International journal of nursing studies
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Case Reports
A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients.
Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. ⋯ We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs. The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.
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Uncertainty is a fact of life for practising clinicians and cannot be avoided. This paper outlines the model of uncertainty presented by Katz (1988, Cambridge University Press, Cambridge, UK. pp. 544-565) and examines the descriptive and normative power of three broad theoretical and strategic approaches to dealing with uncertainty: rationality, bounded rationality and intuition. It concludes that nursing research and development (R&D) must acknowledge uncertainty more fully in its R&D agenda and that good-quality evaluation studies which directly compare intuitive with rational-analytical approaches for given clinical problems should be a dominant feature of future R&D.
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Making decisions to call emergency assistance to patients is an important dimension of nursing practice. Most usually these decision making situations are uncertain and it is expected nurses rely on past clinical experiences. This study, approved by the ethics committees of both a university and an area health service, aimed to describe nurses' reliance on past experiences and identify associated judgement strategies (heuristics). ⋯ Main findings were: nurses did use their past experiences and these experiences were used in the form of the three "classic" heuristics, representativeness, availability and anchoring and adjustment. It can be concluded past experiences are intrinsic to decision making and this has implications for both the clinical components of nursing educational programs and staffing allocations made by administrators. Some nurses, however, did not include referral to past experiences in their decision-making accounts which may be a limitation of the study design.
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Comparative Study
A comparative study of the experiences of violence of English and Swedish mental health nurses.
Recent studies suggest that violence in health care environments, especially mental health care, appears to be increasing. Although there is a lack of cross-cultural studies to prove it, this increase in violence would seem to be an international phenomenon. The present study sought to compare the extent and nature of violence encountered by mental health nurses in Sweden and England. ⋯ Significant differences were found with English nurses experiencing more violence than their Swedish counterparts. Yet support for English nurses appeared to be less good than for Swedish nurses. Reasons for the differences are discussed along with possible measures to minimise the frequency of violence against nurses and the negative effects on their work.
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Comparative Study
Postoperative pain: a comparison of adolescent inpatient and day patient experiences.
This three-year study investigated the experience of postoperative pain and its management following elective surgery in an adolescent population aged 12-18 years (n=351) in 5 NHS trusts. In addition to the adolescents, one parent of each adolescent and a range of health professionals including surgeons, anaesthetists and registered nurses were interviewed concerning their views on acute pain in adolescent patients. ⋯ Data were collected pre-operatively and postoperatively (days 1 and 3) using semi-structured interviews, telephone interviews, self-completion questionnaires and standardised tools to measure pain intensity (Adolescent Pediatric Pain Tool), psychological adjustment to adolescence (Offer Self-Image Questionnaire-Revised) and emotional state (Hospital Anxiety and Depression Scale). Day cases were discharged on the day of surgery while most inpatients were discharged on the first postoperative day.