Nitrate leaching to shallow groundwater systems from agricultural fields with different management practices.

Monitoring the concentration of NO(3)-N from agricultural fields to the subsurface and shallow ground water resources have received considerable interest worldwide, since agriculture has been identified as a major source of nitrate-nitrogen (NO(3)-N) pollution of groundwater systems in intensively farmed watersheds. A study was conducted to quantify the impact of two tillage practices viz. chisel plow (CP) and no till (NT) with liquid swine manure application on nitrate leaching to the shallow ground water system under corn-soybean production system. This study is part of the long-term field experiments conducted at Iowa State University using completely randomized block design. The NO(3)-N concentrations in the shallow ground water were monitored at three depths viz., a network of subsurface drains at a depth of 1.2 m and piezometers at depths of 1.8 m and 2.4 m. Results of this study showed that the average NO(3)-N concentration during the study period was 16.1 mg l(-1), 14.4 mg l(-1) and 11.8 mg l(-1) at 1.2 m, 1.8 m and 2.4 m depths, respectively implying significant amount of NO(3)-N leaching past the subsurface drain depth of 1.2 m into the shallow groundwater but the NO(3)-N concentration decreases with the depth. The NO(3)-N concentrations in shallow groundwater were significantly higher under the chisel plow system in comparison with the no till method of tillage. Fall application of liquid swine manure caused more leaching in comparison with the spring application. Higher NO(3)-N concentration was observed under corn in comparison with the soybean plots. An in-depth analysis of the data showed a definite relationship between the NO(3)-N concentration in subsurface drain water at a depth of 1.2 m and shallow groundwater at depths of 1.8 m and 2.4 m depths.

Opioid tapering in hematopoietic progenitor cell transplant recipients.

PURPOSE/OBJECTIVES: To describe current opioid-tapering practice, patient pain levels and withdrawal symptoms, and nurse documentation during opioid tapers. DESIGN: Descriptive, exploratory, prospective, quantitative, and qualitative. SETTING: A 32-bed blood and marrow transplant unit in a large, tertiary U.S. care center. SAMPLE: 45 blood and marrow transplant recipients between the ages of 7-64. Types of transplant were autologous, allogeneic, and unrelated donor marrow; peripheral blood stem cell; and umbilical cord blood. METHODS: In daily interviews, patients reported pain levels and withdrawal symptoms during opioid tapers. Demographic, medication, and nurse documentation data were obtained from patient hospital records. MAIN RESEARCH VARIABLES: Taper length, daily opioid dosage, pain, withdrawal symptoms, and nurse documentation. FINDINGS: Length of taper ranged from 1-17 days (X = 6.53, SD = 4.26). Analysis of variance indicated no difference by disease or transplant type in length of taper, cumulative opioids given pretaper or during taper, or number of self-reports of withdrawal symptoms. Daily changes in nurse-administered opioid dosage during tapers ranged from a decrease of 67% to an increase of 14%. Children received significantly more opioids/kg during taper than adults. Means of adults' and children's self-reports of pain were low. The means of patient-reported withdrawal symptoms were highest on taper days two through six. Nurse documentation was sparse. CONCLUSIONS: Daily taper rates vary widely, pain is well managed, and most patients experience several withdrawal symptoms. IMPLICATIONS FOR NURSING PRACTICE: Use of an opioid-taper guideline may promote consistency of tapering while not increasing levels of pain or withdrawal symptoms.

Development of an opioid-taper algorithm for hematopoietic cell transplant recipients.

PURPOSE/OBJECTIVES: To describe an opioid taper algorithm for hematopoietic cell transplant (HCT) recipients and its development. DATA SOURCES: Nonresearch-based published guidelines, published research on opioid withdrawal symptoms, clinical experience, and multidisciplinary consultant recommendations. DATA SYNTHESIS: Many HCT recipients receive opioid therapy for several weeks and thus become physically dependent on opioids. If opioids are discontinued abruptly or tapered too rapidly, patients may experience discomfort from withdrawal symptoms. An algorithm can guide clinicians in providing patient care. CONCLUSIONS: No research-based opioid-taper guidelines exist in the literature; existing guidelines vary widely and are not specific to HCT recipients. Thus, the algorithm addresses a gap in the literature and also provides flexibility when dealing with patient discomfort. IMPLICATIONS FOR NURSING PRACTICE: Use of an algorithm may promote consistency of opioid tapering and patient comfort.

