Surgery patients' perspectives of their role in postoperative pain: A scoping review.

Background: Post-operative pain is a major factor in surgical recovery. There is evidence that pain remains undermanaged. Complications related to the undermanagement of acute pain can increase length of stay and contribute to readmission and the development of chronic pain. It is well acknowledged that pain assessment is critical to pain management and that self-report of pain is the gold standard. As a result, patients play a central role in their own pain management. A preliminary review of the literature failed to provide a clear or consistent description of this key patient role. Objective: A scoping review was conducted with the objective of reviewing literature that described adult patients' perspectives or highlighted the adult patient's role in post-operative pain management, including assessment. Understanding patients' attitudes toward their roles in pain management through a scoping review of the current literature is critical for informing research and improvements in post-operative pain management. Design: Scoping review. Methods: The databases searched for the review included CINAHL, MEDLINE, PubMed, and SCOPUS (ending May 2022). Thematic analysis, using the methodology of Arksey and O'Malley, was applied to the records identified. Results: Of the 106 abstracts initially identified, 26 papers were included in the final analysis. Two major themes identified through thematic analysis were attitudes toward pain and pain management, with the subthemes of patient expectations and beliefs and desire to treat; and care and communication, with the subthemes of pain assessment and education. Conclusions: This paper provides one of the first known comprehensive scoping reviews of surgical patients' perspectives of their role in pain management, including assessment, and offers an important global awareness of this patient role. The findings suggest that improved understanding of patients' perspectives of their roles in pain assessment and treatment is critical to improving post-operative pain management. Engaging patients as partners in their care can facilitate enhanced communication and improving congruence in pain assessment and treatment decisions. The complex nature of patients' beliefs, expectations, and subjective experiences of pain present challenges for health care practitioners. These challenges can be met with enhanced education for patients, respect for patients' beliefs and expectations, and the provision of dignified care.

Insights into patient characteristics and documentation of the use of sedative-hypnotic/anxiolytics in primary care: a retrospective chart review study.

BACKGROUND: Despite the known safety risks of long-term use of sedative-hypnotic/anxiolytic medications, there has been limited guidance for the safe and effective use of their chronic use in a primary care clinic setting. Understanding the characteristics of patients who receive sedative-hypnotic/anxiolytic medication and the clinical documentation process in primary care is the first step towards understanding the nature of the problem and will help inform future strategies for clinical research and practice. OBJECTIVES: Characterize patients who received a sedative-hypnotic/anxiolytic prescription in primary care, and (2) gain an understanding of the clinical documentation of sedative-hypnotic/anxiolytic indication and monitoring in electronic medical records (EMR). METHODS: A random selection of patients who received a prescription for a benzodiazepine or Z-drug hypnotic between January 2014 and August 2016 from four primary care clinics in Winnipeg were included. Data was collected retrospectively using the EMR (Accuro®). Patient variables recorded included sex, age, comorbidities, medications, smoking status, and alcohol status. Treatment variables included drug type, indication, pattern of use, dose, adverse events, psychosocial intervention, tapering attempts, social support, life stressor, and monitoring parameters for sedative-hypnotic use. Demographic and clinical characteristics were described using descriptive statistics. RESULTS: Records from a sample of 200 primary care patients prescribed sedative-hypnotic/anxiolytics were analyzed (mean age 55.8 years old, 61.5% ≥ 65 years old, 61.0% female). Long-term chronic use (≥ 1 year) of a sedative-hypnotic/anxiolytic agent was observed in 29.5% of the sample. Zopiclone (30.7%) and lorazepam (28.7%) were the most common agents prescribed. Only 9.5% of patients had documentation of a past tapering attempt of their sedative-hypnotic/anxiolytic. The most common indications for sedative-hypnotic/anxiolytic use recorded were anxiety (33.0%) and sleep (18.0%), but indication was undetermined for 57.0% of patients. Depression (33.5%) and falls (18.5%) were reported by patients after the initiation of these agents. CONCLUSIONS: A higher proportion of females and users 65 years and older received a prescription for a sedative-hypnotic/anxiolytic, consistent with previous studies on sedative-hypnotic use. We found inconsistencies in the documentation surrounding sedative-hypnotic/anxiolytic use. The indication for their use was unclear in a large number of patients. These findings will help us understand the state of the problem in primary care and inform future strategies for clinical research.

