Journal of advanced nursing
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The effect of a study day on the subject of pain for nurses working at the thorax surgery department The aims of this investigation were: to describe patients' evaluation of pain and the treatment of pain after thorax surgery via sternotomy; to repeat the evaluation with another group of patients following a study day for nurses, featuring pain and pain treatment; and to examine whether the study day influenced the nurses in their treatment of pain. The investigation included daily evaluation of pain using a visual analogue scale (VAS), and an interview with the patients before discharge, where they were asked to review their experience of pain and its treatment. The nurses on the thorax surgery ward and on the intensive care unit (ICU) completed a questionnaire before and after the study day. ⋯ A small group of patients had more evident pain than others. When administering opiates the ICU nurses often chose a lower dose than the standing order prescribed. After the study day the nurses gave larger doses of intravenous opioids and the patients experienced less pain.
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Postoperative pain, if unrelieved, will impede patients' recovery. A theoretical model of factors which influence nurses' choices of titrated dosages of intravenous (IV) morphine was constructed for this study. This study aimed to examine whether or not a patient's vital signs would influence nurses' choices of titrated dosages of IV morphine for relieving pain following cardiac surgery. ⋯ The importance of accepting patients' verbal reports of pain as well as the provision of optimal dosages of IV morphine for pain relief is highlighted. A disadvantage of using a vignette and questions method is that the patients' clinical status is somewhat unreal. Further studies, however, were also recommended.
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The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. ⋯ Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.
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The moral distinctions between prolonging life, allowing for a dignified death, and assisting patients to die (hastening death) are troublesome to health practitioners. On 26 June 1997 the United States Supreme Court ruled that individuals do not have a constitutional right to physician-assisted suicide, but that individual states can legislate their preferences. ⋯ How health professionals integrated their perspectives of science/data with their perspectives on persons and personal goals affected the vigour with which they would institute treatment for the terminal patient. Further, ethical uncertainty dominated the decision making of all participants in this study when they were confronted with the question of assisting/hastening patients' dying.