timer Asked: Apr 13th, 2020

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Rubric with eposter criteria, eposter example and paper are all attached. Please be creative and not pull things directly from paper, make eposter look presentable and original. The template is meant to guide you however the color and design should be changed to fit the originality. Please let me know if you have any questions. Also please look at the example and eposter assignment details thoroughly.

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PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS The Use of Multimodal Models Instead of Opioids for Pain Management in Knee and Hip Arthroplasty Chanel Nelson Institutional Affiliation 1 PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 2 The Use of Multimodal Models Instead of Opioids as Pain Managements Approaches in Knee and Hip Arthroplasty One of the critical issues in preoperative care is pain management. Parvizi et al. (2017) noted that an increase in prescription opioids for pain management had been the leading factor in continued use and street drug abuse of this drug since no standard measures are guiding the amount of opioids that should be prescribed. The quality of patient outcome is measured using factors such as patient satisfaction and the use of the evidence-based practice in offering patientcentered care. Therefore, when pain management meets the patient's satisfaction and overall goals, the positive patient care and quality services are registered. Opioids are most commonly used in pain management, especially in the postoperative period (Zajonz et al., 2017). Nonetheless, their use in pain management has received a lot of controversies over the past years because of issues like addiction and misuse, hence, the need for the use of other measures such as multimodal methods. For the past decade, the use of opioids has been on the rise, a factor that too many people can be termed as an epidemic and not a medical practice. In the late 1990s, medical firms reassured the healthcare providers that the chances of patients becoming addicted to the use of opioids as pain relievers was close to zero. In response, the medica community were encouraged to increase their prescription for these pain management drugs at relatively higher rates. This then resulted in the extensive deviation and misappropriation of opioids before the healthcare providers realized that these medicines could certainly be highly addictive. By 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids (Bonnie et al., 2017). In 2018, CDC reported that 128 people died of opioid overdosing daily. These stats PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 3 show how the opioid epidemic has progressed over the years and the need for drastic measures to be taken to address the issue. The patient population on the skilled nursing unit at St. Elizabeth Medical Center consists mainly of the majority of postoperative hip and knee replacement. As a result, patients are being discharged from the hospital with an opioid prescription that matches what they initially received in the postoperative period. There has been no attempt to taper or wean the patient from the opioids or to provide an effective plan of combining opioids with a variety of non-opioid medications that could be offered on a PRN basis to help with this process. A non-narcotic option would be to provide Tylenol for breakthrough pain or to begin to provide it with every other request for pain management. However, with the increasing death rates of opioid misuse and addiction, the hospital should consider moving towards a new direction in pain management. In regards, NIH Director Francis S. Collins, proclaimed the introduction of the HEAL (Helping to End Addiction Long-term) Initiative in 2018, which is "an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis" ("Opioid Overdose Crisis," 2020). That way, the general increase in opioid misuse can be reduced considerably, while patient satisfaction and positive feedback can be attained. Literature review on the use of opioid and the controversies on its importance in pain management Several studies have been conducted to try and understand the purpose of opioids in pain management, including its efficacy in pain management and the controversies regarding its use. The results point to different issues regarding the same. PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 4 Phillips, Ford, and Bonnie (2017) conducted a systematic review to study the intersection between pain management and the opioid epidemic. They established that there is an ongoing opioid crisis and that the crisis lies between two crucial public health concerns: reducing the problem of pain suffering and decreasing the increasing number of the issues that can arise from the use of opioid medicines, primarily addiction. Rosenquist (2020) evaluated the use of opioids in the treatment of pain for non-cancer patients. She found that controversies from opioid use result from the fact the use of these analgesia-causing drugs has equally extreme risks and dangers as it is beneficial. There is a lack of enough evidence to support the long-term efficacy of this pain management approach to mitigate the risk of extreme harm and misuse of the drug through addiction and accompanying health complications. The author opines that every patient has their own needs based on the best pain management measures and that nurses should ensure that they understand what best fits the patient before administering pain-relieving medication. Literature review on the solution Chou et al. (2016) provided a guideline based on a systematic review of pain management measures from which