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Article
Publication date: 8 July 2019

Terri MacDougall, Shawna Cunningham, Leeann Whitney and Monakshi Sawhney

The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional…

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Abstract

Purpose

The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC).

Design/methodology/approach

The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project.

Findings

Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form.

Research limitations/implications

This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide.

Practical implications

Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice.

Originality/value

This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

Case study
Publication date: 20 January 2017

Tim Calkins and Ann Deming

Executives at biotechnology firm Genzyme are debating funding a clinical trial for a new version of a medical device called Synvisc. The trial is expensive and the odds of success…

Abstract

Executives at biotechnology firm Genzyme are debating funding a clinical trial for a new version of a medical device called Synvisc. The trial is expensive and the odds of success are not high, but the upside is substantial. The case presents a common business question: invest or not? The case forces students to think about customer insights, wrestle with a number of complex issues, and evaluate the financials of the decision.

The case is ideal for teaching financial analysis and decision making. It can also be used to teach marketing, new product strategy, and healthcare industry management.

Details

Kellogg School of Management Cases, vol. no.
Type: Case Study
ISSN: 2474-6568
Published by: Kellogg School of Management

Keywords

Article
Publication date: 24 June 2019

Christos Begkos, Sue Llewellyn and Kieran Walshe

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat…

1920

Abstract

Purpose

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore strategizing pathways and the ways they can mobilise accounting to advance from practical coping to explicit strategic intent.

Design/methodology/approach

The authors conducted semi-structured interviews with Clinical Directors, Business Managers and Finance personnel at three NHS hospitals. Documents were also collected, such as business cases and financial reports. The authors employed theories on strategizing agency, episodes and practical coping to select examples of strategizing and indicate how strategizing is constructed and performed. The authors present the results of this qualitative analysis in three strategizing narratives.

Findings

The analysis highlights how Clinical Directors’ strategizing with accounting, in response to their financial problems, can take on contesting, conforming and circumventing modes. As the strategizing pathway unfolds, accounting acts as an obligatory passage point through which Clinical Directors pursue their strategic intent. Along each pathway the authors identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious.

Originality/value

The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organisational strategy as “done” in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organisational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.

Details

Accounting, Auditing & Accountability Journal, vol. 32 no. 5
Type: Research Article
ISSN: 0951-3574

Keywords

Book part
Publication date: 1 July 2004

Jinee Lokaneeta

This paper argues that contemporary executions by lethal injection represent spectacles of death. This spectacle of death upholds the sovereignty of the liberal state by evoking a…

Abstract

This paper argues that contemporary executions by lethal injection represent spectacles of death. This spectacle of death upholds the sovereignty of the liberal state by evoking a sense of fear among the citizens. The State uses the apparently “painless” and “humane” form of execution by lethal injection to legitimize the death penalty in the U.S. I take the example of McVeigh’s execution to suggest that spectacles of execution continue in modern society, along with disciplinary processes that the liberal state depends on for its legitimacy. This paper, thus, aims to contribute towards a rethinking of a Foucauldian notion of power.

Details

Studies in Law, Politics and Society
Type: Book
ISBN: 978-0-76231-109-5

Article
Publication date: 1 December 2005

John Holden and Emma Wooff

The purpose of this article is to review all patients having received a steroid injection for rheumatic problems in the period 1995‐2003 by one general practitioner.

353

Abstract

Purpose

The purpose of this article is to review all patients having received a steroid injection for rheumatic problems in the period 1995‐2003 by one general practitioner.

Design/methodology/approach

Self‐completion questionnaire given to patients at the time of the injection to be returned after one month.

Findings

Most of the 435 patients (92 per cent) were pleased that they had received the injection. Pain was relieved better than mobility. Results for different sites were similar. Complication rates were low and many patients had further steroid injections.

Practical implications

It is feasible to collect large series reviewing the outcome of interventions in general practice. Results can be usefully compared with those obtained in randomised controlled trials.

Originality/value

This is the largest review of steroid injections carried out in a single general practice in the UK. It provides information with which others can compare their own practice and results, especially in primary care.

Details

Clinical Governance: An International Journal, vol. 10 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 7 March 2016

Martin Kerridge-Weeks and Neil John Langridge

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic…

Abstract

Purpose

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic consultation. The purpose of this paper is to determine if a CSP could allocate patients into distinct diagnostic triage categories in line with national and international guidelines. A second aim was to describe the CSPs clinical decision making.

Design/methodology/approach

A review of 100 spinal patients, consecutively referred between February and April 2013 to a CSP spinal triage clinic was undertaken. Patient demographics (age, gender, employment status), clinical diagnosis and diagnostic triage categories selected for each patient were recorded. Subsequently, if clinical triage led to further investigation or a consultant opinion then the onward management pathway was followed to calculate conversion to consultant surgical intervention.

Findings

In total, 69 per cent of patients were independently managed by the CSP and discharged back to the General Practitioner or on to therapy. In total, 30 per cent of patients (n=30) were referred for consultant opinion, of these 12 underwent intervention. This represents a conversion rate to consultant intervention of 40 per cent.

