Effects of Tactile Desensitization on Postoperative Pain After Amputation Surgery

PURPOSE

Pain in the acute setting after amputation is complex with multiple types of pain experienced, including somatic and neuropathic. No studies have measured multiple pain control modalities while using self-management techniques for acute amputation pain. Desensitization could provide a means of pain control for somatic and neuropathic pain. The purpose of this study was to test the efficacious use and effects of tactile desensitization in managing acute postoperative pain after lower limb amputation.

DESIGN

This was a pre-experimental repeated measure study.

METHODS

Pain description, intensity, anxiety, depression, and medication usage were measured during repeated time periods. Pain intensity was measured before and after each intervention along with efficacy.

FINDINGS

Of the times the intervention was self-administered (n = 50) there was a statistically significant reduction in the pain level (P < .001) with large effect sizes for all paired comparisons. Participants found the intervention efficacious and feasible to use.

CONCLUSIONS

The findings support a reduction in pain intensity scores using pain medication coupled with tactile desensitization.

School Nursing: Becoming Credible and Visible

A group of school nurses attending the innovation relay event at the NASN 2017 Annual Conference were asked to tackle the problem expressed by many school nurses: How can we increase the visibility and credibility of school nurses? The innovation relay allowed school nurses to look at the problem differently so that they could identify innovative solutions. This article shares more detail on each of the team's solutions and illustrates how school nurses can look at problems in a new light.

Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan curricula and teaching modalities using the community engagement model

BACKGROUND

Curricula evaluation is an essential phase of curriculum development. Study describes the implementation of a formative evaluation used by faculty members between Universidad Nacional Autonóma de Nicaragua (UNAN-Leon) Escuela de Enfermeriá, Nicaragua and East Carolina University College of Nursing (ECU CON) in North Carolina, US.

OBJECTIVES

Program evaluation study to conduct an assessment, comparison of a medical-surgical adult curriculum and teaching modalities. Also, explore the Community Engagement (CE) Model to build a Central American-US faculty partnership.

DESIGN

Methodological evaluation study utilizing a newly developed International Nursing Education Curriculum Evaluation Tool related to adult medical and surgical nursing standards. Also, the CE Model was tested as a facilitation tool in building partnerships between nurse educators.

DATA

Nicaragua and US nursing faculty teams constructed the curriculum evaluation by utilizing the International Nursing Education Curriculum Evaluation Tool (INECET) by reviewing 57 elements covering 6 Domains related to adult medical and surgical nursing standards.

METHODS

Developed, explored the utilization of the INECET based on a standard of practice framework. The Community Engagement Model, a fivephase cycle, Inform, Consult, Involve, Collaborate, and Empower was utilized to facilitate the collaborative process.

RESULTS

Similarities between the US and Nicaraguan curricula and teaching modalities were reflective based on the 57 elements covering 6 Domain assessment tool. Case studies, lecture, and clinical hospital rotations were utilized as teaching modalities. Both schools lacked sufficient time for clinical practicum time. The differences, included UNAN-Leon had a lack of simulation skill lab, equipment, and space, whereas ECU CON had sufficient resources. The ECU school lacked applied case studies from a rural health medical-surgical adult nursing perspective and less time in rural health clinics. The UNAN-Leon nursing standards generalized based on the Ministry of Health (MINSA) and the US program was specific based on the American Nurses Association and various sub-specialties of nursing practice requirements. The CE Model was a useful framework to facilitate a collaborative partnership.

CONCLUSION

Collaborative evaluation study using the International Nursing Education Curriculum Evaluation Tool can be an effective method to evaluate medical and surgical curricula similarities and differences within international nursing schools. The Community Engagement Model fostered a faculty partnership.

A School-Based Health Center-University Nursing Partnership: How We Filled in the GAPS

Young adolescents, age 10-15 years, have increasing psychosocial and biomedical health care needs, yet are some of the lowest users of conventional health services. In eastern North Carolina, school-based health centers (SBHCs) provide primary health care to thousands of school-age children in the most rural, medically underserved areas. SBHCs receive reimbursement from local, state, and private funding sources and their viability depends on the demonstration of outcomes. Using the Guidelines for Adolescent Preventive Services (GAPS) assessment tool, an SBHC-university nursing partnership evaluated the use of preventive health services by fifth and sixth grade students (n = 690). Findings suggest that the vast majority of early adolescents needed a referral for a physical exam, nutrition, mental health, or health education services. This article describes key components for a successful SBHC-university nursing partnership that can evaluate and improve existing school health programs.

A community pediatric prevention partnership: linking schools, providers, and tertiary care services

Integrated school health services traditionally have been provided through the local board of education or health department. However, increased competitiveness in the health care arena has challenged providers to find innovative models to deliver health services to school-aged children. This article describes a partnership among a hospital, a university, private providers, and a local school system and health department to provide school health services. Noteworthy aspects of the project include the organizational structure and funding of the program, implementation of a case management model, and a focus on documenting outcomes. This program has been successful in building local alliances to provide health care services to school children. Implications for other school systems struggling to fund health services for school-aged children are discussed.

