Management of chronic pain

[Extract] Chronic pain is suffered by a significant number of people from all age groups. Most of these people manage the pain themselves in a range of positive and sometimes negative ways - they take analgesics and remedies and modify their lifestyles to accommodate changes that may accrue in elements of life such as function and affect. People who suffer from chronic pain classically refer themselves to general practitioners who now act as agents for a broad range of conventional and complementary specialists to manage chronic pain. The majority of nurses become involved in the care of people with chronic pain when it affects function or psychological wellbeing to such an extent that independence in activities of living (Roper et al,2000) or self-care needs(Orem, 2001)are adversely affected. These nurses take a supportive and educative role to enable people with chronic pain to recognise positive strategies that ameliorate their state of pain and maximise their independence. However, there are nurse practitioners who specifically work with people who are referred to pain clinics and there are specialist nurses who work with people with conditions that are particularly associated with enduring pain, for example people with cancer and specialists in oncology nursing, or people with long-term angina and specialists in cardiac rehabilitation nursing. These nurses work in multidisciplinary teams and have extended knowledge of the aetiology of chronic pain and skills in the assessment, therapy and evaluation of chronic pain management. This chapter is written for nurses and other health professionals as a broad overview of a complex topic. There is no intention to delve into the specifics of specialist diagnosis and treatment but rather to draw a picture of the size and the nature of the problem, and the array of therapies that are available to suit particular individuals with chronic pain. While we refer to nursing and nursing theories of self-care, we recognise that the management of chronic pain is essentially in the hands of individuals and that support for them comes from a range of health professionals whose roles can overlap to a large degree in the offering and delivery of a person-centred philosophy of health care service

2010-2014 Pedestrian and Bicycle Traffic Count Preliminary Report

The Step Into Cuba Alliance (the Alliance) is a broad coalition of local, state and national organizations and individuals working to increase opportunities for physical activity in the Village of Cuba, NM (the Village). A primary goal of the Alliance is to increase the walkability of Cuba to encourage walking as a convenient and low-cost form of physical activity. One of the areas of focus for the Alliance is US Highway 550 (US 550), a four lane, federal highway that bisects the Village and serves as Cuba’s main street. The Alliance is also working to make NM 126, leading from US 550 to the Village of Cuba St. Francis of Assisi Park, more pedestrian friendly. US 550 is a primary route connecting Albuquerque to Northwestern New Mexico and Colorado. In Cuba, US 550 is estimated to have a traffic count of about 8,200 vehicles per day.1 Cuba’s health clinic, post office and other essential services are located on US 550, and the Village of Cuba serves as the commercial center for the area. Residents from within the municipality and the outlying areas visit Cuba regularly to retrieve their mail from the post office (there is no mail delivery service in the Cuba area), shop for food and other necessities, receive medical care, and obtain social services. Many residents of Cuba live within walking distance of the commercial center. Most roadways used by residents to reach services and businesses on US 550 do not have safe sidewalks or walkways. Additionally, on US 550 there are no traffic lights or stop signs, only two crosswalks, and the sidewalks are not continuous. In winter, snow removal from the highway leads to piles of snow on sidewalks and highway shoulders, obstructing pedestrian access. The Village and the Alliance have been working with the NM Department of Transportation (NMDOT) to explore ways to make US 550 and NM 126 more pedestrian friendly. In 2011, federal funding was obtained and utilized to complete a new section of pedestrian-friendly sidewalks along US 550 on the south end of Cuba. Applications have been approved and funding has been earmarked for additional improvement projects along US 550 and adjoining roadways. Pedestrian and bicycle traffic counts represent another way in which the Alliance and the Village have focused needed attention on US 550 and its intersecting streets. Faculty and staff from the University of New Mexico Prevention Research Center (UNM PRC), working with an independent transportation planning consultant and pedestrian and bicycle safety expert, organized the counting effort, trained counters and participated in the counting. Community members from the Cuba area contributed to the effort by conducting the counts as volunteers and paid workers. This report provides data on the use of US 550 and intersecting roads, including NM 126, and the Village of Cuba’s St. Francis of Assisi Park by pedestrians, bicyclists and other non-motorized transportation (e.g., skateboarders). Baseline data were collected in 2010, and follow-up data collected in 2011-2014. The repeated counts document changes in non-motorized use following improvements to make the area safer and more attractive for pedestrians. Data from the counts have also been submitted to the National Bicycle and Pedestrian Documentation Project, a nationwide effort to create a consistent, uniform collection and analysis system for non-motorized transportation

Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia

BACKGROUND The relative effectiveness of second-generation (atypical) antipsychotic drugs as compared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We compared a first-generation antipsychotic, perphenazine, with several newer drugs in a double-blind study. METHODS A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and randomly assigned to receive olanzapine (7.5 to 30 mg per day), perphenazine (8 to 32 mg per day), quetiapine (200 to 800 mg per day), or risperidone (1.5 to 6.0 mg per day) for up to 18 months. Ziprasidone (40 to 160 mg per day) was included after its approval by the Food and Drug Administration. The primary aim was to delineate differences in the overall effectiveness of these five treatments. RESULTS Overall, 74 percent of patients discontinued the study medication before 18 months (1061 of the 1432 patients who received at least one dose): 64 percent of those assigned to olanzapine, 75 percent of those assigned to perphenazine, 82 percent of those assigned to quetiapine, 74 percent of those assigned to risperidone, and 79 percent of those assigned to ziprasidone. The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine (P<0.001) or risperidone (P=0.002) group, but not in the perphenazine (P=0.021) or ziprasidone (P=0.028) group. The times to discontinuation because of intolerable side effects were similar among the groups, but the rates differed (P=0.04); olanzapine was associated with more discontinuation for weight gain or metabolic effects, and perphenazine was associated with more discontinuation for extrapyramidal effects. CONCLUSIONS The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons. Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone. Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism

I live my life according to the pain: the lived experience of chronic pain in adults living in rural Queensland

