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Aim. The aim of this paper is to examine the pain profile of three types of day surgery operation and undertake a comparative analysis of the intensity and duration of pain over a consecutive 4-day period. Background. Although studies on pain after day surgery have figured prominently, evidence is limited as to what intensity and duration of pain should be regarded as unacceptable, and how it varies for different operation types. Methods. A prospective postal survey ( n = 785) was undertaken during a 12-month period in 1998/1999 involving three day surgery units in three different areas in England and Wales and based on three commonly performed operation types: hernia repair, varicose vein surgery and laparoscopic sterilization. A visual analogue scale was used to measure the intensity of pain experienced over a 4-day consecutive time period. Analysis of variance was used to explore statistically significant differences between levels of pain for the operation types. Results. On the day of surgery and even on the third postoperative day, high levels of severe pain (>50 mm on a Visual Analogue Scale) were experienced. Pain levels differed across different operation types. On the day of surgery, more patients undergoing laparoscopic sterilization experienced severe pain. By the third postoperative day, more of those who had been operated on for hernia repair, followed by varicose vein surgery and laparoscopic sterilization, continued to experience severe pain. Conclusion. A large number of patients experienced severe levels of pain after day surgery. This could have resulted from a lack of knowledge about the assessment and management of pain, in which nurses play an important role. This study has highlighted that different pain trajectories are associated with different operation types, and this has important implications for the preoperative and postoperative preparation of day surgery patients as well as the role of nurses in the overall success of the day surgery process. [ABSTRACT FROM AUTHOR]

ameen j., coll a.m.&peters m. (2005) Journal of Advanced Nursing50(6), 583–594Impact of tele-advice on community nurses’ knowledge of venous leg ulcer careThis paper reports a study assessing the impact of the provision of expert tele-advice to community nurses in enhancing their knowledge of leg ulcer care.Community nurses have traditionally been responsible for the care of patients with leg ulcers. However, access to expert medical and nursing advice has been restricted to the local hospital environment. The introduction of e-health and telemedicine have created opportunities to provide online and immediate access to wound care expertise from centres of excellence to primary health care staff in managing patients’ wounds in their own home.A stratified randomized controlled trial was used to examine community nurses’ knowledge before and after the provision of expert tele-advice. A knowledge measurement tool comprised of 40 multiple-choice questions was adopted, with correct responses identified by a panel of wound care experts. The questions covered the three themes of dressings, management and physiology, with different levels of difficulty categorized as easy, medium or difficult. The tool was administered before and after the intervention (12 weeks) to both the experimental and control groups.Statistically significant improvements were observed only for the experimental group in the areas of dressings and management, as well as in the medium level questions. No statistically significant improvement was seen for the easy questions, as there was little room for improvement because of preintervention high scores. For the difficult questions, it was thought that more time would be needed for a more positive outcome.The results suggest that tele-advice can be of great benefit to community nurses in enhancing their knowledge in the practice of leg ulcer care. This will have significant implications for more efficient use of human resources and cost effectiveness in wound care. [ABSTRACT FROM AUTHOR]

coll a.m., ameen j.r.m. & mead d. (2004) Journal of Advanced Nursing 46(2), 124–133 Postoperative pain assessment tools in day surgery: literature review Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients’ experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management. [ABSTRACT FROM AUTHOR]

coll a.m., ameen j.r.m. & moseley l.g. (2004) Journal of Advanced Nursing 46(1), 53–65 Reported pain after day surgery: a critical literature review Despite technological advancements in anaesthesia and analgesia, reported pain levels after day surgery remains high. Whilst it is unrealistic to expect no pain, the level that constitutes ‘acceptable’ pain remains unclear because of inconsistencies in reporting. These inconsistencies have resulted from different interpretations of what pain is and the use of different measurement tools. The aim of this paper is to report a study investigating any disparity in reported levels of pain following day surgery, within different specialities and in relation to specific operative procedures. Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, postoperative complications, pain after day surgery, day surgery, ambulatory surgery, nursing, operation types, operative procedures, surgical procedures, descriptors of pain, pain intensity, verbal descriptor scale, numerical rating scale, visual analogue scale, validity, reliability, design, sample size, data collection methods and their various combinations. Databases searched were Medline, CINAHL , Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search was restricted to publications in the English language. Twenty-four papers were identified. Inconsistencies in the reported intensity of pain are highlighted, in relation to different operative procedures and specialities. Data in the papers are based on different descriptors, measurement tools and data collection methods. In many cases, sample size, and validity and reliability can also be questioned. There is a disparity in reported levels of pain after day surgery. It is important that a unified day surgery pain measurement strategy is established, so that patients can be informed about the intensity of pain that they are likely to experience following specific procedures. [ABSTRACT FROM AUTHOR]

Screening of acute stroke patients for signs of dysphagia (swallowing impairment) is recommended within 24 hours of hospitalization owing to increased risk of morbidity and mortality Speech and language therapists (SLTs) are the lead health professionals responsible for assessment of dysphagia. However, increasing demand for assessment and the relative dearth of SLTs in the NHS has resulted in delays in assessment of up to 6 days. Subsequently there is a drive for nurses to perform this screening process using a validated screening method and tool. This paper centres on the exploratory phase of a three-stage programme of research, designed to develop and evaluate a bedside dysphagia screening tool for use by registered nurses. Here the authors focus on a review of the salient professional literature and the findings of a survey of current dysphagia screening practices employed by nurses across 52 NHS trusts in England and Wales. The literature review revealed a lack of consensus on the requisite construct of a dysphagia screening tool and on criteria for determining signs of swallowing difficulties and their complications. These reported findings were echoed in the survey which highlighted wide variation in screening practices and use of screening criteria based on limited or no research-based evidence. The authors describe how this initial work has acted as a springboard for the design and evaluation of a screening tool for use by nurses at the patient's bedside, which employs a minimal combination of evidence-based criteria. [ABSTRACT FROM AUTHOR]