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Background and Purpose: Research has revealed nurses' perception that traditional workload measures do not adequately capture the complexity of workload. Using a human factors approach to address the multiple and complex dimensions from the subjective perception of the worker, the Subjective Workload Assessment for Nurses (SWAN) was developed. Methods: Survey data from 188 medical-surgical registered nurses were used to establish the instrument's psychometric properties. Results: SWAN Sections 1, 2, and 3; General Information Form Section 1; and the Nursing Texas Load Index demonstrated internal consistency with this sample. Findings supported interrelationships between activity complexity, performance circumstances, and individual characteristics described in the literature. Conclusion: Further study is needed to refine the SWAN and to establish psychometric properties with nurses in other practice areas.Keywords: nursing workload; human factors; subjective mental workload; cognitive workload; mental workloadChanges in the nursing skill mix and increasing demands on nurses employed in both the hospital and the community have resulted primarily because of decreases in length of stay for hospitalized patients along with a steady increase in the complexities of health care and associated technologies (Aiken, Clarke, & Sloane, 2002; American Nurses Association, 2001; Gregg, 1993; Simpson, 2004; Stone et al., 2007; Stone et al., 2003). Increasing patient acuity levels and multiple technology advances have resulted in most nursing positions today, placing a greater emphasis on cognitive rather than motor performance (National Research Council Staff, 1995). Multiple patient safety threats were identified in the Institute of Medicine's report, Keeping Patients Safe: Transforming the Work Environment of Nurses (Page, 2003). Of importance is examining the nurses' workload and work environment in an effort to maintain and increase the quality and safety of care provided. Other recent studies have supported the influence of the nurses' work environment on patient safety outcomes (Holden et al., 2011; Liu, Lee, Chia, Chi, & Yin, 2012). Understanding nurses' perceptions of work and the work environment is crucial to understanding nurse fatigue and is critical to the safety of the patient and the nurse (Bae & Farby, 2014). This study proposed to develop a tool-Subjective Workload Assessment for Nurses (SWAN)-that would increase this understanding and more accurately measure workload from the nurse's perspective.BACKGROUNDCognitive psychology and human factors researchers have expended considerable resources across disciplines to separate workload into physical and mental components with the underlying premise that the worker is the only one who can truly describe the amount of work involved within an assignment. Work is fundamentally a unique quality identified by the individual worker (Hart & Staveland, 1988; Havens & Vasey, 2003; Holden et al., 2011).Because researchers have attempted to quantify workload demands, a popular approach has been to ask the participants to report how hard they are working (Gregg, 1993; Reid & Nygren, 1988). Human factors, or human-centered, research has continued to rely on subjective workload measures because of the view that only the worker truly knows how much work is required to meet demands. If the worker declares there is too much work associated with a given system or function, ways to reduce the workload need exploration.Complexity of WorkloadIndividual perception of the work required can vary, even when the environment and expectations are similar. These individual differences in perception influence the subjective determination of workload (Havens & Vasey, 2003; Kahneman, 1973). Workload, therefore, is more than an intrinsic activity, task, or property; it becomes apparent as the requirements interact and are made known.Subjective Workload MeasurementVarious methodologies and approaches (e. …

Aims and objectives. This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. Background. Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. Methods. One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows. Results. The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. Conclusions. Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.

craft m.a., davis g.c. & paulson r.m. (2012) Expressive writing in early breast cancer survivors. Journal of Advanced Nursing69(2), 305–315. doi: 10.1111/j.1365-2648.2012.06008.x. Abstract Aims. This article is the report of a study aimed at determining whether or not expressive writing improves the quality-of-life of early breast cancer survivors. An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results. Background. The risk of distress can extend well beyond the time of a breast cancer diagnosis. Emotional expression may assist in dealing with this. Design. Randomized controlled study. Methods. Participants (n = 120) were randomized into one of four groups: a control group (no writing) or one of three expressive writing groups: breast cancer trauma, any self-selected trauma and facts related to breast cancer. Participants wrote 20 minutes a day for 4 consecutive days. Their quality-of-life was measured, using the ‘Functional Assessment of Cancer Therapy-Breast Cancer Version’, at baseline and at 1 month and 6 months after writing. Paired t-tests, multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment, collected in 2006. Intention-to-treat analysis was used. Results/findings. Expressive writing about one’s breast cancer, breast cancer trauma and facts related to breast cancer, significantly improved the quality-of-life outcome. Conclusion. Expressive writing, focusing the instructions on writing about one’s living and dealing with a diagnosis of breast cancer, is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality-of-life.

