Pain as the ‘fifth vital sign’ highlights the significance of pain assessment in patient care, but has often been found to be mechanistic and devoid of meaningful significance in clinical settings. Due to the complex nature of pain experience, nurses and doctors rarely depend on the patient self-report of Numerical Rating Scale (NRS) alone to initiate, modify, supplement or discontinue analgesia. Hence, there is a need to supplement the existing pain assessment using NRS with more clinically-relevant strategies in pain assessment. The article depicts the issues with using NRS and encourages nurses to use clinically meaningful pain assessment methods, citing an example of Clinically Alligned Pain Assessment tool (CAPA©), a new pain assessment tool.

Re-feeding syndrome is a metabolic complication that can occur when enteral or parenteral nutritional rehabilitation is initiated for severely malnourished patients.It is fatal if not recognized and treated properly. This article discusses the body’s adaptation to starvation, the pathophysiology, risk factors of re- feeding syndrome, adverse consequences which can occur in the early stages of re-feeding, and its management. It focuses on challenges faced in caring for patient during re-feeding. Starvation causes adaptive reductions in cellular activity and organ function, accompanied by electrolyte and micronutrient depletion. During starvation insulin decreases and glucagon levels rise, resulting in gluconeogenesis and the breakdown of protein and lipid. Free fatty acids and ketone bodies replace glucose as the major energy source. When nutritional rehabilitation is started the re-feeding triggers a shift from fat back to carbohydrate metabolism, with consequent insulin release, and increased shift of potassium, phosphate, magnesium, and water into the cells. In a starved individual, cardiac mass may be significantly depleted, leading to the risk of fluid overload and cardiac failure during re-feeding. Nurses play a significant role in identification and prevention of re-feeding complications.

People can tell a measure of their health by their bowel movement. Patients experience delayed bowel movement after the abdominal surgery because of an inevitable response to surgical trauma called postoperative ileus/paralytic ileus. Chewing gum is known to activate the cephalic phase of digestion mediated by vagus nerve, reducing the incidence of ileus. Postoperative ileus is also associated with prolonged hospitalization. Hence, a quasi experimental research was conducted to assess the effect of chewing gum therapy on selected postoperative outcomes among patients undergoing abdominal surgery in selected surgical wards of a tertiary hospital in South India. Totally 45 patients who underwent abdominal surgery were chosen by convenience sampling method. Patients shifted to intensive care unit and who had ileostomy/colostomy postoperatively were excluded. The participants in control group were given regular post operative care and observed for first three weeks. In the later three weeks of period, the experimental group were given one sugarless chewing gum three times a day along with regular post operative care till the participants were discharged. A bowel motility chart and an observation checklist were used to assess the effectiveness of chewing gum therapy in regard to the occurrence of bowel movement. The thirst distress scale and oral hygiene index were used to measure intensity of thirst and oral hygiene of the participants respectively from both control and experimental group. Results demonstrated that the mean time taken to pass first flatus and stool by the participants in the experimental group was 55.71 hours and 84.11 hours, and in the control group was 51.84 hours and 80.79 hours. The difference in the time taken to pass first flatus and stool in the experimental and control group was not statistically significant. The oral hygiene of the participants in the experimental group was significantly better in the control group (p <. 001). Thirst experienced by the participants in the experimental group with regards to dry mouth was significantly less than the control group (p < .05). There was a statistically significant association between the type of surgery and duration of surgery with postoperative ileus (p < .05). The study findings highlighted the advantages of having chewing gum therapy in the regular post operative care with the improved oral hygiene and reduced discomfort from thirst.

Appropriate thromboprophylaxis can prevent venous thromboembolism - the most prevalent potentially preventable complication among surgical patients. Anti-embolism stockings are a simple and effective mechanical thromboprophylactic modality which is widely used. This study was undertaken to assess the knowledge, attitude and practice of nurses regarding the use of anti-embolism stockings. Convenience sampling was used to recruit nurses working in surgical wards of a tertiary hospital. A knowledge questionnaire, an attitude scale and an observation checklist were used in the study. Sixty four nurses were observed for knowledge / attitude and 72 nurses were observed for practice regarding the use of anti- embolism stockings. It was found that 65.6% had moderately adequate knowledge and 90.6% had highly favourable atttitude. Majority of the nurses (91.7%) demonstrated inadequate practice in the use of stockings. Prevention of venous thrombo-embolism and the use of anti- embolism stockings needs to be added as an in-service education topic for nurses and clinical teaching for the nursing students. It can also be considered as a component of health education to the patients. Use of a protocol and documentation form can ensure appropriate use of the anti- embolism stockings. Incorporating this topic in the syllabus and as a procedure in the log book can ensure mandatory learning about use and application of anti- embolism stockings.

