An evaluation of Neonatal Pain Assessment

Abstract In the UK, on average 1 in 10 newborn babies (termed neonates until 4 weeks of age) require some sort of treatment in a neonatal unit (NAO, 2007). Neonates on these units may require painful procedures be carried out as part of their diagnosis or treatment, others may suffer tissue damage as part of their condition, while some may suffer both. Pain causes an activation of the sympathetic nervous system resulting in a ‘stress’ response. The physiological and behavioural changes that result, can be used in the assessment of pain and are often incorporated into the basis of pain assessment tools. However, this work questions the very nature of pain assessment – can pain assessment only be carried out through the use of pain assessment tools or are nurses using their professional judgement to assess pain continually? It questions whether waiting for a neonate to show signs of pain is best practice, and highlights that nurses should be predicting, preventing and alleviating pain where ever possible. This dissertation seeks to question - exactly what is pain assessment? Does a formal pain assessment score need to be documented for a nurse to have ‘performed’ a pain assessment. The work suggests whether the terminology of ‘pain assessment’ may better be phrased as ‘stress measurement’. In addition to ethical issues that morally mandate nurses as health professionals to prevent and alleviate pain in neonates, this work also discusses the legislation and professional guidelines surrounding pain assessment in this group of patients. This dissertation is aimed at healthcare professionals, nurses in particular, who work in the neonatal setting to help further their knowledge, question their practice and offer recommendations for their practice

Hospital administration

The Administrator of a hospital, particularly of a teaching hospital, is faced with the task of organising increasingly complex and specialised, high technology institutions, under constant pressure to improve patient care and community services, training of health personnel, and to seek new knowledge, therapies and techniques. In addition, acute general hospitals are being forced to re-examine their goals and functions in the light of greater competition from other health and social services for scarce resources - and of changing environmental circumstances. These activities must be undertaken in the context of new theories of management with greater emphasis on the psycho-social aspects of organisation, decision-making processes and advances in information-processing techniques. To be equipped for this task the hospital administrator must also acquire new knowledge and skills. It was therefore frustrating to discover that no training courses for hospital administrators, medical or otherwise were available in this country and that there was a dearth of literature with specific reference to the Republic. Thus, it was as a measure of desperation that this thesis was embarked on, in order to satisfy a personal need to learn about the theory of administration and to meet the need for basic research into, and documentation of, hospital administration in South Africa. In view of the necessity to study virtually every aspect of the subject and the fact that so little research had been done on the management of South African hospitals, it was felt that hospital administration should be examined as a totality rather than selecting any single aspect of the subject. General Systems theory which views any open system as a whole, in constant interaction with its environment, provided an appropriate conceptual framework for the general study of hospital administration. The Groote Schuur Hospital Group provided a suitable model within which to l examine the application of general systems theory; for analysis of the environment, resources, organisation and products of a hospital; and upon which to base some general conclusions regarding the administration of hospitals, recommendations for change and for further research. This thesis which is presented in eight chapters with a short summary of the contents at the end of each chapter has examined one teaching hospital group as a whole system. No attempt has been made to study any aspect of hospital administration in great detail, but rather to identify areas where immediate changes can be implemented to improve the effective and efficient utilisation of resources, and those where further research is essential to find better ways of achieving these goals and meeting societal needs. In the words of Tenon - The hospital is the conscience of a civilisation whose worth, in the end will be measured not by articles of faith and lofty doctrines but by the way it nurtures life; succours distress, rights injustices and transforms misery, frailty and want into hope, dignity and sufficiency

The cancer nurse coordinator service in Western Australia: Perspectives of specialist cancer nurse coordinators