Purpose: To determine whether the Papilla Gown designed specifically to meet the needs of postmastectomy patients with a closed drainage system in place is more comfortable than is a typical hospital gown. Background: The closed wound drainage system used for breast cancer patients immediately following mastectomy requires external drainage tubes that connect to a pouch. The pins that are usually used to attach the drains to a patient's gown create problems. The Papilla Gown® (Papilla is the Latin term for breast) was designed with safety pouches for supporting the drains. Methods: A convenience sample of 13 postmastectomy patients participated in this preliminary study of the gown's use. Participants were taught how to properly wear the typical hospital gown and Papilla Gown before surgery. Patients were discharged with the gowns and two questionnaires that were to be returned approximately 1 week following surgery. Thirteen of the 38 (34%) who agreed to participate submitted usable forms. The Wilcoxon signed-ranks test was used for comparing the comfort scores of the Papilla with the hospital gown. Findings: Participants reported significantly higher scores (p

Background. Women aged 65 years and over are at high risk for a fractured hip because of osteoporosis. One of the devastating effects of a fracture is the loss of ability to live independently. Aim. The major aim of this study was to describe the functional status, or ability to perform activities of daily living, of women aged 65 years and older who had experienced a fractured hip in the recent past and to explore possible differences in selected variables (e.g. age and length of rehabilitation) for those who were fully performing activities of daily living at least 6 months after fracture and those who were not. Design. Following Institutional Review Board approval, data were collected from 23 Caucasian women ranging from 65 to 95 years of age (M = 82, sd = 6·83) who had experienced fractured hips related to a fall in the recent past (6 months to 4 years). All were living independently prior to their fractures. Three Registered Nurses, in a structured interview, collected the data using a Demographic Data Form, an Osteoporosis Risk Factor Checklist, the Katz Index of Independence in Activities of Daily Living, and the Lawton Instrumental Activities of Daily Living Scales. Results. Nine of the participants reported prior fractures, suggesting that this could have been a risk factor for this group. Eighteen achieved the maximum independence score of six on the Katz Index of Independence in Activities of Daily Living; help with bathing was required by the other five. Of the Instrumental Activities of Daily Living, those requiring physical activity for home maintenance were the most problematic. Ability to perform Instrumental Activities of Daily Living was significantly related to ability to perform the activities required to live independently. Conclusions. Results suggest that achieving a functional level that will support independence is possible for older women who were residing independently prior to a hip fracture.

Purpose: To explore barriers to pain management experienced by older adults with arthritis, identify themes, and develop a theoretical model of relationships among the themes. Design and Methods: Focus groups were used to collect data with 57 older-adult participants who had self-reported arthritis. Coding techniques consistent with grounded theory methodology were used for data analysis. Findings: Nine themes were identified to describe barriers to chronic pain management experienced by older people with arthritis. The resulting model shows personal decision-making regarding the use of pain management methods. Conclusions: Findings provide direction for enhancing independent older people's ability to manage chronic pain. The nine categories of barriers show direction for education of both clients and health care providers, as well as for planning other types of needed support. The theoretical model shows the complexity of barriers experienced by older adults with arthritis.

The purpose of this study is to demonstrate the use of a self-report exercise log and a heart-rate monitor in the measurement of adherence to the dimensions of an exercise prescription and to propose an alternative way to define adherence to a 24-week home-based women’s walking program, which reflects the dynamic process of behavior change. Adherence was measured with exercise logs, Polar Vantage XL Heart-Rate Monitors, and pre-to postintervention change in VO2 max. Of the dimensions of the exercise prescription, frequency of walks documented by both the heart-rate monitor and the exercise log had a higher correlation than duration and intensity of walking, with change in VO2 max suggesting that frequency was potentially the most predictive adherence measure. Examination of the total number of walks and the number and sequence of weeks without walks over the 24-week intervention revealed dynamic patterns of adherence suggesting variation in the degree of behavioral change.

