Critical Appraisal Bibliography, Scientific Abstract, and Matrix/Evidence Table

Introduction and Background As chronic and acute pain disorders continue to be diagnosed in the clinical setting, the number of patients searching for medical care in hopes of alleviating their symptoms is on the rise. Working in both medical and psychiatric facilities as a certified nursing assistant, I saw opioids frequently prescribed as a pharmacological treatment for individuals looking to lessen the pain associated with a multitude of pain related disorders. Working in long term care facilities, I watched individuals who had never struggled with substance use disorders develop clinical dependencies on narcotic medication due to the fact that they were prescribed opioids as a means of pain reduction. I watched as individuals who had no prior history of substance abuse or addiction begin to scream in anger and frustration every four hours demanding their medication the second it was available to them after undergoing an event that caused them to experience severe pain (e.g, invasive procedures, falls, etc). Being even a few minutes late to administer their narcotic medication could mean completely destroying a therapeutic rapport with a patient. I saw patients who were previously able to carry out pleasant conversation spending all day in an opioid induced stupor, declining in neurological functioning, and so high from their medication, they were unable to complete ADLs without extensive assistance from a member of the healthcare team. While the patient is not to blame for this phenomenon, as they are just doing what is available to them as treatment for their condition, the healthcare system is doing patients a disservice by not offering alternative forms of pain management for individuals suffering with pain related symptoms. Because of this, we became interested in researching the opioid crisis, how it came to be, and ways that healthcare providers can help to reduce the amount of patients who are forced to deal with clinical dependency and opioid induced debilitation by providing alternative forms of pain management, specifically for individuals experiencing post-operative pain, as it was the most common trigger of pain I saw in the patient populations I have worked with in the clinical setting. Purpose Statement The population we will be researching includes individuals experiencing postoperative pain, who would typically undergo pharmacotherapy with opioids to alleviate their symptoms. The interventions we will be researching include ways that the registered nurse and providers can help reduce their patient’s pain using different forms of alternative pain management that do not include opioid medication. We will be comparing the effectiveness and practicality of opioid therapy to that of other forms of pain management to better understand the ways that patients can work to reduce their pain symptoms in ways that do not include narcotic medication. The way we will evaluate outcomes is by evaluating the current literature surrounding the topic and comparing the results from studies comparing the effectiveness of opioid therapy and the results from alternative forms of pain management. Literature Review In order to research this topic in greater depth, we used google scholar, PubMed, and CINAHL to ensure that each source we used was evidence-based and peer reviewed to the information we gathered was accurate, unbiased, and applicable to the clinical setting. Some databases we utilized included The National Library of Medicine, The Journal of Nursing Regulation, & Arthroscopy: The Journal of Arthroscopic & Related Surgery, all evidence-based and peer-reviewed databases. Luckily, there is an objectively large amount of data existing around the concept of pain management, as it is such a prevalent problem for individuals seeking medical care. Findings After researching forms of alternative pain management for post operative patients, we found three concepts to explore as an alternative to narcotic medication for pain management. These three concepts include: acupuncture therapy, low dose steroid use, and medical cannabis. There is strong evidence to support the effectiveness of these three treatments for managing pain symptoms. While the research on medical cannabis for post operative pain tends to be limited due to legality issues and issues regarding how to correctly dose the drug, there is large evidence to support the effectiveness of cannabis for chronic pain disorders and neuropathy that can result from undergoing surgical procedures. Conclusion After reviewing these three concepts as a form of alternative pain management, we found that there is evidence to support these forms of treatment as a viable alternative to opioid medication, or by implementing these treatments, patients may be able to reduce the amount of opioids it takes to alleviate their pain, reducing their chances of developing side effects or overdosing. There are gaps in the literature regarding cannabis as an effective treatment for acute pain due to complications of researching a schedule one substance, but there is evidence to support cannabis as a treatment for chronic pain issues that can develop from invasive surgical procedures. It is important that nurses are informed about these methods of alternative pain management in order to ensure that their clients are undergoing the best course of care possible if opioids are not a reasonable form of treatment for managing postoperative pain

A FIELD STUDY TO DETERMINE EMPLOYERS\u27 LEVELS OF SATISFACTION WITH THE MENTALLY HANDICAPPED STUDENTS ENROLLED IN THE OMAHA PUBLIC SCHOOLS\u27 WORK EXPERIENCE PROGRAM

Purpose. This study measured employers\u27 satisfaction with mentally handicapped students participating in Omaha, Nebraska\u27s public schools\u27 work experience program from 1976 through 1981. Instrument. An eighty-six item Likert scale questionnaire was sent to 100 randomly selected employers. Jobs were classified as food or nonfood service. Findings. Major findings revealed employers were most satisfied with students\u27 conduct in the areas of: (1) grooming and hygiene, (2) behavior on the job, (3) keeping track of time, (4) responsibility to employers, and (5) recognizing position of employer. Employers were least satisfied with students in the areas of understanding: (1) job search practice, (2) interviewing techniques, (3) company benefits, (4) salary schedule, and (5) abilities and limitations. Conclusions. The study concludes that employers were generally satisfied with students. Food service employers were more satisfied than those in nonfood service, and they were generally more satisfied with boys than girls. Recommendations. Study recommendations included: (1) The Omaha school district should implement and evaluate a course for handicapped students prior to their on-site work experience that concentrated on areas of weakness identified by employers in this study. (2) A program for continuing evaluation of the program should be initiated