Children's perceptions of pain during 3 weeks of bone marrow transplant experience.

Most patients undergoing bone marrow transplant (BMT) experience severe pain. Because self-reporting is the most reliable source when assessing pain, it is important that health care providers understand how children perceive their pain and alleviating factors. The purpose of this descriptive, exploratory study was to understand children's perceptions of: (a) their BMT pain, (b) interventions effective in relieving their pain, and (c) caregivers' role in managing their pain. The sample consisted of 20 children (50% male), age 5 to 17 years, undergoing BMT. All study participants received continuous-infusion opioid therapy with additional boluses as needed for pain. Using investigator-developed structured interview guides, children were interviewed four times: on the day of transplant, then at three weekly intervals. Data were analyzed using a content analysis approach. In the first interview, children reported that when they hurt, they most commonly told someone. Several children used nonpharmacologic techniques to relieve pain. Although all had been told to expect some pain during BMT, only one-third of the children described the kinds of pain that they anticipated having during BMT. During subsequent interviews, the majority said that medication worked best to decrease their pain. In the final interview, most children said they still hurt. They reported pain predominantly in their mouth and throat, but mentioned seven other pain sites. Anecdotal comments included that pain management should be improved on the first BMT day and that nurses need to teach children that it is okay to use drugs for pain. Implications for clinical practice, education, and research are discussed.

Pain in adult recipients of blood or marrow transplant.

Severe pain is a problem for most bone marrow transplant (BMT) recipients. The purpose of this descriptive study was to describe the pain experience of adults undergoing autologous BMT, allogeneic BMT, or peripheral blood stem cell transplant. The sample consisted of 20 adults, 21 to 54 years of age. Using investigator-developed structured interview guides, investigators interviewed each participant four times: on the day of transplant, then at 3-weekly intervals. Investigators used a content analysis approach when analyzing data. During the first interview, 18 participants said that they were told to expect mouth sores during BMT, yet only six said that they actually expected to experience mouth sores during BMT. During successive interviews, 13 reported mouth sores. Eight other pain sites were reported. Participants reported that their tolerance of mild, moderate, and severe pain decreased over 2 weeks, and they named a wide variety of factors that caused or relieved pain. Ten said that they used nonpharmacologic techniques to feel more comfortable. Seven said that their BMT pain was worse or more difficult than they had expected. Overall pain ratings ranged from 0 to 8 on a 0 to 10 scale, M = 4.5. Five said the side effects of analgesics bothered them more than their pain. Most of them said a pain-rating scale was useful. Three weeks post-BMT, seven said they still experienced pain. Implications for clinical practice, research, and education are discussed.

Pain and distress in adults and children undergoing peripheral blood stem cell or bone marrow transplant.

