Ng Sau Kwan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 107-127). / Abstracts in English and Chinese. / ABSTRACT --- p.ii / ACKNOWLEDGEMENTS --- p.vi / TABLE OF CONTENTS --- p.vii / LIST OF TABLES --- p.ix / LIST OF APPENDICES --- p.x / Chapter Chapter 1: --- INTRODUCTION / Background of the study --- p.1 / Significance of the study --- p.3 / Chapter Chapter 2: --- LITERATURE REVIEW / Introduction --- p.6 / Search Strategy --- p.6 / Overview of the Concepts of Pain --- p.7 / Types of Pain --- p.8 / Nature of Postoperative Pain --- p.9 / Effects of Pain --- p.9 / Factors Influencing Pain Management Outcomes / Undermanaged Postoperative Pain --- p.11 / Assessing Pain in Postoperative Patients --- p.14 / Pain Relief and Patient Satisfaction --- p.16 / Health Locus of Control --- p.20 / Health Care Professionals' Attitudes --- p.22 / Barriers to Postoperative Pain Relief --- p.24 / Psychosocial Factors Influencing Patient Satisfaction --- p.26 / Nursing and Quality Assurance of Pain Management --- p.29 / Pain Management Strategies / Organization of an Acute Pain Service --- p.32 / Pharmacological Pain Management --- p.35 / Nonpharmacological Pain Management --- p.37 / Summary of Literature Review --- p.38 / Chapter Chapter 3: --- METHOD / Introduction --- p.41 / Aim and objectives of the study --- p.41 / Research Questions --- p.42 / Research Hypotheses --- p.43 / Operational Definitions --- p.43 / Research Design --- p.44 / Settings --- p.45 / Sample --- p.46 / Instruments --- p.47 / The Modified American Pain Society Patient Outcome Questionnaire (APS-POQ-Modified) --- p.48 / The State Scale of State-Trait Anxiety Inventory (STAI) --- p.50 / The Multidimensional Health Locus of Control Form C Scale (MHLC) --- p.53 / The Modified Patient Satisfaction Questionnaire (PSQ-Modified) --- p.54 / Demographic Data Form --- p.55 / Translation and Content Validity of the Instruments --- p.55 / Pilot Study --- p.57 / Data Collection Procedures --- p.60 / Data Analysis / Effect Size and Power of the Study --- p.62 / Ethical Considerations --- p.64 / Conclusion --- p.65 / Chapter Chapter 4: --- RESULTS / Introduction --- p.66 / Reliability of the Instruments --- p.67 / Demographic Characteristics / Medical Characteristics --- p.70 / Physical and Psychosocial Characteristics of Pain / Pain intensity and pain interference --- p.72 / Beliefs about pain --- p.73 / State anxiety --- p.73 / Health locus of control --- p.73 / Patient satisfaction --- p.75 / Responses to Modified Patient Outcome Questionnaire --- p.75 / Comparisons of Patient Satisfaction Ratings with Demographic / Characteristics --- p.77 / Correlates of Patient Satisfaction --- p.78 / Predictors of Patient Satisfaction --- p.80 / Conclusion --- p.82 / Chapter Chapter 5: --- DISCUSSION / Introduction --- p.84 / Demographic Characteristics --- p.84 / Effect Size and Power of the Study --- p.85 / Patient Satisfaction with Pain Management and Pain Intensity --- p.86 / Multidimensional Health Locus of Control --- p.90 / Beliefs or Misconceptions about pain --- p.94 / Education on Pain Management --- p.98 / Conclusion --- p.101 / Chapter Chapter 6: --- "LIMITATIONS, IMPLICATIONS, RECOMMENDATIONS AND CONCLUSION" / Introduction --- p.102 / LIMITATIONS OF THE STUDY --- p.102 / IMPLICATIONS FOR NURSING PRACTICE --- p.106 / RECOMMENDATIONS FOR FUTURE PRACTICE / AND RESEARCH --- p.110 / CONCLUSION --- p.113 / REFERENCES --- p.115

