Pain in elderly orthopaedic patients

Summary

• ? This paper focuses on one aspect of a study of elderly orthopaedic patients, namely pain control.
• ? One-hundred patients aged 70 years and over were interviewed on up to five occasions during admission to an acute orthopaedic unit.
• ? The majority of patients had significant post-operative and/or post-trauma pain, and backache and joint pain were reported frequently.
• ? None of the patients received more than half of the maximum prescribed number of doses of opioid analgesics over a period of 48 h following surgery.
• ? The well-recognized problem of inadequate pain relief among hospital in-patients is discussed, in particular its relevance to elderly orthopaedic patients.

     

The experiences of mothers caring for a child with severe atopic eczema

• ? Atopic eczema is a relatively common disease which frequently occurs during childhood.
• ? This paper reports the findings of a research study which explored the effects upon family life of caring for a child with severe atopic eczema.
• ? Seventy-seven accounts written by mothers of preschool children with this disease were analysed using qualitative latent content analysis.
• ? The focus of this paper is on the implications of the disease for the mothers' role and the additional work generated by the disease.
• ? The implications of these findings for nursing practice, in particular the work of health visitors and paediatric community nurses, is discussed.
• ? Throughout this paper the term ‘nurse’ is used to describe both nurses and health visitors.

     

Do health visitors promote client participation? An analysis of the health visitor—client interaction

Summary

• ? This paper presents one aspect of a larger study the aim of which was to explore and describe the extent to which clients participate in family health-promotion encounters with health visitors.
• ? The health visitor–client interaction during a home visit was seen to be the most appropriate setting in which to carry out the study.
• ? Analysis of 62 tape-recorded interactions and 75 paired interviews revealed that client participation is rarely initiated by the client or elicited by the health visitor.
• ? This has implications for the future education and practice of health visitors when they are being asked to take a more empowering approach to health promotion.

     

Spousal caregiving in the institutional setting: visiting

• ? The purpose of this study was to investigate the visiting experience of wives whose husbands had been admitted to a long-term care institution.
• ? The study employed a longitudinal and prospective design and combined qualitative and quantitative approaches.
• ? The data were drawn from a larger study designed to explore the transition to quasi-widowhood.
• ? This article reports on one aspect of spousal caregiving following the admission of a husband to a long-term care setting, i.e. visiting.
• ? In this study, wives visited frequently. Their reasons for visiting included love and devotion, duty and obligation, the monitoring of husbands' well-being and the provision of assistance to both husbands and staff. They engaged in task performance and social interaction during visiting. Their feelings of satisfaction and enjoyment with visiting were associated with their husbands' well-being and feeling useful.
• ? Over the 9-month period of the study, two patterns of visiting and involvement emerged that were associated with different outcomes related to depression, morale and satisfaction with institutional dimensions of care.

     

Maternal–infant attachment following caesarean delivery

• ? A study group of 50 low-risk primigravidae of normal stature delivered by emergency caesarean section during the course of labour were compared with a closely matched control group of 50 primigravidae delivered vaginally.
• ? Data for the purposes of the study was collected from a number of sources including semi-structured interviews on the 3rd or 4th postnatal day and 6 months after the birth.
• ? Women delivered by emergency caesarean section took significantly longer than those delivered vaginally to feel close to their infants and these differences persisted for several months.
• ? Contact between women delivered by caesarean section and their babies was found to be restricted in the 24 h following caesarean delivery.
• ? This paper focuses on maternal-infant attachment following delivery, and discusses some of the implications of the findings for midwifery practice.

     

Introduction to Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010

• ? Introduction to Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010
• ? Planning for Neonatal Resuscitation and Identification of the Newborn Infant at Risk. ARC and NZRC Guideline 2010
• ? Assessment of the Newborn Infant. ARC and NZRC Guideline 2010
• ? Airway Management and Mask Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010
• ? Tracheal Intubation and Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010
• ? Chest Compressions during Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010
• ? Medication or Fluids for the Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010
• ? The Resuscitation of the Newborn Infant in Special Circumstances. ARC and NZRC Guideline 2010
• ? After the Resuscitation of a Newborn Infant. ARC and NZRC Guideline 2010
• ? Ethical Issues in Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010

     

Protecting privacy during video recording resuscitations

The practice of video recording resuscitations is reviewed with respect to the following issues:

• ? the protection of patients' rights to privacy during and after recordings
• ? the non status of recordings as a medical record
• ? the need for staff acceptance and institutional approval prior to beginning recordings
• ? the use of recordings for quality improvement audit, critical incident monitoring, instructional feedback and resuscitation review conferences
• ? the recommendation that recordings are then erased, and
• ? the utility of legislative protection to facilitate the process of quality improvement.