PURPOSE/OBJECTIVES: To examine the pattern of self-report of pain, opioids received, and nurses' assessments of pain, somatic distress, mood/behavior, cooperation/compliance, and activity in adults and children undergoing stem cell or bone marrow transplant. DESIGN: Descriptive, longitudinal design; quantitative approach. SETTING: A 32-bed bone marrow transplant unit in an urban tertiary-care center. SAMPLE: 20 adults (10 males and 10 females) 21-54 years of age and 20 children (10 males and 10 females) 5-17 years of age. METHODS: Once daily over a period of 22 days, study participants used the Patient Self-Report of Pain Log to record their pain level and nurses used a Nurse Observations tool to record patient assessments. Researchers used a Patient Record Data form to record demographic data and daily totals of opioids given. MAIN RESEARCH VARIABLES: Pain, somatic distress, mood/behavior, cooperation/compliance, activity, and daily totals of opioids received. FINDINGS: Means of adults' and children's daily self-reported pain levels were low to moderate. Means of morphine equivalents/kg that children received daily were between 3 and 5.6 times more than means of morphine equivalents/kg that adults received. Nurses' assessments of somatic distress, mood/behavior, and cooperation/compliance were similar in adults and children. Cooperation/compliance was not related consistently to pain or somatic distress. CONCLUSIONS: Continuous infusion of an opioid with titration or bolus doses as needed allows patients to experience low to moderate pain levels. Although children received far more opioids/kg than adults received, children's and adults' self-reported pain levels were similar. Thus, children may need greater relative amounts of opioids than do adults to maintain a comparable level of comfort. IMPLICATIONS FOR NURSING PRACTICE: Administering opioid therapy by continuous infusion with titration or bolus doses as needed was effective in managing pain in transplant recipients. Nurses should be prepared to give children more opioids/kg than adults receive to maintain a comparable level of comfort. Self-reported pain level should not be expected to correlate with level of patient cooperation/compliance with care.

Pediatric pain management: a research-based clinical pathway.

Nurses want to provide pain management for pediatric patients, but different approaches lead to inconsistent pain management. This article presents a pediatric pain management clinical pathways developed as a result of research in the pediatric intensive care unit and based on pain management research. Using this pathway can help nurses deliver consistent pain management to pediatric patients.

Bone marrow transplant nurses' knowledge, beliefs, and attitudes regarding pain management.

PURPOSE/OBJECTIVES: To measure bone marrow transplant (BMT) nurses' knowledge, beliefs, and attitudes regarding pain management. DESIGN: Descriptive, exploratory. SETTING: A 32-bed BMT unit in a 567-bed tertiary-care institution located in the midwestern United States. SAMPLE: 39 BMT nurses (20 pediatric, 19 adult). The mean length of BMT experience was 7.05 years. METHOD: BMT nurses completed a 49-item, investigator-developed questionnaire. MAIN RESEARCH VARIABLES: Nurses' knowledge, beliefs, and attitudes related to pain management. FINDINGS: Many BMT nurses had high knowledge levels and positive beliefs and attitudes related to pain management. The mean of correct responses to knowledge items was 79%. Nurses had a high knowledge level of pain assessment, but only 74% indicated that patient self-report of pain is the most reliable indicator of pain. The majority of the nurses' responses were congruent with literature sources regarding the onset of mucositis pain, self-report of pain, and opioid tapering. Most nurses agreed that pain management is rewarding and satisfying; fewer agreed that it is not stressful. Nurses' requests for information focused on opioid therapy. CONCLUSIONS: The investigators identified specific knowledge gaps. The variability of scores indicated that some nurses are more expert than others regarding pain management and therefore could be resources for other nurses. IMPLICATIONS FOR NURSING PRACTICE: Educational offerings can increase knowledge and promote positive beliefs and attitudes among BMT nurses, thereby enhancing pain management.

A survey of pediatric critical care nurses' knowledge of pain management.

BACKGROUND: Although nurses are accountable for pain management, it cannot be assumed that they are well informed about pain. Nurses' knowledge base underlies their pain management; therefore, it is important to measure their knowledge. OBJECTIVE: To measure pediatric critical care nurses' knowledge of pain management. METHOD: A descriptive, exploratory study was done. After a pilot study, an investigator-developed Pain Management Knowledge Test was distributed to 50 pediatric ICU nurses. Test responses were collected anonymously and coded by number. Item analysis was done, and descriptive statistics were calculated. Modified content analysis was used on requests for pain-related information. RESULTS: The test return rate was 38%. The overall mean score was 63%. Mean scores within test subsections varied from 50% to 92%. Other mean scores were 85% on a nine-item scale of drug-action items and 92% on a two-item scale of intervention items. However, no nurse recognized that cognitive-behavioral techniques can inhibit transmission of pain impulses; only 32% indicated that meperidine converts to a toxic metabolite, only 47% recognized nalbuphine as a drug that may cause signs and symptoms of withdrawal if given to a patient who has been receiving an opioid; and only 63% indicated that when a child states that the child has pain, pain exists. Thirteen nurses requested pain-related information, and all requests focused on analgesic medications. CONCLUSIONS: Testing nurses' knowledge of pain indicated gaps that can be addressed through educational interventions. Research is needed in which the test developed for this study is used as both pretest and posttest in an intervention study with pediatric critical care nurses or is modified for use with nurses in other clinical areas.

