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BACKGROUND: This study aims to measure the effect of guided imagery and hand massage on self-rated wellbeing and pain for palliative care patients. METHODS: This study adopted a quasi-experimental one-group pre-test post-test design. The sample consisted of n = 20 adult palliative care patients who received one session of guided imagery and hand massage. Self-reported levels of wellbeing and pain were measured on a scale of 0-10 before and after the intervention. Results were analyzed using a one-tailed sign test in SPSS Software. RESULTS: The intervention elicited a statistically significant improvement in self-reported levels of wellbeing (p = .029) and pain (p = .001). Feedback from participants showed the intervention was helpful and relaxing. CONCLUSION: The intervention had an immediate positive effect on wellbeing and pain among palliative care patients. Considering the promising results of this pilot study, guided imagery and hand massage should be studied further in the palliative care setting.

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BACKGROUND: Technological advances have allowed ultrasound machines to become portable, pocket-size aids to diagnosis and clinical examination. As technology becomes more available, physicians are challenged to educate themselves and new generations of health providers in the usage of bedside portable ultrasonography. OBJECTIVES/DESIGN: The aim of this study was to survey a representative sample of geriatricians in South Carolina to evaluate their current knowledge about the use of ultrasound machines in the primary care of the elderly, to determine their willingness to adopt the technology and willingness to educate physicians and medical students, and to identify hurdles for the implementation in the clinical and educational environment. PARTICIPANTS: Fourteen physicians and geriatricians participated in the survey. SETTING: Outpatient geriatric practice, Program of All-inclusive Care for the Elderly, inpatient geriatric practice, home-based care, Veterans Affairs hospital program. SURVEY: A 22-item survey regarding geriatric bedside ultrasound (GEBUS) in the clinical setting and in education. RESULTS: Most physicians (92.8%) had heard of GEBUS performed by primary care physicians, and 21.4% had previous formal training. That same percentage also had some training in interpreting ultrasound. Only one physician felt comfortable using the machine and none felt ready to instruct other medical staff and students. Most of the participating group of physicians (71%-85%) expressed an interest in learning this new skill to apply in clinic, research, and medical education. Challenges for wide implementation were identified. CONCLUSIONS: GEBUS is a technology that is now available to the practitioner. Participating geriatricians are ready to embrace this technology in clinical practice and in medical education. Challenges to current implementation include cost, training, liability, credentialing, and lack of reimbursement.

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BACKGROUND: Pain constitutes a constant challenge facing staff and residents of skilled nursing facilities (SNF) and nursing homes (NH). Many SNF and NH have not adopted a uniform plan to assess and treat pain for their residents despite published literature that demonstrates that the implementation of scales improves detection and treatment of pain. The objective of this study was to analyze the baseline pain level in the institutionalized elderly, and then implement a standard pain scale for its assessment and evaluation, while simultaneously identifying challenges in adopting this standardized method. METHODS: As part of a Quality Improvement Project (QI), a total of 40 patients were chosen at random in 2 of the major skilled care and dementia units at a Columbia area nursing home, 20 patients from each. A chart review was conducted to document the presence or absence of pain syndromes, pain medications used, and use of standardized tools for the evaluation of pain. Documentation regarding diagnosis of depression and behavioral problems were also noted as potential markers for the manifestation of pain. Verbal and nonverbal pain scales were introduced and approved by the medical and nursing staff. Training sessions for the administration of such tools were implemented. A baseline evaluation of pain level was obtained applying these newly adopted tools. One cycle using the PDSA (Plan-Do-Study and Act) model for QI was followed. RESULTS: Our evaluation showed that 84.2% (32/38) of our study population were females, and the mean age was 91.4 years. Fifty percent (19/38) of patients had mild to moderate pain. Because of nonstandardized approaches to analgesia, some regimens rendered clear potential for toxicity: ie, receiving more than 3 grams per day of acetaminophen. Most patients with cognitive deficits had lower levels of moderate pain (9.5% [2/21]) but higher levels of mild pain (33.3% [7/21]) when compared with patients with normal cognition or mild cognitive deficits (35.3% [6/17] and 17.6% [3/17], respectively). Nursing staff adopted successfully the chosen pain tools and gave positive feedback after the trial period, indicating that they were helpful tools to identify pain and treat it promptly. Active participation of nursing staff through the process of decision making, tailoring of the pain assessment scales, and feedback during the period of implementation of pain assessment tools was perceived to facilitate better results. New cycles of pain evaluation and improvement were scheduled. CONCLUSIONS: Pain evaluation and management is of paramount importance because of its high prevalence and demonstrated deleterious effects on both quality of life and long-term survival. Tools for verbal and nonverbal evaluation of pain are necessary in both NH and SCF. Also, regular cognitive and behavioral assessment may help evaluate pain by providing additional information to physicians, nurses, and other caregivers when treatment becomes more challenging and complex. The use of standard standing orders can easily help decrease the potential of toxicity related to the use of analgesics.

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