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Issue 107 - 26 August 2009

Articles

1. Editorial: This might hurt ... a reflection on pain management in the 21st century
by Haigh, Carol. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p1961-1962
Abstract:
The author reflects on pain management in the 21st century in Great Britain. She suspects that pain control and pain management continue to be areas of interest and concern for medical practitioners all over the world. The author believes that the reason for the failure of understanding the mechanism of pain is turning the importance of pain management into glib truisms.

2. A systematic review of wound cleansing for pressure ulcers
by Moore, Zena & Cowman, Seamus. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p1963-1972
Aim.
The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing.
Background. Pressure ulcers impose a significant financial burden on health care systems and negatively affect the quality of life. Wound cleansing is an important component of pressure ulcer care; however, there is uncertainty regarding best practice.
Design. Systematic review.
Methods. The Specialised Trials Register of the Cochrane Wounds Group, the Cochrane Central Register of Controlled Trials and bibliographies of relevant publications were searched. Drug companies and experts in the field were also contacted. Randomized controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion. For dichotomous outcomes, relative risk (RR) plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified.
Results. No studies compared cleansing with no cleansing. A statistically significant improvement in healing occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline ( p = 0·025). No statistically significant change in healing was seen when water was compared with saline (RR 3·00, 95% CI 0·21, 41·89). No statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2·10, 95% CI 0·93–4·76). Conclusion. There is little trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers.
Relevance to clinical practice. No firm recommendations for ways of cleansing pressure ulcers in clinical practice can be made, the lack of RCT evidence should be a concern for health care providers. [ABSTRACT FROM AUTHOR]

3. A systematic review of silver-releasing dressings in the management of infected chronic wounds
by Shu-Fen, Lo et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p1973-1985
Aim.
This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds.
Background. Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so. Methods. A systematic review of literature from 1950–May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds.
Results. Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors.
Conclusion. The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies.
Relevance to clinical practice. This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment. [ABSTRACT FROM AUTHOR]

4. Pain management: a review of organisation models with integrated processes for the management of pain in adult cancer patients
by Brink-Huis, Anita et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p1986-2000
Aims and objectives.
This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness.
Background. Pain is experienced by 30–50% of cancer patients receiving treatment and by 70–90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process.
Design. Systematic review.
Method. The review involved a systematic search of the literature, published between 1986–2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases.
Conclusion. Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a ‘stand-alone’ model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes.
Relevance to clinical practice. We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed. [ABSTRACT FROM AUTHOR]

5. The impact and effectiveness of nurse-led care in the management of acute and chronic pain: a review of the literature
by Courtenay, Molly & Carey, Nicola. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2001-2013
Aims and objectives.
To identify, summarise and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in acute and chronic pain.
Background. A diverse range of models of care exist within the services available for the management of acute and chronic pain. Primary studies have been conducted evaluating these models, but, review and synthesis of the findings from these studies has not been undertaken.
Design. Literature review.
Method. Searches of Pubmed (NLM) Medline, CINAHL, Web of Knowledge (Science Index, Social Science index), British Nursing Index from January 1996–March 2007 were conducted. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by
contact with experts in the field. Results. Twenty-one relevant publications were identified and included findings from both primary and secondary care. The areas, in which nurses, caring for patients in pain are involved, include assessment, monitoring, evaluation of pain, interdisciplinary collaboration and medicines management. Education programmes delivered by specialist nurses can improve the assessment and documentation of acute and chronic pain. Educational interventions and the use of protocols by specialist nurses can improve patients understanding of their condition and improve pain control. Acute pain teams, led by nurses, can reduce pain intensity and are cost effective.
Conclusions. Nurses play key roles in the diverse range of models of care that exist in acute and chronic pain. However, there are methodological weaknesses across this body of research evidence and under researched issues that point to a need for further rigorous evaluation. Relevance to clinical practice. Nurse-led care is an integral element of the pain services offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in acute and chronic pain. [ABSTRACT FROM AUTHOR]

