The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Multicenter Study
Factors associated with hospital arrival time for stroke patients.
Patients who experience a sudden ischemic stroke can benefit from administration of intravenous tissue plasminogen activator (tPA) to reduce the resulting disability, yet few arrive in time to be eligible for tPA administration. The purpose of this study was to determine (a) the stroke warning signs that most commonly result in the decision to seek hospital care, (b) who makes the decision to seek hospital care, (c) the most common mode of transportation to the hospital, (d) hospital arrival time in relation to the onset of the first warning sign, and (e) factors most associated with hospital arrival time for stroke survivors. Using a descriptive, cross-sectional design, data from a convenience sample of 50 stroke survivors and/or their companions (family, friends, or others seeking hospital care for the patient) were obtained by face-to-face interview during the patient's hospital stay using a structured interview guide developed by the investigator. ⋯ Patients arriving by private car or taxi and those perceiving their incomes as comfortable had the longest arrival times, suggesting public education efforts also should target people from higher socioeconomic groups. The nonsignificant associations between hospital arrival time, warning signs, and other demographic characteristics of initiators suggest there may be other unmeasured behavioral factors that play a more important role in reducing hospital arrival time for stroke patients. Further study of additional factors associated with early hospital arrival time is recommended to support educational efforts for early stroke treatment and prevention.
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Multicenter Study Clinical Trial
Managing chronic nonmalignant pain with continuous intrathecal morphine.
One alternative to traditional treatment modalities for chronic pain is continuous intrathecal administration of morphine via an implanted pump. However, relatively little is known about the benefits and long-term complications of this therapy for chronic nonmalignant pain. The purpose of this study was to describe patient responses to continuous intrathecal morphine over the course of one year with respect to morphine dosage used, complications and subjective assessments of pain. ⋯ A statistically nonsignificant increase in the mean daily dosage of morphine occurred and few long-term adverse effects were present. Complications of implantation occurred in 33.3% of the patients and were successfully managed without discontinuing therapy. In selected patients with chronic pain, intrathecal administration of morphine via an implanted pump can reduce pain with minimal long-term adverse effects or complications.
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Multicenter Study Clinical Trial
The assessment of discomfort in elderly confused patients: a preliminary study.
With the increasing numbers of older adults in our population, nurses are reexamining all aspects of nursing care in order to best meet the needs of these individuals. Normal age changes, the impact of decades of environmental challenges, successful adaptations, acute illnesses, trauma and chronic illnesses combine to create a challenge for accurate and effective assessment of elderly patients. The nurse finds her assessment skills challenged with increasing frequency by the elderly patient who is also acutely confused and experiencing discomfort. The purpose of this study was to explore the clinical utility, validity and reliability of four different approaches to nursing assessment of discomfort with this particularly vulnerable group of elders.