Writing activities and the hidden curriculum in nursing education.

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric-driven competency-based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper-focus on "figuring out" the teacher with minimal focus on the act of writing. Students used a form of behavioral "code-switching" to maximize their grade while considering how their "valuing" of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment.

Early life exposure to antibiotics and the risk of mood and anxiety disorders in children and adolescents: A population-based cohort study.

OBJECTIVE: Mood and anxiety disorders (MADs) are common conditions with multiple aetiologies. Exposure to antibiotics has been proposed as a possible risk factor in animal studies. We aimed to assess maternal antibiotic use in pregnancy and child antibiotic use in the first three years of life, collectively called early life, as potential risk factors for subsequent development of MADs during childhood and adolescence. METHODS: A population-based retrospective cohort study was conducted including 221,139 children born in Manitoba, Canada between 1996 and 2012. Exposure was defined as having filled one or more antibiotic prescriptions during early life. Children were followed until the earliest MADs diagnoses, 19th birthday, migration, death, or end of the study period. We computed crude and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) using Cox proportional hazard regression. RESULTS: Children born to mothers who received one or more antibiotic courses in pregnancy had significantly higher rates of MADs compared with non-exposed children (aHR 1.08, 95% CI 1.03,1.13). Overall antibiotic exposure during the first three years of life was not significantly associated with MADs (aHR 1.00, 95% CI 0.94,1.07). A significantly increased risk of MADs was observed after postnatal exposure to tetracyclines, aminoglycosides, quinolones (33%) or sulfonamides and trimethoprim (28%). Postnatal exposure to macrolides, lincosamides, and streptogramins significantly reduced the risk of MADs by 16%. CONCLUSION: Early life exposure to antibiotics is associated with different risk effects on MADs in children. The apparent associations may have been confounded by indication and may not be clinically meaningful.

Navigating creativity within arts-based pedagogy: Implications of a constructivist grounded theory study.

BACKGROUND: Educators implement arts-based pedagogy with the hope that it will foster meaningful learning for students. However, nursing students have varied reactions to artistic assignments, and there is a need to further understand students' learning processes with this novel approach and the factors influencing their learning. This understanding could promote the more effective implementation of arts-based pedagogy into nursing education. OBJECTIVE: To develop a theoretical understanding of how and when undergraduate nursing students learn through arts-based pedagogy. DESIGN: Constructivist grounded theory. SETTINGS: Canadian baccalaureate nursing program. PARTICIPANTS: Thirty third-year undergraduate nursing students and eight of their nursing instructors. METHODS: Participants who had experienced arts-based assignments were recruited with purposive and then theoretical sampling. We collected four sources of data: a socio-demographic questionnaire, semi-structured interviews, photo/art elicitation, and field notes. The socio-demographic data were analyzed with descriptive statistics and all other data with constructivist grounded theory procedures. RESULTS: Our findings revealed that students had to navigate a creative process with arts-based assignments, which involved several iterative phases. This type of learning was unique within their program and somewhat constrained by the context of nursing education. There was notable variation in the students' experiences. Although many reported meaningful learning, approximately 20% of the students did not value the assignment. Our findings elucidated multi-level enabling and restraining factors that influenced students' engagement with and learning from this creative process. CONCLUSIONS: These findings provide insight into modifiable factors that influenced students' engagement and learning, and have important implications for making ABP accessible and meaningful for more students.

The arts as a catalyst for learning with undergraduate nursing students: findings from a constructivist grounded theory study.

Background: There is a growing interest in arts-based pedagogy (ABP) to promote the wide range of competencies needed for professional nursing. The aim of this study was to develop a theoretical understanding of how students learn through ABP in undergraduate nursing education. Methodology and Methods: We used a constructivist grounded theory methodology which incorporated art-elicitation interviews. Thirty nursing students and eight nurse educators shared about their ABP experiences. Data were analyzed with grounded theory procedures. Results: The arts as a catalyst for learning emerged as the core category and elucidates how the unique quality of the arts created powerful pedagogical processes for many students. When students engaged with these processes, they resulted in surprising and transformative learning outcomes for professional nursing. Conclusions: These findings provide insight into why and how students learned through ABP, and can inform the effective implementation of ABP into healthcare education.

Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters.

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re-centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value-laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy.