6. Knowledge and attitudes regarding pain management among nurses in Hong Kong medical units
by Lui, Liza Y et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2014-2021
Aims.
To investigate knowledge levels and attitudes regarding pain management among nurses working in medical units in Hong Kong and factors that might influence their knowledge and attitudes.
Background. Pain, a common symptom for patients in medical units, can be relieved by effective pain management. Nurses have a vital role in implementing pain management effectively and must, therefore, have a solid foundation of knowledge and a positive attitude towards pain management. Design. Cross-sectional study.
Methods. A self-administered survey including demographics and the nurses’ knowledge and attitudes survey regarding pain-Chinese version (NKASRP-C) was completed by 143 nurses working at medical units in a public hospital. Descriptive statistics and stepwise regression were used in the data analysis.
Results. A deficit in knowledge and attitudes related to pain management was prominent (percentage of total score = 47·72, range = 20–76%). Although nurses had developed appropriate attitudes towards pain management, discrepancies between practice and attitudes existed. Those with a higher percentage of correct scores in NKASRP-C had longer clinical working experience and applied knowledge of pain to their daily work.
Conclusions. The findings of this study, identifying problems of inadequate knowledge and inappropriate attitudes regarding pain management, are of concern. A better understanding of the factors that affect such knowledge and attitudes and of the discrepancy between attitudes and practice, can provide useful information to be included in education programmes for nurses and to inform policy on the provision of pain management. Relevance to clinical practice. To improve nurses’ knowledge and attitudes regarding pain management, the educational curriculum may include the pharmacological area, patient assessment and the integration of knowledge about pain into daily practice. It is hoped that the results of this study may increase an awareness of knowledge deficit among nurses and help them to find ways of making changes to their practice. [ABSTRACT FROM AUTHOR]

7. Pain management: evaluating the effectiveness of an educational programme for surgical nursing staff
by Pi-Chu Lin et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2022-2031
Aims and Objectives.
The purpose of this study was to assess the effectiveness of a pain management education programme in improving the nurses’ knowledge about, attitude towards and application of relaxation therapy.
Background. Pain of surgical patients has long been an existing problem of health care. Nursing staff need to be educated continuously to develop the professional ability of pain management. Methods. A quasi-study design with pre- and posttest and post- and posttest was used. Subjects were chosen from a medical centre in Taipei by convenience sampling. The total sample size of 81 was segregated into a study group of 42 and control group of 39 participants.
The study group attended a seven-session pain management programme totalling 15 hours. The control group received no pain management training. Scaled measurements were taken on pain management knowledge and attitude and relaxation therapy practice.
Results. (1) Scores for pain management knowledge differed significantly between the two groups ( F = 40·636, p = 0·001). (2)Attitudes towards pain management differed between the two groups ( F = 8·328, p = 0·005) and remained stable over time ( F = 1·603, p = 0·205). (3) Relaxation therapy practice differed significantly between the two groups, with the study group better than the control group ( F = 4·006, p = 0·049). (4) Relaxation therapy was applied to nearly all (97·5%) of the patients cared for by study group nurses. All of the instructed patients performed this technique one to three times per day postsurgery.
Conclusions. Continuing education can improve nurses’ knowledge about, attitude towards and behaviour of pain management. Relevance to clinical practice. Results of this study could be used to guide the development and implementation of continuing education programmes for nursing staff to enhance patients’ care knowledge and skills. [ABSTRACT FROM AUTHOR]

8. District nurses’ involvement in pain care: a theoretical model
by Blomberg, Anne-Marie et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2032-2041
Aim.
To explore district nurses care of chronic pain sufferers and to create a theoretical model that can explain the variation in district nurses experiences when caring for these patients. Background. Many people suffer from chronic pain, which greatly affects their wellbeing and causes physical suffering and psychosocial limitations. District nurses frequently meet patients who suffer from chronic pain and consequent problems. District nurses often feel powerless and ill-equipped, and they experience difficulties during interactions with these patients. Method. This is a qualitative study with a theory-generating approach. Data were collected from interviews with 20 district nurses in five focus groups. Interviews were taped, transcribed and then analysed as per the grounded theory method.
Results. The result is a theoretical model of district nurses’ involvement in pain care. The model: (1) illustrates three
main conditions in the care situation that influence district nurses’ involvement in pain care and (2) explains the connection between how district nurses actively or passively detect and actively or passively respond to patients with pain problems.
Conclusions. The model explains why district nurses sometimes
feel powerless or ill-equipped in dealing with chronic pain problems. Insufficient conditions make it difficult for district nurses to become involved with pain problems and thus result in passive detection of and passive response to pain problems. Supporting patients to communicate their pain, collaboration with and involvement from other professionals regarding pain care, the organisation’s guidelines and support for pain care and training in pain care are interventions that will contribute to district nurses’ involvement in pain care.
Relevance to clinical practice. Through the model, chronic pain care can be better explained and understood; consequently chronic pain care can be improved. The model can be used in each, unique, case-study analysis. Nursing staff and students can also use the model as a basis for discussions about chronic pain sufferers. [ABSTRACT FROM AUTHOR]