The major purpose of this study was to determine the current services provided by religious institutions in supporting their oldest members. Individuals representing 34 institutions in one southwestern metropolitan area were surveyed to determine support provided in four categories. Spiritual/counseling programs were more likely to be regularly planned programs than material/financial assistance or physical/health services, which were more likely to be offered on an as-needed basis. Most of the churches reported access for persons with disabilities. Study results were used to develop a model and make recommendations illustrating the religious institution's role in providing eldercare and support.

This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown.Surgical removal of the breast may lead to activity limitation, self-image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design.One hundred and forty-five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty-six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2-way anovas were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p-values are two sided. All statistical analyses were performed using sas 9.2 for Windows.The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge.Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.

This article is the report of a study aimed at determining whether or not expressive writing improves the quality-of-life of early breast cancer survivors. An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results.The risk of distress can extend well beyond the time of a breast cancer diagnosis. Emotional expression may assist in dealing with this.Randomized controlled study.Participants (n = 120) were randomized into one of four groups: a control group (no writing) or one of three expressive writing groups: breast cancer trauma, any self-selected trauma and facts related to breast cancer. Participants wrote 20 minutes a day for 4 consecutive days. Their quality-of-life was measured, using the 'Functional Assessment of Cancer Therapy-Breast Cancer Version', at baseline and at 1 month and 6 months after writing. Paired t-tests, multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment, collected in 2006. Intention-to-treat analysis was used.Expressive writing about one's breast cancer, breast cancer trauma and facts related to breast cancer, significantly improved the quality-of-life outcome.Expressive writing, focusing the instructions on writing about one's living and dealing with a diagnosis of breast cancer, is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality-of-life.

Valid and reliable instruments are essential to responsible and accurate diagnosis, planning, and evaluation by professional nurses working independently or collaboratively with other healthcare professionals. The author provides an overview of the instrument development process and emphasizes the importance of measurement as an intrinsic part of the clinical decision-making process. Discussion focuses attention on the differences between an index and a scale, both of which are needed as part of assessment protocols. Some differences in strategies required for estimating validity and reliability for scales and indexes are highlighted.

As it relates to the person experiencing chronic nonmalignant pain, the conceptual meaning of pain management has not been clarified previously. This article describes a concept analysis of pain management that resulted in a definition of the term and three defining attributes: pain relief, pain modulation, and self-efficacy. A model case is provided with examples of borderline and related cases. The findings of this analysis will contribute to instrument development, theory testing, and an understanding that should positively impact the self-management of persons experiencing chronic nonmalignant pain.

What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim of the study was to determine the educational needs for and barriers of advocacy for nurses working with patients experiencing pain. An ASPMN Advocacy Survey Instrument was developed to gather data about advocacy activities and interventions. The sample consisted of 188 ASPMN nurses (20% of the membership) who responded via the internet. Study findings revealed that the majority of nurse respondents were active in personal advocacy, serving as guardians of the patient. They confronted physicians as necessary and assisted patients to evaluate their pain management. Regarding making the public aware of pain management-related issues (i.e., public awareness advocacy), the respondents were not as active. Respondents were knowledgeable about pain management and best practices/best evidence, with the exceptions of legislative issues and media training. These two areas need support and educational intervention. Additional areas in need of education and training, as identified by respondents, are social and political advocacy interventions. "Lack of time" was identified as the barrier to advocacy experienced by the greatest number of nurses.

The study's major purpose was to explore the pain management of the older adult with rheumatic disease. Medication, rest, heat, distraction, exercise, and talking with others were methods most often used by older adults (n = 31). Methods identified by them as most helpful included medication, rest, and heat. When the pain management techniques of those adults 65 and over were compared with those of younger adults (n = 51), several differences were noted. The combined number of methods used by the younger group was significantly greater, and they rated relaxation techniques as being significantly more helpful. Increasing the elderly arthritis patient's repertoire of pain management modalities and measuring the ongoing individual effectiveness of the individual and combined methods used are identified as needs to be addressed in improving pain management.

