Nurses' assessment of pain in surgical patients

AIM: This paper reports a study to compare nurses' ratings of pain intensity and suffering (affect) in adult surgical patients with patients' own ratings of these variables, and to investigate whether pain ratings were influenced by cultural and ethnic differences. BACKGROUND: Studies show that postoperative pain continues to be under-treated in a large proportion of cases. The problem may be partly due to inaccurate pain assessment by nurses. METHOD: A convenience sample of 95 patients and 95 nurses in adult surgical units was selected from four hospitals in Jerusalem, Israel in 2003-2004. A questionnaire was administered to each patient by the researcher. The questionnaire included: (a) a Hebrew translation of the Short-Form McGill Pain Questionnaire for pain sensation, pain affect, and present pain intensity at rest and on movement; (b) visual analogue scales for overall pain intensity, suffering, and satisfaction with treatment; and (c) demographic and cultural data. Within a few minutes of the patient completing the questionnaire, a nurse who had been allocated to care for that patient made an independent assessment of the patient's pain. The nurse then left the patient's room and filled in the same questionnaire. FINDINGS: Nurses significantly underestimated all dimensions of pain on the above scales, but accurately assessed patient treatment satisfaction. There were no statistically significant effects for cultural and ethnic differences in pain assessment. Both types of clinical area where nurses worked and nurses' level of nursing education were found not to influence their assessment. CONCLUSION: The findings have implications for the management of postoperative pain by highlighting the need for more accurate pain assessment. Further research is required to elucidate the way in which nurses and patients conceptualize pain and to understand better the process of pain assessment in clinical nursing practice.     

Examining health visiting expertise: combining simulation, interview and observation

BACKGROUND: Resource constraints and the drive towards evidence-based practice are currently prompting the review of health visiting services, which are a costly element of community health services in the United Kingdom. There is a shortage of evidence about effective domiciliary health visiting practice that can inform local and national decisions about developing and reforming this service. AIMS: This paper is based on a study which aimed to articulate the health visiting expertise involved in recognizing and responding to client need during home visits. The paper describes the innovative, multi-method approach used to articulate this expertise, and presents the rationale for this unusual approach. DISCUSSION: The study used the complementary methods of a 20-minute simulated visit to an actress-client, a postsimulation focused interview and subsequent observation of actual home visits with 15 study participants. Data-gathering took place between 2001 and 2002. The rationale, strengths and limitations of the methodology are discussed, and recommendations made for further development based on the work. CONCLUSIONS: The findings confirmed the utility of this unusual combination of methods, with their blend of control and naturalism, for articulating the knowledge and expertise which underpins assessment practice. Further research using a similar approach is recommended for the systematic examination of professional expertise in nursing and multi-disciplinary contexts.     

高等护理专业法律教育课程的调查研究

目的通过对实习护生、临床带教老师和护理专业教师的问卷调查,旨在了解目前浙江省高等护理专业法律教育的现状、以及护生和护理专业教师对法律知识的掌握情况。方法采用自行设计的3份不同的问卷,分别随机对485名本、专科(含高职)实习护生、192名临床带教老师及75名护理专业教师进行问卷调查。结果目前高等护理法律教育课时数偏少,学期安排不尽合理;护生和护理专业教师法律基础知识薄弱等。结论高等护理专业应加强师生的法律教育,培养师资,改进教学方法,以提高学生的法律意识。     

病人关怀与实践课程的效果评价

目的评估“病人关怀与实践课程”结束后学生体验的效果。方法课程活动包括由专业辅导员带领辅导团体进行同理心体验,尔后让学生至附设医院陪伴病人及家属以及陪伴后分享相关经验三部分。参加学生为2005年入学的医学系一年级新生118人。结果学生回馈数据显示,经由课程设计之团体辅导及陪伴病人后,学生更能体验何谓同理心,并能体会到陪伴病人的正向情绪经验。结论学生参加“病人关怀与实践课程”,能使学生在正式接触医学专业之前,更了解如何同理病人、帮助别人,进而提升医学生的人文关怀。     

