The effect of injection speed on the perception of intramuscular injection pain. A clinical update.

Injections are frequently administered by occupational health nurses in worksite health promotion programs. The purpose of this study was to examine the effect of varying injection speed on the perception of pain. Fifty workers were given intramuscular (i.m.) hepatitis B vaccine at injection speeds of 10 and 30 seconds per cubic centimeter (s/cc). The perception of pain was measured on a visual analogue scale and reported post-injection at three different time intervals. The results showed that no difference in pain was perceived by participants between the two injection speeds. Results also revealed that women consistently had higher mean pain scores than men and significantly more pain at the 0 hour measurement of the 10 s/cc injection. While the results of this study indicate no need to administer an i.m. injection slower than 10 s/cc, occupational health nurses will need to consider gender differences in pain perception when administering injections.

Contracting with outpatient hemodialysis patients to improve adherence to treatment.

The purpose of this study was to examine the relationship between contingency contracting and adherence to prescribed therapy in outpatient chronic hemodialysis patients. A quasi-experimental, pretest/posttest design was used. The sample included 15 hemodialysis patients, 6 in the phosphorus group and 9 in the weight-gain group. The study was conducted at an outpatient hemodialysis center in a Midwestern rural state. Specific variables investigated were interdialytic weight gains and serum phosphorus levels that reflect adherence to fluid restrictions and to taking phosphate-binding medications. Weekly interviews were conducted with each patient and content analysis of interview data was completed to identify categories related to adherence and nonadherence. Pre- and postcontract weight gains and phosphorus levels were analyzed with a paired two sample t-test. The categories related to adherence and nonadherence included physiological, psychological, environmental, locus of control/self-control/self-praise, economical, medical, knowledge deficit, health benefits, family support, and social support. Adherence to taking phosphate-binding medication responded more favorably to contingency contracting than did adherence to fluid restrictions. Chronic outpatient hemodialysis patients in the sample responded to the use of contingency contracting and developed techniques to remember to take phosphate-binding medications in order to lower serum phosphorus medications.

Managed Care in Rural Health: The Stroke Survivor on Horseback.

Managed care has been slow to come to underserved rural areas, where profits may not be as large as in metropolitan areas. In the last decade, increased threat of takeover by out-of-state managed care organizations (MCOs) has prompted rural community hospitals and providers to develop some new models of managed care that fit both their economic and health care needs. Stroke survivors in rural areas have the same need for coordinated, ongoing care during their lifetime, but it is more difficult to deliver it in rural areas. Rehabilitation providers are urged to be proactive in creating innovative managed care approaches that will improve both the health and recovery outcomes of rural stroke survivors.

The Role of Medical Conditions and Depression in the Functional Outcome of Stroke Survivors: A Review and Pilot Study.

This study is a secondary analysis conducted to describe the population of medically ill people who have had a stroke in terms of functional outcome over time. Functional outcome did not differ between stroke survivors with medical illness and those without medical illness at the two time periods studied. However, there was a difference in functional outcome over time between stroke survivors with medical illness who were depressed and those who were not.

Evaluation of a PhD program: paving the way.

Quality assurance in doctoral education in nursing is a high priority as programs are developed and changed. The discipline and profession of nursing will not be well served if doctoral program quality is not monitored in a systematic way. Without the demands of a periodic, required evaluation by an external accrediting body, the motivation for quality assurance must be internally driven. One pragmatic motivating factor is that today's sophisticated doctoral applicant has resources available to assist with program choice by assessment of quality indicators. High-quality programs will attract the highly qualified students who will lead nursing in the next century. This article has presented a process leading to evaluation of quality and outcomes of one doctoral program. Some of our ideas and experiences may be helpful to those initiating an evaluation process in their own institutions.

Primary care in the emergency room: a collaborative model.

Emergency rooms have become primary care centers for a large portion of the population. Unfortunately, most are neither designed nor appropriately staffed to deliver first-line, continuous, comprehensive, family-oriented, and self-actualizing care. This paper describes a nurse-managed collaborative primary care practice model that has been functioning for 8 years in an inner city emergency department.

Prevention and other special management issues in the postacute care of the geriatric stroke patient.

Rehabilitation of older stroke patients does not take place isolated from social and medical problems. Nurses and internists are crucial members of the interdisciplinary team, maintaining health and preventing long- and short-term complications in the stroke survivor. This review describes our research interests and clinical approaches to some of the special medical and nursing needs of the population, using prevention as a model for caring for these chronically ill patients and their families.

Recognizing depression: Preliminary testing of the Whitney Observational Depression Index.

The preliminary results of an observational instrument for depression is presented. The Whitney Observational Depression Index (WODI) was developed to capitalize on the observational powers of both formal and informal caregivers who care for vulnerable populations (such as stroke victims), among whom self-report depression measures are unreliable or impossible to use. It is a 59-item checklist with a total score and subscale scores related to verbal-cognitive, affective, and vegetative signs noted on observation. The scale shows good construct, content, face, and criterion validity (convergent and divergent), inter-rater reliability, and within-subject reliability. The WODI shows significant correlations with accepted depression measures (Beck Depression Index, r = 0.19, p = <0.05; Zung Depression Scale, r = 0.23, p= <0.01). Further testing is suggested to allow factor analysis of the items and other statistical testing. There is optimism expressed for the use of this instrument in both research and clinical settings.

Relationship of laterality of stroke to emotional and functional outcome.

The role of hemispheric laterality and emotion in the stroke population has been studied less than in other brain-damaged populations. Neuroscience nurses caring for stroke patients need knowledge about the anatomical placement of ischemic deficits and the relationship of emotions to that placement to understand observed affect and behavior. Knowing how to assess negative affect and behavior will help nurses design interventions to produce optimal recovery.

Turning clinical problems into research.

The nursing process is well known by practicing nurses. The model for approaching the development of nursing research using this process has been presented. The clinical arena is rich in data and problems worthy of detailed research work. The models provide structure and methods that are familiar to practicing nurses so that they may begin to work with colleagues and other researchers in the clinical setting. A nurse who wants to use this model to begin research efforts needs interested colleagues in nursing, friends with patient ears, superiors who value this type of work, and affable determination.

Alzheimer's disease: toward understanding and management.

It is vital that nurse practitioners be knowledgeable about the most common primary dementia, Alzheimer's disease. A review of the etiology, pathology, signs and symptoms are presented. This article suggests a method for the nurse practitioner to use in assessing the demented patient, with a view of the differential diagnosis and diagnostic work-up. Current methods of drug, diet and life-style management are discussed. Nursing interventions, guided by the progressing phases of Alzheimer's disease, are offered.

Guidelines for neurological consultation.

Referral to specialists for care which requires expert knowledge is a common occurrence in primary care. The role of the nurse practitioners is often to make judgments about the need for such referrals, seek appropriate specialists, prepare records and the patient for the referral and maintain contact with patient once expert advice and diagnosis is complete. This article specifically addresses the referral of patients with neurologic problems. Emphasis is placed upon general rules relating to how to refer and how to determine the need for referral. Some common complaints of ambulatory proteins which may need referral such as headache, dizziness the difference between those complaints which need referral and those that do not.