     

Evaluation of a new night nursing service for elderly people suffering from dementia

• ? A new night hospital nursing service was developed for older people with dementia.
• ? A case study approach to evaluation was adopted using a structure-process-outcome quality assurance cycle.
• ? The effects and attendance of patients are reported and discussed.
• ? Discussion relating to care provision for the future is presented.
• ? The effects on carers of patients' attendance are briefly discussed.

     

The management of diabetes in adolescents and young adults: a preliminary case study

• ? This paper describes one part of a first-stage study concerned with the care received by a group of adolescents and young adults with insulin-dependent diabetes mellitus (IDDM) in one district health authority.
• ? The paper reports findings from a self-selected sample of 30 patients aged between 15 and 25. Each of the 30 patients was interviewed during a routine appointment at a diabetes clinic. The patients' doctor at the clinic and one of the diabetes specialist nurses also filled in a short questionnaire for each of the patients interviewed.
• ? The main finding was that although all 30 patients interviewed reported that their diabetes control was at least moderately good, a significant number of patients had blood glucose levels above the recommended norm.
• ? The study lends support to the widely held belief that young adults with diabetes have particular difficulties in maintaining blood glucose levels within a normal range.
• ? It is suggested that processes within the current mode of care may be contributing to this poor level of control. Recommendations for a controlled trial of specialist nurse versus doctor care are made.

     

If you are pregnant and smoke,admission to hospital may damage your baby's health

Summary

• ? It is recognized that smoking adversely affects the outcome of pregnancy. However, clinical experience suggested that women admitted to hospital during pregnancy smoked more than when they were at home.
• ? Forty-one women who were over 20 weeks pregnant, who smoked and had been in hospital for 2 days or more were interviewed using a structured schedule.
• ? The women had made a significant reduction in their cigarette consumption during pregnancy but on admission to hospital the number of cigarettes smoked had almost returned to the pre-pregnancy level. Boredom was seen as the main factor contributing to this increase.
• ? Strategies for reducing the effects of admission to hospital on smoking behaviour are suggested.

     

The impact of nurses' encounters with cancer on their attitudes towards the disease

Summary

• ? A study to develop understanding of nurses' knowledge, confidence and educational needs in relation to cancer care was undertaken.
• ? Data from this study on nurses' attitudes and the effect of professional encounters with cancer on such attitudes are presented.
• ? A cancer attitude scale was completed by 127 nurses, and 68 of the sample were interviewed in depth.
• ? Data presented reveal a pervasive negative attitude towards cancer amongst these nurses, and the important negative impact that professional encounters with cancer have on nurses' feelings about the disease.
• ? Data presented are taken from a larger study, which is reported elsewhere (Corner, 1990; Corner & Wilson-Barnett, 1992).

     

Community psychiatric nurses for the elderly: well tolerated,few side-effects and effective in the treatment of depression

• ? Depression in elderly people is a common yet treatable psychiatric problem.
• ? The Gospel Oak depression study researched this much overlooked group and has shown that a community psychiatric nurse (CPN) was able significantly to improve the mental state of depressed elderly people.
• ? A multifaceted package of care was co-ordinated and delivered by one CPN over a study period of 3 months.
• ? A detailed account is given of those interventions implemented, highlighting those which were of most benefit for the patient.
• ? Outcome was assessed independently and it was found that those patients allocated to CPN care improved significantly compared to the non-intervention control group.
• ? Ways in which nurses can enhance care given to patients in the community are discussed.

     

Post-operative patients' views of sleep,pain and recovery

• ? One-hundred patients who had undergone abdominal surgery were interviewed about their experiences of pain and sleep.
• ? Pain was the most common cause of disturbed sleep and half of the patients felt that pain was worse during the night.
• ? More than one-third of the sample felt that tiredness affected post-operative pain, for the most part making it worse.
• ? One-third felt that sleep reduced pain intensity, three-quarters felt that sleep helped them to cope with their pain and almost all believed that sleep enhanced recovery from surgery.
• ? For the post-operative patient, therefore, pain and sleep cannot be considered separately.
• ? Methods for the effective assessment and control of pain at night (leading to associated improvements in sleep) require development by nurse researchers and practitioners.

