Journal of advanced nursing
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The assessment and control of pain in elderly patients present unique problems. Old people are likely to experience more pain, both chronic and acute, than their younger counterparts. ⋯ This paper discusses issues specific to pain in elderly people, and suggests that wide ranging and careful assessments are needed. Benefits can be achieved not only from the appropriate use of analgesic drugs, but also physical and psychological therapies.
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Clinical Trial Controlled Clinical Trial
Preparing children and families psychologically for day surgery: an evaluation.
The increasing use of ambulatory care settings for children's surgery places more responsibility on parents for psychological preparation of children for surgery and for their post-operative care. This paper describes the evaluation of a pre-admission programme to prepare children between the ages of 3 and 15 years and their families psychologically for day surgery. Seventy-five families comprised the study sample, 23 in the programme group and 53 in the non-intervention group. ⋯ Children and parents with previous surgical experience reported higher levels of pre-surgical anxiety than inexperienced families. Families reported the physicians and day surgery nurse as their primary sources of information and rated the day surgery nurse highest in their satisfaction with information received. Implications for practice, particularly for meeting the needs of young children and out-of-town families, are discussed.
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This paper reports on the results of two studies conducted to further validate the Abu-Saad Paediatric Pain Assessment Tool, a Dutch-language questionnaire developed to assess pain in school-age children. Children of 5 to 15 years of age reported in the first study their post-operative pain before and after the administration of analgesic medication using word descriptors of pain, the 10-cm scale, the Oucher, and a visual analogue scale (VAS). ⋯ In the second study, the correlations between pain and fear, a concurrently used measure with the pain instruments, were low, substantiating the discriminant validity of the pain tool. The significance of the results in relation to instrument development and multidimensional pain assessment in children are further discussed and elaborated.
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Comparative Study
Care of the critically ill patient: the impact of stress on the use of touch in intensive therapy units.
The literature suggests that stress is a major factor for nurses personally 'disengaging' from patients who are critically ill. This research aimed to investigate if nurses in a general intensive therapy unit (ITU) disengage from their patients by using touches that are mainly task orientated, rather than caring/social touches. This study sought to establish whether there was a relationship between categories of touch deployed by nurses and the individual characteristics of the nurses. ⋯ However, there was a significant relationship between caring/social touch and a nurse's length of service (rs = -0.54, P < 0.01). The interview data discovered that the stressors were related to the organizational pressures of the environment in which care was delivered, rather than the involvement of caring for critically ill patients. This apparent contradiction of the literature contributes a further dimension in considering the impact of management changes and organizational structures upon nurses' stress, which has further implications for the delivery of care in ITUs.
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The purpose of this study was to elicit the components of diagnostic reasoning utilized by experienced triage nurses when making triage dispositions via the telephone. Five first-level nurses triaged two simulated calls portrayed by the author. The resultant interactions were recorded on an answer-phone and subsequently replayed to the relevant participant. ⋯ Although deprived of the opportunity for methodical deliberation, nurses, when making decisions, did so within a systematic and identifiable framework. The process was found to centre around five major considerations; the most likely cause of the presenting problem, the impact of the problem upon the caller, the accessibility of alternative sources of health care, the ability of the nurse to control the reactions of the caller and the nurses' perception of their vulnerability. The final triage disposition was made through balancing the most probable outcome against the worst possible outcome.