North Dakota Nurse - April 2021

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Page 6 The North Dakota Nurse April, May, June 2021 How To Help A Nurse With Their Anxieties And Depression Member Highlight: Susan Indvik By: Stanley Popovich Do you know a nurse who suffers from fear, anxiety, and depression and do not know what to do? It can be frustrating to watch someone you know suffer and not be able to help them. Here are six ways to help the person cope in these kinds of situations. 1. Learn as much as you can in managing anxiety and depression: There are many books and information that will educate you on how to deal with fear and anxiety. Share this information with the person who is struggling with their mental health issues. 2. Be understanding and patient with the person struggling with their fears: Dealing with depression and anxiety can be difficult for the person so do not add more problems than what is already there. Do not get into arguments with the person whose having a difficult time with their anxieties. 3. Talk to the person instead of talking at them: It is important not to lecture the person who is struggling with anxiety and depression. Talk to the person about their issues without being rude. Most people will listen if you approach them in a proper manner. 4. Ask for help: Seek assistance from a counselor who can help your friend or relative with their mental health issues. A counselor can give you advice and ideas on how you can help your friend or relative who is struggling. 5. Find out why the person won’t get help: Address the issues on why the person will not seek treatment. Many people who are struggling are fearful and frustrated. Try to find out the reasons why he or she won’t get the help they need and then try to find ways that will overcome their resistance of seeking assistance. 6. Remind the person on the consequences of not getting help: Anxiety and depression will not go away by themselves. Explain to the person that ignoring their mental health issues will only make things worse in the long run. New Nursing Display at Bonanzaville A new, revised Cass County nursing history display will open at Bonanzaville in West Fargo on May 1, 2021. The previous display was in a building that was removed. The new display will be available for two years in the main building. Members of NDNA have been working on display items and scripts for about a year. Watch for announcements of an opening event celebration date for nurses. Sanford, NDNA (former District 4), and individuals are financing the display. For additional information, contact Marlene Batterberry (701-282-4575) or Evelyn Quigley (701-237-5942). by Sherri Miller What position(s) do you hold with the North Dakota Nurses Association? I currently am in the position of “Nominating Committee Member” What is your background? I have worked in the medical field my entire adult life. I started out as a CNA in my early 20’s, I then decided to go back to school and became a respiratory therapist. Then in my mid-forties I decided I did not want to be that what if person. My desire has always been to become a nurse. I took the leap and enrolled in the nursing program at Dakota Susan Indvik College at Bottineau and have not looked back. I am very proud of my successes and because of my age I needed to do and work as much as possible. I have always had the support of my family who encouraged me throughout this entire process. What are your favorite nursing areas you have worked in? I have enjoyed every area that I have worked in because I have had the opportunity to work with great people, meet family members and care passionately for my patients. I have worked in Acute Care, ER, Chemotherapy, Charge floor nurse, & Med/Surg. I have worked as a travel nurse all over the states of ND, SD, MT, and MN. I currently hold my RN license in ND & MN. The best place I have worked is for the Mayo Clinic Health System, in MN. I learned so much and is an experience that I will never forget. What are you up to in nursing right now? I recently began teaching as a Clinical Nursing instructor/Faculty Allied Health and remain the Student Health Nurse at Dakota College at Bottineau. How long have you been a nurse? I started my nursing school in the fall of 2011 and graduated May of 2014 and have been working multiple jobs and positions ever since graduation. I have continued my education since enrolling in my first class, I currently have my Master’s and am enrolled in my Doctorate program. What or who inspired you to be a nurse? I have had many great nurses who inspired me throughout my life but can honestly say it was many family members of patients I helped care for as a CNA that inspired me the most. Nursing is rewarding. Describe one of your most rewarding experience in nursing. When I run into a patient or family member and they tell me what a difference I made in their or family members life. What advice would you give new grads or students? You are never too old to become a nurse. Never let anyone tell you “you cannot.” And inspire to be great every day. Be the inspiration. What do you feel are the most critical issues regarding nursing and/or healthcare right now? The shortage of nurses is at an all time “critical” high. Nursing burnout, nurse to patient ratio, and lack of training time for graduate nurses, on the floors. In what ways has membership to NDNA benefitted you? There is so much up to date information on what is happening in our state. Support for areas of concern and so much more. Letter from Susan’s Students To whom it may concern, Hello, my name is Tia Blanchard and I am writing on behalf of our AD nursing class in which Susan Indvik taught for the Spring 2020 Semester through Fall Semester 2020 at Dakota College at Bottineau. When Susan told us that she was to be highlighted in the next issue of The North Dakota Nurse, we were thrilled for her. Though Susan’s time spent in our class was short, she left a major impact. Susan is an amazing nurse, instructor, mentor, and woman in general. She has such a caring and genuine heart and it was felt through her teaching. She is a true example that nursing is a life-long commitment to learning and continuing education, no matter the age or phase of life. She is living proof that hard work pays off and helped to inspire us stay the path, especially when things got tough through nursing school. We are so proud to see her being recognized and cannot wait to see what else she does throughout her career. Sincerely, ADN Students: Tia Blanchard Jayme Rafiu Jessie Newsome Ashley Mikula
