Development of a Subjective Workload Assessment for Nurses: A Human Factors Approach.

BACKGROUND AND PURPOSE: Research has revealed nurses' perception that traditional workload measures do not adequately capture the complexity of workload. Using a human factors approach to address the multiple and complex dimensions from the subjective perception of the worker, the Subjective Workload Assessment for Nurses (SWAN) was developed. METHODS: Survey data from 188 medical-surgical registered nurses were used to establish the instrument's psychometric properties. RESULTS: SWAN Sections 1, 2, and 3; General Information Form Section 1; and the Nursing Texas Load Index demonstrated internal consistency with this sample. Findings supported interrelationships between activity complexity, performance circumstances, and individual characteristics described in the literature. CONCLUSION: Further study is needed to refine the SWAN and to establish psychometric properties with nurses in other practice areas.

Expressive writing in early breast cancer survivors.

AIMS: This article is the report of a study aimed at determining whether or not expressive writing improves the quality-of-life of early breast cancer survivors. An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results. BACKGROUND: The risk of distress can extend well beyond the time of a breast cancer diagnosis. Emotional expression may assist in dealing with this. DESIGN: Randomized controlled study. METHODS: Participants (n = 120) were randomized into one of four groups: a control group (no writing) or one of three expressive writing groups: breast cancer trauma, any self-selected trauma and facts related to breast cancer. Participants wrote 20 minutes a day for 4 consecutive days. Their quality-of-life was measured, using the 'Functional Assessment of Cancer Therapy-Breast Cancer Version', at baseline and at 1 month and 6 months after writing. Paired t-tests, multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment, collected in 2006. Intention-to-treat analysis was used. RESULTS/FINDINGS: Expressive writing about one's breast cancer, breast cancer trauma and facts related to breast cancer, significantly improved the quality-of-life outcome. CONCLUSION: Expressive writing, focusing the instructions on writing about one's living and dealing with a diagnosis of breast cancer, is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality-of-life.

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient.

AIMS AND OBJECTIVES: This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. BACKGROUND: Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. METHODS: One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows. RESULTS: The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. CONCLUSIONS: Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.

Factors that influence patient advocacy by pain management nurses: results of the American society for pain management nursing survey.

What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim of the study was to determine the educational needs for and barriers of advocacy for nurses working with patients experiencing pain. An ASPMN Advocacy Survey Instrument was developed to gather data about advocacy activities and interventions. The sample consisted of 188 ASPMN nurses (20% of the membership) who responded via the internet. Study findings revealed that the majority of nurse respondents were active in personal advocacy, serving as guardians of the patient. They confronted physicians as necessary and assisted patients to evaluate their pain management. Regarding making the public aware of pain management-related issues (i.e., public awareness advocacy), the respondents were not as active. Respondents were knowledgeable about pain management and best practices/best evidence, with the exceptions of legislative issues and media training. These two areas need support and educational intervention. Additional areas in need of education and training, as identified by respondents, are social and political advocacy interventions. "Lack of time" was identified as the barrier to advocacy experienced by the greatest number of nurses.

A goal attainment pain management program for older adults with arthritis.

The purpose of this study was to test a pain management intervention that integrates goal setting with older adults (age > or =65) living independently in residential settings. This preliminary testing of the Goal Attainment Pain Management Program (GAPMAP) included a sample of 17 adults (mean age 79.29 years) with self-reported pain related to arthritis. Specific study aims were to: 1) explore the use of individual goal setting; 2) determine participants' levels of goal attainment; 3) determine whether changes occurred in the pain management methods used and found to be helpful by GAPMAP participants; and 4) determine whether changes occurred in selected pain-related variables (i.e., experience of living with persistent pain, the expected outcomes of pain management, pain management barriers, and global ratings of perceived pain intensity and success of pain management). Because of the small sample size, both parametric (t test) and nonparametric (Wilcoxon signed rank test) analyses were used to examine differences from pretest to posttest. Results showed that older individuals could successfully participate in setting and attaining individual goals. Thirteen of the 17 participants (76%) met their goals at the expected level or above. Two management methods (exercise and using a heated pool, tub, or shower) were used significantly more often after the intervention, and two methods (exercise and distraction) were identified as significantly more helpful. Two pain-related variables (experience of living with persistent pain and expected outcomes of pain management) revealed significant change, and all of those tested showed overall improvement.

A bone health intervention for older adults living in residential settings.

Osteoporosis, a major health problem that increases with age, may lead to fractures and loss of independence. This study focused on testing a bone health intervention aimed at assisting older adults living independently in residential settings to maintain healthy bones with the long-term goals of fracture prevention and maintenance of independent function. Forty-seven participants (M (age) = 79.36 years) completed six 1-hour educational sessions. Pre-intervention testing of osteoporosis knowledge and healthy bone behaviors was followed by posttests at 1 week, 6 weeks, and 7(1/2) months. Findings revealed significant increases in knowledge and behaviors from baseline to 9(1/2) months, although a slight decline during the last 6 months when there was no reinforcement of learning suggests the need for periodic follow-up.

Measurement of the experience of living with primary recurrent headache.

