Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff's Work-related Problems

Purpose@#The purpose of this study was to assess nursing staff's work-related problems as perceived bytheir managers and thereafter develop strategies that would serve as a guide for nurse managers tomanage these problems. @*Methods@#A descriptive research design was used. The participants included in the study consisted of thefollowing two groups: Group 1-a convenience sample of 150 first-line managers working at threedifferent hospitals; and Group 2-a panel of experts for the Delphi technique, selected using theSnowball sampling technique. Tools for data collection included the following: Tool 1-questionnaireabout nursing staff's problems; Tool 2-Delphi technique to develop strategies for managing nursingstaff's problems; and Tool 3-opinionnaire format. @*Results@#The recruited first nurse managers were of the opinion that job stress, work overload, conflict,workplace violence, poor performance, staff turnover, demotivation, lack of empowerment, and staffabsenteeism were among the common problems faced by staff nurses at work. @*Conclusion@#From the expert panelists’ perspectives, the newly developed strategy in this study wasconsidered valid; the researchers recommend the strategy developed in this study to be universalized indifferent health care settings and used as a guide for nurse managers.

Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff's Work-related Problems

Purpose@#The purpose of this study was to assess nursing staff's work-related problems as perceived bytheir managers and thereafter develop strategies that would serve as a guide for nurse managers tomanage these problems. @*Methods@#A descriptive research design was used. The participants included in the study consisted of thefollowing two groups: Group 1-a convenience sample of 150 first-line managers working at threedifferent hospitals; and Group 2-a panel of experts for the Delphi technique, selected using theSnowball sampling technique. Tools for data collection included the following: Tool 1-questionnaireabout nursing staff's problems; Tool 2-Delphi technique to develop strategies for managing nursingstaff's problems; and Tool 3-opinionnaire format. @*Results@#The recruited first nurse managers were of the opinion that job stress, work overload, conflict,workplace violence, poor performance, staff turnover, demotivation, lack of empowerment, and staffabsenteeism were among the common problems faced by staff nurses at work. @*Conclusion@#From the expert panelists’ perspectives, the newly developed strategy in this study wasconsidered valid; the researchers recommend the strategy developed in this study to be universalized indifferent health care settings and used as a guide for nurse managers.

Percutaneous image-guided radiofrequency ablation of painful bone metastases

To determine the value of radiofrequency ablation [RFA] in alleviating pain in patients with refractory pain secondary to bone metastases. Over 11 months, [from January 2006 to November 2006] 14 patients with painful osteolytic metastases were treated with image-guided radiofrequency ablation. The inclusion criteria were pain score >/= 4 [scale of 0-10] over a 24-hour period not responding to standard treatment such as radiation or opioid analgesics, or patients unfit for radiotherapy. Primary pain assessment and follow- were according to the Brief Pain Inventory-Short Form, Worst pain intensity was the primary end point with a 2-units drop considered clinically significant. Follow-up was scheduled one day post procedure, then weekly for one month and thereafter every other week, up to six months. Analgesics used were also recorded at these follow-up intervals. Follow-up contrast enhanced CT was performed one week after the procedure. Complications were monitored. The procedure was technically successful in all patients. Initial pain relief was achieved in 100% of patients [14 of 14]. There was a significant decrease in the VAS [visual analogue scale] score from 7 +/- 2.4 to 1.2 +/- 1.8 Analgesic reduction was achieved in 92.9% [13 out of 14 patients]. The tumor necrosis ratio ranged from 40% to 100% [mean, 67.1% +/- 5.9]. No serious complications were observed. There was transient local pain in most cases. Adverse events were seen in 2 patients, including a second degree skin burn at the grounding pad site in one patient and transient bowel and bladder incontinence following treatment of metastases involving the sacrum in the second patients. RFA is effective and safe for palliation of pain in cases of osteolytic metastases. It provides significant pain relief for patients who have failed standard treatment

Value of post contrast FLAIR in the diagnosis of cerebral metastases in cancer patients

Metastases to the brain, epidural space and meninges constitute the major cause of neurological dysfunction in cancer patients. MRI, FLAIR imaging is a useful non invasive screening modality for brain metastases. Post contrast FLAIR imaging effectively depicts parenchymal and leptomeningeal metastases. To evaluate the usefulness of pre- and post contrast FLAIR images in the detection of intracranial lesions which may be encountered in cancer patients, compared to conventional T1, T2W as well as post contrast T1W images. Seventy patients with known malignancy and suspected cranial metastases underwent FLAIR and spin echo T1W before and after contrast as well as T2W images. Images were compared for lesion conspicuity and enhancement, number of parenchymal metastases and extension of leptomeningeal cisternal metastases. Parenchymal metastases were demonstrated in 59 patients. Compared with T1W images, post contrast FLAIR images showed 10 metastases more in 5 patients, an equal number [45 lesions in 20 patients] and fewer numbers of 8 lesions in 5 patients. Regarding lesion conspicuity, post contrast FLAIR images were superior in 5, equal in 16 and inferior in 9. Superior FLAIR results for lesion number, conspicuity and enhancement were observed in the same 5 patients. Postcontrast FLAIR is a useful adjunct to post contrast T1W imaging and the routine use of FLAIR imaging before and after the administration of contrast material is particularly useful for delineating leptomeningeal cisternal and cranial nerve metastases

Discrimination of small hepatic hemangiomas from hypervascular malignant hepatic tumors with three phase helical CT

To compare the appearance of small hepatic hemangiomas at non-enhanced and contrast enhanced helical computed tomography [CT] with that of small [>3 cm] hyper-vascular malignant tumors and to evaluate the accuracy of multiphase helical CT in such aspects. A total of 30 patients with small hemangioma like lesions detected by ultrasonographic scanning were examined using 3 phase helical CT images in the pre-contrast and after contrast material injection, in the arterial and portal venous phases. Radiologists evaluated the lesion type and degree of change in enhancement from arterial to portal venous phase. They rated their confidence in the discrimination of hemangiomas from malignant tumors. Diagnosis was established by means of histologic findings in specimens obtained at percutaneous biopsy, or MRI for hemangioma like in ultrasonography. Ten HCCs were shown as nodular enhancement on early arterial-phase CT. The density of the whole tumor decreased rapidly on late and delayed phases, and the edge of 4 tumors [4/10] remained relatively hyperdense compared with the surrounding liver tissue, and demonstrated as rim enhancement. Rim enhancement was shown as 1 to 2-mm-wide irregular, uneven and discontinuous circumferential enhancement at late, and delayed-phase of CT. Eight hyper-vascular metastases were noted [6 in breast carcinomas, 1 in renal cell carcinoma and 1 in neuroendocrine tumors]. Twelve hemangiomas were found. Multiphase CT showed atypical pattern in 4 cases of small hemangiomas, [homogenus enhancement in arterial phase, 3 cases and non enhancement in 1 case]. Readers diagnosed hemangiomas with 66% mean sensitivity with all enhancement phases and diagnosed malignant lesions with 96% mean specificity. Small hemangiomas frequently show atypical appearances at CT. Two-phase helical CT does not improve sensitivity but does improve specificity for differentiating hemangiomas from hypervascular malignant tumors. If initial US scanning of the liver depicts a hemangioma like lesions, especially in patients at risk, other confirmatory imaging studies are necessary since 50% of hemangioma in this study were hypervascular malignant tumors. Percutaneous biopsy can be safely performed and findings can be used to confirm the diagnosis