Chronic pain is ubiquitous in people all over the world. Australia is no exception, with up to a fifth of the population claiming that they have experienced chronic pain over the past year. Chronic pain has been explored in a multitude of studies over the past century, with the majority being quantitative studies aimed at understanding the patho-psycho-physiological aspects of pain, or the psychological/behavioural management issues. More recently, qualitative studies have been undertaken to begin to understand the individual person’s perspective on chronic pain in an attempt to inform health care professionals so they can better assist those they care for to live with their pain. In this study, living in rural areas provided a contextual background to living with chronic pain. Geographical distance often imposes restrictions on the health care services that are available, and these restrictions increase the impact of living with chronic pain in a rural area. The aim of this study was to answer the question: What is it like to live with chronic pain in a rural area of Queensland? An interpretive study using van Manen’s (1997) approach to hermeneutic phenomenology explored the experiences of seven adults living with chronic pain in rural areas of Queensland. Hermeneutic phenomenology was chosen as the underlying philosophy for this study. Conversational interviews were conducted with adults between the ages of 23 and 55 years in small towns in several parts of Queensland. The interviews were transcribed verbatim, and the resulting transcripts analysed using van Manen’s (1997) analytic approach. Several sub-themes emerged and fell into the four existential concepts or essences described by van Manen: spatiality, temporality, corporeality and relationality. \ud \ud Spatiality - ‘The country style of life’ included four sub-themes. ‘Distance is the biggest problem’ spoke of geographical distance to sophisticated health care that was found to be a problem, both in additional physical discomfort during travel, and in personal and financial costs. As well, a diminution or lack of health care services in country areas was apparent. ‘Living in a small town’ assists the person to deal with their chronic pain quietly and privately. The ‘Safety and comfort of living in a small town’ revolved around the trust and the relationships participants developed with community members over the years. ‘Retreating to private spaces’ permitted disengagement from others, both mentally and physically, fostering relaxation and reducing pain.\ud \ud Temporality - ‘This is my life now’, was constituted by four sub-themes. The temporal discontinuity between ‘what was’ and ‘what is now’ was explored in ‘I am different to what I was’. Grief was endured because of these changes and lives and identities were fragmented. As part of this experience, participants also attempted to retrieve a sense of self. ‘This is my life now’ told of the endurance and acceptance of the pain, and the recognition that the pain would be a constant companion. ‘Things will not improve’ extended this theme with reference to uncertainty, maintaining independence and the value of distraction. ‘Pace of life in the country’ demonstrated some of the positive factors that assisted with living with chronic pain in a rural area – quiet, fewer interactions and the slower rhythm of the country lifestyle.\ud \ud Corporeality - ‘Some days are better than others’ included four sub-themes. ‘Pain is invisible – but it really does hurt’, related the psychological burden of not being able to actually demonstrate the hurt, and feeling like a fraud. ‘Difficult to name – all there is is the pain’ emphasised participants’ inability to articulate pain and the increased necessity for health care professionals to be astute in their assessment of the person living with chronic pain. ‘What’s wrong? What’s wrong? – the meaning of pain’ tells of making sense of the pain for peace of mind and giving it a name so as to legitimize it. ‘Balancing the pain’ brought forth the experience of persisting versus pacing of activities to reduce the effects of the pain, being aware of personal limitations, use of analgesia, and distraction to cope with the pain. ‘Mind over matter – the scary mental side of things’ tells of believing in their own body rather than worrying that they were losing their mind, the effects of mind over the somatic body and of depression, of memory loss and of cognitive dysfunction. \ud \ud Relationality - ‘Relationships in Pain’ included four sub-themes. ‘Silence on pain’ relates stoicism, reticence about the pain, independence and perseverance. ‘Privacy – you don’t have to look and act happy’ protects as it keeps the pain from others. ‘Support and comfort’ from family, friends, community, animal companions and God helps cope with the pain. Good, solid family relationships empower, but as the circle widens, support and comfort became less apparent. ‘He just doesn’t understand’ paints a telling story of participants’ relationships with health care professionals. Inadequate care and difficult interactions were often experienced. As a consequence, traveling great distances to consult compassionate doctors occurred, although nurses were seldom mentioned. \ud \ud Several key recommendations arose from the findings of this study. In respect to education, suggestions for future curricula development to help health care professionals to learn to provide more empathetic assistance to people living with chronic pain were made. In respect to clinical practice, the development more effective strategies to assist people living with chronic pain is suggested. Advanced practice nurses with an interest in, and further studies in assessing and managing chronic pain are needed in rural areas, both as practitioners and as mentors to other nurses. Adoption of standardised pain management strategies by professional organisations, and especially dissemination of these through their rural networks would assist health care professionals to practice in a consistent and contemporary way. The importance of aggressive and thorough pain assessment of people seeking health care advice in rural areas is an important finding in this study and should be utilized by all first-contact health care professionals. \ud \ud In reference to research, specific recommendations were made. Since pain assessment and pain management are currently taught in the health care disciplines and have been for at least a couple of decades (personal experience), research projects are urgently needed to determine why this knowledge has not translated into practice in order to address the indifference, lack of knowledge and the stigma that people living with chronic pain face from the professionals who are supposed to assist them. Further qualitative studies are recommended to increase the scope of knowledge of the experiences of people living with chronic pain in rural areas

Collaborative voices: ongoing reflections on nursing competencies

In a rapidly changing Australian health care environment, providers of undergraduate nursing programs are continually upgrading their assessment methods to ensure that graduates are competent and safe to practice. Competence assessment is based on the existing Australian Nursing & Midwifery Council (ANMC) Competency Standards for Registered Nurses. It is acknowledged that there are issues surrounding the validity and reliability of current assessment methods, primarily due to organisational constraints both at the University and the service provider level. There are a number of highly reliable tools available that enable assessment of nursing students in the psychomotor domain. Assessment in other domains is less precise. This paper explores some of the issues relating to competence assessment processes in order to promote discussion and discourse between educators, facilities and policy makers. It is envisaged that increased debate will result in an enhanced level of academic and clinical preparation for the upcoming nursing workforce in this country

