MSc Nursing, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Critically ill patients are particularly vulnerable to pain as a result of the severity of their disease conditions, diagnostic and treatment interventions but pain management is not considered a priority in the Intensive Care Unit (ICU) team (Holden, 1991: Walsh & Ford, 1992). Pain causes complications in the ICU patient, which increases their ICU stay and cost of ICU treatment (Pooler-Lunse & Price, 1992). The purpose of this study was to describe the parameters identified by ICU nurses that can be used to assess pain in the critically ill unconscious patient in the adult Intensive Care Units and whether these parameters are considered by the ICU nurses when managing the unconscious patients’ pain. The objectives of the study were to describe the parameters identified by ICU nurses that can be used for assessing pain in unconscious patients and to determine whether these parameters were considered by ICU nurses when managing the unconscious patient’s pain. A non-experimental, descriptive, prospective, comparative, two part design was used for the study. The sample comprised of ICU nurses (n = 40) in four adult ICU’s and the unconscious patients (n = 40) they nursed. Part one involved the nurses’ responses to a self administered Likert-type questionnaire about parameters that could be indicative of pain in the unconscious patient and part two involved a prospective record review of the unconscious patients ICU charts. A comparison was then done between these two parts to determine if the parameters identified by ICU nurses that could be indicative of pain in the unconscious patient, were considered in their management of the unconscious patients pain. Descriptive statistics were used to analyse data. Of the responses elicited from the questionnaire, ICU nurses agreed that raised blood pressure, pyrexia, increased respiratory rate, dilated pupils and increased heart rate could all be indicative of pain in the unconscious patient but these did not influence their management of the unconscious patient’s pain.

According to the American Cancer Society (2009) it is estimated that there will be 1.5 million new cases of cancer in the United States in 2009. Pain is a common symptom experienced by cancer patients throughout various stages of the disease process, as well as while undergoing cancer treatment. Research has found that between 30 and 45% of cancer patients report pain upon diagnosis or at some stage throughout the course of the disease, while 75% of patients with advanced cancer report suffering from pain. The pain experienced by cancer patients is often under treated. Unrelieved pain has negative effects on almost every aspect of an individual's life resulting in needless suffering, decreased quality of life, immunosuppression, and additional burdens on family caregivers. The under treatment of pain in cancer patients could be due in part to the fact that cancer pain is not always completely relieved by analgesic medications. Research is beginning to support the integration of complementary, nonpharmacologic, interventions for pain relief along with a traditional analgesic regimen in order to provide optimal management of pain in cancer patients. The purpose of this integrative review of literature is to examine the use and effectiveness of complementary therapies for the management of pain in cancer patients. Findings indicate that the majority of complementary therapies are effective in improving the pain experience among cancer patients. Recommendations for nursing practice, research, and education will be provided.

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Presentation will describe the overarching recommendations put forth by the PMTF and apply findings from the PMTF report in the context of South Central Appalachia.

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: The purpose of this study is to investigate what post-operative analgesic agents if any, are provided by clinicians for their pediatric dental patients. The study will also evaluate the clinician's philosophy toward pain management in the child patient and look for trends in these philosophies, as well as trends in where they currently practice with regards to pain management and specific analgesic agents. Methods: An on-line survey (appendix A) was sent to gather data from board certified pediatric dentists. The American Board of Pediatric Dentistry (ABPD) website was used to obtain an e-mail directory of addresses of all registered ABPD members. This e-mail provided them with a link to an online survey site where they could access the survey. The online survey site used was surveymonkey.com. The survey was available on-line for 3 months. Mantel-Haenszel and chi-square tests were used to check the relationships of hours of patient care, years of experience, and region of the country with other items in the survey. Results: Responses were received from 210 (27%). The region distribution of the responders was compared to the region distribution of all pediatric dentists. The distributions were found to be similar (p=0.81 using a one-sample chi-square test). Conclusions: Ibuprofen and acetaminophen are recommended most frequently for over the counter (OTC) post-operative pain control by board certified pediatric dentists. Acetaminophen with codeine is prescribed most frequently for post-operative pain control by board certified pediatric dentists. The majority of board certified pediatric dentists adhere to the same philosophies with regard to post-operative pain management as taught in their respective post graduate programs.

Objective: The objective of this study was to add to the body of knowledge about the impact of music on postoperative pain and anxiety. The specific purpose of this research study was to determine if listening to music and/or having a quiet rest period just prior to and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety, or impact mean arterial pressure, heart rate, respiratory rate, and/or oxygen saturation in patients following a total knee arthroplasty. Methods: An experimental repeated measures design was used. Setting: A postoperative orthopedic unit in a 300-bed community hospital in the southeastern United States. Sample: Fifty-six patients having a total knee arthroplasty, randomly assigned to either a music intervention group or a quiet rest group. Measures: A visual analog scale was used to measure pain and anxiety. Physiological measures, including blood pressure, heart rate, oxygen saturation, and respiratory rate, were also obtained. Results: A repeated measures analysis of variance between and within groups was conducted for pain and anxiety. Statistical findings between groups indicated the music group's decrease in pain or anxiety was not significantly different from the comparison rest group's decrease in pain (F = 1.120, p = .337) or anxiety (F = 1.566, p = .206) at any measurement point. However, statistical findings within groups indicated that when the groups were combined, the sample had a statistically significant decrease in pain (F = 6.699, p = .001) and anxiety (F = 4.08, p = .013) over time. Post hoc analyses showed the significant decrease in pain was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 4.751, p = .000). Post hoc analyses showed the significant decrease in anxiety was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 2.86, p = .006). Additionally, anxiety decreased significantly from time 3 (just after physical therapy) and time 4 (after second period of 20 minutes of music or rest period) (t(55) = 2.222, p = .030). Implications: Results of this research provides evidence to support the use of music and/or a quiet rest period to decrease pain and anxiety when initiated just before and just after ambulation on postoperative day 1 following a total joint arthroplasty of the knee. The interventions pose no risks, and have the benefits of improved pain reports and decreased anxiety. It potentially could be opioid sparing in some individuals, limiting the negative effects from opioids. Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence, knowing there is evidence to support its efficacy.