The purpose of this study was to test a pain management intervention that integrates goal setting with older adults (age > or =65) living independently in residential settings. This preliminary testing of the Goal Attainment Pain Management Program (GAPMAP) included a sample of 17 adults (mean age 79.29 years) with self-reported pain related to arthritis. Specific study aims were to: 1) explore the use of individual goal setting; 2) determine participants' levels of goal attainment; 3) determine whether changes occurred in the pain management methods used and found to be helpful by GAPMAP participants; and 4) determine whether changes occurred in selected pain-related variables (i.e., experience of living with persistent pain, the expected outcomes of pain management, pain management barriers, and global ratings of perceived pain intensity and success of pain management). Because of the small sample size, both parametric (t test) and nonparametric (Wilcoxon signed rank test) analyses were used to examine differences from pretest to posttest. Results showed that older individuals could successfully participate in setting and attaining individual goals. Thirteen of the 17 participants (76%) met their goals at the expected level or above. Two management methods (exercise and using a heated pool, tub, or shower) were used significantly more often after the intervention, and two methods (exercise and distraction) were identified as significantly more helpful. Two pain-related variables (experience of living with persistent pain and expected outcomes of pain management) revealed significant change, and all of those tested showed overall improvement.

Osteoporosis, a major health problem that increases with age, may lead to fractures and loss of independence. This study focused on testing a bone health intervention aimed at assisting older adults living independently in residential settings to maintain healthy bones with the long-term goals of fracture prevention and maintenance of independent function. Forty-seven participants (M (age) = 79.36 years) completed six 1-hour educational sessions. Pre-intervention testing of osteoporosis knowledge and healthy bone behaviors was followed by posttests at 1 week, 6 weeks, and 7(1/2) months. Findings revealed significant increases in knowledge and behaviors from baseline to 9(1/2) months, although a slight decline during the last 6 months when there was no reinforcement of learning suggests the need for periodic follow-up.

Recurrent primary headache is a major public health concern that impacts both society and the individual, reducing productivity and limiting participation in work, social, and leisure activities. The purpose of this study was to develop a valid and reliable instrument to measure the experience of living with chronic recurrent primary headache. This tool, Chronic Pain Experience Instrument-Headache Version (CPEI-HA), is intended to provide a measure of the affective component of headache that could complement the assessment of intensity, density, and disability. Psychometric testing of 25 items with a community-based headache sample ( N = 150) resulted in a 19-item tool with high internal consistency (α = .92). Principal components analysis was used to explore the meaning of the headache experience, and three underlying dimensions (i.e., Helplessness, Stress—Personal and Interpersonal, and Emotional Struggle) emerged to provide a better understanding of the experience. Construct validity was supported by the empiric relationships between the CPEI-HA and the eight theoretically related health concept subscales of the RAND 36-Item Health Survey 1.0. As predicted, all of the relationships were positive and in the moderate range (.31–.52). Findings suggest that the CPEI-HA has the potential for providing a valid and reliable tool for both clinical and research applications with persons who experience primary recurrent headaches.

Studies indicate that pain interferes with sleep and, in turn, sleep disturbances increase pain. Statistics show that up to 60% of those with arthritis experience pain during the night. But despite these findings, sleep is not generally addressed as a major treatment concern among this population. This article reviews the relationship between pain and sleep; sleep issues as they relate to 3 common types of arthritis--osteoarthritis, rheumatoid arthritis, and fibromyalgia; and holistic approaches that may be used by the patient in the self-management of pain and sleep.

Women aged 65 years and over are at high risk for a fractured hip because of osteoporosis. One of the devastating effects of a fracture is the loss of ability to live independently.The major aim of this study was to describe the functional status, or ability to perform activities of daily living, of women aged 65 years and older who had experienced a fractured hip in the recent past and to explore possible differences in selected variables (e.g. age and length of rehabilitation) for those who were fully performing activities of daily living at least 6 months after fracture and those who were not.Following Institutional Review Board approval, data were collected from 23 Caucasian women ranging from 65 to 95 years of age (M = 82, SD = 6.83) who had experienced fractured hips related to a fall in the recent past (6 months to 4 years). All were living independently prior to their fractures. Three Registered Nurses, in a structured interview, collected the data using a Demographic Data Form, an Osteoporosis Risk Factor Checklist, the Katz Index of Independence in Activities of Daily Living, and the Lawton Instrumental Activities of Daily Living Scales.Nine of the participants reported prior fractures, suggesting that this could have been a risk factor for this group. Eighteen achieved the maximum independence score of six on the Katz Index of Independence in Activities of Daily Living; help with bathing was required by the other five. Of the Instrumental Activities of Daily Living, those requiring physical activity for home maintenance were the most problematic. Ability to perform Instrumental Activities of Daily Living was significantly related to ability to perform the activities required to live independently.Results suggest that achieving a functional level that will support independence is possible for older women who were residing independently prior to a hip fracture.