Is there a doctor in the house? Integrating medical education and home health care

This article describes how one rural home health agency collaborated with a school of medicine to integrate medical education into the daily operations of the agency. Noteworthy aspects of this project include integration of home care concepts at all levels of the medical school curriculum, use of an advanced practice nurse to coordinate the program, collaboration between the home health agency and the schools of medicine and nursing, and reliance on telecommunication technology to minimize the barriers related to transportation to and scheduling of physician visits.

Telephone communications between diabetes clients and nurse educators

The purpose of this study was to describe the use of telephone communications between diabetes nurse educators (DNEs) and their clients with diabetes. A questionnaire was designed to examine the use of the telephone with diabetes clients from the perspective of DNEs. A total of 465 DNEs across the US were selected using a systematic sample from the membership directory of the American Association of Diabetes Educators. A total of 247 were questionnaires completed and returned (55%). Ninety-one percent of DNEs reported using the phone with clients and averaged 15 phone calls per week. Over 90% frequently reported discussing the following topics with clients: home blood glucose monitoring, hyperglycemia, hypoglycemia, insulin use, and diet. Analysis of telephone users showed that DNE experience and diabetes educator certification were significant factors in the differences observed in the reported topics discussed over the telephone. These findings suggest the need for guidelines for telephone contact with diabetes clients.

A comparison of two noninvasive methods of blood pressure measurement in the triage area

OBJECTIVE In triage of patients in the emergency department, nurses can identify conditions such as elevated blood pressure that can lead to serious health problems. It is imperative that the method used to evaluate blood pressure is dependable and accurate. The introduction of new technology may yield results that are not comparable to traditional measures. Therefore we compared the traditional auscultatory method of measuring blood pressure with the use of an automated device. METHODS The blood pressure of 100 healthy adult volunteers was measured first with the traditional cuff method and then with an automated device (IVAC model 4200). The measurements were recorded and then compared for each individual. RESULTS The mean difference between the paired systolic measurements was 4.3 mm Hg (p = 0.0001). The mean difference between the paired diastolic measurements was 1.3 mm Hg. There was a clinically significant difference (> 9 mm Hg) in 37% of the systolic readings and 26% of the diastolic readings. In 76% of those clinically significant systolic differences, the IVAC 4200 measurement exceeded the manual method. For the clinically significant diastolic differences, 58% of the IVAC 4200 measurements were greater than the manual method. CONCLUSION Clinicians must be cautious when using new technology to measure blood pressure. Results may not be comparable with results obtained with the traditional method.

Cognitive failure to thrive in high-risk infants: the importance of the psychosocial environment

We evaluated early social risk assessment as a predictor of cognitive development in high-risk infants. A social worker assessed social risk in 122 infants before discharge from a neonatal intensive care unit. Infants were evaluated at ages 12 and 36 months adjusted for prematurity. We found no difference in 12-month cognitive development among medical, neurologic, or social risk groups. However, from 12 to 36 months there was a significant decline in mean developmental quotient in the groups with social risk alone, neurologic and social risk, and medical and social risk, but not in the groups with medical or neurologic risks without social risk. Social risk assessment correctly predicted 36-month cognitive outcome in 71% of infants who had normal findings at 12 months. We conclude that neonatal social risk assessment can help identify infants at highest risk for cognitive retardation and is particularly important for infants who have medical or neurologic problems.

Advancing nursing in the academic community: adopt an administrator

The role of faculty in nursing schools is unique. Faculty members belong to the community of scholars, as well as the community of practitioners. The authors describe a program to educate key university leaders about the role of nursing faculty. The program achieved its objectives in a timely, cost-effective manner, and could be easily replicated at other universities.

A collaborative health promotion effort: nursing students and Wendy's Team Up

Community health nursing students, faculty, and Wendy's fast food restaurant conducted a 2-day health fair that provided health screening, counseling, and educational opportunities for the community, an exciting learning experience for the students, funds for the school of nursing, and good public relations for Wendy's. The authors describe the planning, implementation, and evaluation of this health fair as a student learning activity.

Predictors of the home environment of high-risk infants

The quality of the home environment is an important predictor of the cognitive and social development of high-risk infants. Community health nurses (CHNs) have played a central role in the assessment and care of families with high-risk infants. We examined predictors of the home environment in a sample of 106 infants discharged from a neonatal intensive care unit. The most consistent predictor of an optimal home environment was an internal parental locus of control. Socioeconomic status affected dimensions of parenting related to cognitive stimulation but not emotional responsivity. Young mothers and those with other children are less responsive to their infants. Males are treated in a more responsive manner than females. These findings suggest that CHNs need to adopt an empowerment model of intervention and focus on the particular needs of young mothers and those with other children.

The sanitarian and the public health nurse: a collaborative team

The task of protecting the environment can be best accomplished by an interdisciplinary team. Sanitarians and public health nurses can increase their accomplishments through collaborative efforts. The use of a specific home environment assessment tool by public health nurses is discussed to exemplify how a cooperative effort between the nurse and the sanitarian can help achieve maximum effectiveness of environmental health programs in the community.