A curriculum-wide assessment of writing self-efficacy in a baccalaureate nursing program.

OBJECTIVES: This study explores patterns of writing self-efficacy fluctuation across three academic years in a baccalaureate nursing program. The goal was to assess if writing self-efficacy predicted program grades. DESIGN: Longitudinal exploratory design. SETTING: Three-year accelerated nursing program in a college setting in Canada. PARTICIPANTS: Follow-up cohort included 49 students; 32 (65.3%) synchronous in program progression and 17 (34.7%) had become asynchronous between first and third year. METHODS: Data was collected five times between August 2013 and May 2016 at program admission, the start of their discipline-specific first-year writing course, the end of the writing course, start of third-year, and the end of third-year. Variables assessed included writing self-efficacy (two measures), writing anxiety, entrance degrees of reading power (DRP) scores, final college cumulative grade point average (GPA), and grades earned on first, second, and third-year papers. RESULTS: Writing self-efficacy statistically significantly improved from the start of the nursing program to the finish (p < .001). Writing self-efficacy fluctuated decreasing from post first-year writing course to the start of the third-year, returning to or exceeding end of writing course levels by the end of the third year. Students who progressed normally through the program (synchronous) were academically stronger (paper grades, DRP, GPA scores) and had higher writing self-efficacy scores than asynchronous students. Using hierarchical regression, DRP scores and synchronous/asynchronous status in the program made a larger contribution to the prediction of final program GPA and paper grades, while the inclusion of writing self-efficacy in the models made a minor contribution to overall variance. CONCLUSIONS: Writing self-efficacy will fluctuate based on context and complexity of writing demanded in academic programs. Second and third-year students require continued support with writing beyond an introductory course. Programs should attend to developing reading comprehension in students as part of their across-the-curriculum writing plans.

Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives.

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer-reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically.

Writing self-efficacy in nursing students: The influence of a discipline-specific writing environment.

AIM: To explore if writing self-efficacy improved among first-year nursing students in the context of discipline-specific writing. The relationship between writing self-efficacy, anxiety and student grades are also explored with respect to various learner characteristics such as postsecondary experience, writing history, English as a second language status and online versus classroom instruction. DESIGN: A one group quasi-experimental study with a time control period. METHOD: Data was collected over the 2013-2014 academic year at orientation, start of writing course and end of writing course. RESULTS: Writing self-efficacy improved from pre- to post writing course but remained stable during the time control period. Anxiety was negatively related to writing self-efficacy but remained stable across the study period. Inexperienced students and students with less writing experience, appeared to over-inflate their self-assessed writing self-efficacy early in the programme. This study gives promising evidence that online and classroom delivery of instruction are both feasible for introducing discipline specific writing.

A Template Analysis of Writing Self-Efficacy Measures.

BACKGROUND AND PURPOSE: This investigation reviews the item content of writing selfefficacy (WSE) measures developed for undergraduate students. Bandura's self-efficacy theory and a writing theory by Flower and Hayes informed the a priori themes used to develop a template of WSE categories critical to the concept. METHOD: Articles describing WSE measures were identified through Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Education Resources Information Center (ERIC), PubMed, Scopus, and Google Scholar (1984-2015). A template analysis method was used to analyze 182 individual items present on 11 WSE instruments. A nursing perspective was applied. RESULTS: The analysis identified 16 categories influencing WSE as well as gaps in current measurement items. CONCLUSION: The theoretical examination of WSE is the first step toward the development of a WSE measure specific to the nursing context and contributes to nursing education by advancing the measurement of WSE.

Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review.