Child malnutrition is still a serious health problem in many developing countries including India. Feeding practices of mothers may play a significant role in improvement of nutritional status of children. A descriptive correlational study was conducted to find out correlation between nutritional status of children and feeding practices of mothers. A purposive sampling technique was used to recruit 60 male and female children between the age group of 6 months to 3 years along with their mothers. Nutritional status of children and feeding practices of mothers were assessed through anthropometric assessment and self- reporting feeding practice checklist respectively. The collected data were analyzed using descriptive and inferential statistics. The results according to weight-for-age calculation revealed that 75% of children had normal nutritional status and 18.3% and 6.7% of children had grade 1 and grade 2 malnutrition respectively. According to height-for-age calculations, 83.3% of children had normal height, 10% of children were short for age, and 1.7% children had gigantism. As per levels of feeding practices of mothers, 31.6% had satisfactory, 41.7% had partially satisfactory and 26.7% had unsatisfactory feeding practices. There was a significant moderately positive correlation (r = .64, p = .01) between weight for age and feeding practices and a non significant low positive correlation (r=.29, p =. 14) between height for age and nutritional practices. Hence, there is a need for creating awareness about healthy feeding practices to combat the problem of malnutrition.

Qualitative research deals with data collected in narrative form which requires an in-depth knowledge in selecting appropriate sampling techniques and data collection methods. Unlike quantitative studies, non- probability sampling techniques are used in qualitative studies to enhance information richness. Sample size is not determined using statistical formula, but is based on the principle of data saturation and the type of qualitative study methodology. Qualitative studies adopt flexible data collection plans which may evolve as the study progresses. Observation, in-depth interviews and focus group discussions are the primary data collection methods in qualitative studies.

Pregnancy may be complicated by a variety of disorders and conditions that can profoundly affect the health of a woman and her fetus. Some of them may exist prior to the woman becoming pregnant, while some may begin with pregnancy. Diabetes mellitus is the most common metabolic complication of pregnancy, which affects the progress of pregnancy and development the fetus. This article reviews the types, pathophysiology, risk factors, diagnosis, effects of diabetes on pregnancy and the fetus and aims to equip the nursing personnel with the knowledge required to provide appropriate care to such women with gestational diabetes mellitus.

Wilson disease, also called hepatolenticular degeneration is an autosomal recessive defect in cellular copper transport. A defect in biliary excretion leads to accumulation of copper in the liver, causing progressive liver injury and cirrhosis. The recommended initial treatment for symptomatic patients or those with active disease is administering chelating agents such as D-Penicillamine. The definitive treatment is liver transplant. This article focuses on the nursing care of a patient with Wilson disease and using the nursing process approach, a case study is presented.

Sleep quality is altered with the advance of age. Acupressure is a non-pharmacological therapy, which involves the stimulation of certain acupoints by pressing with the fingers. A study was conducted in two old age homes in Madurai to assess the effectiveness of acupressure on improvement of sleep quality among the elderly. Quantitative approach with one group pre-test post-test design was used. Pittsburg Sleep Quality Index (PSQI) was used to measure the sleep quality. All the subjects reported poor quality of sleep. Majority had moderate level of poor quality of sleep in pre-test (61.7%). Following acupressure 43.3% of subjects reported good quality of sleep. Acupressure was found to be significantly effective in improving sleep quality. As acupressure has no significant adverse effects or side effects, nurses can empower themselves with acupressure skills and intervene when elderly clients have poor sleep quality.

HIV is one of the most threatening acquired infections which can be transmitted from mother to baby. Women of reproductive age comprise more than half of the 33 million people currently living with HIV around the world. Amongst 0.48% of the antenatal mothers attending antenatal clinics it is estimated that 20,000 children are infected by HIV/AIDS contributing to 30% of vertical transmission. In India, stigma and discrimination towards HIV patients hinders them from seeking the best health care services. This descriptive study was done to assess the knowledge of staff nurses in caring for HIV infected pregnant women. Staff nurses working in a Government Hospital, Visakhapatnam were selected through purposive sampling. Questionnaire was administered and data was analyzed using descriptive and inferential statistics. The results showed that 16.67 % had inadequate knowledge, 60 % had moderately adequate knowledge, and 23.33% had adequate knowledge. This study highlighted the need for the knowledge of the nurses as they are the key persons in antenatal clinics providing awareness and Counselling for HIV mothers in order to increase the effective use of Antiretroviral therapy to prevent parent to child transmission.

Primary caregivers of hemodialysis patients experience burden of care giving because they are obliged to play an important role in supporting patients on hemodialysis. The patient prognosis and maintenance is dependent on the characteristics of the caregiver and the patient. Care giving is an important factor that determines psychosocial wellbeing of the primary caregivers. Psychosocial wellbeing comprises of their physical, psychological, spiritual and social dimension. The objective of this study was to evaluate the validity and reliability of the researchers’ prepared tool to assess the psychosocial wellbeing of the primary care givers of patients on hemodialysis. Fifty six samples were selected for the study through complete enumeration. The tool was compared with the standard WHO prepared subjective wellbeing inventory. The psychosocial wellbeing tool had a strong positive correlation with the subjective wellbeing inventory. This instrument can be used by the nurses in assessing psychosocial wellbeing of the primary care givers of patients on hemodialysis.