Tuesday, 22 April 2014

Non-pharmacological pain interventions

Roger Watson, Editor-in-Chief

A systematic review by Hökka et al. (2014) published in JAN considers non-pharmacological treatment of pain in advanced cancer. The search for such treatments is doubtless spurred by the desire for treatments that will not lead to dependence and will have few, or no, adverse side-effects. However, it is hard to imagine any treatment that has an effect not having a side-effect. That is how treatments work; they disrupt some function of the body to produce a desired effect and this, inevitably, has an unwanted effect. The search continues for treatments with good therapeutic indices: the appropriate balance between desired effect and unwanted side-effect. From this perspective, the search for – so-called – non-pharmacological treatments may be fruitless as, if they work, they are either having an effect, with the risk of side-effects, or the person receiving them thinks they work; i.e. they have a placebo effect. 

Non-pharmacological treatments fall under the umbrella of complementary and alternative medicine (CAM) and this covers a very broad range of purported treatments that are united by a single concept: they have not been shown to work. Numerous reviews over the years have, largely, demonstrated this. Some would say that the ‘jury remains out’ on the issue; others would say that judgement has been delivered. 

Nevertheless, the use of CAM continues and the reasons they are used range from mild to severe symptoms and – while it could be argued that resources should not be invested in their development and testing – the fact that they are widely used, despite the lack of evidence, merits their study. Certainly, the evidence for efficacy needs to be evaluated and reported.

Hökka et al. (2014) report very little evidence that the treatments they reviewed work for people with advanced cancer. Moreover, in the words of the authors: ‘There are several research gaps: we found no studies about music, spiritual care, hypnosis, active coping training, cold or ultrasonic stimulation.’ This means that, for a remarkably wide range of non-pharmacological treatments being used to treat pain in advanced cancer, there seems to be no effort to study them. If people are asking to use these treatments or if nurses are proposing them, then they need to be honest about the state of evidence in this field.


Reference

Hökka M, Kaakinen P, Pölkki T (2014) A systematicreview: non-pharmacological interventions in treating pain in patients withadvanced cancer Journal of Advanced Nursing doi:10.1111/jan.12424




Tuesday, 15 April 2014

Older nurses in the workforce

Roger Watson, Editor-in-Chief

A study of nurses over 50 years of age in New Zealand, published in JAN, provides a very interesting and clear pattern of the decisions and career shifts that nurses make in the final 10-15 years of their career.

The ageing of the nursing workforce has been a major consideration worldwide for at least a decade with reports highlighting the issue and proposing solutions (Buchan 1999, Watson et al. 2003). The ageing of the nursing workforce cannot be ignored for the sake of political correctness; older nurses are closer to retirement and older nurses cannot possibly undertake some of the roles of their younger counterparts if they have had a full career in nursing. Nursing is a physically and psychologically demanding profession and the accumulated physical and mental stresses are bound to have an effect. However, health services need to function in hospitals and communities, and there is also a recognised shortage of nurses entering the profession (Buchan & Calman 2004) and a propensity for attrition from the profession (Buchan 2013), often for the reasons stated above. Increasingly, therefore, we rely on older nurses as a proportion of the nursing workforce (Watson et al. 2003). We do not have the option of allowing older nurses to retire too early and if we do we lose an incredible repository of knowledge and experience and also investment in education and career and professional development, often over up to four decades.

The study by North et al. (2014), using a retrospective cohort analysis over 5 years of nurses aged over 50 shows that there is a move out of hospital care and into community care. However, a quarter of the cohort were no longer practicing, therefore, there was a net loss of practising nurses. Over the 5 years of the analysis there was a clear trend towards reduced working hours. It is clear - generally - what older nurses like to do: work fewer hours and work out of hospital and in the community. If this is the case then, to staff vital areas where older nurses like to work and to maintain their valuable contribution to healthcare, some accommodation of these facts must be made.


References

Buchan J (1999) The ‘greying’of the United Kingdom nursing workforce: implications for employment policy andpractice. Journal of Advanced Nursing 30, 818–826

Buchan J (2013) Nurses’ turnover: reviewing the evidence, heeding the results. Journal of Advanced Nursing 69, 1917-1918

Buchan J, Calman L (2004). The global shortage of registered nurses: An overview of issues and actions. International Council of Nurses, Geneva

North N, Leung W, Lee R (2014) Aged over 50 years and practising: separation and changes in nursing practice among New Zealand’s older Registered Nurses. Journal of Advanced Nursing DOI: 10.1111/jan.12426

Watson R, Manthorpe J & Andrews J (2003) Nurses over 50: Option, Decisions and Outcomes. The Policy Press, Bristol