April, May, June 2021 The North Dakota Nurse Page 7 Nonpharmacological Pain Management Interventions for Older Adults Appraised by: Alanna Rohweller SN, Morgan Erickson SN, Brielle Marman SN, Kyla Schock SN, Morgan Erickson SN, (NDSU School of Nursing at Sanford Bismarck) Allison Sadowsky MSN, RN Assistant Professor of Practice (Faculty) Clinical Question: In the elderly population, what are the health effects of nonpharmacological interventions on pain management compared with pharmacological interventions. Sources of Evidence: Fitzgerald, S., Tripp, H., & Halksworth-Smith, G. (2017). Assessment and management of acute pain in older people: Barriers and facilitators to nursing practice. Australian Journal of Advanced Nursing, 35(1), 48-57. Koo, V., Shicheng Jin, Wan, B. A., Ahrari, S., Lam, H., Rowbottom, L., Chow, S., Chow, R., Chow, E., & DeAngelis, C. (2018). Pain management in older adults with dementia: A selective review. Journal of Pain Management, 11(4), 333–344. Park, J., & Hughes, A. K. (2012). Nonpharmacological approaches to the management of chronic pain in community-dwelling older adults: a review of empirical evidence. Journal of the American Geriatrics Society, 60(3), 555– 568. https://doi-org.ezproxy.lib.ndsu.nodak. edu/10.1111/j.1532-5415.2011.03846.x Qi Zhang, Lufei Young, & Feng Li. (2019). Network Meta-Analysis of Various Non Pharmacological Interventions on Pain Relief in Older Adults with Osteoarthritis. American Journal of Physical Medicine & Rehabilitation, 98(6), 469–478. Tang, S. K., Tse, M. M. Y., Leung, S. F., & Fotis, T. (2019). The effectiveness, suitability, and sustainability of non-pharmacological methods of managing pain in community-dwelling older adults: a systematic review. BMC Public Health, 19(1), 1–10. https://doi-org.ezproxy.lib.ndsu.nodak. edu/10.1186/s12889-019-7831-9 Synthesis of Evidence: Older adults usually receive pharmacological treatment for pain management of chronic pain, but because of age related changes, older adults are at a significantly higher risk of adverse effects from pain medications including liver and kidney damage, gastrointestinal bleeding, high blood pressure, worsening of heart failure, and constipation. Five articles were reviewed as evidence in this report. Four of the articles were systematic reviews that used randomized control studies, and one article that was a systematic review including cluster randomized trials, double blind randomized study, double-blind doubledummy placebo-controlled crossover study, randomized double blind placebo controlled crossover trial, open medication study, quasiexperimental design, and a pilot randomized controlled trial. Non Pharmacological interventions may be most appropriate for individuals who cannot tolerate pain medications because of the side effects or are reluctant to take pain medications and are seeking alternative methods for controlling chronic pain. In addition, non-pharmacological interventions may be suitable for older adults who are taking multiple medications for numerous chronic diseases and who seek to reduce dosages and frequency of pain medications and drug-drug interactions that can result from taking multiple medications. Non-pharmacological pain regimens may provide alternative therapeutic balance to pain relieving medication, decreasing the doses of medications needed and minimizing adverse events and side effects (Park & Hughes, 2012). Fitzgerald, Halksworth-Smith, and Tripp (2017) conducted an integrative literature review of a combination of quantitative and qualitative studies. The review included 13 articles with a total of 9,161 older adult patients and 756 nurses. The aim of the review was to examine pain management practices of nurses and identify barriers and facilitators to assessment of pain and management of pain for older adults in the acute hospital setting. A total of 101 findings were taken from the 13 studies. These findings were synthesized into fourteen themes, which were grouped into four categories; nursing practice, organizational factors, knowledge and education, and power balance. Findings indicated that nurses need to improve their communication and interactions with older patients, as well as their knowledge of pain assessment and pain management. Koo, Shicheng, Wan, Ahrari, Lam, Rowbottom, Chow, S., Chow, R., Chow, E., and DeAngelis (2018) conducted a systematic review of a variety of studies. The systematic review included 11 different studies. The study types consisted of cluster randomized trials, double blind randomized study, doubleblind double-dummy placebo-controlled crossover study, randomized double blind placebo controlled crossover trial, open medication study, quasi-experimental design, and a pilot randomized controlled trial. The goal of this study was to examine the different options for pain management in older adults that have dementia. There were a total of 1102 participants that included older adults aged 67-91 who have dementia and pain. The interventions included a variety of nonpharmacological and pharmacological methods to reduce pain. The main interventions used were acetaminophen, stepwise protocol, morphine, oxycodone, music therapy, ear acupressure, massage therapy, and Namaste care. Some of the interventions were also carried out by leadership, proper staffing, and quality care. This systematic review displays