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.     

General practitioners' views on a mental health service

Aim : This study set out to investigate general practitioners (GPs) views on a Mental Health Service. It seeks their views on how well the Trust is providing those services and suggestions for change and development of the service.
Method : A short survey questionnaire which addressed the major services offered was sent to all GPs in the Grampian region. The data were analysed using non-parametric statistical techniques.
Findings : Maybe rather surprisingly, GPs felt that the service provision overall was of a good standard. Two areas which GPs suggested required more provision were highlighted.
Conclusion : The survey was used to inform Trust Management of GPs views and as a basis for meetings with GPs about the service. As a result new services have been developed.     

Achieving partnership: the contribution of nursing education to the production of a flexible workforce

Aim : This paper examines education's contribution to labour force reform in the nursing profession within the United Kingdom.
Background : In a globalized society there is increasing demand for more flexible forms of working. Nursing faces radical change in its employment characteristics if it is to continue to meet the health care needs of the population in the new century.
Origins of information and data analysis : Key sociological texts and contemporary analysis of nursing skill have been analysed and synthesized to identify the dynamic of change in nursing and nursing education's contribution to these changes.
Key issues : Patterns of upskilling and multiskilling are leading to the breakdown of professional role boundaries in the broader workforce. These patterns can also be seen in nursing. Upskilling is associated with increased stress and 'risk' for the individual, therefore achievement of flexibility is not without cost. Changes in the skill level in nursing lead many to conclude that the profession will become divided into a core and periphery distinction. This simplistic analysis does not account for the complexities of nursing and nursing skill although there is clearly a growing need for a 'knowledge and technical elite'.
Conclusions : The core–periphery distinction is too simplistic to analyse nursing skills and the dynamic of change in the workforce. A radical perspective of nursing characterized by workers with a range of skills and competencies is less likely to lead to rigid professional boundaries. There is a clear need for multiskilled and knowledgeable workers; the 'technical and knowledge elite'. These nurses may be recognized as advanced practice nurses. High quality education is required to prepare these practitioners. Adaptation of nursing to the postmodern world needs to be facilitated by changes in current educational policy and practice.     

A retrospective study of spinal cord injuries in Cape Province rugby players, 1963-1989. Incidence, mechanisms and prevention.

A retrospective study was undertaken to determine aetiological factors for 117 catastrophic neck injuries in rugby players admitted to the Spinal Cord Unit, Conradie Hospital, Cape Town, between 1963 and 1989. Nineteen of these players were known to be dead; the files of another 10 were missing. Questionnaires were sent to the remaining 88 players and 52 responded (59%). Their data were supplemented with information obtained from the medical records of the patients who did not respond. The annual number of admissions increased dramatically after 1976 with 83% of all injuries occurring after that date. A further increase since 1984 contrasts with a falling incidence of these injuries in Britain, Australia and New Zealand. Increased risk of injury was related to the following factors: 98% of injuries occurred in matches and 81% were incurred by adults; 69% of injuries occurred in age-group A team or senior first team players; and 57% of injuries occurred in the tackle situation and 39% in scrums, rucks and mauls. Hooker, centre and flyhalf were the playing positions at greatest risk. Injuries were more common in early season matches and again after the mid-season break. This study confirmed that spinal cord injuries occur under predictable circumstances and are therefore foreseeable and preventable. The high incidence of these injuries in the Cape Province is as unacceptable today as it was when first reported in 1977.     

Protectionism or competition in managing British nursing research? Current debate among nurse and midwifery teachers

Aim   The intention is to highlight key issues related to research by nurse and midwifery teachers.
Background   The debate centres on the 'culture change' facing teachers from traditional colleges moving to universities where a more formal research requirement prevails.
Origins of information   Data were drawn from selected official reports and other literature informing the introductory discussion. Emerging themes were discussed by 25 nurse and midwife teachers at Forresterhill College, Aberdeen in March 1996 and their views were recorded and analysed.
Data analysis   Selected documents and discussion records were reviewed, using a thematic approach.
Key issues   Main themes concerned nursing as art and science, balance between multidisciplinary and unidisciplinary research and ring-fencing nursing research funds.
Conclusions   Anxieties among teachers centred on the increased research requirement in universities with possible neglect of teaching excellence.