Administration of post-operative analgesia

Pain is one of the major problems encountered by patients who have undergone surgery. The relief of pain is an important part of their treatment, and is both a nursing and a medical responsibility. Analgesics, both narcotic and non-narcotic, are usually prescribed by doctors on a pro re nata, or ‘as needed\u27 basis. The responsibility for administration lies with the nurses, and they choose the type and quantity of drug to be given. Research into the area of pain relief has shown that both nurses and doctors need further education in the judicious use of analgesics, particularly narcotics. This study was conducted on 27 patients on two orthopaedic wards in a public hospital. Using the patients\u27 drug charts and information obtained from nurses, the relationship between the type of drug (narcotic and non-narcotic) and quantity of analgesics administered post-operatively, and several environmental and patient related variables was investigated. The study tested whether any statistically significant correlations exist between the variables (gender of the patient, age of the patient, the nurses\u27 perception of the severity of injury, the person initiating the analgesia, time lapsed from surgery, and the shift the nurse is working) and the type and quantity of analgesia administered. It was hypothesised that positive correlations would be found for all the variables. Results showed no relationship between the age or gender of the patient and analgesia administered. A negative correlation was found between the nurses\u27 perception of the severity of the patient\u27s injury and the quantity of analgesia given. There was no difference between the quantity or type of analgesia administered during different shifts. A pattern of administration was found for the first 48 hours post-operatively. Results also showed a significant correlation between the person initiating the administration of analgesic and the type of analgesic given. From these findings it was recommended that further investigation of the correlations be done using a larger population from different wards and social background. Education of both nurses and patients is essential for pain management. Some ways in which this can be improved are by using pain measurement instruments to enhance nurses 1 assessment skills, incorporating pain management skills into both basic and in service education for nurses, and implementing a \u27pain management nurse specialist’ to educate patients pre-operatively and serve as a resource person for nursing staff

Perceptions of hypertension treatment among patients with and without diabetes

<p>Abstract</p> <p>Background</p> <p>Despite the availability of a wide selection of effective antihypertensive treatments and the existence of clear treatment guidelines, many patients with hypertension do not have controlled blood pressure. We conducted a qualitative study to explore beliefs and perceptions regarding hypertension and gain an understanding of barriers to treatment among patients with and without diabetes.</p> <p>Methods</p> <p>Ten focus groups were held for patients with hypertension in three age ranges, with and without diabetes. The topic guides for the groups were: What will determine your future health status? What do you understand by "raised blood pressure"? How should one go about treating raised blood pressure?</p> <p>Results</p> <p>People with hypertension tend to see hypertension not as a disease but as a risk factor for myocardial infarction or stroke. They do not view it as a continuous, degenerative process of damage to the vascular system, but rather as a binary risk process, within which you can either be a winner (not become ill) or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome. Patients with diabetes are more likely to accept hypertension as a chronic illness with minor impact on their routine, and less important than their diabetes. Most participants overestimated the effect of stress as a causative factor believing that a reduction in levels of stress is the most important treatment modality. Many believe they "know their bodies" and are able to control their blood pressure. Patients without diabetes were most likely to adopt a treatment which is a compromise between their physician's suggestions and their own understanding of hypertension.</p> <p>Conclusion</p> <p>Patient denial and non-adherence to hypertension treatment is a prevalent phenomenon reflecting a conscious choice made by the patient, based on his knowledge and perceptions regarding the medical condition and its treatment. There is a need to change perception of hypertension from a gamble to a disease process. Changing the message from the existing one of "silent killer" to one that depicts hypertension as a manageable disease process may have the potential to significantly increase adherence rates.</p

Countrywide Computer Alerts to Community Physicians Improve Potassium Testing in Patients Receiving Diuretics

More than 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium testing. The physicians were experienced users of a computerized medical record (CMR) that provided online laboratory test results. A nightly batch file checked pharmacy diuretic purchases against the patient's potassium blood test status. On-screen computer-generated reminders were sent to physicians of patients lacking a recent potassium test. Reminders to clinicians increased potassium testing by 9.8% (p < 0.001). Physician age and gender played a small part in predicting compliance to the alert, but specialty and practice size did not. The time delay between the date a reminder was sent and the potassium test date decreased steadily during the intervention. The success of this reminder system encourages expansion to include more drug–laboratory interactions. Furthermore, direct alerts to patients at multiple organization/patient contact points are planned