data from multiple studies that show acetaminophen, or the combination of a stepwise program can sufficiently decrease pain the best in elderly patients with dementia. However, the findings were also consistent throughout the articles stating that music therapy, ear acupressure, massage therapy, and Namaste care can also significantly reduce pain in the elderly. Park & Hughes (2012) used randomized control trials (RCTs) of physical and psychosocial interventions to summarize existing evidence of nonpharmacological interventions. All of the studies were conducted in the United States, except for one in South Korea and one in Hong Kong. The mean age of the participants in the 28 articles were aged 65 and older, community dwelling older adults, and noncancer chronic pain was a primary outcome measured in the study. All 28 articles reviewed the Visual Analog Scale (VAS) and the Western Ontario and McMasters Universities Index (WOMAC). The study looked at the effects of both physical and psychosocial interventions. The physical interventions included: TENS, TENS and electoacupuncture, TENS and acupuncture, exercise, exercise with light resistance, acupuncture, acupuncture with exercise, acupuncture with exercise and advice, exercise (walking) and education, Qigong, and Qigong with exercise. The psychosocial interventions included: selfmanagement education, cognitive - behavioral therapy, mindfulness meditation, music listening, and guided imagery. This study showed nonpharmacological interventions most appropriate for individuals who cannot tolerate pain medications because of side effects or are reluctant to take pain medications and are seeking alternative methods for controlling chronic pain. In addition, these interventions may be suitable for older adults who are taking multiple medications for numerous chronic diseases and who seek to reduce dosages and frequency of pain medications and drug-drug interactions that can result from taking multiple medications. The review fell short in identifying the most appropriate non-pharmacological pain interventions for this population. Zhang, Young, & Li. (2019) authored a network meta-analysis to compare the effectiveness of different nonpharmacological interventions on pain relief in older adults with osteoarthritis. They conducted this study by collecting articles only using randomized controlled trials. The articles were dated between 1997 through 2017. The sample sizes ranged from 21 to 454 patients. Altogether, 32 articles and 3228 patients were included. 11 of the articles came from the United States, six from China, three from Denmark, and the remaining from Brazil, Israel, Japan, New Zealand, Norway, Italy, France, Netherlands, and Canada. The nonpharmacological interventions used were resistance training, neuromuscular electrical stimulation, walking, gait training, nordic walking, targeted dynamic balance training, cycle ergometry, whole-body vibration, strengthening exercise, usual care, activities of daily living, health education, yoga, stretching exercise, acupuncture, aquatic exercise, healing touch, heat treatment, intervention in a heated pool, short-wave diathermy therapy, balneotherapy, mud-bath therapy, Tai Chi, and weight loss. Out of the interventions used acupuncture was the least effective while strengthening exercise had the greatest long term effect on pain management. Tang, Tse, Leung, and Fotis (2019) wrote a systematic review of randomized controlled studies. This systematic review was conducted to evaluate the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for communitydwelling older adults. The information was collected from 10 different articles searched on five different databases. The interventions included acupressure, acupuncture, guided imagery, periosteal stimulation, Qigong, and Tai chi. The different pain rating scales were the visual analogue scale, numeric rating scales, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). These studies compared the preintervention mean pain intensity, compared to the post-intervention mean pain intensity. After implementing non-pharmacological pain interventions, pain intensity decreased by anywhere from one to three on a zero to ten rating scale. The study concluded that non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults and can be promoted widely in the community. Conclusion: All five articles indicated success with nonpharmacological interventions in reducing pain in older adult populations. The articles also mentioned that with the use of nonpharmacological interventions, there was a decreased need for pharmacological interventions, therefore decreasing the risk of side effects associated with those medications. Another benefit was the cost effectiveness of non-pharmacological interventions as healthcare costs increase. The literature review by Fitzgerald, Halksworth-Smith, and Tripp (2017) concluded that there is a need for nursing education, and the promotion of individualized effective pain management within institutions, to overcome these barriers and promote better outcomes for the older population. Implications for Nursing Practice: Consistent implications that we saw within all five articles were educating nurses to better assess and individualize pain for each older adult, as well as educating nurses on ability to implement non-pharmacological interventions. Another consistency was being able to equip older adults with skills to improve their self-efficacy in managing pain, taking into consideration racial/ethnic disparities, cognitive function, and ability to perform the non-pharmacological interventions, rather than solely investigating the effectiveness of the interventions themselves. Similarly, all articles mentioned implicating a way to maintain sustainability of pain reductions, and stay ahead of the pain, rather than the nonpharmacological interventions only being effective for a short time.
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