Making sense of it: a neuro-interactional model of meaning emergence in critically ill ventilated patients.

Emphasis on meaning underpins a current thrust of knowledge development in nursing, especially in the client domain. Examination of meaning in the interactional context and through varying levels of consciousness has not been examined. Initially, an integrated model was developed deductively from philosophical, theoretical and research-oriented sources. This model was meant as a guide to begin examining how patients with varying levels of consciousness make sense of their intensive care unit experience. Over a 10-month period of fieldwork, this author observed patients twice daily through their intensive care unit stay to capture the nature and content of thinking processes. The resulting neuro-interactional model describes patients' thinking processes and scope of meaning as a function of levels of consciousness as well as factors which affect thinking and meaning. Theory, research and practice implications are presented.

Presence: four ways of being there.

Presence is an important but confusing concept in nursing. At times, it is used to simply characterize a nurse's physical presence, while, at other times, it is used in a highly metaphysical sense to depict a nurse's full physical, psychological, and spiritual presence. As a concept, presence has not been clearly defined. Its core characteristics need to be identified and separated from those characteristics that reflect its variability. The authors establish a definition of presence as "being there" based on the essence of the concept as it is used in the nursing literature; identifying four ways in which presence varies based on the quality of being there, the focus of the nurse's energy, and the nature of the nurse-patient interaction; and address possible outcomes of each type.

Developing a translation of the McGill pain questionnaire for cross-cultural comparison: an example from Norway.

The ability to measure pain across diverse cultures is important for understanding the universal aspects of pain and expediting nursing intervention. The McGill Pain Questionnaire (MPQ) is the most valid and reliable single multidimensional pain instrument available for measuring pain. Although it has been translated in several languages, most efforts, including two Norwegian translations, have resulted in a variety of new versions, all lacking sufficient faithfulness to the original MPQ to allow qualitative or quantitative cross-cultural comparisons. There is a need for direct translations that maintain the original denotation, connotation and numerical value of the MPQ and thus provide a base for future cross-cultural studies of pain. This paper reports on the development and initial testing of a direct translation of the McGill Pain Questionnaire into Norwegian (NMPQ). The translation process involved three phases: translation, back-translation and consensual. In order to evaluate its performance and validity, the NMPQ was administered to a group of adult surgical patients at two different points in time during the postoperative period. The NMPQ was examined for its feasibility, its sensitivity in detecting decreases in intensity of pain postoperatively and for construct validity. A visual analogue scale was used to check for converging validity, and Spielberger's state anxiety scale was used to assess discriminate validity. The initial testing of the NMPQ with adult surgical patients suggests that the NMPQ is culturally acceptable, relevant, sensitive to fluctuations in pain and numerically consistent with the original MPQ. The moderate levels of validity attend lend considerable assurance to the instruments readiness for use in cross-cultural studies of pain.

Client-nurse interaction: testing for its impact in preoperative instruction.

This study tests for the impact of client-nurse interaction, an essential element lacking in earlier research on preoperative instruction. An experimental design compared the effects of three models of intervention: Facilitator, Informational and Routine Treatment on postoperative pain and anxiety in 91 cholecystectomy patients. Planned comparisons showed that subjects in both experimental conditions reported significantly less postoperative anxiety than subjects who received the routine treatment. There were no differences in anxiety levels between the two experimental groups or in pain scores among the three groups. Refinements in the facilitator model are recommended to enhance the problem-solving nature of the interaction and to strengthen future research. The findings support the importance of providing the patient with sensation information and postoperative exercise instruction.

Action research: what is it? How has it been used and how can it be used in nursing?

Action research has enjoyed increasing popularity across a wide variety of disciplines including nursing. Action research was designed specifically to bridge the gap between theory, research and practice and incorporates both humanistic and naturalistic scientific methods. As such, action research is a highly compelling method for nursing. However, action research does not easily lend itself to definition. A variety of approaches, definitions and uses have emerged since it was created by Kurt Lewin and have given rise to much debate within social and behavioural sciences. This confusion has carried over into nursing literature without any systematic identification of or debate about the core characteristics of action research or the multitude of approaches or uses that have come to be associated with this method. Thus this paper addresses the central characteristics, three major approaches to action research that exist today and how action research has been used and can be used in nursing.

The postoperative pain experience: a description based on the McGill Pain Questionnaire.

In surgical nursing practice, postoperative pain is of particular concern because of its documented effect on recovery and behaviors associated with recovery. Yet, little is known about the nature of this pain, other than its intensity. In this study, a description of the nature of the postoperative pain experience was generated from analysis of patient responses to the McGill Pain Questionnaire in four nursing intervention studies. The combined sample included 246 adult cholecystectomy patients. Patient descriptions of pain on the third postoperative day suggest a circumscribed sensory experience of moderate intensity. Sensory descriptors selected reflect two levels of noxious stimulation, one at the deeper somatic level (e.g., throbbing, stabbing, cramping, pulling, and burning) and one at a more superficial level (e.g., pricking, sharp, pinching, itching, sore, and tender). Descriptors of deeper pain tended to reflect greater intensity. The overall experience was characterized by 16 descriptors, selected by more than 30% of the sample and reflecting sensory, affective, and evaluative dimensions of the pain experience. Comparison of the findings from this combined sample drawn from hospitals in the northeastern United States were remarkably similar to those reported by Taenzer in Canada. The descriptors selected support, extend, and validate the kind of "sensation information" needed in preoperative instruction used in nursing practice and for abdominal surgery and can be useful in the assessment and management of postoperative pain.

Risk taking among diabetic clients.

Diabetic clients must make daily decisions about their health care needs. Observational and anecdotal evidence suggests that vast differences exist between the kinds of choices diabetic clients make and the kinds of chances they are willing to take. The purpose of this investigation was to develop a diabetic risk-assessment tool. This instrument, which is based on subjective expected utility theory, measures risk-prone and risk-averse behavior. Initial findings from a pilot study of 18 women clients who are on insulin indicate that patterns of risk behavior exist in the areas of exercise, skin care, and diet.

Are nurses healthier and happier than the general public?

During the last decade, an increasing amount of research has been done on the health of nurses. This work has been limited by a focus on illness and single health behaviors as well as by a lack of systematic comparisons with non-nurses. Analysis of General Social Survey data from the National Opinion Research Center is used to compare the general health status, experiences and behaviors, and general level of happiness of nurses with non-nurses. Findings suggest that nurses tend to evaluate their personal health status more positively than non-nurses, although nurses and non-nurses tend to be very similar in terms of their smoking behaviors and the amount of hospitalizations, disabilities, and stressful life events that they experience. Nurses, however, more often report using alcoholic beverages. Finally, both nurses and non-nurses report rather high levels of happiness with their personal lives and marriages.