With an increased focus on wellness and health promotion, there is a need for community-based strategies to complement traditional strategies aimed at improving individual and aggregate health. An educational program on the prevention, diagnosis, and treatment of osteoporosis was provided for 188 women age 60 and older in three different community settings: churches, retirement homes, and senior citizen centers. The major purposes of the study were to determine whether a community-based program might (a) contribute to older women's knowledge about osteoporosis and (b) promote their intent to use this knowledge. Each participant completed a demographic profile, the Osteoporosis Risk Checklist, and the Osteoporosis Knowledge Questionnaire (OKQ), with the OKQ serving as a pre- and post-test. Before post-testing, a 30-min educational program was provided. Differences among the three groups were risk factors, prior knowledge about osteoporosis, and knowledge at the completion of the program. A majority of the clients indicated an intent to increase calcium in their diet, discuss osteoporosis with their health care provider, check their home environment for safety/falls, and discuss what they had learned with others. Nurses need to plan educational programs in all settings to teach older clients about the risk factors, prevention, diagnosis, and treatment of osteoporosis.

Patient satisfaction is an important quality outcome indicator of health care in the hospital setting. The measurement of patients' satisfaction with nursing is particularly important since nursing service is often a primary determinant of overall satisfaction during a hospital stay. This article reports on a study designed to update and revise the definition of patient satisfaction for application with ambulatory surgical patients and to develop a questionnaire that captures this definition. The Patient Satisfaction Scale, which specifically focuses on patient satisfaction with nursing care and is used extensively by nursing researchers, was selected for factor analytical examination. Psychometric testing resulted in a 15-item scale with three underlying dimensions.

The nurse's role in pain management is changing because nurses are increasingly working in a variety of settings where chronic pain is a major health problem. If nurses are to play a vital role in pain management, nursing practice must expand beyond a limited protective approach to pain management. Instead, pain must be viewed from a multidimensional perspective that requires an interdisciplinary team approach.

The initial development of the Pain Management Inventory (PMI), a precise clinical index of pain management methods intended for use with patients with arthritis, is reported. The PMI differs from available instruments in its intent to assess specific methods that the individual is currently using for arthritis pain management and the perceived helpfulness of these methods, thus providing information to be used in combination with other clinical indicators for planning and evaluating ongoing pain self-management. Sixteen of 17 items, or methods, initially demonstrated content validity. Using methods appropriate for an index of independent items, psychometric testing with a sample of 82 persons having a primary diagnosis of osteoarthritis or rheumatoid arthritis then focused on estimating the construct validity and test-retest reliability of each item. Findings assist in better understanding how various methods relate to overall pain management when it is defined as successfully taking care of or handling the pain as viewed within a cognitive-behavioural framework. Findings suggest that there are eight items that represent valid and reliable pain management methods. These items should be used and evaluated with additional arthritis samples to determine whether the findings replicate.

Health care professionals are becoming increasingly aware of the complex nature of chronic pain. Measurement instruments are needed which will assist in better understanding the patient's response to the pain. The McGill Pain Questionnaire (MPQ) and an expanded version useful in comprehensive clinical assessment, the McGill Comprehensive Pain Questionnaire (MCPQ), are currently-available tools for assessing chronic pain. The major purposes of this study were to test the discriminant and concurrent validity of the MPQ and to describe the major responses of the person with rheumatic disease to chronic pain using both instruments. Two sample groups were used: (1) 30 patients with chronic pain related to rheumatic disease, and (2) 30 patients with acute pain related to a surgical procedure. The MPQ's Affective Subscale discriminated between acute and chronic pain, and its Present Pain Intensity (PPI) Scale correlated moderately with the Visual Analogue Scale (VAS), another commonly-used scale for measuring pain intensity. While the MCPQ was useful in describing the patient's response to chronic pain, administration was time-consuming, and its open-ended format makes validity and reliability testing impossible. The information gained through the use of the MCPQ was helpful in determining what living with chronic pain means to the individual. Such information should be useful in the future development of a valid and reliable instrument for more efficiently measuring the chronic pain experience. Such an instrument would be useful in coordination with the MPQ which focuses on pain description.