Includes bibliographical references. Electronic publication: Fulltext available in PDF format; abstract in HTML format. The nursing practice of monitoring patients in the post-operative (PO) phase upon returning to the general ward setting has traditionally consisted of the systematic collection of vital signs and observation of other aspects of the patient's recovery. For the most part the primary focus of this monitoring has been the detection of post-operative complications. There is a need for more substantive evidence to support an appropriate frequency of post-operative observation. The aim of this research was to identify if the current practice of PO vital sign collection detects PO complications in the first 24 hours after the patient has returned to the general ward setting. Due to the complex world in which nurses practice the research was undertaken using a combination of methods within a triangulated approach to collect data. Electronic reproduction.[Australia] :Australian Digital Theses Program,2001.

This thesis has set out to investigate the role of music therapy in the form of the specialist Bonny Method of Guided Imagery and Music (GIM) with a view to exploring how meanings related to adjustment from a health crisis (such as cardiac surgery) are depicted in music-supported imagery. Factors shaping clinical interpretations of verbal and musical responses in music therapy practice are often unclear or undelineated. A systematic interpretive process relevant to clinical health care was developed using the Bonny Method of Guide Imagery and Music (GIM), providing a means for exploring the emotional difficulties of coronary bypass patients, who typically recover quickly from physical surgery but often experience residual symptoms such as depression, pain, and anxiety. The interpretive process accessed both verbal and non-verbal texts, playing them against each other in order to find significance for music therapy practice in rehabilitation. A Bonny Method of Guided Imagery and Music (GIM) series was undertaken by patients recovering from coronary artery bypass grafting (CABG), with each session audiotaped and transcribed. This narrative data was analyzed thematically, and grand themes were used to focus further intertextual (semiotic) and Jungian perspectives, in the process of deriving substantial clinical meanings. Results suggested that participants used a wide range of personal, cultural and archetypal texts to convey meanings about their health care situation, including images of the music during the therapeutic process. Clinical change in the rehabilitative process was suggested by grand themes comprising 'Looking through the frame', 'Feeling the impact', 'Spiralling into the unexpected', 'Sublime plateau', and 'Rehearsing new steps' and the further music-related grand theme of 'Sounding the changes'. This project highlights the value of GIM as a vehicle to track clinical change with cardiac patients, based on a systematic interpretive process sensitive to the interweaving verbal and nonverbal texts evident in the music therapy context.

Introduction: Patients having total joint replacement often experience moderate to severe pain postoperatively. Postoperative pain can reduce patients’ mobility, affecting their motivation to participate in any rehabilitation activities. For patients having total join replacement, rehabilitation plays an important role in promoting their early recovery. Therefore, it is crucial for healthcare professionals to develop and evaluate intervention that can better control patients’ post-operative pain. In the clinical setting that I am working, pharmacological method is the major means of postoperative pain management. However, many Chinese patients are reluctant to use analgesic to control their post-operative pain because of the side effects and adverse reactions of the drugs. In this dissertation, music therapy, a non-pharmacological method that can be managed by nurses, is adopted for postoperative pain control. It is used to promote rehabilitation for patients who have undergone total joint replacement. Objectives: The objectives of this study are (1) to review the published research articles that investigated the effects of music therapy in reducing the post-operative pain and promoting rehabilitation for patients having total joint replacement; and (2) to establish an evidence-based guideline for the use of music therapy by nurses to control postoperative pain and to facilitate rehabilitation for patients having total joint replacement. Methods: A comprehensive literature search on four electronic databases including CHINAL, Medline (OvidSP), PubMed and the British Nursing Index were conducted. A total of eight RCTs and two non-randomized controlled trials were eventually identified. Results: All the reviewed studies showed that music therapy has a statistically significant effect on reducing postoperative pain. Sedative or relaxation music (music which has no lyrics, sustained melodic quality; rate of 60-80 beats per minutes; absence of strong rhythms or percussion) are recommended in the guideline. The target setting is a total joint replacement centre in a public hospital of Hong Kong. The target clients are adult patients (aged 19 or above) that are referred by the orthopedic out-patient department and are pending for their total knee/ hip replacement in the center. The transferability and feasibility of the literature are high. The guideline is developed based on the evidence in reviewed literature. A pilot testing plan is established to detect the potential barrier and friction of the guideline before the implementation. After that, an evaluation plan for patients, healthcare providers and system outcomes was also proposed. Conclusion: An evidence based guideline is developed for the total joint replacement center. It is anticipated that, with the use of this guideline by nurses, it will not only facilitate better rehabilitation for patients having total joint replacement, but also enhances nurses’ autonomy in their nursing practice. / published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / abstract / toc / Surgery / Master / Master of Philosophy

