Barriers to adequate pain management in hospice and palliative care settings are an important area of investigation. In this study, a Caregiver Pain Medicine Questionnaire (CPMQ) was developed and psychometrically tested. The CPMQ is a 22-item self-report instrument that measures concern about reporting pain, concern about administering analgesics, and difficulty administering analgesics. One hundred fifty-one caregivers of patients admitted to three Chicagoland hospice agencies participated; these individuals were family members, hired caregivers in the home, or staff nurses in skilled care facilities. While only a small percentage of the caregivers expressed concern about communicating information about the patient's pain, more than a quarter were concerned about addiction, tolerance, and side effects from medications. A fourth of the caregivers had difficulty administering medications because of fear of doing something wrong and difficulty deciding which or what amount of medications to give. Male caregivers and hired caregivers had greater concerns, both about reporting information about the patient's pain and administering medications. Greater concerns were also evident among less educated caregivers, caregivers who worked in blue-collar jobs, and caregivers who were homemakers or retired. Concerns of caregivers in the home were significantly greater than staff nurse caregivers in skilled care facilities only in the belief that pain could not be controlled and concern about addiction. Caregivers who had greater concern about addiction and tolerance, and more difficulty administering medications, rated the patient's pain as less completely controlled. These findings remind hospice staff members of the importance of assessing specific caregiver concerns about medication administration and devising appropriate strategies to address them.
Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.
Abstract-TheNational Aeronautics and Space Administration's (NASA's) Space Launch System (SLS) Program, managed at the Marshall Space Flight Center, is making progress toward delivering a new capability for human spaceflight and scientific missions beyond Earth orbit (BEO). Developed with the goals of safety, affordability, and sustainability in mind, the SLS rocket will launch the Orion Multi-Purpose Crew Vehicle (MPCV), equipment, supplies, and major science missions for exploration and discovery. Making its first uncrewed test flight in 2017 and its first crewed flight in 2021, the SLS will evolve into the most powerful launch vehicle ever flown, capable of supporting human missions into deep space and to Mars. This paper will summarize the planned capabilities of the vehicle, the progress the SLS Program has made in the years since the Agency formally announced its architecture in September 2011, and the path the program is following to reach the launch pad in 2017 and then to evolve the 70 metric ton (t) initial lift capability to 130 t lift capability. The paper outlines the milestones the program has already reached, from developmental milestones such as the manufacture of the first flight hardware and record-breaking engine testing, to life-cycle milestones such as the vehicle's Preliminary Design Review in the summer of 2013. The paper will also discuss the remaining challenges in both delivering the 70 t vehicle and in evolving its capabilities to the 130 t vehicle, and how the program plans to accomplish these goals.In addition, this paper will demonstrate how the Space Launch System is being designed to enable or enhance not only human exploration missions, but robotic scientific missions as well. Because of its unique launch capabilities, SLS will support simplifying spacecraft complexity, provide improved mass margins and radiation mitigation, and reduce mission durations. These capabilities offer attractive advantages for ambitious science missions by reducing infrastructure requirements, cost, and schedule. A traditional baseline approach for a mission to investigate the Jovian system would require a complicated trajectory with several gravity-assist planetary fly-bys to achieve the necessary outbound velocity. The SLS rocket, offering significantly higher C3 energies, can more quickly and effectively take the mission directly to its destination, providing scientific results sooner and at lower operational cost.The SLS rocket will launch payloads of unprecedented mass and volume, such as "monolithic" telescopes and in-space infrastructure, and will revolutionize science mission planning and design for years to come. As this paper will explain, SLS is making measurable progress toward becoming a global infrastructure asset for robotic and human scouts of all nations by harnessing business and technological innovations to deliver sustainable solutions for space exploration.
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