Formal Assessment Tools Research Articles

Survey of assessment and management of pain for critically ill adults

To investigate critical care nurses' current practice and knowledge related to pain assessment and management for critically ill adults able and unable to self-report pain. Cross sectional self-report survey. Survey response rate was 57%. Though more respondents used formal pain assessment tools often or routinely for patients able to self-report compared to patients unable to communicate (P<0.0001), there was no difference in perceived importance of pain assessment tools. Nurses were less confident in their ability to accurately assess pain for patients unable to self-report (P<0.0001). Behaviours most frequently considered routinely indicative of pain were grimacing (88/140, 62.9%), vocalisation (78/140, 55.7%) and wincing (73/140, 52.1%). Haemodynamic instability, nursing workload and patient inability to communicate were the barriers considered to interfere with pain assessment and management most frequently. Enablers to effective management included pain prioritisation, and adequate prescription of analgesia. Most respondents (118/140 84.3%) had received continuing education on topics related to pain. Though nurses considered pain assessment equally important for patients unable and able to selfreport, formal assessment tools were used less frequently and nurses were less confident in their ability to assess pain for patients unable to self-report.

The Role of the Social Worker in the Adult Critical Care Unit: A Systematic Review of the Literature

Social workers provide care to patients and families in the adult critical care unit. We conducted a systematic review of the literature to more clearly identify the role of the social worker practicing in the intensive care unit. We conducted a comprehensive search of the literature using the Pubmed, Embase, ISI, Scopus, and Social Work s databases using the terms “intensive care,” “critical care,” and “social work.” Articles were selected for review if they met the following criteria: formal studies or opinion papers whose primary focus was the role or scope of practice of the social worker in the adult critical care unit. Articles were selected and reviewed independently by two social work investigators. Our search retrieved 550 potentially relevant articles. Twelve full-text articles were deemed eligible for abstracting. Three of the articles were studies that examined different aspects of social work practice including implementation of a family assistance program, social work response to anxiety levels of families in critical care and common activities of critical care social workers. Nine articles were primarily opinion pieces. All of the opinion articles described psychosocial support and counseling as a primary role of critical care social work. Other frequently identified roles were crisis intervention, psychosocial assessment, facilitating communication, end-of-life care, and practical assistance. There is little empiric data describing the role of the critical care social worker. Consistent themes from the articles identified include the role of social workers as counseling professionals, facilitators of communication, and resource agents. Further research to identify formal assessment tools and outcome studies of specific counseling techniques will provide important information for best practice guidelines in this area.

How Is Medication Prescribing Ceased?

Medication prescribing is a complex process where the focus tends to be on starting new medication, changing a drug regimen, and continuing a drug regimen. On occasion, a prudent approach to prescribing may necessitate ending an ongoing course of medication, either because it should not have been started in the first place; because its continued use would cause harm; or because the medication is no longer effective. To identify effective strategies for stopping pre-existing prescribing in situations where continued prescribing may no longer be clinically warranted. Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951-November 2009), EMBASE (1966-September 2008), and International Pharmaceutical Abstract b (1970-September 2008). A manual search for relevant review articles and a keyword search of a local database produced by a previous systematic search for prescribing influence and intervention research were also conducted. Following initial title screening for relevance 2 reviewers, using formal assessment and data extraction tools, independently assessed abstracts for relevance and full studies for quality before extracting data from studies selected for inclusion. Of 1306 articles reviewed, 12 were assessed to be of relevant, high-quality research. A variety of drugs were examined in the included studies with benzodiazepines the most common. Studies included in the review tested 9 different types of interventions. Effective interventions included patient-mediated interventions, manual reminders to prescribers, educational materials given to patients, a face-to-face intervention with prescribers, and a case of regulatory intervention. Partially effective interventions included audit and feedback, electronic reminders, educational materials alone sent to prescribers, and distance communication combined with educational materials sent to prescribers. It appears possible to stop the prescribing of a variety of medications with a range of interventions. A common theme in effective interventions is the involvement of patients in the stopping process. However, prescribing at the level of individual patients was rarely reported, with data often aggregated to number of doses or number of drugs per unit population, attributing any reduction to cessation. Such studies are not measuring the actual required outcome (stopping prescribing), and this may reflect the broader ambiguity about when or why it might be important to end a prescription. Much more research is required into the process of stopping pre-existing prescribing, paying particular attention to improving the outcomes that are measured.