T型管植入治疗喉气管狭窄的护理

目的探讨喉气管狭窄行T型管植入术后的护理。方法对22例喉气管狭窄患者实施T型管植入治疗,术前行心理护理、完善的术前检查及沟通指导,术中保持呼吸道通畅并监测生命体征,术后行系统的基础护理、T型管护理、饮食护理、感染预防及并发症观察。结果 22例喉气管狭窄患者接受T型管植入治疗后,呼吸困难明显改善,随访0.5~2年,22例患者均无呼吸道狭窄,未发生护理并发症。结论精心的术前准备、密切的术中生命体征观察、完善的术后护理是T型管植入治疗成功的重要保障。     

PICC置管在白血病静脉化疗中的应用

目的 为白血病患者建立良好的静脉通道，避免化疗药物对外周静脉和局部组织产生不良反应。方法 经患者贵要静脉、肘正中静脉或头静脉插入PICC导管至上腔静脉中、下1／3处行化疗。结果 20例患者19例置管成功，占95％(19／20)，置管时间最短为5日，最长超过300日。结论 PICC置管是一安全、简便、并发症少、保留时间长、能有效保护外周静脉网、避免局部组织损伤的静脉通道，值得推广。     

将循证护理学纳入高等护理专业教学的探索

目的:探索高等护理专业开展循证护理学的教学模式。方法:将护理本科生120人随机分为三组,于不同时期开展循证护理学教学,将收集的资料用SPSS12.0统计软件包进行分析。结果:教学前后三组比较,经F多重检验,差异有统计学意义(P<0.05)。结论:将循证护理纳入高等护理教育既提高了护理教育的质量,又探索出了开展《循证护理学》的教学模式。     

运用质量管理工具降低护理不良事件发生率

目的通过分析我院护理不良事件发生的种类及引发因素,制定相应护理对策,从而降低护理不良事件的发生率。方法针对我院2014年非惩罚性上报护理部的42例护理不良事件,运用质量管理工具进行分析,提出整改措施并实施。结果通过实施改进措施后,护理不良事件发生率明显下降,差异具有统计学意义(P0.05)。结论质量管理工具使护理管理者抓住重点,有针对性地实施改进措施,有效降低护理不良事件发生率。     

Is the DNP the Answer to the Nursing Faculty Shortage? Not Likely!

The DNP is being touted as the answer to the faculty shortage. There is no evidence that DNP graduates are any more willing to embrace the low salaries of nursing faculty than PhD graduates. The idea of the DNP as the answer to the faculty shortage is challenged.     

Health visitors' assessments of parent-child relationships: a focus group study

BACKGROUND: Health visitors (HVs), also known as public health nurses, in the UK provide a universal community-based service to preschool children and their parents. Since they have ongoing supportive contact with almost all mothers and young children they have opportunities to identify problems in the parent-infant relationship: for example during developmental screening, home visits and immunisation clinics. Research into the role of screening for problems in the parent-child relationship in early childhood is sparse and little is known about how such problems are currently identified in the community. OBJECTIVE: To explore the approaches taken by health visitors (HVs) to identifying problems in the parent-child relationship. DESIGN: Focus group study. SETTING: Glasgow, Scotland. Participants: 24 health visitors sampled purposively. RESULTS: Multiple sources of information were used by health visitors in assessing parent-child relationships. These include use of known risk factors, knowledge of local norms, direct observations of behaviour, reflection on the relationship between the parent and health visitor, as well as more intuitive reactions. In many cases understanding difficulties in parent-child relationships involved piecing together a jigsaw over a considerable time span. Continuity of relationships appeared to be crucial in this task. Home visits were described as the most informative setting in which to develop an understanding of the parent-child relationship. Participants reported a lack of formal training in the assessment of parent-child relationships and were keen to obtain more training. CONCLUSIONS: Health visitors use complex strategies to integrate information about parent-child relationships. These strategies are acquired in a variety of ways, but receive little emphasis during basic professional training.