https://cjnr.archive.mcgill.ca/ <p class="p1"> </p> <p> </p> <p> </p> <p> </p> en-US Canadian Journal of Nursing Research Archive 0844-5621 <p class="p1"><span class="s1">Articles in this journal are made available under a</span><span class="s2"> <a href="http://creativecommons.org/licenses/by/3.0/"><span class="s3">Creative Commons Attribution License</span></a>. Copyright has been assigned to the McGill Library and Archives. </span><span class="s4">Authors retain all moral rights in their original work. </span></p> https://cjnr.archive.mcgill.ca/article/view/1555 Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1548 Several years ago I had a conversation with Leora Kuttner, child clinical psychologist and author of the seminal works The Child in Pain (Kuttner, 1996) and No fears, No Tears: Children Coping with Cancer (Kuttner, 1986). This conversation changed my thinking and the way I speak about what it is that we do as clinicians to help people in pain. During our conversation, Dr. Kuttner challenged my use of the term "non-pharmacological" when referring to cognitive and behavioural interventions to relieve pain. She said the term indicated a bias towards pharmacological interventions and implied that cognitive and behavioural interventions were inferior. Since that conversation, I have tried to be meticulous in my choice of words when describing interventions to relieve pain in infants and children. Although the language becomes cumbersome at times, I have tried to avoid the term "non-pharmacological" when I really mean behavioural and environmental interventions. I try to avoid implying that pharmacological interventions are the gold standard for pain relief and that we must choose one kind of intervention over the other. I have argued that environmental and behavioural strategies provide the foundational substrate for neonatal pain management to which pharmacological therapy is additive or synergistic (Franck & Lawhon, 1998). Linda S. Franck Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1549 The physiological and behavioural effects of music during recovery from heel lance were examined in 14 preterm infants at 29 to 36 weeks post-conceptual age (PCA). Infants were tested on 2 occasions: during a music condition and during a no-music control condition. Each condition was videotaped during 3 periods: baseline, heel lance, and recovery. Infants were divided into 2 age groups for data analyses: less than and greater than 31 weeks PCA. Mixed model ANOVAs showed that heel lance elicited a stress response (i.e., increased heart rate, decreased oxygen saturation, increased state-of-arousal, and increased facial actions indicative of pain) in both age groups. The stress response was greater in the older group. During recovery, the older group had a more rapid return of heart rate, behavioural state, and facial expressions of pain to baseline levels in the presence of compared to the absence of music. It was concluded that music is an effective NICU intervention following a stress-provoking stimulus in infants older than 31 weeks PCA Michelle L. Butt Barbara S. Kisilevsky Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1550 Patients have been found to receive inadequate analgesia despite moderate to severe pain after coronary artery bypass graft (CABG) surgery. The purpose of this pilot study was to evaluate a preadmission educational booklet for patients undergoing their first uncomplicated CABG. A randomized controlled trial (RCT) was undertaken at the largest cardiovascular centre in Canada. Repeated measures were used to compare data from Judy Watt-Watson Bonnie Stevens Judy Costello Joel Katz Graham Reid Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1551 A program for elderly persons with cognitive impairment and their caregivers was evaluated for its effectiveness and efficiency with regard to caregiver burden, sense of coherence, satisfaction, and cost to the health-care system. The program consisted of a weekly 2-hour visit and walk by volunteers. During a 9-month period in 1997, all eligible referrals were randomly assigned to receive the service immediately (experimental group) or be placed on a waiting list to receive it 6 weeks later (control group). Eleven caregivers/ recipients formed the experimental group; 10 caregivers/recipients formed the control group. All completed questionnaires at randomization and at 6-week follow-up. Perceived burden decreased by 8% only for the caregivers in the experimental group (F = 6.8, p = .02). They indicated that they appreciated the respite and support and that the care recipient enjoyed the visit/walk. Although this study was short in duration and small in sample size, improvements were noted in perceived caregiver burden and caregivers expressed satisfaction with the program. The program did not result in additional health and social-service expenditures. Laurie Wishart Jean Macerollo Patricia Loney Anne King Lesley Beaumont Gina Browne Jacqueline Roberts Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1552 The past decade has witnessed increased public awareness and use of alternative therapies