Recurrent primary headache is a major public health concern that impacts both society and the individual, reducing productivity and limiting participation in work, social, and leisure activities. The purpose of this study was to develop a valid and reliable instrument to measure the experience of living with chronic recurrent primary headache. This tool, Chronic Pain Experience Instrument-Headache Version (CPEI-HA), is intended to provide a measure of the affective component of headache that could complement the assessment of intensity, density, and disability. Psychometric testing of 25 items with a community-based headache sample ( N = 150) resulted in a 19-item tool with high internal consistency (alpha = .92). Principal components analysis was used to explore the meaning of the headache experience, and three underlying dimensions (i.e., Helplessness, Stress--Personal and Interpersonal, and Emotional Struggle) emerged to provide a better understanding of the experience. Construct validity was supported by the empiric relationships between the CPEI-HA and the eight theoretically related health concept subscales of the RAND 36-Item Health Survey 1.0. As predicted, all of the relationships were positive and in the moderate range (.31-.52). Findings suggest that the CPEI-HA has the potential for providing a valid and reliable tool for both clinical and research applications with persons who experience primary recurrent headaches.

Improved sleep may reduce arthritis pain.

Studies indicate that pain interferes with sleep and, in turn, sleep disturbances increase pain. Statistics show that up to 60% of those with arthritis experience pain during the night. But despite these findings, sleep is not generally addressed as a major treatment concern among this population. This article reviews the relationship between pain and sleep; sleep issues as they relate to 3 common types of arthritis--osteoarthritis, rheumatoid arthritis, and fibromyalgia; and holistic approaches that may be used by the patient in the self-management of pain and sleep.

Functional status in older women following hip fracture.

BACKGROUND: Women aged 65 years and over are at high risk for a fractured hip because of osteoporosis. One of the devastating effects of a fracture is the loss of ability to live independently. AIM: The major aim of this study was to describe the functional status, or ability to perform activities of daily living, of women aged 65 years and older who had experienced a fractured hip in the recent past and to explore possible differences in selected variables (e.g. age and length of rehabilitation) for those who were fully performing activities of daily living at least 6 months after fracture and those who were not. DESIGN: Following Institutional Review Board approval, data were collected from 23 Caucasian women ranging from 65 to 95 years of age (M = 82, SD = 6.83) who had experienced fractured hips related to a fall in the recent past (6 months to 4 years). All were living independently prior to their fractures. Three Registered Nurses, in a structured interview, collected the data using a Demographic Data Form, an Osteoporosis Risk Factor Checklist, the Katz Index of Independence in Activities of Daily Living, and the Lawton Instrumental Activities of Daily Living Scales. RESULTS: Nine of the participants reported prior fractures, suggesting that this could have been a risk factor for this group. Eighteen achieved the maximum independence score of six on the Katz Index of Independence in Activities of Daily Living; help with bathing was required by the other five. Of the Instrumental Activities of Daily Living, those requiring physical activity for home maintenance were the most problematic. Ability to perform Instrumental Activities of Daily Living was significantly related to ability to perform the activities required to live independently. CONCLUSIONS: Results suggest that achieving a functional level that will support independence is possible for older women who were residing independently prior to a hip fracture.

Population-based osteoporosis education for older women.

With an increased focus on wellness and health promotion, there is a need for community-based strategies to complement traditional strategies aimed at improving individual and aggregate health. An educational program on the prevention, diagnosis, and treatment of osteoporosis was provided for 188 women age 60 and older in three different community settings: churches, retirement homes, and senior citizen centers. The major purposes of the study were to determine whether a community-based program might (a) contribute to older women's knowledge about osteoporosis and (b) promote their intent to use this knowledge. Each participant completed a demographic profile, the Osteoporosis Risk Checklist, and the Osteoporosis Knowledge Questionnaire (OKQ), with the OKQ serving as a pre- and post-test. Before post-testing, a 30-min educational program was provided. Differences among the three groups were risk factors, prior knowledge about osteoporosis, and knowledge at the completion of the program. A majority of the clients indicated an intent to increase calcium in their diet, discuss osteoporosis with their health care provider, check their home environment for safety/falls, and discuss what they had learned with others. Nurses need to plan educational programs in all settings to teach older clients about the risk factors, prevention, diagnosis, and treatment of osteoporosis.

The measurement of patient satisfaction.

Patient satisfaction is an important quality outcome indicator of health care in the hospital setting. The measurement of patients' satisfaction with nursing is particularly important since nursing service is often a primary determinant of overall satisfaction during a hospital stay. This article reports on a study designed to update and revise the definition of patient satisfaction for application with ambulatory surgical patients and to develop a questionnaire that captures this definition. The Patient Satisfaction Scale, which specifically focuses on patient satisfaction with nursing care and is used extensively by nursing researchers, was selected for factor analytical examination. Psychometric testing resulted in a 15-item scale with three underlying dimensions.

Barriers to managing chronic pain of older adults with arthritis.

PURPOSE: To explore barriers to pain management experienced by older adults with arthritis, identify themes, and develop a theoretical model of relationships among the themes. DESIGN AND METHODS: Focus groups were used to collect data with 57 older-adult participants who had self-reported arthritis. Coding techniques consistent with grounded theory methodology were used for data analysis. FINDINGS: Nine themes were identified to describe barriers to chronic pain management experienced by older people with arthritis. The resulting model shows personal decision-making regarding the use of pain management methods. CONCLUSIONS: Findings provide direction for enhancing independent older people's ability to manage chronic pain. The nine categories of barriers show direction for education of both clients and health care providers, as well as for planning other types of needed support. The theoretical model shows the complexity of barriers experienced by older adults with arthritis.