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Attitudes of patients, housestaff, and nurses toward postoperative analgesic care
96 7) Housestaff activism: The emergence of patient-care demands HOFFMAN, L.M. Columbia Univ. Sch. of Law, New York, NY, U.S.A. J. Health Polit. Policy Law 7(2), 421-439,
1982
Two trends are evident within the physician housestaff movement: increased acceptance of collective bargaining and unions, and a shift from narrower economic to broader political demands, including some involving patient care. Case studies of politically active housestaff associations in New York, Chicago, and Los Angeles are utilized to examine the emergence of “patient-care” demands and their compatibility with collective bargaining frameworks. As housestaff have become principal providers of care to indigent populations in public hospitals, and economic cutbacks have endangered service as well as the positions of physicians, patient-care demands arise and become infused with demands for participation and control in decision-making. Common factors in the politicization of housestaff have been the contribution of activists of the 1960s as leaders, and the impact of fiscal crisis and economic retrenchment in the 1970s. However, the emergence and resolution of these issues has differed, depending upon legal, political, historical, and organizational variations. In general, patient-care issues are supported by housestaff when they dovetail with housestaff interests. However, physician interests can diverge from those of patients, as in the case of manpower redistribution. On the whole, wages and benefits have done better than educational or patient-care demands. Educational demands have met with counterattack, and patient care, limited by the traditional scope of collective bargaining, has had to evolve indirectly, and has been hurt by long-term economic trends. Finally, national housestaff organization is limited by the wide-ranging politics and ideas of diverse regional organizations which represent different types of training institutions and career orientations.
8) Attitudes of patients, housestaff, and nurses toward postoperative analgesic care WEIS, O.F., SRIWATANAKUL, K., ALLOZA, J.L., et al. Dept. Pharmacol. Toxicol., Univ. Rochester Sch. Med. Dent., Rochester, NY, U.S.A. Anesth.
Analg.
62(l),
70-74,
1983
A survey was conducted among housestaff and nurses involved with postoperative patient care to assess their knowledge of analgesics and their attitudes toward postoperative analgesic care. Only one fifth of the respondents prescribed for complete pain relief. There were some misconceptions about adding other drugs to narcotic analgesics as well as fear of the addictive prop-
erties of these narcotics. The respondents lacked confidence about their knowledge of narcotic analgesics. Fear of respiratory depression was less prominent. Nine percent of the physicians and 31% of the nurses believed that response to a placebo indicates factitious pain. Fifty-four percent of the physicians and 74% of the nurses believed that patients receive adequate pain relief. Eighty-one patients were questioned on their beliefs about pain and its relief; 66 of these were monitored postoperatively to assess the effectiveness of pain relief, which was judged by the authors to be ineffective (ie, moderate to severe pain at the peak of analgesia) in 41%. Seventy-five percent of the patients reported that their overall postoperative pain relief had been adequate. There was no correlation between the amount of analgesic required postoperatively and either the degree to which patients believed pain builds character or the degree to which they rated themselves sensitive to pain. This study emphasizes the need for better and more comprehensive training of housestaff and nurses in analgesic care.
PATIENT COMPLIANCE Of continuing importance is the research on patient compliance underway in all clinical areas. A study in Australia on patients with epilepsy and a study from the Netherlands on patients with hypertension reflect the continuing endeavor of health professionals to find ways of improving care through improving patient compliance with recommended regimens.
9) Determinants of patient compliance with anticonvulsant therapy PETERSON, G.M., MCLEAN, S., and MILLINGEN, K.S. Sch. Pharm., Univ. Tasmania, Hobart, Tasmania, Australia Epilepsia
23(6),
607-613,
1982
Determinants of compliance were examined in 101 hospital outpatients with epilepsy. Self-reported patient compliance was associated with plasma anticonvulsant levels, prescription refill frequencies, and appointment keeping. Factors independently related to compliance were worry about one’s health, having generalized tonic-clonic seizures, and the absence of barriers to good compliance. Seizure frequency indirectly contributed to patient compliance through worry about one’s health. Removing potential barriers to compliance, in combination with counseling patients who have been relatively seizure-free, may improve compliance with anticonvulsant therapy.