9. Postoperative pain management – the influence of surgical ward nurses
by Ene, Kerstin Wickström et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15:p2042-2050
Aim.
To compare pain levels reported by patients with those documented by ward nurses and to find out to what extent the amount of opioids given correlated with the pain level. Secondly, to study if pain management and nurses’ approaches to this task had improved during a two-year period, including an educational pain treatment program for ward staff.
Background. The management of postoperative pain continues to remain problematic and unsatisfactory and ward nurses play an important role for this task.
Design. The study was a cross-sectional, descriptive, two-part study based on survey data from both patients and nurses on two urology surgical wards.
Methods. Part I of the study included 77 patients and 19 nurses. Part II took place approximately two years later and included 141 patients and 22 nurses. Data were collected the day after surgery by asking patients about ‘worst pain’ experienced. The pain scores given by the patients were compared with those documented in the patients’ records and with the doses of opioids administered. Nurses’ approaches to pain management were sought after, by using a categorical questionnaire.
Results. The nurses’ ability to assess pain in accordance with the patients’ reports had increased slightly after two years even if and the number of documented pain scores had decreased. Forty per cent of the nurses reported that they did not use visual analogue scale and that they did not assess pain at both rest and activity, neither did one fourth evaluate the effect of given analgesics.
Conclusion. The study showed a discrepancy in pain scoring between nurses and patients, where active treatment was related to nurses’ documentation rather than to patients’ scoring.
Relevance to clinical practice. The study shows a need for more accurate pain assessment, since the patient experiences and suffers pain and the nurse determines upon treatment. [ABSTRACT FROM AUTHOR]

10. Women’s descriptions of postoperative pain and pain management after discharge from cardiac surgery
by Leegaard, Marit & Fagermoen, May Solveig. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2051-2060
Aim and objectives.
To provide new insights into the postoperative pain experiences of women after coming home following cardiac surgery.
Background. Studies show that many patients experience postoperative wound discomfort after cardiac surgery and women experience more pain than men before discharge. Male experiences have shaped the accepted biomedical theories on how cardiac surgery influences the lives of women. This has led to more cardiac
studies with only female respondents in the past 10 years, but few focus on pain and pain management after early discharge.
Methods. The study reported here is part of a larger qualitative descriptive study. A self-developed pain diary measured pain intensity, types and amount of pain medication and its effectiveness at bedtime every day after returning home from hospital. The Brief Pain Inventory – Short Form provided a basis for comparison with the pain scores rated in the diaries from the final sample of nine women. Semi-structured interviews gave illuminating statements. Results. The women had pain in the chest almost every day the first two weeks at home and this was expected. The pain in their neck, shoulders and back was unexpected and this pain worried them more. The women wanted to take as little medication as possible. Regular intake of pain medication resulted in more even pain scores, but not necessarily lower pain scores.
Conclusions. The study adds new insights into how women experience postoperative pain upon returning home. Findings indicate that the women did not follow the recommended pain medication despite reporting worst pain as moderate or more during the whole period.
Relevance to clinical practice. Early discharge from hospitals gives patients more responsibility for taking care of themselves. Patients need more specific information about taking pain medication on a specified schedule to control pain. [ABSTRACT FROM AUTHOR]

11. Quality of life in chronic low back pain patients treated with instrumented fusion
by Bentsen, Signe Berit et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2061-2069

Aim. The aim of this study was to examine pain and quality of life in a group of preoperative chronic low back pain patients ( n = 25) and a group of postoperative chronic low back pain patients ( n = 101) treated with instrumented fusion 1–8 years ago.
Background. Reduced quality of life is common in chronic low back pain patients and the aim of treatment is to improve quality of life.
Design. In the present study, a comparative survey design was used. Methods. The McGill Pain Questionnaire and the SF-36 Health Survey were used to examine pain and quality of life.
Results.
The pre- and postoperative groups did not differ with regard to age, gender, education, other chronic conditions or previous spinal surgery. Compared with the preoperative group, the postoperative group reported significantly lower total, sensory, affective and evaluative pain, used less pain medication ( p < 0·05) and reported better scores in all SF-36 components ( p < 0·05), except for general health. The effect size was =0·8 for all pain components and =0·4 for all SF-36 components, except for general health (effect size = 0·009). With regard to long-term follow-up, patients who underwent surgery 5–8 years ago reported better physical role functioning ( p < 0·05) compared with those who underwent surgery 1–2 years ago.
Conclusion. Results showed that the postoperative group reported significantly less pain and better physical and mental health compared with the preoperative group. However, despite surgery, the postoperative group reported suffering from pain and reduced quality of life. Relevance to clinical practice. Psychosocial interventions focusing on psychosocial consequences of pain are needed to modify the pain experience and increase the quality of life in patients who have undergone this kind of surgery. [ABSTRACT FROM AUTHOR]