Systematic Review of Interventions to Improve Prescribing

To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions. Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951-May 2007), EMBASE (1974-March 2008), International Pharmaceutical Abstracts (1970-March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews. DATA SELECTION AND SYNTHESIS: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams. Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.

Smoking Restrictions and Treatment for Smoking: Policies and Procedures in Psychiatric Inpatient Units in Australia

Tobacco smoking is the leading preventable cause of death and disease in Australia. Even though smoking prevalence in the general population has been reduced (20% smoke), prevalence rates remain high among psychiatric inpatients (70%-90%). This study aimed to identify smoking policies and procedures in public psychiatric inpatient units in New South Wales, Australia; the provision of "smoking care" in such units (for example, quit-smoking advice or nicotine replacement therapy); and policies and procedures associated with the assessment of smoking status and provision of smoking care. A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales for completion by nurse unit managers. Of the 131 units, 123 units completed and returned surveys (94%). Over one-third (36%) of respondents reported instances in which inpatients began smoking during their admission. A similar proportion (39%) reported that staff provided cigarettes to patients who smoked when patients' supply was expended. Fifty percent of respondents reported that all patients were assessed for smoking status; however, 70% reported that nicotine dependence was not assessed. Units on which staff adhered to smoking restrictions were three times as likely to assess patients' smoking status as units where staff never adhered to restrictions (odds ratio=3.05, p=.01). Inadequate establishment of nonsmoking environments and of smoking restriction enforcement as well as inconsistencies in the provision of smoking care were evident. The findings suggest that failure of psychiatric services to provide smoking care is systemic and not related to particular types of services (for example acute versus nonacute or regional versus metropolitan).

Pharmacologic Treatment of Posttraumatic Stress Disorder Among Privately Insured Americans

Although psychological trauma affects millions of Americans, few studies have examined treatment of posttraumatic stress disorder (PTSD) in real-world service environments. This study explored pharmacological treatment of PTSD among privately insured individuals. Data were from the MarketScan database, which compiles claims from private health insurance plans nationwide. Descriptive statistics and multivariate logistic regression were used to identify predictors of any use of a psychotropic medication and use of three medication classes: antidepressants, anxiolytics or sedative-hypnotics, and antipsychotics. Of 860,090 adult mental health care users in 2005, only 10,636 (1.2%) had a diagnosis of PTSD. Sixty percent of PTSD patients received any psychotropic medication: 74.3% of those received antidepressants, 73.7% received anxiolytics or sedative-hypnotics, and 21.3% received antipsychotics. Greater likelihood of any medication use was associated with greater use of mental health services and with several comorbid psychiatric disorders. Having a comorbid diagnosis of an indicated disorder was the most robust predictor of use of each of the three medication classes: major depressive disorder and dysthymia were most strongly associated with antidepressant use, schizophrenia and bipolar disorder were associated with antipsychotic use, and anxiety disorders were associated with use of anxiolytics or sedative-hypnotics. Psychotropic medications were frequently used in the treatment of PTSD among privately insured clients. Although use targeted specifically to PTSD and to comorbid disorders was common, substantial use appeared to be unrelated to diagnosis and may be targeted at specific symptoms rather than diagnosed illnesses. Further research is needed to determine symptom-specific responses to medications across diagnoses.

Assessment of Operative Competency in Otolaryngology Residency: Survey of US Program Directors

1) Assess current status of operative competency assessment and feedback among US Otolaryngology residency programs. 2) Evaluate correlations between assessment or feedback tools and remediation. Survey of Program Directors. The survey was sent to 100 Program Directors inquiring about program size, mode of feedback, assessment tools, surgical portfolios, remediation, and number of residents requiring remediation in past 5 years. Associations between assessment questions and remediation (yes or no) were statistically assessed with the [chi]2 goodness-of-fit test. For more complicated analyses, multiple logistic regression models were created to assess predictors of the binary outcome of radiation. Among 72 respondents, subjective evaluations are used by 95.8% (69 of 72). Formative feedback after cases is used by 38.9% (28 of 72). Summative feedback at end of the rotation is done by 57.0% (41 of 72). Objective Structured Assessments of Technical Skills is used by 15.3% (11 of 72) of programs, most are large on the basis of number of residents or faculty or both. Operative portfolios are kept by 48.6% (35 of 72) of programs. The percentage of programs with mechanisms for remediation is 41.7% (30 of 72). Similarly, of the programs who responded to the remediation question, the percentage with at least one resident requiring remediation is 37.5%. Programs who report at least one resident remediation are statistically more likely to have a remediation mechanism in place (75% vs. 27.5%; P <.001). There is also a statistically significant association with formative feedback and having resident remediation (58.3% vs. 30%; P = .025). Standardized surgical curricula and assessment tools are needed. Programs with more intensive evaluation or remediation mechanisms are statistically more likely to report residents requiring remediation. This may reflect their ability to better identify the struggling resident. Alternatively, having a resident requiring remediation may be the catalyst that initiates the need for more intensive evaluation tools and remediation mechanisms. The Accreditation Council for Graduate Medical Education's and society will demand that we produce competent surgeons. Therefore, all Otolaryngology training programs should be developing and implementing formal surgical assessment tools, methods to identify residents requiring remediation, and remediation mechanisms.

