Nurses' knowledge of pain management: implications for staff education.

Among the 217 nurses responding (one third of those queried), average scores on the NKAS were slightly higher (68%) than that reported in the literature but still inadequate. Nurses' greatest knowledge deficits were related to pharmacotherapeutics. Knowledge scores were uncorrelated with self-assessed level of knowledge about pain. Strategies for re-dressing these nurses' knowledge through Department of Nursing Education interventions are explored.

Where does culture fit in outcomes management?

The authors describe the concept of cultural competence and ways in which culture, a structure of care variable, is important to the delivery of culturally competent care. The role of culture in outcomes assessment and management is explored. The culture of the patient, the health care professional, and the organization is examined as it influences the potential to deliver culturally competent care. Strategies for developing a culturally competent work force are proposed with examples from ongoing projects in a large metroplex in the southwestern part of the United States.

Suitability of patient education materials for cardiac catheterization.

Changes in healthcare delivery for such diagnostic procedures as cardiac catheterization have resulted in an emphasis on patient self-study, using booklets and videotapes given to them before the procedure. This transition mandates an evaluation of the appropriateness and effectiveness of these materials. The purpose of this study was to systematically assess the suitability of materials used to prepare patients for cardiac catheterization. Three videotapes and four booklets were evaluated using the Suitability Assessment of Materials instrument. Concrete objective information (procedural and sensation information) was also evaluated. Scores revealed only one video and two booklets suitable for patient education. None received a superior rating. These results suggest that some patient educational materials used to prepare patients for cardiac catheterization are unsuitable. Clinicians should augment current suitable materials to enhance their effectiveness.

Identifying skilled management and evaluation needs of home health care patients.

This article describes the development of an assessment inventory to identify home care clients needing skilled management and evaluation services. Evidence supporting the inventory's content, criterion-related and predictive validity is presented. The inventory accurately predicted those patients readmitted within 60 days of discharge. Home health care nurses found the inventory easy to use without being time consuming. Use of the inventory by home health care nurses will permit care agencies to more easily document the need to continue care and reduce recidivism and cost while increasing care quality.

Patients' recollections of critical care.

Warm, caring, competent critical care nurses who communicate respect for patients' dignity and individuality alleviate fear and stress of a critical care unit stay. Patients perceive these nurses as professionals who deliver quality care. When cared for by critical care nurses with these characteristics, patients' satisfaction with care is heightened. This article provides an insight to patients' responses concerning their care in a critical care unit.

Ameliorating adults' acute pain during phlebotomy with a distraction intervention.

This study evaluated the effectiveness of a distraction intervention on subjects' perceptions of pain. During phlebotomy, 96 adults received either usual care or used a kaleidoscope as a distraction. After phlebotomy they rated their level of experienced pain with each of three instruments: Wong-Baker FACES Pain Scale, pain visual analogue scale, and Present Pain Intensity Scale. Statistical analyses revealed significantly lower perceptions of experienced pain among subjects using the kaleidoscope and concurrent validity for using the FACES Pain Scale with adults. Because the distraction intervention is effective, inexpensive, and easy to implement, its routine use during phlebotomy is recommended.

Recovery from laparoscopic cholecystectomy procedures.

The authors studied the postoperative experiences of 53 patients who had uncomplicated laparoscopic cholecystectomy procedures. Patients rated their pain, nausea, vomiting, and fatigue before surgery, before discharge, and on postoperative days one, two, three, four, and seven. The majority of patients reported more difficult and painful and slower recoveries than they expected or that they believed were indicated in the education materials provided to prepare them for surgery. The experiences of the patients in this study clearly indicate a need to modify preoperative preparatory education materials.

Preparatory information for myelogram.

This study identified preparatory information appropriate for patients undergoing myelogram. Twenty-eight patients (16 lumbar and 12 cervical) described the sensations they experienced as they were having a myelogram. Sensations reported by 40% or more of the participants having both kinds of myelograms included hard, cold examining table; wet and cold cleansing of site; stick with injection of local anesthetic; sharp stick with spinal needle insertion; and burning (cervical) or sharp, tingling (lumbar) with contrast medium injection. These sensations, linked with the temporal elements of the procedure, yield a preparatory information intervention appropriate for those scheduled for myelogram. When preparatory information is used for the same myelogram procedure as described in this study, patients should experience reduced anxiety before and during the procedure.

Changes in oxygen saturation during weaning from short-term ventilator support after coronary artery bypass graft surgery.