Acute and chronic pain conditions have a significant impact on the individual who is experiencing pain and resolution of pain continues to present a challenge to nurses and other health care professionals. It is widely accepted that pain education for nurses is necessary if nurses are to deliver effective, evidenced based pain care. Although it has been shown that participation in pain education improves nurses’ pain knowledge, very little is known about the way in which nurses use their improved pain knowledge in their practice or about the conditions that promote application of that pain knowledge. The aims of this study are (a) to explore the transfer of pain knowledge from a continuing education nursing course into practice, and (b) to investigate the impact that the nurses’ participation in action research has on their ability to improve aspects of their pain practice. Participants are 14 registered nurses who successfully completed two accredited pain course units as part of their BSc / BN degree in Nursing. The nurses formed two groups of inquiry, who used both their participation in the pain course and in action research to investigate and change aspects of pain assessment and management practices within their clinical areas. The inquiry groups were located in two different Health Board locations in Scotland. Following involvement in a pain course, the strategies used by the participating nurses to enhance their pain assessment and management practices are examined. Qualitative data was obtained through individual and group interviews, and analysis of significant incidents. An action research approach contributes to an understanding of conditions that promote application of pain knowledge into practice following participation in the course, and focuses on the possibilities for action and improvement of pain care. The findings from this study demonstrate how nurses develop a more patient-centred approach to pain care and become more accountable for their pain practice. The research also identifies a range of strategies used by nurses to improve collaborative working practices with their colleagues that help to reduce some of the obstacles to delivery of effective pain care. From the outcomes of the inquiry, it is evident that these nurses’ participation in action research has increased the possibilities of their involvement in pain practice interventions. Conditions are created through pain course participation and involvement in action research, which supports nurses’ transfer of pain knowledge into practice Additionally, findings demonstrate the potential action research has for identifying problems with pain care and its potential for helping to develop relevant and workable solutions for improving aspects of care. The findings from this study are significant because they inform teaching and learning approaches which can be used with pain education that helps to prepare nurses to deliver more effective pain care within their health care settings.

Due to technologic breakthroughs, neonatal intensive care units (NICU) are caring for sicker and tinier clients. However, personal beliefs and attitudes about neonatal pain have not kept up with the times. The purpose of this study was to explore knowledge and attitudes of NICU RNs regarding the assessment and management of neonatal pain. The theoretical framework for this study was Travelbee's Human-to-Human Relationship Theory. The sample was drawn from a mailing list obtained from the Central Indiana chapter of the National Association of Neonatal Nurses. Thirty nurses completed the study's tool, Use of Drugs for Pain and Agitation Survey of NICU's Questionnaire. Statistical analysis included frequencies and percentages. Results revealed that there was consistent agreement among nurses regarding the belief that neonates do feel pain and that pain assessment and management is different for neonates as compared to adults. Implications are discussed in relation to improvement in nursing practice and to nursing education. / School of Nursing

The abstract of the diploma thesis is focused on the acupressure and its influence of backache of medical staff. We chose the theme of acupressure because it is a non-invasive treatment method which can be practiced by everyone in the comfort of the home and no aid is necessary to have, just the basic knowledge and training how to perform acupressure. Acupressure is not physically or time consuming and that is why it is considered as a suitable means as an additional treatment of pain and other health disorders. It can improve nursing care. The theoretical part deals with pain and pain of medical staff who are the highest risk group of backache in the lumbar region. The backache is the most frequent cause of incapacity for work. Furthermore, in the theoretical part we deal with acupressure, one of the methods of alternative medicine. For the processing of the theoretical part, we used the available foreign and Czech literary sources. The empirical part of the diploma thesis is a quantitative method. The results obtained from the research were processed in the overview tables and case reports. For the thesis we set two research objectives. The first objective was to find out the experience of medical staff with acupressure. The second objective was to verify the influence of the techniques of acupressure for backache of medical staff. On the basis of the aim two hypotheses were created. The first hypothesis should show whether the backache will be softened by application of the acupressure techniques. The second one shows whether there is the difference in approach of nurses and doctors to perform acupressure.