Spiritual assessment in intensive and cardiac care nursing

The aim of this paper is to explore various approaches to spiritual assessments in contemporary intensive and cardiac care (ICU/CCU) environments. Despite the increasing recognition that spiritual care is essential for quality patient care, an agreed spiritual assessment approach and tool for use in ICU/CCU settings remains elusive. An overview of spiritual assessment and spiritual assessment tools. It is suggested that the staff in ICU/CCU nursing settings choose or develop a formal assessment tool that most closely matches their considered collective definition of spirituality, which has been considered in light of their mission statement and philosophy of care. Spiritual assessment is essential to formulate a care plan as spiritual care provides a powerful inner resource to critically ill patients in acute clinical environments.

Nurses’ knowledge of mouth care practices

to assess nurses' knowledge and practices concerning oral care on surgical and medical wards in a district general hospital in Ireland. a survey of all qualified nurses on three medical and three surgical wards was carried out. Two hundred questionnaires were distributed and 50 were returned with 43 of these rendered useable. the majority of nurses (90%) viewed oral care as an important aspect of nursing care. However, nurses lacked adequate knowledge of oral care practices, and experienced problems attending to oral care as a result of time constraints, lack of oral care packs, patients being confused or uncooperative, lack of toothpaste and toothbrush, limited education and low status attached to oral care. Although most nurses (over 70%) had received education on oral care, this was of short duration. Sixty-four per cent did not use an assessment tool to measure the condition of the patient's oral cavity, while 73% believed that an assessment tool would be important to measure a baseline of the condition of the patient's oral cavity. although oral care is an essential component of quality nursing care, it appears to be given low priority by some nurses. This study indicates the need for educational updates for qualified nurses, adequate supply of oral care equipment and promotion of formal assessment tools usage in the hospital setting.

Implementation of a Computerized Psychiatric Assessment Tool at a DUI Treatment Facility: A Case Example

Psychiatric comorbidity is common among patients in a variety of treatment settings, yet treatment providers seldom use standardized mental health assessments to identify these problems. Using standardized assessment tools gives practitioners and clients the opportunity to tailor treatment and aftercare efforts to a potential problem, and trains practitioners to provide valid and reliable measurements of mental health. Despite the benefits, there are barriers to implementing formal assessment tools. This paper discusses the barriers the authors encountered and the strategies they used to implement a standardized mental health assessment at a state-licensed Driving Under the Influence (DUI) offender treatment program.

Comprehensive management of cardiometabolic risk factors

Comprehensive management of cardiometabolic risk requires management of a patient's underlying risk factors. The initial approach to treatment demands a careful assessment of patient risk, using formal risk assessment tools (eg, the Framingham Risk Score and the National Cholesterol Education Program Adult Treatment Panel III definition of metabolic syndrome), combined with comprehensive knowledge of the patient. There is increasing evidence that lifestyle modification and pharmacotherapy can delay or prevent the progression of insulin resistance to diabetes and cardiovascular disease. Periodic reassessment of a patient's risk can assist in guiding long-term therapy to achieve optimal cardiometabolic health.

Current management for word finding difficulties by speech-language therapists in South African remedial schools

Word finding difficulties frequently found in learners with language learning difficulties (Casby, 1992) are an integral part of Speech-Language Therapists' management role when working with learning disabled children. This study investigated current management for word finding difficulties by 70 Speech-Language Therapists in South African remedial schools. A descriptive survey design using a quantitative and qualitative approach was used. A questionnaire and follow-up focus group discussion were used to collect data. Results highlighted the use of the Renfrew Word Finding Scale (Renfrew, 1972, 1995) as the most frequently used formal assessment tool. Language sample analysis and discourse analysis were the most frequently used informal assessment procedures. Formal intervention programmes were generally not used. Phonetic, phonemic or phonological cueing were the most frequently used therapeutic strategies. The authors note strengths and raise concerns about current management for word finding difficulties in South African remedial schools, particularly in terms of bilingualism. Opportunities are highlighted regarding the development of assessment and intervention measures relevant to the diverse learning disabled population in South Africa.

