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.     

Associations between work schedule characteristics and occupational injury and illness

DE CASTRO A.B., FUJISHIRO K., RUE T., TAGALOG E.A., SAMACO‐PAQUIZ L.P.G. & GEE G.C. (2010) Associations between work schedule characteristics and occupational injury and illness. International Nursing Review 57 , 188–194 Background: Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer‐imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms. Aim: This study investigates how these work characteristics are associated with nurses' work‐related injury and illness over and above long work hours. Methods: In this cross‐sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work‐related health outcomes. Results: After weekly work hours, shift length and demographic variables were accounted for, non‐day shifts were associated with work‐related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work‐related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work‐related injury (OR = 1.22; 95% CI: 1.06, 1.41), work‐related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work‐related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44). Conclusions: These findings suggest that non‐day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse‐to‐patient ratios and work–family conflict, should be examined in future studies.     

Traditional practices used by infertile women in Turkey

AYAZ S. & YAMAN EFE S. (2010) Traditional practices used by infertile women in Turkey. International Nursing Review 57 , 383–387 Background: Numerous traditional methods are used in the treatment of infertility around the world. Aim: To identify the traditional practices of infertile women using one clinic in Ankara, Turkey. Design and Methods: The population comprised all women (5700) who attended one infertility outpatient clinic in 2007. The sample was calculated using sample calculation formula and 410 women were included in the study. The survey method was used for data collection. Findings: Of the responding women, 27.3% had tried a traditional practice, and 67.8% who tried traditional practices used an herbal mixture. The reason for the women's use of a traditional practice was ‘hope’ (66.9%), and 15.2% of them had experienced an adverse effect related with traditional practice. Maternal education level, perceived economic status, duration of marriage all significantly affected the use of traditional practices (P < 0.05). The women who had received unsuccessful medical treatment for infertility and who had experienced side effects after medical treatment had a higher rate of use of traditional practice (P < 0.05). Conclusions: Almost one in three of the women who responded to the questionnaire had tried traditional methods, and some experienced adverse effects related to the practice. For couples with infertility problems, educational programmes and consultation services should be organized with respect to their traditional culture. Women should be informed about the hazards of traditional practices and avoidance of harmful practices, and continuous emotional support must be provided for infertile couples. In the future, nursing staff should play a much larger role in these supportive services.     

Supporting Indian nurses migrating to New Zealand: a literature review

WOODBRIDGE M. & BLAND M. (2010) Supporting Indian nurses migrating to New Zealand: a literature review. International Nursing Review 57 , 40–48 Background: New Zealand, like many other Western countries, is struggling to cope with increasing demands for nursing services. Registered nurses are being actively recruited internationally and New Zealand has become a popular destination for nurses who wish to emigrate, including those from India. These nurses have unique cultural, professional and educational needs yet it is unclear how to best support them as they move to their destination countries. Aims: The issues around nursing migration and its effects have been discussed in many forums, but there is evidence of a gap in understanding the issues around acculturation and socialization. This selected literature review sought to identify the significant factors that impact on migrating nurses becoming competent and confident registered nurses in the New Zealand practice environment. Methods: A bibliographical database search was undertaken (Web of Knowledge, Web of Science, CINAHL, Medline, Academic Search Elite, and Ebscohost EJS) along with national and international nursing websites for the period 2002–2009. Search terms included Indian nurse, international nurse, migration, experience, cultural safety, globalization, nurse migration, nurse recruitment, New Zealand and research. The search was limited to texts published in English, with preference given to peer‐reviewed research‐based articles. Results: A significant volume of literature was located. The key themes that arose were migration, education, language, nursing skills, competence, cultural safety and reflection on practice. Literature considered to best reflect these main themes, and of most relevance to New Zealand, was selected for this review, with preference given to research reports and official nursing publications. Conclusion: Strategies such as providing ongoing professional education, ensuring cultural safety and offering mentoring in practice environments will contribute to a safe passage for migrating nurses. Further research is required into the acculturation and socialization of Indian nurses, especially those moving to New Zealand.