PATIENTEDUCATIONAND COUNSELING
1982
Two trends are evident within the physician housestaff movement: increased acceptance of collective bargaining and unions, and a shift from narrower economic to broader political demands, including some involving patient care. Case studies of politically active housestaff associations in New York, Chicago, and Los Angeles are utilized to examine the emergence of “patient-care” demands and their compatibility with collective bargaining frameworks. As housestaff have become principal providers of care to indigent populations in public hospitals, and economic cutbacks have endangered service as well as the positions of physicians, patient-care demands arise and become infused with demands for participation and control in decision-making. Common factors in the politicization of housestaff have been the contribution of activists of the 1960s as leaders, and the impact of fiscal crisis and economic retrenchment in the 1970s. However, the emergence and resolution of these issues has differed, depending upon legal, political, historical, and organizational variations. In general, patient-care issues are supported by housestaff when they dovetail with housestaff interests. However, physician interests can diverge from those of patients, as in the case of manpower redistribution. On the whole, wages and benefits have done better than educational or patient-care demands. Educational demands have met with counterattack, and patient care, limited by the traditional scope of collective bargaining, has had to evolve indirectly, and has been hurt by long-term economic trends. Finally, national housestaff organization is limited by the wide-ranging politics and ideas of diverse regional organizations which represent different types of training institutions and career orientations.
8) Attitudes of patients, housestaff, and nurses toward postoperative analgesic care WEIS, O.F., SRIWATANAKUL, K., ALLOZA, J.L., et al. Dept. Pharmacol. Toxicol., Univ. Rochester Sch. Med. Dent., Rochester, NY, U.S.A. Anesth.
Analg.
62(l),
70-74,
1983
A survey was conducted among housestaff and nurses involved with postoperative patient care to assess their knowledge of analgesics and their attitudes toward postoperative analgesic care. Only one fifth of the respondents prescribed for complete pain relief. There were some misconceptions about adding other drugs to narcotic analgesics as well as fear of the addictive prop-
erties of these narcotics. The respondents lacked confidence about their knowledge of narcotic analgesics. Fear of respiratory depression was less prominent. Nine percent of the physicians and 31% of the nurses believed that response to a placebo indicates factitious pain. Fifty-four percent of the physicians and 74% of the nurses believed that patients receive adequate pain relief. Eighty-one patients were questioned on their beliefs about pain and its relief; 66 of these were monitored postoperatively to assess the effectiveness of pain relief, which was judged by the authors to be ineffective (ie, moderate to severe pain at the peak of analgesia) in 41%. Seventy-five percent of the patients reported that their overall postoperative pain relief had been adequate. There was no correlation between the amount of analgesic required postoperatively and either the degree to which patients believed pain builds character or the degree to which they rated themselves sensitive to pain. This study emphasizes the need for better and more comprehensive training of housestaff and nurses in analgesic care.
PATIENT COMPLIANCE Of continuing importance is the research on patient compliance underway in all clinical areas. A study in Australia on patients with epilepsy and a study from the Netherlands on patients with hypertension reflect the continuing endeavor of health professionals to find ways of improving care through improving patient compliance with recommended regimens.
9) Determinants of patient compliance with anticonvulsant therapy PETERSON, G.M., MCLEAN, S., and MILLINGEN, K.S. Sch. Pharm., Univ. Tasmania, Hobart, Tasmania, Australia Epilepsia
23(6),
607-613,
1982
Determinants of compliance were examined in 101 hospital outpatients with epilepsy. Self-reported patient compliance was associated with plasma anticonvulsant levels, prescription refill frequencies, and appointment keeping. Factors independently related to compliance were worry about one’s health, having generalized tonic-clonic seizures, and the absence of barriers to good compliance. Seizure frequency indirectly contributed to patient compliance through worry about one’s health. Removing potential barriers to compliance, in combination with counseling patients who have been relatively seizure-free, may improve compliance with anticonvulsant therapy.
PATIENTEDUCATIONAND COUNSELING