     

A pilot study of the prevalence and psychological sequelae of sexual harassment of nursing staff

Summary

• ? A pilot study of nurses and nursing auxiliaries was carried out to determine the prevalence and psychological sequelae of sexual harassment.
• ? Thirteen nurses and 22 nursing auxiliaries were interviewed.
• ? Sixty per cent reported having experienced sexual harassment on at least one occasion.
• ? The results showed that the predominant experience typically occurred:

• – to female nursing staff;
• – by male patients;
• – on the wards;
• – often while washing patients.

• ? There was minimal reporting of the incident.
• ? The overriding emotion felt was embarrassment which was perceived as resulting in impaired work performance.

     

A study of the efficacy of dressings in preventing infections of continuous ambulatory peritoneal dialysis catheter exit sites

• ? This paper describes a preliminary investigation into the efficacy of dressings in preventing catheter exit site infections in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). It has been carried out in the form of a pilot study.
• ? The background to the study is described and the literature is reviewed. This revealed that it is an important field of research.
• ? Exit site infections are the main cause of morbidity and treatment failure in CAPD patients.
• ? The rationale for carrying the study out, the findings and the implications for further study are reported and discussed.
• ? There is little guidance in current literature for clinicians on the prevention of catheter exit site infection. Patients are difficult to recruit to research studies. Practising nurses need training and careful management as data collectors.

     

Increased parental participation in a paediatric surgical day-care unit

• ? Day care is currently a common way of providing treatment for minor and average paediatric surgical procedures.
• ? The purpose of this study was to assess possible benefits of increasing parental involvement in the care of operated children in a day-care surgery unit.
• ? By giving parents information and education about post-operative care, the goal was to facilitate recovery and minimize time spent in hospital.
• ? Results show that parents in the intervention group were well prepared to assume a greater part of the care of their children.
• ? Children in the intervention group appeared to have less pain and fewer children vomited post-operatively than children in the control group.

     

Admission to care: facilitating role transition amongst family carers

• ? Admission to care after a period of family care-giving has been the focus of much recent research.
• ? Rather than being seen as an end in itself, admission is part of a process.
• ? This article concentrates on ‘reaching the end’ of family care-giving and the ‘new beginning’ of entering residential care.
• ? A cross-national study conducted in the USA and the UK is discussed, and similarities and differences in the two cultures are highlighted.
• ? Decisions to enter a nursing home were often taken hurriedly and with lack of information in both countries.
• ? Issues of quality of care and emotional responses by former carers were also important in both settings.

     

Maintenance of closed urinary drainage systems: are practitioners more aware of the dangers?

Summary

• ? An indwelling urethral catheter predisposes patients to local or systemic infection, and to problems related to infection such as encrustation. Although some infections may be unavoidable others, in particular those originating from contaminated drainage bags, may be related to nursing management.
• ? A prospective longitudinal study recorded the errors in practice occurring during the care of 334 patients in a UK district general hospital. Independent observations of bag emptying by nurses were recorded for 66 patients.
• ? Disconnections occurred on 107/972 (11%) occasions, incorrect techniques when emptying the drainage bag were observed on 6–7% of occasions; but incorrect positioning of the bag was rarely recorded.
• ? Significant bacteriuria occurred in 88/334 patients, but cultures from the nurses gloved hands were consistently negative. These results are compared with those obtained during a survey in 1984, and the implications for nursing practice discussed.

     

A supportive–educative caring rehabilitation programme; improvements of physical health after myocardial infarction

• ? The aim of this study was to evaluate the effects of a supportive–educative caring rehabilitation programme involving interdisciplinary efforts to improve the physical health of myocardial infarction patients (MI-patients).
• ? MI-patients chosen at random participated either in a 6-month programme or normal medical follow-up.
• ? Instruments designed for both subjective and objective measuring of recovery of physical health were used.
• ? Subjective capacity showed significant differences (P 0·05-0·001) concerning: (i) reported pain and exertion 5 weeks and 6 months after MI during physical exercise, (ii) perceived breathlessness, chest pain, fatigue, physical fitness 6 and 12 months after MI, and (iii) reported callisthenics and coitus 6 and 12 months after MI.
• ? Significant differences (P 0·05-0·001) in objective capacity were indicated concerning: (i) a symptom-limited submaximal physical exercise test 5 weeks and 6 months after MI, and (ii) reinfarctions 12 months after MI.
• ? The strength of the study rests on the fact that the improvements of physical health could be statistically verified, regarding both subjective and objective capacity of the MI-patients. The described caring efforts are simple, easy to carry out and take little time for the MI-patients and their next-of-kin as well as for the health-care personnel.