Lani Zimmerman

The relationship and influence of anxiety on postoperative pain in the coronary artery bypass graft patient

The purposes of this study were to investigate the relationship of postoperative anxiety and pain following coronary artery bypass graft (CABG) surgery, and to determine the effects of level of anxiety, demographic, and other factors on the level of postoperative pain. Pain intensity, sensory pain, and affective pain were measured along with anxiety on postoperative day 2 and day 3 by the McGill Pain Questionnaire Subscales (PPI, PRIS, and PRIA) and State Anxiety Inventory Scale, respectively. A direct relationship of anxiety with pain was found over time with the highest relationship on postoperative day 2 (r = 0.235-0.492, P < 0.001). A significant interaction between time and level of anxiety on affective pain was specific to postoperative day 2 (P < 0.01). Significant differences by level of anxiety and time were reported. Factors of age, gender, marital status, number of previous surgeries, and operation time had no effect on the level of postoperative pain.

Psychological variables and cancer pain.

Pain can cause both physical and psychological distress that has a negative impact on a patients quality of life. The purpose of this descriptive study was to determine whether cancer patients (N = 60) with pain (n = 30) had higher scores of depression, anxiety, somatization, and hostility than did cancer patients without pain (n = 30). The study was conducted in a midwestern medical center hospital during a 9-month period. Psychological variables were measured using subscales of the Brief Symptom Inventory (BSI). Patients who reported pain completed the McGill Pain Questionnaire (MPQ) and Visual Analogue Scale. Significant positive correlations were found between total MPQ scores and all four subscales of the BSI (r = 0.60-0.78, p < 0.05). Patients with pain scored higher on all four subscales of the BSI, with significant differences occurring in somatization (t = 2.05, p < 0.05) and hostility (t = 1.93, p < 0.05). The findings suggest a relationship between pain intensity and psychological status. Nursing interventions aimed at reducing these factors may help to decrease the pain, in addition to then decreasing the psychological distress experienced by patients with cancer.

The development and validation of a scale measuring effective clinical teaching behaviors.

The purpose of this methodological study was to describe the development and validation of an instrument that would measure effective clinical teaching behaviors of nursing faculty. Two hundred eighty-one nursing students evaluated their clinical instructors using a 43-item Likert scale entitled Effective Teaching Clinical Behaviors (ETCB), and data were used to test the validity and reliability of the instrument. Content validity of the scale is adequately documented, and factor analysis suggests that the tool is measuring one major factor, effective clinical teaching behaviors. Internal consistency and test-retest reliability coefficients achieved satisfactory standards for reliability. Alternate scales reliability coefficient was also satisfactory. The ETCB fills a void in the instrumentation available for clinical instructors. Since students are the direct recipients of instruction, it seems imperative that a valid and reliable scale be available for them to evaluate their instruction.

Pain perception and its relation to functional status post total knee arthroplasty: a pilot study.

PURPOSE This pilot study examined the influence of pain perception on functional status. DESIGN A descriptive longitudinal correlational exploratory design was used. SAMPLE The sample comprised 23 participants ranging in age from 47 to 85 years. RESULTS Data were collected for pain perception components, anxiety, and functional status. Negative correlations were noted between pain and functional status on days 42 and 84. Common descriptors used over the first 3 days were sharp, aching, tender, and tiring. CONCLUSIONS Pain intensity is only one component of pain perception. Management of the sensory and affective components needs further research.

Variations among nurses in behavioral intentions toward the dying.

The purposes of this study were to describe nurses behavioral intentions toward the dying and to determine if they were related to selected characteristics of nurses caring for the dying. A questionnaire containing behavioral intention items and a characteristics profile was completed by 372 registered nurses working in a variety of settings in one midwestern state. Analyses of the data suggested that although nurses were very likely to provide general nursing care and to communicate openly with the dying, they were not likely to provide continuing care for bereaved family members. Major implications of the study were that the continuing care needs of bereaved family members are not being met by nurses in traditional health care settings, and that different groups of nurses have different approaches to care of the dying as well as different learning needs.

Distance Education Programs for Advanced Practice Nurses: Questions to Ask

This article reviews the use of distance learning in nursing education and to summarize key questions that must be addressed by programs or students considering advanced practice nursing education using distance technology. An acute care nurse practitioner program using distance learning strategies is provided as an example to illustrate delivery of a clinically based curriculum. Examples of questions to be addressed in evaluating a distance education program include: How much of the course or graduate nursing program is available on-line? What are the specific informational technologies used? How does communication occur between graduate students and faculty? How are clinical requirements of a course managed? Are there any requirements for time to be spent directly on campus? Is it necessary for the student to have a computer and Internet provider? Knowledge of the available technology and components of distance education can enhance the ability of the advanced practice nurse to evaluate better and choose educational program offerings.

Preoperative and postoperative pain in total knee replacement patients.

This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20 subclasses of descriptors scaled on intensity dimensions, was administered to each subject prior to and on two occasions after surgery. The findings support results from previous studies indicating that clusters of words are more often selected to express chronic pain, and other patterns are used to describe acute pain during the early postoperative period. Also, subjects experienced considerable pain intensity related to arthritis prior to surgery, and they reported less overall pain intensity following their TKR.

Nursing students' evaluation of classroom teaching: developing and testing an instrument.

Although literature on instruments measuring classroom teaching is abundant, it is difficult to find an established tool that meets the specific evaluation needs of faculty teaching in a contemporary nursing college. This methodological study developed and tested an instrument for student completion that assessed the effectiveness of a faculty member’s classroom teaching in a modern curriculum. The items were developed from a literature review and feedback from content experts. Four midwestern nursing schools participated in the assessment of the instrument’s reliability and validity. A coefficient alpha of .98 was reported for internal consistency (N = 233) and r = .85 (p < .001) for test-retest reliability (n = 35). Factor analysis revealed one dominant factor that measured effective traits/methods in classroom teaching. This factor’s eigenvalue of 28.95 accounted for 60% of the total variance.