Managing Congestive Heart Failure Patient Factors in the Device Era

Device-based care such as implantable cardioverter-defibrillators and cardiac resynchronization therapy extends congestive heart failure (CHF) care into a new era. The purpose of this paper is 2-fold: (1) to review the development of device-based CHF management and the implications from a medical and patient management perspective, and (2) to provide assessment and treatment approaches on how to clinically manage patient outcomes optimally. Quality of life, depression, and anxiety are targeted as concerns for patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators. Brief clinic-based interview questions and formal assessment tools are reviewed. Furthermore, a cognitive-behavioral paradigm using the "Appropriate Education, Behavioral Support, and Cognitive Coping" (ABC) model is proposed to aid health care professionals in addressing patients' device-specific concerns. Available research suggests the need for future studies assessing the efficacy of cognitive-behavioral treatments in patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators.

Developmental assessment of children: A survey of Australian and New Zealand paediatricians

To determine the current practice for developmental assessment of children by Australian and New Zealand paediatricians. To determine factors associated with higher levels of self-reported confidence and expertise in developmental paediatrics and factors associated with better practice. A cross-sectional postal survey of Australian and New Zealand paediatricians conducted in 2003, enquiring about their training in developmental paediatrics and their practice for evaluating development. Of 811 questionnaires sent, 590 (73%) were returned. Ninety-one respondents indicated that they did not see children with developmental issues leaving 499 surveys for analysis. The overwhelming majority of paediatricians felt that more training was required in developmental paediatrics (88%) and that there was a need to be taught a formal developmental assessment tool (83%). Higher self-ratings of confidence and expertise in developmental paediatrics were associated with a period of formal developmental training (OR (95% CI) 2.7 (1.6-4.4), 3.4 (2.0-5.8), respectively), and being taught a formal developmental assessment tool (OR (95% CI) 2.0 (1.2-3.2), 2.2 (1.3-3.7), respectively). Predictors of paediatricians performing a formal developmental assessment included formal developmental training (OR (95% CI) 2.0 (1.1-3.8)) being taught an assessment tool (OR (95% CI) 2.8 (1.5-5.2)) and mandatory training (OR (95% CI) 2.4 (1.4-4.1)). Developmental paediatrics is a significant and important part of paediatric practice. This survey suggests, however, that paediatric training and continuing education should have not reflected this practice. The overall method and content of developmental training including whether formal assessment tools should be taught needs to be reviewed and revised.

The Use of Two Language Tests to Identify Pragmatic Language Problems in Children With Autism Spectrum Disorders

Pragmatic language disorders (PLDs) are difficult to diagnose in a cost-effective manner, and there are few assessment tools that yield quantitative data. This investigation was designed to determine whether two formal assessment tools would differentiate PLDs in children with autism spectrum disorders (ASDs) from controls matched on verbal IQ and language fundamentals. Thirty-four matched participants were given the Test of Pragmatic Language (TOPL; D. Phelps-Terasaki & T. Phelps-Gunn, 1992) and the Strong Narrative Assessment Procedure (SNAP; C. J. Strong, 1998). Participants with ASDs had significantly poorer scores than controls on the TOPL. On the SNAP, the children with ASDs performed similarly to controls on syntax, cohesion, story grammar, and completeness of episodes. The controls performed significantly better only on the ability to answer inferential questions. The TOPL was effective in differentiating PLDs in children with ASDs when performance was compared tomatched controls. The SNAP did not clearly differentiatelanguage problems in these two groups. Research is needed to develop formal assessment tools that target the unique language disabilities of high-functioning individuals with ASDs.

