Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective

This study sought to explore the impact of the psychological variables anxiety and depression, on pain experience over time following surgery. Eighty-five women having major gynaecological surgery were assessed for anxiety, depression and pain after surgery. To gain further understanding, 37 patients participated in a semi-structured taped telephone interview 4–6 weeks post-operatively. Pre-operative anxiety was found to be predictive of post-operative anxiety on Day 2, with patients who experienced high levels of anxiety before surgery continuing to feel anxious afterwards. By Day 4 both anxiety and depression scores increased as pain increased and one-third of the sample experienced levels of anxiety in psychiatric proportions whilst under one-third experienced similar levels of depression. These findings have significant implications for the provision of acute pain management after surgery. Future research and those managing acute pain services need to consider the multidimensional effect of acute pain and the interface between primary and secondary care

Fatigue in patients receiving chemotherapy: patterns of change

Fatigue is reported to be a significant and distressing problem for people receiving chemotherapy, but the phenomenon is poorly understood and little is known about the factors influencing it. Nurses need to understand the dimensions of fatigue in order to provide effective help for individuals with cancer who experience it. This article describes a study that employed a daily diary with the aim of prospectively charting the onset, pattern, duration, intensity, and distress associated with fatigue in 109 patients receiving chemotherapy. The diary comprised four visual analogue scales measuring selected dimensions of fatigue: extent of fatigue, distress caused by fatigue, the influence of fatigue on the ability to engage in social activities, and the impact of fatigue on work-related activities. The patients' diaries produced detailed time series of data that captured the dynamics of their fatigue. Analyses of these data revealed the patterns of fatigue after the administration of chemotherapy, which appear strongly related to both the timing of treatment and the manner in which cytotoxic agents are administered. Furthermore, Kruskal-Wallis tests performed to compare fatigue among subgroups of patients revealed that it is statistically associated with particular types of cancer, specific chemotherapy regimens, and certain methods of drug administration. Fatigue varied throughout the day, more frequently occurring in the afternoon and early evening. These insights, gained during this study about the likely pattern of fatigue in the period after the administration of chemotherapy, and the potential benefits of maintaining a fatigue diary could be utilized by nurses engaged in the care of chemotherapy patient

Suctioning: a review of current research recommendations.

Effective suctioning is an essential aspect of airway management in the critically ill. However, there are many associated risks and complications. These range from trauma and hypoxaemia to cardiac dysrhythmias and, in extreme cases, cardiac arrest and death. This paper identifies the current research recommendations for safer suctioning practices. The literature is reviewed in three parts: prior to suctioning; during suctioning; and post-suctioning. The recommendations prior to suctioning include patient assessment, patient preparation and hyperoxygenation. The recommendations during suctioning include appropriate catheter selection, depth of insertion, negative pressure, duration of procedure and number of suction passes. Measures for maintenance of asepsis, such as hand-washing, wearing gloves, goggles and aprons are other essential considerations, which must not be overlooked. The recommendations post-suctioning include reconnection of oxygen, patient assessment, reduction of oxygen to baseline level, and providing patient reassurance. In order to improve standards of care, it is imperative that nurses are aware of current research recommendations. This will enable nurses to make informed decisions about their own suctioning practices, based on the individual needs of the patient

NHS cadet schemes: do they widen access to professional healthcare education?

Aim. The aim of this paper is to report a study investigating the extent to which National Health Service cadet schemes widen access to professional health care education. Background. Cadet schemes have been reintroduced in the United Kingdom to increase recruitment of nurses and other health care staff to the National Health Service and also to widen access and increase participation in professional health care education by groups poorly represented in such education, including minority ethnic groups. Methods. A questionnaire survey of all cadet schemes (n = 62) in England at the time of the study was carried out, and the respondents were cadet scheme leaders (n = 62) and cadet students (n = 411). The questionnaires to scheme leaders enquired about when the schemes were established, what the schemes were preparing cadets for, modes of delivery and entry qualifications. The questionnaires to cadets enquired about age, gender, family circumstances, prior experience and ethnic background. Findings. The majority of schemes had been established since the health service reforms of 1999 and most were preparing cadets to enter professional nurse education programmes. Very few provided opportunities for part-time study and some asked for entry qualifications. Cadets were younger on entry than a comparator group of student nurses, fewer were married, fewer had previous employment or health-related employment and a lower percentage of cadets were white. Conclusion. Cadet schemes have the potential to widen access to professional health care study, but there is only limited evidence that they are doing so. In particular there was a lack of mature entrants to health care professional education via the schemes. However, the majority of schemes offered a route into professional education for students who did not hold sufficient educational qualifications for direct entry to professional health care education. It is encouraging that cadet schemes appear to be attracting a significantly greater proportion of students from Black and minority ethnic groups than preregistration nursing programmes overall