nurses in postoperative care can use to help the patient manage pain through non-opioid steps. However, they first need to assess the best mechanisms to use based on the individual needs of the patient. They observed that several patients who go through surgical procedures experience acute postoperative pain, although evidence shows that more than half report effective preoperative pain relief. They suggested that clinical caregivers should use multimodal regimens in such cases, although the precise elements of effective multimodal care will depend on the individual needs of the patient. PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 5 Zajonz et al. (2017) conducted a pilot study on the effect of multimodal pain management measures among 21 patients. The results indicated that the first approach to providing the best care on pain management is through the establishment of an algorithm to define each patient's need regarding the most effective method for pain management. They also found that although multimodal approaches did not provide long-term solutions, they were effective in the first 30 minutes of the care. Through these findings, nurses can, therefore, tailor the best pain management measures to meet individual needs and enhance positive treatment outcomes. Implementation There is no specific way of addressing the issues surrounding the misuse of opioids and its effects on the quality of care, but there are several ways in which patient care and treatment outcomes can be improved. In regards, there is one primary approach of non-opioid pain management that surgical units like the skilled nursing unit at St. Elizabeth Medical Center could use to improve patient care outcomes and promote positive patient feedback. The unit can focus on using evidence-based care to provide patient-centered care in pain management. Since the majority of the patients in St. Elizabeth’s Hospital for postoperative care are those who come for hip and knee replacement, the healthcare team should consider multimodal measures rather than relying on the mainstay use of opioids (Diwakar, 2017). Diwakar (2017) noted that “multimodal pain management involves the introduction of adjunctive pain control methods in an attempt to control pain with less reliance on opioids and fewer side effects.” An example is the use of traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and the associated cyclooxygenase type-2 (COX-2) inhibitors to improve pain control (Zajonz et al., 2017). PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 6 One thrilling aspect of multimodal measures is that they are easily applicable and manageable (Gaffney et al., 2017). Currently, the use of multimodal models has become the standard unit of care for pain management after knee and hip arthroplasty. The increase in the use of the multimodal models in pain management has come as a result of the limited time required for their implementation. For instance, administering oral medicines only requires the usual time intervals for any regular oral treatments. To measure the effectiveness of the proposed individualized use of multimodal models is reduced cost of care, hospital readmissions, positive patient feedback, and outcomes of care. Most important, patients will not leave the hospital still taking opioid medications, and they will be significantly further along in the recovery process. Besides, it is possible to individualize treatment based on the type of procedure and patient needs, thus increase in patient satisfaction, elimination of opioid use, and its effects, as well as the general quality of care. Decreasing opioid use is primary that results in increased patient satisfaction and positive outcomes. PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 7 References Bonnie, R., Ford, M., & Phillips, J. (2017). Pain management and the opioid epidemic (1st ed.). The National Academies Press. Chou, R., Gordon, D., de Leon-Casasola, O., Rosenberg, J., Bickler, S., & Brennan, T. et al. (2016). Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 17(2), 131-157. Diwakar, M. (2017). Pain Management Techniques in Hip and Knee Arthroplasty: A Review of Literature. Journal of Orthopedics & Bone Disorders, 1(3). Gaffney, C., Pelt, C., Gililland, J., & Peters, C. (2017). Perioperative Pain Management in Hip and Knee Arthroplasty. Orthopedic Clinics of North America, 48(4), 407-419. Opioid Overdose Crisis. (2020). Retrieved 11 April 2020, from Rosenquist, R. (2020). Use of opioids in the management of chronic non-cancer pain. Retrieved 1 April 2020, from PAIN MANAGEMENT IN POST-SURGICAL OPERATIONS 8 Strickler, G., Kreiner, P., Halpin, J., Doyle, E., & Paulozzi, L. (2020). Opioid Prescribing Behaviors — Prescription Behavior Surveillance System, 11 States, 2010–2016. MMWR. Surveillance Summaries, 69(1), 1-14. Zajonz, D., Fakler, J., Dahse, A., Zhao, F., Edel, M., Josten, C., & Roth, A. (2017). Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients. Patient Safety in Surgery, 11(1). CAP e-Poster Creation Poster presentations present research and clinical projects in an interactive setting. Your electronic (e-) poster will present key elements of your Clinical Application Project (CAP) in an easy-to-read format. ❖ The CAP e-poster is to be designed on a PowerPoint template, but not printed. You will simply submit the PowerPoint file to the Brightspace submission folder. ❖ If you are unfamiliar with creating a scientific poster, instructions are outlined at the bottom of this document. It’s easier than you think. Because you are limited by space in the poster format, you must be clear and concise in your writing. ❖ Refer to the CAP rubric for all necessary requirements. General guidelines for e-poster: • • • • • • The e-poster should look neat, professional, and visually appealing Use a simple font (like Arial), no smaller than size 32; larger for section headings and even larger for title/presenter name Regarding text: o Labels or headings should be clear and easy to understand. o Select contrasting colors; darker letters are effective when used on a light background & vice versa. o Text should be brief and to the point; use short sentences or phrases to summarize key points; bullet points work well. If you are planning to use charts or graphs on your poster: o Visual data help to express ideas; graphics should be understandable. o Keep it simple; don’t overwhelm the audience with too many numbers. o Make sure there is a clear caption so the reader understands the significance. Assure consistency in use of format. Check and double check spelling. Reminders: • Include a copy of any form, brochure or handout you develop as part of the project. • A reference page in APA format must be available for viewing near your e-poster. The reference page should include at least the journal articles that were discussed in the literature reviews of the clinical topic and solution. Poster Instructions • Open the poster template in the course shell and save it to your computer. • Now you’re ready to make it your own: experiment with different colors, fonts, designs. • Keep in mind the “general guidelines” listed above. • Add your content, graphics, charts, etc. • Save your work frequently as you create. JD/2018 Gestational Diabetes Mellitus (GDM): Gestational Diabetes Mellitus: Interventions for Hispanic/Latina Pregnant Women Interventions for Hispanic/Latina Pregnant Women Luis A. Gutierrez PSMEMC OB Unit (Clinical Unit Here) Resurrection University, NUR 4642: Role Transition Resurrection University, NUR 4642: Role Transition PROBLEM/TOPIC LITERATURE REVIEW IMPLEMENTATION • Gestational Diabetes Mellitus (GDM) impacts 2%-10% of all pregnancies in the United States every year (Center for Disease Control and Prevention, 2017). Problem/topic • Cultural/linguistic barriers. Carolan-Olah et al. (2017) identify that language is one of the barriers understanding the impact that GDM could have on the mother’s health as well as the newborns. In addition, cultural food selection greatly increases the risk for developing GDM for Spanish speaking mothers. Recruitment • Per care team, PSMEMC has experienced an influx of Hispanic/Latina pregnant women diagnosed with GDM. • Language barrier is the biggest obstacle with patient education. Staff members reported that Spanish speaking resources for GDM and nutritional education are scarce. Table 1 • Lack of activity and poor dietary selections. Chasan-Taber (2012) identifies that there is a higher likelihood for gestational diabetes and macrosomia to develop in Latinas who are obese. Solution • Linguistic adaptation. Schellinger et al. (2017) demonstrate that Hispanic/Latina pregnant women participating in a group care model offered in Spanish showed indicators of effective education and implementation regarding GDM and pregnancy. • Cultural background, socioeconomic status and nutrition. Rhoads-Baeza and Reiz (2012) determine that the relevancy of the dietary recommendations provided to women, incorporating cultural factors, contributed and facilitated the success of interventions addressing Hispanic/Latina pregnant women. • Women at risks for GDM will be referred to group by PSMEMC OB Clinic Intervention • Group will receive psychoeducation on GDM • Participants will be taught to test and measure glucose levels independently • Utilizing food journals to track meals and generate discussion around their current dietary practices • Nutrition education providing suggestions to each participant based off of food that is culturally relevant to them. Assessment • Staff member will be able to track and share patient information with their medical physician for continuity of care. • To monitor patient’s health status throughout their pregnancy, surveys and glucose levels will be utilize. FUTURE IMPLEMENTATIONS COMMUNITY BACKGROUND SOLUTION The racial disparities seen in GDM directly impacts St. Mary’s and Elizabeth Medical Center due to the physical location of the hospital. St. Mary’s and Elizabeth Medical Center is located near the Humboldt Park neighborhood. • An educational group program will be implemented at the St. Mary’s and St. Elizabeth’s OB unit. • The educational group program will provide: • Access professionals in Spanish. • Education and information on reducing their risk for GDM. • Space and support for women to learn healthy diet options that are culturally and linguistically relevant. While Hispanic/Latina women are the population that is being seen at PSMEMC, they are not the most at risk for GDM. Nationally, Asian/Pacific Islander women are increasing at faster rates (See Table 1). Utilizing this model of incorporating cultural components to dietary interventions could also assist in dropping rates of GDM in that population. ACKNOWLEDGEMENTS I would like to thank my Preceptor Ami Patel, BSN-RN and secondary preceptor Jennifer Kruc, BSN-RN who endorse this project and felt that it would be beneficial to the unit. I would also like to thank the OB residents who provided feedback on my intervention. Clinical Application Project Title Student Name Hospital and Unit Resurrection University, NUR 4642: Role Transition Place titles here Your information here Your information here Your information here Title Your information here Your information here Your information here Using simple, well designed graphics can help to effectively communicate results Your information here ( ...
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