Improving the patient's experience of a bone marrow biopsy - an RCT.

AIMS: To compare nitrous oxide 50%/oxygen 50% (N(2)O/O(2)- entonox) plus local anaesthetic (LA) with placebo (oxygen) plus LA in the management of pain experienced by patients undergoing a bone marrow biopsy. BACKGROUND: Bone marrow biopsies are a common procedure for many haematological conditions. Despite the use of a LA, pain during the procedure has frequently been reported by patients. Previous research in pain management of other invasive diagnostic procedures (e.g. sigmoidoscopy) has reported N(2)O/O(2) as an effective alternative to LA. DESIGN: Double-blind randomized controlled trial. METHODS: Forty-eight patients requiring a bone marrow biopsy were randomized to receive either N(2)O/O(2) or oxygen in addition to their LA. Participants were asked to complete a pain score and comment on their experience of the procedure. RESULTS: Although the overall pain scores were moderate, there was a wide range of scores. N(2)O/O(2) resulted in significantly less pain for men, but not for women. All patients who had had previous biopsies reported significantly more pain, regardless of the gas used. There were no significant adverse effects in either group. CONCLUSION: N(2)O/O(2) is a safe, effective, easy-to-use analgesic which merits further investigation in potentially painful diagnostic (and other) interventions. Relevance to clinical practice. Relief of pain is an important issue for nurses. Appropriate assessment of pain experience is a key issue. Nurses should reflect on their own area of practice and identify what is known about the effectiveness of pain management from their patient's perspective. Individual differences may be important, and careful instruction regarding appropriate administration of analgesic agents, such as N(2)O/O(2) may enhance their effectiveness.

Expert Patient Programme: managing patients with long-term conditions.

It is estimated that currently there may be as many as 17.5 million adults in Great Britain who are living with a long-term condition. Often these conditions will have a huge impact on the quality of life experienced by the person and any carers who might be involved. The impact on health care services is also profound. Long-term conditions potentially pose serious problems for healthcare systems in terms of adequate and appropriate resources to deal with the complexity of care required. Empowerment programmes which develop individuals' ability to self-manage their conditions are one way of helping people to maintain their independence and maximise their well-being. This article outlines one model (the Expert Patient Programme) and describes key issues with developing this approach in one acute Trust.

Clients' perceptions of support received from health visitors during home visits.

AIMS AND OBJECTIVES: The current study sought to identify how many mothers from 149 visits carried out by seven health visitors identified support as a feature of the visit, whether this type of support was unique to the health visitor and what support meant to them. These responses were then compared with the taxonomies of social support from the social support literature. BACKGROUND: Some studies of client perceptions describe support as an element of home visits by health visitors. However, the importance, relevance and impact on the client of this support are not described in detail. Social support theory suggests that there are tangible benefits to people's well-being and their ability to cope with various challenges that may arise from individuals' perceptions of receiving support. DESIGN: Qualitative study using semistructured interviews. METHODS: Seven volunteer health visitors recruited 149 women into the study. These clients were interviewed by the researcher, usually within one week of the home visit by their health visitor. The discussions were audio-taped and the resulting transcripts analysed using content analysis. FINDINGS: Thirty-seven women identified receiving support which they said was only available from the health visitor. The relevance of this support to the mother and the impact on her well-being varied within the group suggesting differing perceptions of support by clients according to their personal situation. There was a correspondence between the descriptions of support given by the women and the taxonomies of social support from the social support literature. CONCLUSION: For some interactions between clients and their health visitors the existing theory of social support may provide an explanation of how health visitors contribute to clients' perceived ability to cope and well-being. RELEVANCE TO CLINICAL PRACTICE: Social support may be defined as a possible outcome of health visiting. This concept will have use within educational programmes to demonstrate to students how health visiting can have an impact on clients' well-being. Similarly, the concept could be used to investigate and record health visiting practice.

Public health nursing: barriers and opportunities.

This paper reports the findings of a descriptive study that examined the understanding and practice of public health nursing in one English NHS Region. Using questionnaires and focus groups, data were collected from nurses working in Health Authorities, senior Trust management, operational management and nursing practice across hospital and community services. The data were analysed using qualitative methods. The paper reports one aspect of the study, namely the views of the lead nurses in the Trusts and the Health Authorities regarding public health and nursing. The findings suggest that there are varying interpretations of public health nursing, lack of collaboration between and within organizations and disciplines and limitations in the knowledge and skills possessed by practitioners. It is argued that these issues all present barriers to the development of public health nursing and need to be considered as a matter of urgency if organizations and clinicians are to make the most of the current opportunities.