nursing, University of Iowa, Iowa City, Iowa (s.)School of Nursing,University of Pennsylvania, Philadelphia, Pennsylvania. Article note: Address correspondence to Kristen Lynne Swafford, Oregon Health & Science University, School of Nursing, Portland, Oregon. E-mail: swaffork@ohsu.edu

Issue Depression is one of the most prevalent psychiatric disorders and when co-occurring with medical illnesses likely creates a vicious circle in which each separate ailment makes treatment outcomes worse [...]

Pain and the presence of others are two variables that directly affect the performance of athletes. Coaches and trainers are often forced to make judgments about the degree and type of pain in order to encourage an athlete to overcome minor physical problems, and yet protect them from harm. Young athletes may not have obtained sufficient experience to differentiate the discomfort of training from pain which indicates serious injury. The ability to evaluate and withstand pain in two groups, 40 college-aged volunteers and a group of 43 children drawn from the second and third grade, was studied. Each age group was further split into a group that was exposed to a painful level of cold either alone or with an audience. The painful stimulus was the immersion of a hand in an icy water bath maintained at 1 to 2 degrees C. (just above freezing). Subjects were told that they could remove their hands whenever they wished. Adults withstood longer periods of immersion than did children, but the presence or absence of an audience made no significant difference on the length of immersion. In contrast, the data suggests that children in athletic competition where others are in attendance could potentially place themselves at risk, and that adults who supervise such activities should be careful to assess children's reports of pain in these conditions.