Elizabeth Rideout

The prevalence of pain complaints in a general population

The authors argue that the study of the complaint of pain falls within the purview of epidemiological study. An analytic survey of 500 randomly selected households on the roster of a group family practice clinic was undertaken. The purpose was to determine the self-reported prevalence rates of any pain complaint and to determine the distribution of pain rates according to selected demographic and socioeconomic variables. Sixteen percent of the individuals sampled from a family practice (H.S.O.) had experienced pain within the 2 weeks preceding the survey. The prevalence rate of those with persistent pain was approximately twice that of those with temporary pain. More women than men reported temporary and persistent pain. The age specific morbidity rate for persistent pain increased with age. The back, lower extremities, and head and face were the most frequently identified sites of pain in both subgroups. Persons with persistent pain used health services, both community physicians and hospital care, more frequently than did those with temporary pain. No significant differences between the two groups were reported for physical, social or emotional function although the persistent pain group characterized their general health status more poorly.

A controlled trial of digoxin in congestive heart failure

Because of conflicting results from studies examining the usefulness of digoxin in congestive heart failure (CHF) patients in sinus rhythm, a cross-over trial was conducted in which 20 patients received 7 weeks of digoxin titrated to a level of 1.54 to 2.56 nmol/liter and 7 weeks of matched placebo. The order of treatments was determined by random allocation and patients, clinicians and research staff were blind to allocation. In patients with deteriorating condition, the treatment period was terminated and outcome measures were obtained. If deterioration occurred during the first period, the patient was crossed over without the code being broken. Seven patients required premature termination of study periods because of increasing symptoms of CHF. All 7 were taking placebo at the time (p = 0.016). Small differences in dyspnea (p = 0.044), walking test score (p = 0.055), clinical assessment of CHF (p = 0.036) and ejection fraction (p = 0.004) favored the digoxin treatment group. Patients with more severe CHF were more likely to benefit from digoxin administration. It was concluded that oral digoxin, in doses titrated to produce a serum level of 1.54 to 2.56 nmol/liter, improved quality of life and functional exercise capacity in some patients with CHF in sinus rhythm.

A Comparison of Problem-Based and Conventional Curricula in Nursing Education

AbstractThe purpose of this study was to compare graduating baccalaureate students in a problem-based curriculum with those in a conventional nursing program with regard to perceived preparation for clinical practice, clinical functioning, knowledge and satisfaction with their education. Prior tograduation, students completed a self-report questionnaire that consisted of five sections and took about 45 minutes to complete. Following graduation, their pass rates on the National Nursing Registration Examination (RN Exam) were also compared.The findings indicated no significant differences in their perceived preparation for nursing practice, although the conventional students scored higher in all areas. There were also no significant differences between the two groups in their perceived clinical functioning, although there was a trend toward higher function in the areas of communication and self-directed learning in the PBL group. There were no statistically significant differences in RN scores. The PBL students scored significantly higher on perceptions of their nursing knowledge, particularly in the areas of individual, family and community health assessment, communication, teaching/learning, and the health care system. The students undertaking the PBL program were more satisfied with their educational experience than their counterparts in the conventional program, indicating higher satisfaction with tutors, level of independence, assessment and program outcomes, but no difference in relation to workload orclarity of expectationsThis study contributes to our understanding of the relationship between different educational approaches and student outcomes. It suggests that PBL is an effective approach for educating nurses. Furthermore, it indicates that nursing students in the PBL program, like their counterparts in PBL medical programs, report higher levels of satisfaction. Future studies that are longitudinal in design and rely less on self-report measures would contribute further to our understanding of the benefits and limitations of PBL in nursing education.

Self-Directed Learning: Faculty and Student Perceptions

This article reports the results of a qualitative study that explored faculty and student perceptions of self-directed learning (SDL) and investigated factors that facilitate or impede it. This study was conducted at McMaster University with faculty and students in a 4-year undergraduate nursing program. Data were collected from 47 faculty and 17 students by means of focus groups that were audiotaped and transcribed. Content analysis was conducted to identify common themes in faculty and student transcripts. The themes that emerged provide insight into the educational strategy of self-directed learning and can be summarized by the following major points: (1) commitment to SDL requires students and faculty to understand the value of empowering learners to take increased responsibility for decisions related to learning; (2) students engaged in self-directed learning undergo a transformation that begins with negative feelings (i.e., confusion, frustration, and dissatisfaction) and ends with confidence and skills for lifelong learning; and (3) faculty development is important to ensure high levels of competency in facilitating self-directed learning.

The Use of the Diary as a Data Collection Technique

The initiation of a research project requires many decisions, not the least of which is the selection of a method for data collection. This decision is, in large measure, guided by the nature of the research question which generally prescribes the selection of a strategy for data collection from among an array of possible alternatives. This article addresses the use of a diary for data collection. Although diaries have traditionally been used in social science and health research, their use in nursing research is more recent. The article begins with a brief discussion of the rationale for using the diary to gather data in a study of personal and professional care giving. A brief review of the use of diaries in previous studies follows, along with a description of the use of a diary in the caregiving study and a discussion of the possible threats to high quality data as well as measures used to ensure the collection of high quality data The article concludes with a discussion of the strengths and weaknesses of the diary andmakes recommendations regarding its use in nursing research.