for the management of diseases and symptoms (Schwartz, Chesney, Irvine, & Keefe, 1997). Spiro (1997) relates the increased use of alternative therapies to the need for personal connection, belonging, and comfort. A variety of biochemical, psychophysiological, and psychological therapies are available, including homeopathic preparations such as sulphur for dermatoses (Linde et al, 1997), acupuncture, reflexology, massage therapy, therapeutic touch, and self-help approaches. Margo (1999) reports that alternative therapies are used by 20% to 50% of persons in industrialized countries, with some $14 billion being spent on such therapies in the United States. A large number of publications have been devoted to alternative therapies (e.g., Journal of the American Medical Association, 280, 1998); medical and nursing schools are offering courses in alternative therapies; and funding has been made available to systematically investigate the effects of alternative therapies (e.g., National Institutes of Health) (Kwekkeboom, 1997). Despite the interest in alternative therapies and the accumulating empirical evidence supporting their effectiveness, some scholars view these therapies with scepticism. Many consider them as placebos (Linde et al., 1997; Shapiro & Shapiro, 1997). The arguments for or against considering alternative therapies as placebos are based on differences in professional paradigms and perspectives on what constitutes a placebo Souraya Sidani Bonnie Stevens Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1553 Mothers of early-adolescent girls (10-14 years) often experience difficulties in dealing with their daughters. This study explored the mother-daughter relationship from the perspective of the mothers, to identify their most pressing concern and the strategies that might help them address this concern. A qualitative design employing a feminist participatory approach was used with 2 groups of mothers living in low socioeconomic status (SES) areas of a small city in Ontario, Canada, over a 10-week period. The most pressing concern of both groups was balancing relationship and discipline. Through the use of questioning to explore their issues, the mothers gained the reassurance, knowledge, skill, and confidence to deal with their daughters. This introductory study should contribute to nurses' understanding of the mother-daughter relationship during adolescence, and it offers a small-group strategy that shows promise in assisting mothers to address their concerns. Elizabeth Diem Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1556 Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1557 Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1558 Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1554 Cynthia Baker Anita J Gagnon Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31 https://cjnr.archive.mcgill.ca/article/view/1547 Symptoms, from the perspective of the health professional, indicate that something is amiss. This "something" could simply be our body telling us that we require rest, nourishment, or fluid, or it could be a complex response from an etiology of known or unknown origin. As health professionals, we are compelled to investigate the nature of symptoms when they are presented to us, verbally or non-verbally, by those for whom we provide care. Based on our assessment, we can generate hypotheses that can be further investigated to determine the cause of the symptom. When it is of an objective nature, such as fever, we are able to measure it accurately in well-established measurement units (i.e., degrees) that correctly indicate the degree of severity. The severity of the symptom provides further information that will aid in the search for the cause of the underlying dilemma. However, when the symptom is of a subjective nature, such as pain, fear, or anxiety, accurate measurement can be a problem, particularly if the individual is unable or unwilling to provide an accurate verbal description. Because these subjective symptoms are all somewhat familiar, our assessment of them frequently is laden with personal opinions, beliefs, attitudes, and expectations about what will effectively eliminate them. Unfortunately we often bring these value-laden biases into new patient situations, thus influencing what we hear from and/or see in those we are caring for. While we are attempting to assess symptoms in an accurate manner, we are also trying to "manage" the symptom using the safest and most efficacious intervention we can. But what do we really mean by "manage"? Ideally, we manage a symptom by instituting an intervention that will eliminate it and prevent its return, or, if this is not possible, by striving to provide a therapy that will relieve, reduce, ameliorate, or simply make whatever is amiss better. Based on this ideology, symptom management should be broad in scope, encompass all types of safe and effective therapies, and be based on the best and most current research evidence available. In reality, however, we frequently Bonnie Stevens Copyright (c) 2000 McGill Library http://creativecommons.org/licenses/by/4.0 2000-03-31 2000-03-31