Barriers to,and facilitators of post‐operative pain management in Iranian nursing: a qualitative research study

Background: Unrelieved post‐operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. Aim: To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post‐operative pain. Methods: This study was qualitative with 26 participant nurses. Data were obtained through semi‐structured serial interviews and analysed using the content analysis method. Findings: Several themes emerged to describe the factors that hindered or facilitated post‐operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post‐operative pain management that included the nurse–patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Conclusion: Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.     

Estimating nurses' workload using the Diagnosis Procedure Combination in Japan

Aim:  To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC).
Methods:  For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub-arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3-year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self-report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource-based relative value scale.
Results:  Twenty-five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC.
Conclusion:  The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload.     

Growing together: a qualitative study of leading nurse scholars in Thailand

TURALE S., KLUNKLIN A. & CHONTAWAN R. (2010) Growing together: a qualitative study of leading nurse scholars in Thailand. International Nursing Review 57 , 202–210 Background: Asia‐Pacific nursing education and research is growing but little is known about the nature and development of nursing scholarship in the region. Aim: This qualitative study explored the perspectives of 14 leading Thai scholars about the development, facilitators and barriers relating to Thailand's nursing scholarship. Method: In‐depth interviews were digitally recorded, and data were subjected to content analysis. Findings: Five themes arose: (1) growing together, (2) visionary leadership, (3) external support to grow nurse scholars, (4) developing nursing through research, and (5) barriers to scholarship. A history of visionary nursing leadership was revealed, underpinned by leaders' values of growing nursing together. Resource sharing among universities, and a significant number of scholarships for study abroad were major facilitators of scholarship growth. Barriers to scholarship included high teaching loads, especially for newly graduated faculty; a low rate of research publications; not enough mentorship for research and changes to teaching practice; and a wide range of different agencies providing courses for entry to practice. Conclusions: Scholarship development in Thailand is a role model for a number of South‐East Asian countries, with inclusiveness and collaboration to facilitate the growth of nursing education inside and outside of the country as a hallmark of its character. However, against a backdrop of nursing shortages, Thai scholars are challenged, in the future, to produce meaningful research outcomes, including publications of studies; to collaborate with other health professionals; change practices to overcome high teaching loads; and provide the much needed mentorship for young scholars.