Stress, Social Support, and Symptoms of Depression in Spouses of the Medically Ill

This study investigated the level and frequency of depressive symptoms in spouses of dialysis patients, as a function of a) severity of patient disease, b) level of stress experienced by the spouse, and c) perception of support from the ill partner. The subjects were forty patients who had begun dialysis in the last year and their spouses. Measures of depression, impact on family, perceived social support, and disease severity were applied. Significant depressive symptoms were reported by 20 percent of spouses. Symptom severity was not correlated with age, sex, or occupation of the spouses, nor with level of depression or functional impairment of the dialysis patients. The amount of social support received from the ill partner accounted for 37 percent of the variance in spouse depression, while social and financial stressors reported by the spouse explained 13 percent of the variance in spouse symptoms. These findings suggest that depressive symptoms in spouses of dialysis patients are associated with the social and economic consequences of the illness for the family but even more so with the amount of perceived support from the patient. The determinants of this perceived support need further exploration.

‘Letting go’: rationale and strategies for student-centred approaches to clinical teaching

To date the clinical practice portion of nursing education has tended to emphasise patient problems related to specific disease processes and the technical interventions needed to deal with those problems. Teacher-centred methods of education that place control of the process and content of learning with the teacher have seemed appropriate. However, the role and function of nursing is changing. Autonomy, independence and decision-making are more highly valued. In order that nurses develop these skills and abilities, a shift in focus in nursing education is required. This paper presents a rationale for more student-centred approaches to education. Strategies for clinical teaching will be described that emphasise collaboration between student and teacher. Suggestions designed to facilitate change in the roles of teachers and students will be offered.

Development of an instrument to assess individual student performance in small group tutorials.

Recognizing the need for a valid and reliable method to assess individual tutorial performance in a problem-based learning curriculum, we developed a 31-item instrument from theoretical frameworks and items used elsewhere. A scale was developed for each of three broad learning domains: self-directed learning (SDL), critical thinking (CT), and group process (GP). The instrument demonstrated high internal consistency (SDL = .88, CT = .90, GP = .83) on a sample of 18 tutors and 167 students. Tutor-student interrater reliability coefficients were estimated to be low (SDL = .16, CT = .18, GP = .14) due to lack of variance on the response scale. The instrument showed high correlation (r = .82) with other forms of summative evaluation. In its current form, this standardized and validated instrument is unreliable in differentiating strong from weak tutorial performance but can have a steering effect on student tutorial behaviors. The process of instrument development has general application to other educational programs.

The impact of personal and situational variables on career patterns among nurses from three types of educational programs

Relationships between educational preparation and employment choices were investigated in a study of the career paths of nursing graduates from three types of educational programs: a community college diploma program, a generic baccalaureate program, and a postdiploma baccalaureate program. Selected personal and work-related correlates of career paths for the three groups also were explored. All available graduates for the years 1984 to 1990 from the three programs (n = 1,544) were sent a self-administered questionnaire. Data were collected concerning demographic variables, employment details, ongoing professional development, and level of satisfaction with nursing. Analysis of the data demonstrated clear variations in the career paths of the three groups of graduates, supporting the belief that the type of educational program does indeed have a steering effect on the subsequent career choices of these nurses.

Digoxin increased risk of death in women, but not men, with heart failure.

(2002) N Engl J Med 347, 1403. Rathore SS, Wang Y, Krumholz HM. . Sex-based differences in the effect of digoxin for the treatment of heart failure. . ; . : . –11 . [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] 
 QUESTION: Does the effect of digoxin therapy differ in men and women with heart failure (HF) and depressed left ventricular systolic function? Randomised {allocation concealed}*, blinded ({participants, healthcare providers,}† and data collectors), placebo controlled trial with up to 48 months of follow up. 302 clinical centres in the US and Canada. 5281 men (median age 64 y, 87% white, 30% New York Heart Association [NYHA] class ≥III) and 1519 women (median age 66 y, 81% white, 40.6% NYHA class ≥III) who had clinically confirmed HF (ie, current or past clinical symptoms or signs or radiographic evidence of pulmonary congestion) and an ejection fraction ≤45%. {Follow up was 99%.}* 2642 men and 755 women were allocated to digoxin, and 2639 men and 764 … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DRathore%26rft.auinit1%253DS.%2BS.%26rft.volume%253D347%26rft.issue%253D18%26rft.spage%253D1403%26rft.epage%253D1411%26rft.atitle%253DSex-Based%2BDifferences%2Bin%2Bthe%2BEffect%2Bof%2BDigoxin%2Bfor%2Bthe%2BTreatment%2Bof%2BHeart%2BFailure%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa021266%26rft_id%253Dinfo%253Apmid%252F12409542%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa021266&link_type=DOI [3]: /lookup/external-ref?access_num=12409542&link_type=MED&atom=%2Febnurs%2F6%2F3%2F80.atom [4]: /lookup/external-ref?access_num=000178888400003&link_type=ISI