OBJECTIVE: To evaluate changes in oxygenation as measured by pulse oximetry (SpO2) and saturated venous oxygenation (SvO2) during weaning from mechanical ventilator support. DESIGN: Exploratory, pilot study. SETTING: Cardiovascular intensive care unit in a private 691-bed acute care medical center in the South. SUBJECTS: Ten adults between 50 and 76 years of age who had uncomplicated coronary artery bypass graft surgery. OUTCOME MEASURES: SpO2 and SvO2 obtained at start of each weaning event and each minute for 5 minutes thereafter. METHOD: Five discrete events associated with the unit's weaning protocol were studied: ventilator adjustments, continuous positive airway pressure trial, respiratory mechanics, removing continuous positive airway pressure and suctioning, and extubation. Weaning events, initiated by unit staff members, were based on subjects' arterial blood gases, SpO2, respiratory rate, blood pressure, heart rate, level of alertness, and respiratory effort. RESULTS: Both SpO2 and SvO2 changed with weaning. For some subjects these changes were clinically important: SvO2 fell by 10% or more, and SpO2 fell to or below 90%. The assessment parameters guiding the weaning process resulted in some weaning events being initiated when SvO2 was at or below 60%. CONCLUSIONS: Measures of SpO2 and SvO2 are sensitive to changes in oxygenation status during weaning. Although more study is needed, SvO2 measures provide valid information about oxygen status and can be used to guide weaning.

Positioning during hemodynamic monitoring: evaluating the research.

Can pulmonary artery or right atrial pressures be obtained accurately when patients are in lateral positions? This review of the published research says probably not.

Discharge planning predicting patients' needs.

The elderly are at higher risk for longer and more frequent lengths of hospital stay than other adults. Comprehensive discharge planning programs, including early identification of those at risk, can alter these statistics. Screening inventories to identify patients at risk have been available for many years, but they are not specific to the needs of the elderly. The Blaylock Risk Assessment Screen (BRASS) is administered on admission and identifies patients at risk for prolonged hospital stay and in need of discharge planning resources. The nurse can use the data BRASS provides to improve care outcomes while the patient is in the hospital and in the transition to home care. It shows promise for use as the first phase of a discharge planning program.

Nursing the system. Key users are sometimes "out of the loop".

Among those with a particular interest in hospital information systems are those who teach nursing students at the college level. To get their views, Southern Hospitals interviewed four Nurse Scholars involved with nursing and research projects for universities across the South. In 1989, Atlanta-based vendors HealthQuest and HBO & Company of Georgia established the Nurse Scholars Program in an effort to help academia stay abreast of technology. It provides nurse educators with comprehensive instruction in emerging technologies and uses of automated patient care systems. The scholars are encouraged to share their new knowledge with students, faculty, practitioners and administrators so that future nurse executives will better understand and communicate what they need and want from information systems.

Backrest elevation and pulmonary artery pressures: research analysis.

Obtaining pulmonary artery pressure readings in the traditionally accepted flat, supine position can be uncomfortable for the patient and time consuming for the nurse. This analysis of published research suggests that some patients need not lie flat.

Effects of backrest elevation and position on pulmonary artery pressures.

This repeated measures study identified each subject's baseline range of fluctuation in pulmonary artery pressures and used this information to evaluate the effects of changes in backrest elevation (0 degrees and 30 degrees) and position (supine and lateral) on pulmonary artery pressures. Sixteen hemodynamically stable patients were studied. Six measures of pulmonary artery pressure were obtained with subjects in the supine (flat) position. Pulmonary artery systolic pressures fluctuated from 2-16 mm Hg, pulmonary artery diastolic pressures from 0-11 mm Hg, and pulmonary artery mean pressures from 0-13 mm Hg. Only pulmonary artery diastolic pressures were not altered in a statistically significant way with backrest elevation. Even though backrest elevation produced clinically significant changes (those exceeding the subject's baseline range of fluctuation) in some subjects, no other changes in parameters of hemodynamic status were observed. These results suggest that pulmonary artery pressures may be obtained with backrests elevated. Since position changes produced both statistically and clinically significant changes in all pulmonary artery pressures, the use of lateral positions during pulmonary artery pressure measurement is not recommended.

Maternal-infant clinical nurse specialist performance assessment: reliability and validity of an evaluation tool.

The Maternal-Infant Clinical Nurse Specialist Performance Evaluation Tool was used to evaluate the clinical performance of two classes of graduate students (n = 7, n = 4) enrolled in maternal-infant clinical practicums. When used by raters very familiar with the tool, i.e., those participating in its development, it yielded valid (.90) and reliable (.93) ratings of performance. When used by raters with limited familiarity with the tool, both validity and reliability declined but were still quite acceptable (.68 and .81, respectively). Better training for such raters should produce even more useful results. These results warrant continued cautious, monitored use of the tool in maternal-infant nursing. The generic content of the tool offers the possibility of its generalization to other specialties.