BACKGROUND: To develop well rounded professional nurses, educators need diverse pedagogical approaches. There is growing interest in arts-based pedagogy (ABP) as the arts can facilitate reflection, create meaning and engage healthcare students. However, the emerging body of research about ABP needs to be systematically examined. OBJECTIVES: To synthesize the best available evidence on the effectiveness of ABP in enhancing competencies and learning behaviors in undergraduate nursing education and to explore nursing students' experiences with art-based pedagogy. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The review considered studies that included participants who are undergraduate nursing students. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The qualitative (QL) component considered studies investigating nursing students' experiences of ABP, and the quantitative (QN) component considered studies evaluating the effectiveness of ABP in undergraduate nursing education. TYPES OF STUDIES: The QL component considered QL studies including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The QN component considered studies that examined the effectiveness of ABP including designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports and descriptive cross-sectional studies. OUTCOMES: The following QN outcomes of ABP were assessed: knowledge acquisition, level of empathy, attitudes toward others, emotional states, reflective practice, self-transcendence, cognitive/ethical maturity, learning behaviors and students' perspectives of ABP. SEARCH STRATEGY: An extensive three-step search strategy was conducted for primary research studies published between January 1, 1994 and April 7, 2015. The strategy included searching CINAHL, MEDLINE, ERIC, PsycINFO, Academic Search Complete, Arts and Humanities Citation Index, Art Full Text, Scopus, ProQuest Dissertations and Theses, A&I, and gray literature. Only studies published in English were included. METHODOLOGICAL QUALITY: Two reviewers assessed all studies for methodological quality using appropriate critical appraisal checklists from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) or the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted from included articles using the standardized data extraction tool from JBI-QARI or JBI-MAStARI. DATA SYNTHESIS: Qualitative studies were pooled through a meta-synthesis. Data from the QN studies were combined using a narrative synthesis as a meta-analysis was not possible. The researchers used a segregated mixed methods approach to integrate the QL and QN components. RESULTS: Twenty-one QL studies of high methodological quality were included. The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes/competencies for professional nursing. These synthesized findings received a moderate ConQual rating. Fifteen experimental/quasi-experimental studies of moderate methodological quality were included. The narrative synthesis suggested that ABP improved nursing students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. In five cross-sectional studies, the majority of students had a positive perspective of ABP. When the QL and QN findings were interpreted as a whole, ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain. CONCLUSION: Nurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and resulted in the development of important competencies for professional nursing. The QN studies provide a very low level of evidence that ABP improved students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. Although the QN findings can inform future research, the evidence is not robust enough to demonstrate improved outcomes.

Evaluating patient satisfaction on an acute leukemia/bone marrow transplant day/night treatment unit: A pilot project.

The transition from hospital to home following hematopoietic stem cell transplantation increases the vulnerability for treatment challenges in patients, often resulting in unscheduled and costly hospital re-admissions. Two Acute Leukemia/ Bone Marrow Transplant Day/Night (ALBMT) inpatient beds were established in 2011 at one tertiary care hospital to support successful transition from inpatient cancer treatment to home. This pilot study aimed to investigate patient satisfaction feedback on information provision, treatment, and emotional support on this care innovation. Fourteen former unit patients participated. Survey responses indicated positive satisfaction for treatment and emotional support, and opportunities for information provision enhancement. Findings of this preliminary study exploring satisfaction of this novel inpatient initiative provide important insights into the patient experience, informing future research and practice.

Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language.

AIMS: To provide the first known concept analysis of psychosocial adaptation, exploring its evolution from the concept adaptation. We also determine how psychosocial adaptation is conceptualized across nursing, health, sociobehavioural and education disciplines. BACKGROUND: Psychosocial adaptation is an important conceptual term that is poorly defined in nursing and other health, sociobehavioural and education disciplines. A thorough understanding of the concept's application in nursing and across disciplines can help to clarify its meaning, facilitate a more effective common language between disciplines and inform future psychosocial adaptation research. DESIGN: Rodger's evolutionary view guided this concept analysis. DATA SOURCES: Peer-reviewed English and Spanish manuscripts published between 2011-2013 were retrieved from the following databases: CINAHL, Psych INFO, PubMed, Scopus and LILACS. REVIEW METHODS: Eighty-nine articles related to psychosocial adaptation were included in the analysis. Findings identify key attributes, antecedents and consequences associated with the use of the concept. Findings were compared vis-a-vis reported characteristics of adaptation. RESULTS: The attributes characterizing psychosocial adaptation are: change, process, continuity, interaction and influence. In psychosocial adaptation, new life conditions serve as antecedents, while consequences are good or bad outcomes. Important features of the evolution of this concept include its broad appropriation across the reviewed disciplines. The attributes of psychosocial adaptation, have some similarities to those of general adaptation. Both concepts include an aspect of change, but unlike adaptation, psychosocial adaptation has branched away from biological descriptors, such as homeostasis and tends to focus on relational characteristics, such as interaction and influences.

A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

BACKGROUND: Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. AIM: This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. METHODS: A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. RESULTS: Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. CONCLUSION: This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory.