Originality/value

Findings suggest that a significant number of spinal patients referred for an orthopaedic consultation may be managed independently by a CSP. Referral for consultant review was deemed appropriate in terms of conversion to intervention, advice on further imaging, referral to other medical disciplines and patient counselling. This study suggests that CSPs can manage a significant number of patients with spinal conditions whilst providing high-quality referrals to surgical colleagues. This audit provides a novel insight into practitioner behaviour that supports the development of advanced practice for non-medical clinicians.

Details

International Journal of Health Governance, vol. 21 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 14 September 2018

Panita Krongyuth, Pimpan Silpasuwan, Chukiat Viwatwongkasem and Cathy Campbell

The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.

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Abstract

Purpose

The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.

Design/methodology/approach

A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting.

Findings

The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports.

Originality/value

The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.

Details

Journal of Health Research, vol. 32 no. 5
Type: Research Article
ISSN: 2586-940X

Keywords

Article
Publication date: 30 March 2012

Claude Besenius, Eleanor Bradley and Peter Nolan

The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic…

Abstract

Purpose

The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic medication, the route of administration, and the extent of service users' involvement.

Design/methodology/approach

A total of 26 psychiatrists and 12 nurses agreed to be interviewed in phase one of this study, concerning general aspects of prescribing. In phase two, 11 of the psychiatrists and five nurses from the first cohort took part in follow‐up interviews that focused specifically on their most recent prescribing experiences. In phase 3 of the study, 18 service users (14 male and 4 female) were recruited, during which their experiences of having medication prescribed was explored.

Findings

This interview‐based survey found that though there was some agreement between the attitudes and perceptions of prescribers and service users, there were also some important differences including differences with respect to the purposes of prescribed medication, when to prescribe, and under what conditions depot medication produces optimal results. It is not always clear to service users as to why certain medicines were prescribed nor is the information provided always understood. A considerable amount of prescribing practice is based on assumptions.

Originality/value

Even though medication (both oral and depot) has been shown to be useful in certain situations, nevertheless, the type of medication, dose and mode of administration continues to be idiosyncratic and inconsistent. This paper seeks to contribute to the debate by identifying in which pharmacological interventions for people with severe mental health problems could be improved.

Details

The Journal of Mental Health Training, Education and Practice, vol. 7 no. 1
Type: Research Article
ISSN: 1755-6228

Keywords

Book part
Publication date: 13 October 2014

Darbi J. Haynes-Lawrence and Adam R. West

The purpose of this study was to survey parents who have Multiple Sclerosis (MS) and examine issues surrounding their parenting.

Abstract

Purpose

The purpose of this study was to survey parents who have Multiple Sclerosis (MS) and examine issues surrounding their parenting.

Design

Qualitative surveys were used to collect data.

Findings

Findings from the study include three themes: (a) They needed to know; (b) Involving children with treatment; and (c) I can’t do this alone. Discussion of findings and conclusions and recommendations for parents, physicians, and future studies are presented.

Research limitations

Data for the study was collected through self-reports and limited demographic data was collected.

Value

Continued research on MS is needed, especially in the area involving children in at-home treatments and children as caregivers. Children can be a challenging population to investigate, yet as evidenced in this study, children are being involved in MS treatments of their parents. A greater, more in-depth look at the role of a child as caregiver is warranted.

Details

Family Relationships and Familial Responses to Health Issues
Type: Book
ISBN: 978-1-78441-015-5

Keywords

Article
Publication date: 2 January 2023

Hawal Lateef Fateh, Negin Kamari, Ayad M. Ali, Jalal Moludi and Shahab Rezayaeian

The nutritional and anthropometric status can be essential in determining their immune response to vaccines. The purpose of this paper was to investigate the association between…

Abstract

Purpose

The nutritional and anthropometric status can be essential in determining their immune response to vaccines. The purpose of this paper was to investigate the association between diet quality and anthropometric indices with the side effects of the Pfizer-BioNTech COVID-19 vaccine and the SARS-CoV-2 immunoglobulin G titer among Kurdish adults.

Design/methodology/approach

This cross-sectional survey-based study was conducted between December 2021 and February 2022. This paper included data on 115 adults, 20–89 years old, from the Kurdistan region. Dietary information was collected using a short food frequency questionnaire, and diet quality was assessed using a plant-based healthy diet score. A blood test was performed to measure the SARS-CoV-2 immunoglobin G (IgG) titer after the vaccination's first and second doses.

Findings

Overweight and obese subjects reported more local pain, myalgia, headache, local bruising and local reactions after receiving the first dose of the vaccine (p = 0.04). People on a less healthy diet reported more local pain, myalgia and headache (p = 0.04) and more local bruising and reactions (p = 0.01) after receiving the second dose of the vaccine. On the other hand, the authors observed that those with healthy dietary habits had more IgG titer after the first and second doses of vaccination than those with less healthy dietary habits (p = 0.001).

Originality/value

The results showed that participants with a healthy diet and normal weight status had fewer side effects of the Pfizer-BioNTech COVID-19 vaccine than obese people and those with a less healthy diet.

Details

Nutrition & Food Science , vol. 53 no. 4
Type: Research Article
ISSN: 0034-6659

Keywords

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