12. The Norwegian version of the American pain society patient outcome questionnaire: reliability and validity of three subscales
by Dihle, Alfhild et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2070-2078
Aims and objectives.
To examine some psychometric properties of the Norwegian version of the American Pain Society's Patient Outcome Questionnaire
(APS-POQ-N).
Background. This study is part of an investigation of Norwegian orthopaedic surgical patients, where the overall aim is to evaluate the quality of postoperative pain management. Therefore, an adequate questionnaire on the quality of postoperative pain management was needed.
Methods. The sample included 114 orthopaedic postoperative patients. The instrument consists of three main subscales, namely the modified Brief Pain Inventory (modified BPI subscale), the subscale on satisfaction with pain management (Satisfaction subscale) and the subscale on beliefs about pain management (Beliefs subscale), together with six single items about pain management. The reliability of these three main subscales was estimated using Cronbach's alpha coefficients and the construct
validity was evaluated using principal-axis factor analysis with oblimin rotation. Results. Face and content validity of the APS-POQ-N were satisfactory, while the modified BPI and the Beliefs subscales showed acceptable internal consistency but the Satisfaction subscale did not. Factor analyses yielded a three-factor solution for the modified BPI, a one-factor solution for the Satisfaction subscale and a two-factor solution for the Beliefs subscale.
Conclusions. The APS-POQ-N appears, in general, to be an acceptable method of evaluating postoperative pain management in orthopaedic postoperative patients. However, the alpha value of the Satisfaction subscale was low, and thus the subscale is not recommended for this purpose.
Relevance to clinical practice. Reliable and valid instruments are important when performing clinical research. This instrument is applicable as an indicator of quality of postoperative pain management in clinical practice and research. [ABSTRACT FROM AUTHOR]

13. Opioid-taking tasks and behaviours in Taiwanese outpatients with cancer
by Shu-Yuan Liang et al. Journal of Clinical Nursing, Aug 2008, Vol 17 Issue 15: p2079-2088
Aim.
The aim of this study was to describe those tasks and behaviours that contribute to self-efficacy in the context of opioid-taking in Taiwanese outpatients with cancer and to explore those factors that influence a patient’s self-efficacy with engaging in these behaviours.
Background. Self-management with prescribed opioid regimen has become a necessary component of the cancer pain experience at home. Tailoring prescribed regimens is a complex and continuing effort for cancer pain control. Few studies, however, have explored the specific skills and behaviours required by patients to manage their opioid analgesics effectively.
Design. A qualitative approach was used to explore those behaviours that contribute to patients’ ability to self-manage medication for their cancer pain. Method. Ten Taiwanese cancer patients aged between 41–75 years attending two oncology outpatient departments, who were prescribed opioid analgesics, were interviewed. All interviews were tape-recorded and were transcribed verbatim. Qualitative content analysis was undertaken to identify categories.
Results. Five main categories of behaviours were identified, which reflected patient’s perceptions of the actions required for effective opioid-taking. These behavioural domains included communicating about pain and analgesic-taking, taking analgesics according to schedule, obtaining help, tailoring medication regimens and managing treatment-related concerns. In addition, patients described various situations in which performance of these behaviours was more or less difficult.
Conclusions. Our results suggest that self-efficacy with opioid-taking includes not only beliefs about the ability to communicate, but also the ability to fulfil more complex tailoring of medication regimens and management of treatment-related concerns.
Relevance to clinical practice. Health professionals need to incorporate strategies to assist cancer patients’ ability to engage in these behaviours and to manage situational impediments that may influence this ability. More importantly, clinicians need to assist patients to enhance their beliefs in their ability in overcoming various situation impediments for opioid-taking. [ABSTRACT FROM AUTHOR]

New Books/Theses added to the  NZNO Library Collection

New book:
This item can be borrowed by members for a period of 4 weeks. We send books out by courier so please provide a street address when requesting items.
14. Acute care nursing: A physiological approach to clinical assessment and patient care
by Alison Pirret
Published in 2009

Theses:

These items are reference only, however they can be requested via the interlibrary loan scheme.  So go into your local library (at your workplace,tertiary institution or public library) and they will request the item from us, on your behalf.

15. Flight Nurse perceptions  of factors influencing clinical decision making in their practice environment.
by Houliston, Sally Leigh
Published: 2007

16. The feasibility of establishing Emergency Care Practitioners in New Zealand.
by Clapperton, Jackie
University of Otago
Published: February 2008

17. From a generic to a gynaecological oncology clinical nurse specialist: An evolving role.
by Glynis Cumming
Otago Polytechnic
Published: March 2008

18. The lived experience of being a core midwife in a New Zealand maternity unit: An interpretive study
by Wynn-Williams, Beth
Victoria University of Wellington
Published: 2006

Journals – Table of Contents

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