No description available.

Our objective was to study the effect of GLN supplementation on whole body protein turnover, somatic growth and gastrointestinal tolerance to enteral feeding in neonates following surgical stress. We hypothesized that GLN in total parenteral nutrition (TPN) would (1) favor retention of lean body mass by reducing protein breakdown (PB) during the acute phase after surgery, (2) promote somatic growth, (3) decrease length of time to achieve full feeds. Protein turnover was measured in a double-blind randomized trial involving neonates admitted to the Neonatal Intensive Care Unit after major surgery. L-GLN (n = 6) was added to TPN at a dose of 200 mg/g of protein intake. Controls (n = 7) were isonitrogenous. Isotope studies were performed on Day 4 of TPN. Subjects were given a 4-hour primed constant intravenous infusion of L-[1-13C]-leucine and [15N2]-urea. In the GLN group, a 15% reduction in PB was measured (unpaired t-test, p < 0.05). There was a trend towards improved net protein balance which was statistically different from zero in the GLN group. There were no differences in somatic growth during TPN course and in the length of time to achieve full enteral feeds. Results suggest that early TPN supplemented with GLN has a beneficial sparing effect on protein metabolism in critically ill neonates after major surgical stress.

This thesis has set out to investigate the role of music therapy in the form of the specialist Bonny Method of Guided Imagery and Music (GIM) with a view to exploring how meanings related to adjustment from a health crisis (such as cardiac surgery) are depicted in music-supported imagery. Factors shaping clinical interpretations of verbal and musical responses in music therapy practice are often unclear or undelineated. A systematic interpretive process relevant to clinical health care was developed using the Bonny Method of Guide Imagery and Music (GIM), providing a means for exploring the emotional difficulties of coronary bypass patients, who typically recover quickly from physical surgery but often experience residual symptoms such as depression, pain, and anxiety. The interpretive process accessed both verbal and non-verbal texts, playing them against each other in order to find significance for music therapy practice in rehabilitation. A Bonny Method of Guided Imagery and Music (GIM) series was undertaken by patients recovering from coronary artery bypass grafting (CABG), with each session audiotaped and transcribed. This narrative data was analyzed thematically, and grand themes were used to focus further intertextual (semiotic) and Jungian perspectives, in the process of deriving substantial clinical meanings. Results suggested that participants used a wide range of personal, cultural and archetypal texts to convey meanings about their health care situation, including images of the music during the therapeutic process. Clinical change in the rehabilitative process was suggested by grand themes comprising 'Looking through the frame', 'Feeling the impact', 'Spiralling into the unexpected', 'Sublime plateau', and 'Rehearsing new steps' and the further music-related grand theme of 'Sounding the changes'. This project highlights the value of GIM as a vehicle to track clinical change with cardiac patients, based on a systematic interpretive process sensitive to the interweaving verbal and nonverbal texts evident in the music therapy context.

Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003. / Copy of author's previously published work inserted. Includes bibliographical references (leaves 273-283). Also available electronically.

Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003. / Includes bibliographical references. Also available in a print form.

Thesis (M.Sc. (Nursing)--Mahidol University, 1979. / Financial support by China Medical Board of New York Inc.