Understanding Primary Care Physicians' Propensity to Assess Elderly Patients for Depression Using Interaction and Survey Data

The objective of this study was to examine primary care physicians' propensity to assess their elderly patients for depression using data from videotapes and patient and physician surveys. An observational study was informed by surveys of 389 patients and 33 physicians, and 389 videotapes of their clinical interactions. Secondary quantitative analyses used video data scored by the Assessment of Doctor-Elderly Patient Transactions system regarding depression assessment. A random-effects logit model was used to analyze the effects of patient health, competing demands, and racial and gender concordance on physicians' propensity to assess elderly patients for depression. Physicians assessed depression in only 14% of the visits. The use of formal depression assessment tools occurred only 3 times. White patients were almost 7 times more likely than nonwhite patients to be assessed for depression (odds ratio [OR], 6.9; P < 0.01). Depression assessment was less likely if the patient functioned better emotionally (OR, 0.95; P < 0.01). The propensity of depression assessment was higher in visits that covered multiple topics (OR, 1.3; P < 0.01) contrary to the notion of competing demands crowding out mental health services. Unexpectedly, depression assessment was less likely to occur in gender and racially concordant patient-physician dyads. Primary care physicians assessed their elderly patients for depression infrequently. Reducing the number of topics covered in visits and matching patients and physicians based on race and gender may be counterproductive to depression detection. Informed by videotapes and surveys, our findings offer new insights on the actual care process and present conclusions that are different from studies based on administrative or survey data alone.

Argument-based medical ethics: A formal tool for critically appraising the normative medical ethics literature

Although there are critical appraisal tools for other genres of the medical literature, there currently is no formal tool for physicians to use in their critical appraisal of the normative medical ethics literature. We present a formal assessment tool for the critical appraisal of the normative medical ethics literature that incorporates the intellectual standards of argument-based medical ethics and evidence-based medicine. We draw on the intellectual standards of argument-based ethics, ethical analysis and argument, and the literature on evidence-based medicine. The tool involves 4 questions about normative medical ethics papers: (1) Does the article address a focused ethics question? (2) Are the arguments that support the results of the article valid? (3) What are the results? (4) Will the results help me in clinical practice? Obstetrician-gynecologists can use this tool to appraise the normative literature of ethics in obstetrics and gynecology formally.

Evaluating Partnership

Partnerships are increasingly seeking tools that enable stakeholders to reflect on their own effectiveness, benchmark the status of their partnership and provide a framework for development. Drawing on the evaluation of two Health Action Zones, this article focuses on the use of one such formal assessment tool, adapted from the Nuffield Partnership Assessment Tool and the Verona Benchmark, to explore the contribution of formal tools to our understanding of partnership. It outlines some key methodological limitations and stresses the continued importance of an understanding of context alongside any measurement of partnership effectiveness. It is suggested that formal assessment tools can be extremely valuable in terms of the learning that can result both from the process itself and from the outcomes of the assessment. However, as a stand-alone device they are open to misinterpretation and unlikely to foster development other than in those partnerships prepared to invest the necessary resources in a broad-based evaluation.

Assessment of pain in the cognitively impaired older adult in long-term care.

This study's objectives were twofold: to identify pain assessment methods used by caregivers of cognitively impaired older adults in long-term care, and to identify medications ordered and administered to them. Over 60% of RNs, with fewer LPNs and CNAs, used formal pain assessment tools. Patient records identified that 77.5% of cognitively impaired patients had a regularly ordered pain medication and 91% had a PRN pain medication order. Thirty percent of patients received at least one PRN medication in a 1-week period. No one diagnosis was significantly associated with a greater tendency for PRN pain medications to be administered, with cancer a possible exception. Eighty-two percent of cognitively impaired patients had a PRN order for acetaminophen. Using minimum data set (MDS) criteria, this study found that patients with greater communication impairments received fewer pain medications.

Science teachers' diagnosis and understanding of students' preconceptions

AbstractResearch has established that students enter their science classes with ideas about the natural world that do not align with accepted scientificbeliefs. The diagnosis of these student preconceptions may be seen as aninitial, crucial step in the process of teacher‐facilitated conceptualchange. So as to capture what science teachers do in their everydayclassroom routines to diagnose these student preconceptions, in‐depthobservations and interviews were conducted with four exemplary secondaryscience teachers. The teachers' strategies for diagnosing students' preconceptions, their use of information found through diagnosis, and the teachers' understanding of students' preinstructional ideas were all analyzed. The four teachers in this study did not use any formal assessment tools such as pretests, concept maps, interviews, or journal writing to diagnose students' ideas, although they all stated that finding out what students know prior to instruction is important. The teachers all declared that they used questioning to gather information on student ideas but were seen in their classes to rely heavily on low‐level, recall questions. One of the teachers, the most experienced, did conduct class discussions where the students were encouraged to express their ideas and preconceptions. The four teachers' understanding of what student preconceptions consist of and the justification for attempting to diagnose these ideas was seen to be weak.The implications of these findings and recommendations for teacher trainingare made in the article. © 2003 Wiley Periodicals, Inc. Sci Ed 87:849–867, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/sce.10092