Nancy Olson Hester

A review of factors predicting children's pain experiences.

Despite decades of research, hospitalized children continue to suffer from unrelieved pain. Failure to apply state-of-the-art knowledge to clinical practice has been termed one of the greatest paradoxes in modern medicine (Kenny, 2001). Clearly, effective pain management requires state-of-the-art knowledge about the pain experience. This article reviews research over the past two decades related to the predictors of age, gender, prior pain experiences, pain expectation, pain acceptance, and pain tolerance. The review underscores implications for clinical practice and indications for future research.

SYMPTOM MANAGEMENT OUTCOMES : DO THEY REFLECT VARIATIONS IN CARE DELIVERY SYSTEMS?

OBJECTIVES Symptom management is increasingly recognized as a critical element of patient care, particularly in managing chronic illness. However, research on outcomes related to symptom management is in its infancy, except for the symptom of pain. This symptom was therefore chosen as a prototype to review the state of the science regarding relations between organizational variables and symptom management outcomes and to illustrate the issues regardless of the symptom managed. This article discusses pain outcome measures appropriate for acute and cancer pain, proposes attributes of the care delivery system that may affect outcome measures, and identifies challenges associated with this type of research. METHODS Review of quality assurance studies raises issues concerning the adequacy of currently used outcomes for pain and satisfaction with pain management. Although considerable effort has been expended in developing pain measurement in adults and children, critical issues for examining pain management outcomes include deciding what perspectives should be used as the most valid indicator of the pain outcome and when the measures should be obtained. RESULTS Critical concerns are raised about the measure of satisfaction with pain management and its appropriateness as the end-result outcome. A key issue is whether respondents actually disentangle satisfaction with pain management from satisfaction with other aspects of care, including caring dispositions of health-care providers. Finally, the question is raised: Are pain outcomes affected by organizational context? CONCLUSIONS Although the answer to this question is unknown, a few research studies suggest that organizational context is likely to influence pain outcomes. It is clear, however, from ongoing work that until several conceptual, methodological, and analytic challenges are resolved, research is unlikely to capture the influence of variations in care delivery systems on symptom management outcomes.

Multisite Clinical Research: A Challenge for Nursing Leaders

The need for the application of research-based data to diversified healthcare systems has led to more attempts by nurse researchers to investigate phenomena across clinical sites. Nurse executives increasingly are asked to justify resource allocation among organizations, and must compare patient-care practices within complex systems that are often geographically distant. This article describes the pitfalls encountered and the progress made by researchers during a 4-year multisite, multimethod clinical investigation collecting clinical outcome and organizational context data from seven hospitals.

Health Perceptions of School-Age Children

Little research has been done on how school-age children perceive health. In this article, the author describes a study focused on how school-age children perceived healthy and unhealthy children. Findings showed that school-age children perceived health from a multidimensional perspective. Some of the study findings were congruent with findings from four other studies. Implications for nursing are addressed.

Health Concerns of School-Age Children

Little research has been conducted with school-age children regarding their health perceptions and their health concerns. In this paper, childrens perceptions of health-related behaviors are described. Areas of health concerns for the school-age child are delineated. Gender and age differences are highlighted as appropriate for the health concerns.

Assessment of Cardiovascular Risks in Parents and Their Sons

Few studies have addressed the cardiovascular risk factors in the context of family aggregates. This study focused on the assessment of cardiovascular risk factors in seven father-mother-son groups. Although the sample size precludes any generalizations beyond this sample, patterns of risk factors among the fathers, mothers, and sons suggest direction for future research in this area.

Research-Generated Nursing Dmgnoses for Healthy Schoolage Children

Typologies of nursing diagnosis generally focus on potential or actual deficit states. In this article a research-generated typology of nursing diagnoses for healthy school-age children is presented that was developed from a study on the perceptions of school-age children regarding health.

A cardiovascular risk assessment of high school sophomores.

Cardiovascular fitness among children has been shown to predict adult cardiovascular fitness. This study examined cardiovascular risk factors of 100 randomly selected adolescents, ages 15 to 18, in a suburban high school of a large western metropolitan city. Respondents were middle to upper-middle socioeconomic class and almost exclusively Caucasian.A survey was used to assess the prevalence of six cardiovascular risk factors in this adolescent sample. The six risk factors were family history of diseases associated with increased cardiovascular risk, smoking, lack of exercise, elevated blood pressure, obesity, and stress. The prevalence of these factors in the adolescent sample is reported using descriptive statistics. In addition, sex comparisons were made on the modifiable risk factors. The findings from this study were compared to national statistics. Implications of these findings are discussed.