Napping during breaks on night shift: critical care nurse managers' perceptions.

BACKGROUND: Fatigue associated with shiftwork can threaten the safety and health of nurses and the patients in their care. Napping during night shift breaks has been shown to be an effective strategy to decrease fatigue and enhance performance in a variety of work environments, but appears to have mixed support within health care. PURPOSE: The purpose of this study was to explore critical care unit managers'perceptions of and experiences with their nursing staff's napping practices on night shift, including their perceptions of the benefits and barriers to napping/not napping in terms of patient safety and nurses'personal health and safety. METHODS: A survey design was used. Forty-seven Canadian critical care unit managers who were members of the Canadian Association of Critical Care Nurses responded to the web-based survey. Data analysis involved calculation of frequencies and percentages for demographic data, use of the Friedman rank test for comparison of managers' perceptions, and content analysis for responses to open-ended questions. RESULTS: The findings of this study offer valuable insights into the complexities and conflicts perceived by managers with respect to napping on night shift breaks by nursing staff Staff and patient health and safety issues, work and break expectations and experiences, and strengths and deficits related to organizational napping resources and policy are considerations that will be instrumental in the development of effective napping strategies and guidelines.

The effects of active warming on patient temperature and pain after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is a procedure with associated risks of inadvertent perioperative hypothermia and significant postoperative pain. Hypothermia may affect patients' experience of postoperative pain, although the link is not well understood. OBJECTIVE: The aim of this prospective, randomized controlled trial was to determine the efficacy of a patient-controlled active warming gown in optimizing patients' perioperative body temperature and in diminishing postoperative pain after TKA. METHODS: Thirty patients who would be undergoing TKA received either a standard hospital gown and prewarmed standard cotton blanket (n = 15) or a patient-controlled, forced-air warming gown (n = 15). RESULTS: Although pain scores were not significantly different in the two groups (P = 0.08), patients who received warming gowns had higher temperatures (P < 0.001) in the postanesthesia care unit, used less opioid (P = 0.05) after surgery, and reported more satisfaction (P = 0.004) with their thermal comfort than did patients who received standard blankets. These findings indicate that patient-controlled, forced-air warming gowns can enhance perioperative body temperature and improve patient satisfaction. Patients who use warming gowns may also need less opioid to manage their postoperative pain. CONCLUSIONS: Nurses should ensure that effective patient warming methods are employed in all patients, particularly in patients with compromised thermoregulatory systems (such as older adults), and in surgeries considered to be exceptionally painful (such as TKA).

Pilot study of a survey to identify the prevalence of and risk factors for chronic neuropathic pain following breast cancer surgery.

PURPOSE/OBJECTIVES: To provide a preliminary determination of the prevalence rate of women who suffer from neuropathic pain post breast surgery (PPBS) and explore potential risk factors associated with its development. DESIGN: Prospective, quantitative, longitudinal survey. SETTING: Breast health clinic in western Canada. SAMPLE: A convenience sample of 17 women undergoing breast cancer surgery. METHODS: The Brief Pain Inventory was administered before surgery and 2 days, 10 days, and 3 months postsurgery. Demographic data also were collected preoperatively. Analysis included determining prevalence of PPBS; descriptive analyses on age, gender, and body mass index (BMI); presence of acute postoperative pain; type of surgery; and two-tailed t tests on age and BMI. MAIN RESEARCH VARIABLES: The symptom experience of chronic PPBS. FINDINGS: Twenty-three percent of the sample developed PPBS. Younger age (50 years or younger), more invasive surgery, acute postoperative pain, and less analgesic use during the acute postoperative period were factors associated with the development of PPBS. CONCLUSIONS: Additional research is required to confirm the significance of these potential risk factors in the development of PPBS. IMPLICATIONS FOR NURSING: Nurses are ideally situated to identify early signs of PPBS. In addition, nurses play a key role in the education of patients and healthcare professionals and can facilitate increased awareness about the possibility of developing PPBS, enabling earlier and more effective treatment of PPBS.

Benefits of napping on night shifts.

Many nurses deliver care when they are fatigued and sleep deprived, which may place them and patients at risk. A qualitative study found restorative napping on breaks during night shifts helped to improve energy, mood, decision-making and vigilance. This article looks at the benefits night napping can offer nurses doing shift work.