<p>Lumbalni bol predstavlja jedan od najučestalijih zdravstvenih problema dana&scaron;njice. Pružanje zdravstvene nege je stresan i težak fizički posao, te spada u grupu visoko-rizičnih poslova za nastanak lumbalnog bola, pa samim tim medicinske sestre &ndash; tehničari predstavljaju vulnerabilnu populaciju. Osnovni ciljevi ovog istraživanja bili su da se utvrdi prevalencija i faktori rizika za nastanak lumbalnog bola kod medicinskih sestara- tehničara, kao i mere prevencije. Istraživanje je sprovedeno u pet zdravstvenih ustanova sa područja Vojvodine u obliku studije preseka, anketiranjem medicinskih sestara &ndash; tehničara. Za ispitivanje je kori&scaron;ćen modifikovani Nordijski upitnik. Rezultati pokazuju veoma visoku prevalenciju lumbalnog bola među medicinskim sestrama- tehničarima, oko 94%. Ispitanici su bili uglavnom ženskog pola, prosečne starosti oko 38 godina. Najveći broj ispitanika ima srednju stručnu spremu. Istraživanjem je utvrđeno da postoji statistički značajna povezanost lumbalnog bola sa porastom godina života i dužine ekspozicionog radnog staža. Takođe, statistički visoko značajna korelacija nalazi se između porasta BMI i lumbalnog bola. Najzastupljeniji poslovi zdravstvene nege koje ispitanici sa lumbalnim bolom obavljaju su: pozicioniranje pacijenata, podizanje i presvlačenje pacijenata u postelji i podela terapije. Statistički značajno veća zastupljenost lumbalnog bola javlja se kod ispitanika koji sami obavljaju negu u odnosu na one koji imaju pomoć. Medicinske sestre &ndash; tehničari koji pripadaju grupi sa vi&scaron;im nivoom stresa na radnom mestu imaju znatno veći rizik za pojavu lumbalnog bola. Smenski rad (naizmenične dnevne i noćne smene od 12 sati) i prekovremeni rad duži od 8 sati dnevno, podizanje tereta većeg od 25 kg i broj pacijenata koje medicinska sestra &ndash; tehničar zbrinjava tokom radnog vremena nemaju značajnu povezanost sa pojavom lumbalnog bola. Oko tri četvrtine ispitanika nije izostajalo sa posla zbog bola. Samo oko 8% ispitanika je promenilo radno mesto zbog lumbalnog bola i ide redovno na periodične lekarske preglede. Kod mera prevencije neophodno je staviti akcenat na smanjenje fizičkog opterećenja donjeg dela leđa i smanjenje ručnog preno&scaron;enja tereta. Primenom adekvatnog ergonomskog pristupa, boljom organizacijom rada, podsticajnom atmosferom na poslu i spremno&scaron;ću nadležnih struktura da iskažu veću brigu prema zaposlenima, smanjila bi se učestalost pojave lumbalnog bola.</p> / <p>One of the today&rsquo;s most frequent health problems is the low back pain. Nursing is stressful and hard physical job which belongs to the group of high-risk jobs that could cause low back pain and therefore medical nurses/technicians represent the vulnerable population. Determination of prevalence, risk factors and prevention of the low back pain were the main goals of this research. The research in the form of cross-sectional study was conducted with nurses filling in the surveys within five medical institutions in Vojvodina. The modified Nordic questionnaire was used for the surveys. The results show very high prevalence of the low back pain, cca 94%, among medical nurses. Most of the respondents were females, who finished high school education, at average age of 38 years. The study showed that there is a statistically significant coherence between low back pain, ageing and working experience as a nurse. There is also a statistically significant coherence between the low back pain and the increase of the BMI. The most common nursing jobs that respondents with the low back pain do are: positioning of patients, lifting patients, dressing patients in bed and giving therapy. The low back pain with the respondents who do the nursing just by themselves is statistically significantly more present then with the respondents who do the nursing with help. Nurses who suffer more stress at their workplaces have a significantly higher risk to develop low back pain. Working 12 hour shifts (alternately day and night shifts), overtime work, more then 25 kg weight lifting and number of patients for nursing per nurse during working hours have no significant correlation with the low back pain occurrence. About three quarters of the respondents had no absence from work caused by the low back pain. Only 8% of the respondents changed their workplace because of the low back pain and have regular health checks. To prevent the low back pain it is necessary to emphasize the physical reduction of the load on the lower back and manual handling of loads. The frequent low back pain with the nurses could be reduced with the appropriate ergonomic access, better work organization, a supportive atmosphere at work and the willingness of responsible authorities to express greater concern about the employees.</p>

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

Aim of the study is to explore the role caring practices within the nurse-patient relationship, in facilitating effective chronic pain management in the primary health care context. Objectives are to analyse the current caring practices within the nurse-patient relationship during the management of patients with chronic pain within primary health care services; explore the challenges experienced by nurses in primary health care services when managing patients with chronic pain; observe the caring practices within the nurse patient interaction for the patients suffering from chronic pain within the Primary health care setting and explain the nurses‟ caring practices when managing their chronic pain in the primary health care setting. Method The research design for this study is sequential, explanatory and mixed method, which is more appropriate due to the complexity of the phenomenon under study. Findings: Although the survey measured the caring practices subjectively which other studies had done consistently, generally nurses associated caring as their core function within the health profession. Nurses do not actively involve the patients in the development of a treatment plan and as a result the caring behaviours that are intended to benefit the patients are not realised and, thus patients report nurses as not being caring. The results indicated that lack of an inclusive treatment plan, which can only be discovered through the development of the therapeutic NPR, is not given priority in the management of patients with chronic pain Conclusions: Caring should not be seen as concrete execution of the set of activities towards the patient but rather as a joint venture between the nurse and the patient. The strength of the model developed in this study is the identification of the nurses‟ internal readiness to create a caring environment by experiencing the love, faith and hope before engaging with the patient. / Health Studies