Management of chronic pain

[Extract] Chronic pain is suffered by a significant number of people from all age groups. Most of these people manage the pain themselves in a range of positive and sometimes negative ways - they take analgesics and remedies and modify their lifestyles to accommodate changes that may accrue in elements of life such as function and affect. People who suffer from chronic pain classically refer themselves to general practitioners who now act as agents for a broad range of conventional and complementary specialists to manage chronic pain. The majority of nurses become involved in the care of people with chronic pain when it affects function or psychological wellbeing to such an extent that independence in activities of living (Roper et al,2000) or self-care needs(Orem, 2001)are adversely affected. \ud \ud These nurses take a supportive and educative role to enable people with chronic pain to recognise positive strategies that ameliorate their state of pain and maximise their independence. However, there are nurse practitioners who specifically work with people who are referred to pain clinics and there are specialist nurses who work with people with conditions that are particularly associated with enduring pain, for example people with cancer and specialists in oncology nursing, or people with long-term angina and specialists in cardiac rehabilitation nursing. These nurses work in multidisciplinary teams and have extended knowledge of the aetiology of chronic pain and skills in the assessment, therapy and evaluation of chronic pain management. This chapter is written for nurses and other health professionals as a broad overview of a complex topic. There is no intention to delve into the specifics of specialist diagnosis and treatment but rather to draw a picture of the size and the nature of the problem, and the array of therapies that are available to suit particular individuals with chronic pain. While we refer to nursing and nursing theories of self-care, we recognise that the management of chronic pain is essentially in the hands of individuals and that support for them comes from a range of health professionals whose roles can overlap to a large degree in the offering and delivery of a person-centred philosophy of health care service

Moving from technical to critical reflection in journalling

This paper outlines a research project aimed at changing the levels of reflection of preregistration nursing students in a tertiary institution. Whilst reflection is widely espoused now in nursing, few studies have been found that identify whether the level of reflective writing can be identified or developed by students. Anecdotal and research evidence however indicates that most student reflective writing occurs at the technical level. A descriptive exploratory study using both qualitative and quantitative techniques was undertaken to apply van Manen's (1977) levels in a structured way in an attempt to facilitate the student's understanding and use of the levels in their reflective writing. The findings of the study indicate that student self evaluation and identification of the levels in their own writing can lead to change in the levels of critical reflective writing achieved by undergraduate students

Developing the future nurse leaders of Fiji

Background: Nurse leaders in Fiji are currently involved in\ud meeting the challenges of being at the forefront of\ud an AusAID supported Health Sector Improvement process. Fiji is experiencing the same shortages of health professionals (including nurses) as is occurring internationally, while simultaneously striving to improve the quality of its health services.\ud \ud Primary argument: This paper provides information about the current situation in relation to health services in Fiji, and describes strategies being undertaken by the nurse\ud leaders of Fiji to meet the challenge of leading an exciting reform process. James Cook University, School of Nursing Sciences, has been privileged to support the provision of contemporary leadership and management education for current and future nurse leaders in the Fiji Health Sector as a component of a current education program to educate registered nurses to bachelor level. This paper will provide an overview of the current Fiji Health Sector Improvement Program, with a particular focus on the\ud preparation of nurse leaders.\ud \ud Conclusion: There is an ongoing need to understand beliefs and values, and styles of interaction and communication,\ud and indeed, ideas about time. With collaboration\ud between Australian academics and Fiji tutors from the\ud Fiji School of Nursing, the program appears to be\ud remarkably successful

Creating and delivering an External Bachelor of Nursing Science course

This paper describes the authors' experience in developing and delivering what they believe is a world first: a pre-registration external bachelor degree in nursing. The paper will explain how the authors identified the need for the course, the processes used in its development and some of the issues inherent in delivering it. The paper details the challenges faced, including cost, student recruitment and retention, package development and faculty learning. The authors also discuss the challenge of balancing the need for a comprehensive programme of clinical placement with the needs of the students, many of whom live in geographical isolation. Finally, the triumphs and positive outcomes of the authors' experience in producing this innovative course are outlined