Nurses' reassessment of postoperative pain after analgesic administration

Objectives: To identify when and how nurses reassess patients' pain after analgesic administration in the postoperative context.
Methods: Fifty-two nurses were observed caring for postoperative patients (N = 364) in 2 surgical settings in a major metropolitan hospital. Seventy-four observation periods of 2 hours duration were studied. The research assistant observed nurses' activities in caring for the allocated patients'. detailing behavioral and verbal responses onto audiotape.
Results: Of the 316 pain activities Ihat occurred in 74 observation periods. 14 (4.4%) were reassessments after analgesic administration. Four themes were evident from the 14 reassessments: opportunistic reassessment. the use of simple questioning, a focus on surgical wound pain not procedural
pain, and nurse-initiated reassessment.
Conclusions: Despite the focus on meeting standards of care in the area of pain management, there was an extraordinary lack of patient reassessment by nurses after the administration of analgesics. Given Ihe raised awareness internationally on assessment generally and a lack of evidence focused on reassessment after an intervention, this may explain why research is failing to identify shifts in pain severity scores and indeed patient pain.

Self-administration of medication in hospital: patients' perspectives

Background. Little information is available about patients' perspectives on self- or nurse-related administration of medication.

Aim. The aim of the study was to determine patients' perspectives about self-medication in the acute care setting.

Methods. A qualitative approach, using in-depth semi-structured interviews, was taken. Ten patients with a chronic medical illness who had experienced multiple hospital admissions for treatment were interviewed about their experiences of medication administration in the acute care setting. Participants were recruited from two cardiovascular wards in a private, not-for-profit hospital in Melbourne, Australia. Data collection occurred between August and September 2002.

Findings. Four major themes were identified from the interviews: benefits of self-administration, barriers to self-administration, assessing appropriateness of self-administration and timing of medication administration. Seven participants had previously experienced self-administration of medications and six were in favour of this practice in the clinical setting. Nine managed their own medications at home, and one self-administered with some assistance from his family. Participants were very concerned about how nurses' heavily regulated routines affected delivery of medications in hospital and disrupted individualized plans of care maintained in the home setting.

Conclusions. In planning and implementing self-administration programmes, it is important to consider patients' views. Medication regimes should be simple and flexible enough to adapt to patients' lifestyles and usual routines. Nurses should also take advantage of opportunities to support and facilitate patient autonomy, to enable more effective management of health care needs when patients return home.

Aesthetic dimensions of educational administration and leadership

The Aesthetic Dimensions of Educational Administration and Leadership provides an aesthetic critique of educational administration and leadership. It demonstrates the importance of aesthetics on all aspects of the administrative and leadership world: the ways ideas and ideals are created, how their expression is conveyed, the impact they have on interpersonal relationships and the organizational environment that carries and reinforces them, and the moral boundaries or limits that can be established or exceeded.

The book is divided into three sections.
Section I examines various philosophical traditions in aesthetics as they inform administrative life, focussing on major modern traditions arising from Kant, romanticism and Nietzsche, Collingwood, the pragmatic school, and critical theory.
Section II explores four aesthetic sources for administrative critique - architecture, literature, film, and movement - as they serve both to understand the social construction of administration and leadership and provide a critique of values, roles, power and authority.
Section III examines more topical and applied problems of charisma, heroism, and authority in practice, concluding with a discussion of the aesthetic analysis of politics and power within the context of contemporary educational administration and leadership theory.

While presenting a significant departure from conventional studies in the field, the international contributors reflect a continuity of thought on the creation, use and abuse of administrative and leadership authority from the writings of Plato through to contemporary theory. This book should appeal to school administrators and leaders and those aspiring to these roles.

Educational administration and social justice

This paper argues that social justice is central to the pursuit of education and therefore should also be central to the practice of educational administration. Social justice in education, as elsewhere, demands both distributive justice (which remedies undeserved inequalities) and recognitional justice (which treats cultural differences with understanding and respect). But, given that cultures are always in the process of change, education is a key agency for negotiating cultural change through the exploration and negotiation of difference. Educational administration as a field can no longer escape the consideration of such issues as they are brought to the fore by the recognition of the failure of schools and school systems to ameliorate injustice in the distribution of resources and to recognise and celebrate difference as a means to social and cultural progress. We still need a model of educational administration centered around the problem of the justice and fairness of social and educational arrangements. Given the renewed interest in such issues, perhaps what was impossible twenty five years ago might now be achieved.

Nursing administration of medication via enteral tubes in adults : a systematic review

Background Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown.

Objectives The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications.

Search strategy The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies.

Selection criteria Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug–nutrient interactions or the bioavailability of specific medications.

Data collection and analysis Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary.

Results There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.

A systematic review of nursing administration of medication via enteral tubes in adults

Aim. This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults.
Background. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown.
Design. Systematic review.
Methods. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data
were presented in a narrative summary.
Results. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself.
Conclusion. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication.
Relevance to clinical practice. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.

Australia local government and e-governance : from administration to citizen participation

This chapter analyses local government’s response to the pressure to modernise its structures through its use of Information Communication Technologies (ICT) to execute its broad range of tasks. The chapter begins by discussing Chadwick and May’s (2003) three basic models of e-government; managerial, consultative and participatory. Using data collected from an analysis of 658 local government websites in Australia together with existing survey research the chapter then analyses the extent to which local government sites fit into the three models. The chapter concludes with a discussion of the issues and problems faced by local government in its attempt to develop e-governance as both an extension of administrative as well as democratic functions.

Teaching educational leadership and administration in Australia

Despite the ubiquity of programmes in educational administration and leadership little is known about the resources used to teach them. This article reviews the sources currently employed in such programmes in Australia by examining the textbooks, book chapters and journal articles specified for 53 separate units (papers) offered at 15 of the key institutions that responded to requests for copies of their reading lists. Surprisingly, few of the units prescribed textbooks (35), relying instead on book chapters (243) and journal articles (362). While there was a very eclectic spread of sources across institutions, 10 major themes emerged. However, there appeared to be little emphasis on Australian research on educational leadership and little reference to major Australian authors of the previous decades. This may be because the field has become global. The second part of the article therefore examines an audit of the contributions made by Australian authors to the global literature represented by leading journals in the field. The audit shows that during the period 1977-2007 an average of 12-13% of papers in key journals were contributed by Australian authors, perhaps more than might be expected given the comparative size of the Australian community.