Extant research on technology adoption provides limited insights into the extent of technology penetration into an organization's work routines, especially in collaborative efforts across supply chains. Further research is required to delve into the broader scope of permanent technology-based solutions that effectively tackle specific issues within the supply chain. This dissertation examines blockchain through three essays to fill these research gaps and contributes to blockchain-based supply chain collaboration and performance literature. Essay 1 examines supply chain behavioral drivers of blockchain assimilation by grounding the hypotheses on social network theory. Findings indicate that supply chain learning, collaboration, and network prominence will affect blockchain assimilation through a cross-sectional survey of supply chain professionals familiar with blockchain. It provides psychometrically validated scales for blockchain assimilation and network prominence, adding to the blockchain literature. Essay 2 builds on institutional theory to argue that peripheral organizations in the blockchain-based network will succumb to institutional pressures and that blockchain principles will require them to play crucial roles in supply chain collaboration efforts to gain legitimacy. By adopting a multi-method approach of a vignette-based experiment and a survey, the findings help supply chain collaboration practitioners manage institutional pressures across emerging blockchain-based systems, particularly for organizations in the early stages of blockchain implementation. Furthermore, the second essay focuses on the structural positions within a blockchain-based business-to-business network. It proposes a novel scale based on network theory to assess the organizational blockchain network periphery. Essay 3 argues that supply chain organizations that adopt blockchain as a set of ordinary capabilities and develop the dynamic capability of integrated supply chain flow will benefit from blockchain potential in managing its archetypal supply chain pain points. Grounding hypotheses in supply chain practice view and dynamic capability theories, the findings indicate that blockchain capabilities partially mediate supply chain pain management through supply chain flow integration based on a cross-sectional survey of supply chain managers familiar with blockchain. Essay three has two crucial practitioner implications. First, the newly developed and validated scales can help develop standardized and comprehensive blockchain performance metrics that cover technical capabilities and supply chain practices for empowered supply chain performance. Second, the one-on-one mapping of blockchain capabilities with supply chain pain points can help blockchain developers provide customer-centric supply chain solutions.

Lower back pain (LBP) is a medical condition that will affect most of us at some point in our lives. Several medical causes have been identified for LBP, yet the large majority of LBP patients do not receive a specific diagnosis. These patients use up a large majority of health care resources, and accumulate billions of dollars in medical costs in countries throughout the globe. In recent years, an increasing focus has been placed on the idea that aquatic therapy may be an effective therapy for LBP patients. Exercise therapy has already proven itself as an effective means for treating LBP. Thus, combined with the unique properties of water, experts believe that aquatic therapy is the future of LBP treatment. This thesis aims to explore the efficacy of aquatic therapy as a treatment for LBP. Through the analysis of controlled peer-reviewed studies, scholarly information databases, and historical data on LBP treatment, this thesis evaluates the relationship between aquatic therapy and LBP in its entirety. Scientific properties of water have shown its many uses in rehabilitative therapy treatments. Water, in theory, is able to manipulate the exercise environment to allow for more substantial progress to be made. In studies where aquatic therapy was tested versus no treatment, aquatic therapy proved to be a more efficient and effective option. Still, when placed against other therapies, aquatic therapy did not always prove more effective. While the analyzed studies support the idea that aquatic therapy is an effective treatment for LBP, further research is needed to determine how aquatic therapy holds up against other forms of treatment.

Fibromyalgia is a chronic widespread pain disorder that can also cause fatigue, depression, sleep disturbances, and cognitive symptoms. Because the etiology of fibromyalgia is unknown, it is difficult to treat. Research shows that medication alone is insufficient to treat the symptoms of fibromyalgia and that complementary therapies are required to fully manage this disorder. The purpose of this research was to determine what complementary therapies patients with fibromyalgia were currently using. The sample for the survey was taken from fibromyalgia support groups throughout the state of Florida. A total of 15 people diagnosed with fibromyalgia participated in the survey. The most commonly used complementary therapies included diet and relaxation techniques. The therapies that were rarely or never used were hypnotherapy, Tai Chi, and Chi (Qi) Gong. These findings provide evidence to support client education concerning the use of complementary therapies for individuals with fibromyalgia. Research with larger samples is recommended to provide further evidence of the effectiveness of complementary therapies for this patient population.