Firing rate dependent effect of cocaine on single neurons of the rat lateral striatum.

Cocaine's effects on striatal neurons related to vertical head movement were studied during a task requiring vertical head movement. The proportion of long-distance head movements was increased by low doses but decreased by the high dose, which produced stereotypic head bobbing. At all doses, normally low firing rates related to movement were elevated to a greater degree than were normally high firing rates. At the high dose, normally high firing rates were strongly suppressed, a restriction which may contribute to the decreased behavioral diversity characteristic of stereotypy.

Nonpharmacologic interventions to manage children's pain: immediate and short-term effects of a continuing education program.

A two-group pretest, posttest design was used to test the effects of a two-hour educational program about using five nonpharmacologic pain management techniques with children on nurses' knowledge of, comfort with, attitude toward, and use of the discussed techniques. Five pediatric patient care units were randomly assigned to a treatment or control group. Pretest responses from 54 nurses indicated that attitude was the only significant determinant of their intention to guide children's imagery. A subset of 35 nurses actually attended the program and completed posttest responses. On posttest, the treatment group reported significantly greater knowledge of and comfort with using the techniques. Comparison of pretest with posttest responses across both groups indicated a significant increase in knowledge of and comfort with using nonpharmacologic techniques. Two months after the program, 24 nurses from both groups reported increased use of the techniques in practice compared with prior to the program.

Promoting parental use of nonpharmacologic techniques with children during lumbar punctures.

A pretest and posttest with control group design was used to examine the effect of teaching eight children with acute leukocytic leukemia, aged 6 to 14 years, and their parents about selected nonpharmacologic techniques, then to support their use of these techniques during children's lumbar punctures. Children's distress behaviors were observed and recorded during the procedures. A Visual Analogue Scale was used to obtain children's self-report and parents' and staff nurses' perceptions of children's pain during the procedure. Posttest comparison of four subjects in the treatment group with four subjects in the control group indicated that the treatment group had fewer expressions of verbal resistance (P = .04), less muscular rigidity (P = .04), and more parent interventions (P = .06). Preintervention with postintervention comparison of all eight subjects indicated that following intervention, children had lower levels of self-reported pain (P = .09), fewer requests for emotional support (P = .07), fewer expressions of verbal fear (P = .10), and fewer information-seeking questions (P = .10). Comments from children and parents indicate that children benefitted from nonpharmacologic techniques.

Effect of imagery on children's pain and anxiety during cardiac catheterization.

Children who undergo cardiac catheterization present pain management challenges to nurses. In this experimental study, the investigator examined the effect of imagery on children's pain and anxiety during cardiac catheterization. Twenty-four children, aged 9 to 17 years were randomly assigned to a control, presence, or imagery condition. Physiological, psychological, and behavioral data were used to rate children's pain and anxiety during cardiac catheterization. Children in the imagery condition displayed fewer distress behaviors during cardiac catheterization. Children in the presence condition reported the lowest levels of pain. Cortisol elevation over baseline was lowest in the control group, a result consistent with findings in previous studies. Several correlations of interest are reported. Implications for nursing practice and research are discussed.

Nurses' use of nonpharmacologic techniques with hospitalized children.