Objective: In Western Australia the cancer nurse coordinator (CNC) role is unique, state wide and situated in nursing. It requires the domains of clinical expert, resource consultant, educator, change agent, researcher and advocate to facilitate seamless coordination of care for patients across metropolitan, rural and remote geographical areas of Western Australia. This study examined the role, function and impact of CNCs from the perspective of coordinators themselves. Design: Prospective two-phase mixed method study. This paper reports data from the Self Report Activity Questionnaire in Phase one. Setting: The state-wide Western Australian Cancer Nurse Coordinator Service. Subjects: Metropolitan and rural CNCs (n=18) who had worked in the role for at least six months. Results: Overall, CNCs spent 70% of time in clinical consultation and 41% of CNCs reported having an educational role. Most CNCs (71%) noted that at least half of their patients had complex psychosocial needs at referral. Key role-related activities related to direct nursing care and patient education were performed most frequently on a daily basis. Tasks related to care management planning, patient advocacy and multidisciplinary clinical care were performed weekly. Strategic, team communication and professional development activities were performed less frequently. Conclusion: Diversity of the CNC role was demonstrated with findings showing that CNCs fulfilled the core components of the specialist cancer nurse. Given the clear need to provide consistent support to cancer patients in an increasingly individualised and integrated manner, we consider the CNC role a fundamental element of quality cancer care

A descriptive survey of renal unit practitioners' knowledge, attitude and practice relative to use and effects of unfractionated heparin in selected adult chronic haemodialysis centres in the Cape Town metropole

Background: Chronic haemodialysis treatment of 3-4 hours' duration two or three times a week is the most common renal replacement therapy for adult patients diagnosed with stage 5 end-stage kidney failure. During the procedure 200-250 ml/minute of the patient's blood volume is extracorporeal and patency of the circuit is maintained by an anticoagulant, for example, unfractionated heparin (UFH). Incorrect dosage or time of administration of UFH can have serious adverse effects if not fatal consequences for patients. It is important to perform base-line clotting studies before the initial administration and subsequent doses of UFH. There is a paucity of published information on renal unit practitioners' knowledge, attitude and practice (KAP) concerning the administration of UFH globally and no published South African studies were located. Aim: To describe renal unit practitioners' self-reported KAP regarding use and effects of UFH in purposively selected adult chronic haemodialysis centres in the Cape Town Metropole. Secondly, to determine whether there is an association between KAP regarding the use and effects of unfractionated heparin and selected variables (category of renal unit practitioner, years of experience, duration of orientation to the adult chronic haemodialysis unit and in-service education on the pharmacology of UFH)

Empowerment counselling in nursing well-child visits for healthy family lifestyles

Background: Empowerment counselling has long been assumed to improve people’s health and is encouraged to be adopted in routine healthcare. However, the questions as to whether empowerment reliably benefits preschool children and families’ health and whether it is being addressed in nursing well-child visits for healthy family lifestyles are yet to be addressed. The overall purpose of this thesis is to contribute toward the clarification and advance of empowerment counselling in nursing well-child visits for healthy family lifestyles. This thesis consisted of three studies. Aims: To synthesize the existing evidence on health interventions using the empowerment concept with preschool-age children and families (sub-study 1). To develop a Portuguese translation and adaptation of the Empowering Speech Practices Scale and investigate its construct validity and reliability (sub-study 2). To describe and compare nurses’ and families’perceptions regarding the degree of empowerment counselling in well-child visits for healthy family lifestyles and explore its associations with nurses’ and families’ sociodemographic and nutritional characteristics (sub-study 3). Design and Methods: We conducted a systematic literature review (sub-study 1), and an observational cross-sectional survey study (sub-study 2 and 3) with 82 families attending a 5-year-old well-child visit and 25 nurses from 12 health functional units situated in Portugal’s Central Region and the Metropolitan Area of Lisbon. Results: In sub-study 1, only ten intervention studies met the criteria for inclusion, with 50% showing positive effects. Children’s participation was scarce. Overall, studies provided limited details on theory application. Sixteen promising behaviour change techniques were identified. Findings from sub-study 2 supported the Portuguese Empowering Speech Practices Scale internal reliability and construct validity, suggesting it has potential usefulness as a measure of empowerment counselling in 5-year-old well-child visits. Sub-study 3 showed that both nurses and families perceived empowerment had been practised to a high degree in the nursing well-child visits. Still, the domain of participatory practices of empowerment counselling can be expanded. The family’s limited familiarity with the health system, having children with overweight, and the well-child visits being conducted in Customized Health Care Units were associated with lower empowerment counselling scores. Conclusions: The findings of the studies give valuable insights to plan further work needed to prove the effectiveness and meaningfulness of using empowerment counselling in well-child visits

