No abstract

BACKGROUND: Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. OBJECTIVE: To determine the extent to which nurses manage pain effectively without side effects related to narcotic analgesics in an intensive care and a surgical unit. METHODS: The sample consisted of 44 patients, 20 from an intensive care unit and 24 from a surgical unit. Patients completed a Visual Analogue Scale to measure pain intensity three times in 24 hours. The narcotic side effects of constipation and sedation were measured using the Constipation Assessment Scale and a sedation scale. Documentation was assessed using the Chart Audit for Pain. RESULTS: Patients in both units continued to experience pain even with pain management interventions. The critical care nurses administered an average of 30% of the maximum narcotic dose ordered and the surgical unit nurses, 36.8%. Documentation of the effect of the pain medication was scant on both units. Although sedation was not a problem in either unit, the majority of patients reported symptoms of constipation. Documentation of this problem was scant in both units. CONCLUSIONS: Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.

Because oncology nursing is changing, reconfirming and updating the blueprint for the certification examination is necessary. Certification examinations beginning in April 2003 will be based on the revised blueprint.

Constipation is a common problem among oncology patients and requires careful assessment. Use of validated instruments is important to improving its management. The aim of this study was to validate the Italian translation of the Constipation Assessment Scale (CAS). To test construct validity, patients and apparently healthy adults were asked to complete the CAS. The results indicated that there was a significant difference between the median CAS of the patient group and that of the apparently healthy group. Test-retest reliability was very high (r=0.96; P=0.0001), and the internal consistency as assessed by Cronbach's alpha was 0.768. These findings suggest that the Italian CAS can be used in clinical practice to document the presence and severity of constipation in cancer patients. However, further studies should be conducted in a larger sample of patients to confirm the results.

Tetanus infection is widespread and difficult to completely eradicate. Thus the present study was designed to assess the tetanus antibody titre in HIV infected subjects in relation to the presence or absence of malaria parasitaemia. 107 subjects consisting of asymptomatic group (asymptomatic HIV, n=17 and asymptomatic HIV-Malaria co-infection, n=17), symptomatic group (symptomatic HIV, n=18 and symptomatic HIV-Malaria co-infection, n=17), and control group (control without malaria, n=19 and control with malaria, n=19) participated in the study. Blood sample collected from the participants were used for the determination of packed cell volume, CD4 + T cell count, malaria parasite, HIV seropositivity and tetanus antibody titre using standard laboratory methods. The tetanus antibody titre was significantly reduced in symptomatic HIV infected subjects with malaria co-infection compared with symptomatic HIV infected subjects without malaria (P<0.05). Similarly, both groups of asymptomatic and symptomatic HIV infected subjects had reduced serum tetanus antibody titre compared with the seronegative control subjects and group with malaria parasitaemia (P<0.05). The CD4 + T cell count and packed cell volume were similar between the asymptomatic HIV infected subjects with malaria and those with only HIV. This was also the case for the symptomatic groups. The finding of the present study suggests that either HIV or malaria infections do interfere with the tetanus antibody titre. The increasing spread of HIV in malaria endemic areas may pose further threat to the current programmes on immunization targeted at eliminating tetanus infection.