The development and testing of the patient record pain management assessment tool.

The article reports a study whose purpose was to develop and test the Patient Record Pain Management Assessment Tool, an instrument to evaluate compliance with the American Pain Society's quality assurance standards on acute pain and cancer pain in chart documentation. Content validity, overall validity, and interrater reliability were all found to be acceptable. The instrument is therefore a useful tool for documenting the level of pain management practice in institutional settings.

Analysis of recent literature concerning relaxation and imagery interventions for cancer pain.

A review of literature concerning relaxation and imagery interventions for cancer pain is necessary because major review articles have excluded nursing research or were written prior to the publication of controlled studies in cancer pain conducted by nurses. This review of published nursing/medical/psychological literature of adults with cancer pain conducted over the past 14 years (1982-95) revealed few controlled studies, weak theoretical frameworks, few complete descriptions of the nature of the pain problem, and lack of control over the interventions. Most had very small sizes and could not demonstrate significant effects. Additionally, the intervention methods and length of the interventions were highly variable. Despite these design shortcomings, relaxation and imagery appear to reduce the sensory experience of pain, have equivocal effects on affective measures, and appear to have no effect on functional status. Suggestions for improvement include the need for more experimental studies, more complete descriptions of pain, improved statistical reporting, controls over adequacy of and compliance to the interventions, use of single interventions, and use of more complex measures of affective outcomes. Additionally, the paper contains a discussion of the problems of measuring selected outcome variables in this type of research.

Effect of attitudes and subjective norms on intention to provide oral care to patients receiving antineoplastic chemotherapy.

The Theory of Reasoned Action (TRA) served as the conceptual framework for this study, which was designed to examine the effect of attitudes and subjective norms on intention to provide oral care for patients receiving chemotherapy. The sample, stratified by type of health care facility, consisted of staff nurses (N = 85) who work in oncology settings in New York State. Data were collected by sending 10 questionnaires to a designee at the randomly chosen facility. Both attitudes and subjective norms were significant predictors of behavioral intention, predicting 39% of the variance. Using the strategy devised by Laschinger and Goldenberg, the sample was divided into two groups: those that scored below the mean on behavioral intention (nonintenders) and those above the mean (intenders). Nonintenders scored significantly lower on attitudes and subjective norms than intenders. The TRA was not supported when examining the data of the nonintenders, whereas for the intenders the theory did operate as designed, predicting 23% of the variance in behavioral intention.

Lessons learned in implementing a staff education program in pain management in the acute care setting.

With the release of Acute Pain and Cancer Pain Guidelines from the federal government, many healthcare agencies will be instituting programs to improve pain management. The authors describe a pilot project in acute pain management that did not yield desired results. On the basis of this experience and through a review of the literature, information is provided to staff development educators about problems and issues in planning and executing a program in pain management using structure, process, and outcome as a framework.

Staff nurses' perceptions of barriers to effective pain management.

The purpose of this study was to investigate staff nurses' perceptions of barriers to pain management including lack of educational preparation; inadequacy of clinical practice skills; and certain legal/political, financial, and ethical problems. Staff nurses rated the adequacy of their knowledge and skills in each of these areas as well as how important they believed each area was on a four-point Likert scale (1 = very inadequate or very unimportant to 4 = very adequate or very important). Nurses were also asked to list the most important pain management problems in their institutions. A random sample of 24 hospitals stratified on the basis of size was drawn from four states in the United States. Of 125 nurses contacted, 108 (86%) responded to the questionnaire. Nurses rated their educational preparation (mean, 2.6; SD, 0.05) and knowledge of legal/political issues (mean, 2.3; SD, 0.05) midway between inadequate and adequate. Practice was rated as adequate (mean 3.1; SD, 0.36), and financial issues were rated as inadequate (mean, 1.9; SD, 0.06). Knowledge of ethical issues was adequate (mean, 3.1; SD, 0.03). Implications of these ratings based on the literature in pain management are discussed.

Camp Fresh Horizons: an innovative wellness experience for patients with cancer.

Recognizing that cancer and its treatment can negatively affect many aspects of an individual's functioning, the Western New York Chapter of the Oncology Nursing Society (ONS) designed an outdoor camping experience that allowed patients to refocus their lives, briefly, from disease and treatment to life and living. The camp, Camp Fresh Horizons, incorporated wellness-related activities designed to assist patients toward self-actualization. Twenty-four adults with cancer, 16 of their guests, and approximately 80 volunteers attended the weekend camp, which included indoor and outdoor recreational programs. Informal evaluations indicated that an experience based on wellness may offer improved emotional and physical functioning for people with cancer. This project proved to be a refreshing and different approach to patient- and family-centered support. The authors suggest that this wellness-centered project may be an important patient intervention useful to other ONS chapters.

The pathophysiology of pain.

Attempting to relieve pain can be difficult, but with a firm understanding of the physiology of pain facilitation and inhibition, meaningful management strategies can be devised. Pain management failure will be more easily understood and less likely to be blamed on the patient. Good pain management requires both the practitioner and the patient to be knowledgeable. There are no shortcuts or prescriptions that will suit every patient experiencing any particular type of pain. This fact is both the difficult dilemma and the challenging aspect of pain control.

Planning the interview for a clinical nurse researcher.

The number of clinical nurse researcher positions seems to be increasing in healthcare agencies today. There are some unique features of the clinical nurse researcher role, including the complexities of a research position, the relatively recent introduction of the role in some clinical settings, and the frequency with which the position is coupled with other major clinical, administrative, or educational responsibilities. To increase the effectiveness of both the chief nurse executive and the clinical nurse researcher during the employment interview, the authors discuss five lines of inquiry that the interviewer or candidate can use.