Use of the CAMEO II Acuity Tool to Decrease Burnout for Nurses Working in a Pediatric Intensive Care Unit

The World Health Organization (WHO) reported registered nurse burnout is an occupational hazard resulting in serious consequences for patients, healthcare organizations, and individual registered nurses (Woo et al., 2020). The purpose of this project was to see if the Complexity Assessment and Monitoring to Ensure Optimal Outcomes II (CAMEO II) Acuity Tool, used as an intervention for staffing and scheduling, would have a positive effect against nurse burnout in a pediatric critical care setting in a pediatric medical center. Maslach’s Burnout Inventory- Human Services Survey for Medical Personnel (MBI-HSSMP) was used as a pre- and postsurvey to measure the emotional exhaustion, reduced personal accomplishment, and depersonalization of registered nurses before and after the use of the CAMEO II Acuity Tool. The initial results from the MBI-HSSMP presurvey were alarming, showing evidence of chronic nurse burnout. While the CAMEO II Acuity Tool was exhausting to use, the results of its implementation into the scheduling of registered nurses had a positive outcome following the results of the MBI-HSSMP postsurvey. Key recommendations for the organization and its leaders were the continued use of a modified acuity tool for its departments and continued research on other factors affecting registered nurse burnout

Postoperative pain : nursing management and organisational commitment

Postoperative pain management has been the subject of several national reports (Royal College of Surgeons of England and College of Anaesthetists, 1990; Audit Commission, 1997; Clinical Standards Advisory Group, 2000) that have each made recommendations for practice at ward level and Trust-wide strategies to improve pain management within an organisation. These two areas represent the foci of the work undertaken in this thesis.The research consisted of two studies; the first surveyed hospital Trusts in the Northern and Yorkshire region (n=35) and the second explored nursing care of 120 patients admitted to four English hospitals (two with an acute pain service) through nonparticipant observation, patient interviews and examination of nursing documentation. The questionnaire results highlighted increases in funding for pain management, staff education, audit practices and written guidelines compared to previous work by the Audit Commission (1998) but wide variations in the nature of these activities. In the second study, hospital two (without a pain service) achieved the lowest pain scores at rest (p=0.018) and on movement (p=0.013) but also had one of the lowest rates of analgesic administration and morphine equivalent doses. This ward had the highest number of pain-related interactions (p=0.004), entries onto pain assessment charts (p=0.03) and documented evaluations in nursing care plans. Data also illustrate the differences between observed and documented care in all hospitals and the low use of pain assessment tools in practice to inform analgesic decision-making.This study provides an insight into hospital activities aimed at improving pain management and surgical nursing practice across Trusts. Recommendations are made to further enhance pain relief in hospital including the promotion of pain as a quality of care indicator and increasing accountability within organisations

THE EFFECT OF NURSING LEADERSHIP AND STRUCTURAL EMPOWERMENT ON STAFF NURSE CLINICAL LEADERSHIP

In an effort to improve patient safety, healthcare organizations have begun to focus on nursing leadership at the clinical level. The purpose of this study was to develop and test a model of staff nurse clinical leadership, defined as a process of leadership which operates at the point of care and is demonstrated in the leader behaviours of staff nurses providing direct patient care. A new measure of clinical leadership was developed for this study. Staff nurse perceptions of the influence of nurse manager leadership practices and empowering work environments on their ability to use clinical leader behaviours in their practice were examined. This was a non-experimental design study using a survey method to access registered nurses in direct care roles in acute care hospitals in Ontario. Results indicated that staff nurses have integrated clinical leadership into their practice and show staff nurse perceptions of nurse manager leadership practices were directly and positively related to empowered work environments. It was through these environments that nurse manager leadership practices influenced staff nurse clinical leadership. This study provided an important contribution to understanding the concept of staff nurse clinical leadership and how this relates to work empowerment and nurse manger leadership practices. It has important implications for nursing practice, nursing administration and nursing education