Pediatric nurses are often present with children who are in discomfort or pain, and are essential to successful management of this pain. Selected nonpharmacologic techniques are effective in reducing children's discomfort and pain, and thus have value in nursing practice. In a descriptive, exploratory study, 54 pediatric nurses responded to a questionnaire that elicited self-report of their use of five nonpharmacologic techniques: distraction, focusing on breathing, focusing on relaxing, imagery, and changing perceptions of painful stimuli. Content analysis indicated that (a) nurses' lack of time and heavy workload impede their use of nonpharmacologic techniques; (b) nurses' most frequent use of nonpharmacologic techniques is with children undergoing painful procedures; and (c) nurses perceive parents as helpful in implementing nonpharmacologic techniques with children. Implications for nursing practice, education, and research are discussed.

Children's and adolescents' experiences while undergoing cardiac catheterization.

PROBLEM: To explore the experiences of children and adolescents undergoing a cardiac catheterization. SUBJECTS: Caucasian children and adolescents (N = 24), 9-17 years, male and female, undergoing cardiac catheterization. METHOD: Exploratory design utilizing content analysis. The authors used an interview guide with 4 subsections to elicit self-reports of knowledge, perceptions, emotions, and evaluations. FINDINGS: Major themes were anticipatory anxiety, pain, invasion of privacy, and being comforted. Many children had misconceptions or lack of knowledge of the procedure. CONCLUSIONS & IMPLICATIONS FOR NURSING: Nurses' knowledge of the impact on children and adolescents of a cardiac catheterization room, high-technology equipment, and invasive procedures may increase their sensitivity to children's and adolescents' perceptions of the experiences and promote individualized nursing care.

Ways to feel comfortable: teaching aids to promote children's comfort.

Children often experience pain and anxiety during invasive procedures. Although parents are usually children's best supports during frightening and/or painful experiences, they may not know how to support their children during procedures in a health care setting. A videotape and accompanying booklet were developed to teach parents and children about nonpharmacologic techniques they can use to promote children's comfort. Ways in which these products are being used as well as plans for future use are discussed.

Presence as a nursing intervention with hospitalized children.

A review of nursing literature indicates that presence is a widely accepted nursing intervention, yet very little discussion exists regarding nursing presence as an intervention with children. The author's purpose is to discuss the importance of nursing presence with children, provide information on ways in which nurses can operationalize and evaluate presence, and identify implications for needed research on presence with children.

Structured controversy versus lecture on nursing students' beliefs about and attitude toward providing care for persons with AIDS.

Like many nurses in clinical practice, a small sample of RN-to-BSN nursing students reported their negative attitude toward providing care for persons with AIDS (PWA). Structured controversy is an interactive educational approach that may promote positive attitudes. This experimental study compared the effectiveness of structured controversy with lecture on BSN students' beliefs about and attitude toward providing care for PWA. A questionnaire, based on Ajzen and Fishbein's (1980) theory of reasoned action, was completed by 51 BSN students following an AIDS class session, and by nursing faculty. When compared with students who had listened to the lecture, students who had participated in structured controversy were more positive in general, and were significantly more positive on individual attitude and belief items. Faculty perceptions of these nursing students' beliefs and attitudes were less positive than the students' actual beliefs and attitudes.

Promoting nursing students' positive attitudes toward providing care for suicidal patients.

Nurses may encounter patients who are suicidal in most clinical settings, yet many nurses report a negative attitude toward providing care for these patients. Nursing programs, in which students learn about suicide and develop skills in assessing and intervening with patients who are suicidal, are opportune settings for promoting a positive attitude toward providing care for suicide attempters. An experimental study compared the effectiveness of an interactive teaching strategy known as "structured controversy" with a lecture on promoting a positive attitude. A questionnaire based on Ajzen and Fishbein's (1980) theory of reasoned action was used to measure attitude, and was completed by 51 senior nursing students following a suicide class session. Students who had participated in structured controversy on suicide were significantly more positive on the stress/frustration factor extracted from a scale of attitude items. Students who had listened to the suicide lecture held significantly more positive beliefs about providing care for suicidal patients. Implications for education and practice are discussed.