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TRANSCRIPT
SUBMITTED BY:
MS. PARVATHY MOHAN
1ST YEAR M.SC. NURSING
MEDICAL SURGICAL NURSING
2009-2011 BATCH.
SARVODAYA COLLEGE OF NURSING.
BANGALORE.
RAJIV GANDHI UNIVERSITY OF SCIENCES, BANGALORE,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
Name of the Candidate and Address
MS.PARVATHY MOHAN
11/2, MAGADI ROAD, AGRAHARA DASARAHALLI, BANGALORE, PIN-560079
2.
Name of the Institution
Sarvodaya College Of Nursing,
Bangalore-79
3.
Course of Study and Subject
1st year M.Sc Nursing,
Medical surgical nursing
4.
Date of Admission of the Course
04.04. 2009
5.
Title of the Study
“A Study To Evaluate The Effectiveness Of Structured Teaching Program On Narcotic policy among staff nurses in selected hospitals at Bangalore.”
6.
Brief Resume of the Work
6.0 Introduction
6.1 Need for the Study
6.1.1 Statement of the Problem
6.2 Review of Literature
6.3 Objectives of the Study
6.3.1 Operational Definitions
6.3.2 Assumptions
6.3.3 Research Hypothesis
6.3.4 Sampling Criteria
(i) Inclusion Criteria
(ii) Exclusion Criteria
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7.
Materials and Methods
7.1 Sources of Data: Data will be collected from the staff nurses in selected hospitals at Bangalore.
7.2 Method of Data Collection: Self administered questionnaire.
7.3 Does the study require any investigations of interventions to be conducted on the
patients or other human being or animals? Yes.
7.4 Has ethical clearance been obtained from your institution?
Yes. ethical committee’s report is here with enclosed.
8.0 List of References : Enclosed
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION:
1.
NAME OF THE CANDIDATE AND ADDRESS
MS. PARVATHY MOHAN
1ST YEAR M.SC. (NURSING) SARVODAYA COLLEGE OF NURSING, MAGADI MAIN ROAD, BESIDE RAHEJA PARK, AGRAHARA DASAR HALLI BANGALORE 79
2.
NAME OF THE INSTITUTION
SARVODAYA COLLEGE OF NURSING, BANGALORE
3.
COURSE OF STUDY AND SUBJECT
1ST YEAR M.SC. MEDICAL SURGICAL NURSING
4.
DATA OF ADMISSION OF THE COURSE
04/04/2009
5.
TITLE OF THE TOPIC
“A study to evaluate the effectiveness of structured teaching programme on Narcotic policy among staff nurses in selected hospitals at Bangalore.”
6. BRIEF RESUME OF THE INTENDED WORK
6. 0 Introduction
“A STRONG POSITIVE MENTAL ATTITUDE WILL CREATE MIRACLE THAN ANY WONDER DRUG”
The term “narcotics” derived from the Greek "narke" that means "numbness or torpor. Narcotics mean any drug that produces sleep or stupor relieves pain, due to its depressant effect on the central nervous system. Usually in medical terms called as opium or opium derivatives, opium till today is the best known source for relieving pain. The word ‘opium’ is derived from the Greek word “opion”in Sanskrit known as Aahipen”. The opium poppy belongs to the family papaveraceae is an annual medicinal herb contains many alkaloids that are frequently used as an analgesic, anti tussive, and anti spasmodic in modern medicine .It was used by ancient Greek physicians such as Galen and Hippocrates for benumbing or paralyzing the area with the use of poppy juice and mandrake roots1.
A 2002 National House hold survey on drug abuse reported approximately 15,000,000 people in U.S.A illicit drugs and about 1% of population abuses narcotics. The number of treatment admissions for all drugs of abuse has been steadily declining since 2002 with the exception of non-heroin opiates, for which admissions increased 26.1%.The DAWN report in 2003 shows narcotic analgesics were involved in 16% of total drug abuse related admissions.2
The National Survey on Drug Use and Health (NSDUH) sponsored by the Substance Abuse and Mental health Services Administration (SAMHSA) provides data that graphically illustrate the increase in prescription of opioid and abuse in the last decade Between 1999 and 2006, the number of persons aged 12 and older illicitly using prescription pain relievers in the month prior to being surveyed increased from 2.6 million in 1999 to 5.2 million in 2006.In 2006, 5.2 million surveyed persons had used prescription pain relievers illicitly in the past month, compared with 0.3 million people who had used heroin.3
The abuse and misuse of legal drugs without prescription ends up with death or addiction. Global drug control system has formulated an International agreement for the regulation of psycho active drugs. The current International frame work came in to force in 1961 with the agreement of United Nations single conventions on Narcotic drugs. Since then the control system has grown in scope with the establishment of agencies like International Narcotics Control Board, United Nations office on Drugs and Crime.4
A survey conducted by the Ministry of Social Welfare and United Nations International Drug Control Programme in Chandigarh reveals that at 3.4 per cent, the consumption of opiates in the region is three times the national average As per the survey, the prevalence of drug and alcohol abuse among females was 45.6 per cent and 54.4 per cent males out of a sample size of 3000 more than in other individuals .5
. People abuse drugs for various reasons. These may range from curiosity, availability and previous drug use to emotional and social pressures. Drug use and abuse as a habit unfortunately could begin quite early in life as part of culture in some societies. The common drugs that are abused and which have attracted both local and international concern include tobacco, marijuana, heroin, cocaine, valium and ecstasy. Young injecting drug users are at high risk for a number of negative health outcomes such as hepatitis B, and Human Immune Deficiency infection.6
The physician or nurse who uses narcotics over a period of time in treating patients with pain may lead to addiction or dependence. The narcotics are abused due to its peculiar features to produce euphoria and also reduces sensitivity to physical and psychological stimuli. Administration of narcotics plays a vital role in managing pain without developing physical dependence.1
According to information from Post Graduate Institute’s de-addiction centre, around 500 new patients come every year. And more than 5,000 patients who are already treated for addiction. Doctors say the number of such cases is consistently increasing by around 10 per cent a year. As many as 40 per cent of the total cases at the Post Graduate Institute’s Centre are related to addiction to opiates, including opium, smacks, heroin, injectables, synthetics and tablets. Region drug abuse statistics shows it’s ahead of national average.7
The use of narcotic analgesic is normally controlled by various regulations and procedures to prevent misuse and to comply with International conventions termed as Narcotic policy. It is the policy of the hospital that all controlled substances shall be counted at the beginning of every shift by off going& oncoming licensed staff nurses. A narcotic record shall be maintained, if patient has an order for narcotics nurse should receive a written order from physician, and from time of taking narcotics till administration and documentation carried out with an eye witness and get signature from two licensed nurses ie: the one who have administered and witnessed. The nurse manager is responsible for the collection, documentation and record keeping, if any manipulation or misuse of narcotics needs to be inquired and clarified. 8
6.1 NEED FOR THE STUDY
A narcotic is drugs, which are very efficient in controlling pain and provides the patient a sense of well being. Misuse or improper dosage, and lack of knowledge regarding narcotic policy among health professionals especially nurses may lead to under estimation of patients pain or lead to physical dependence in patients.9
A study on narcotic addiction in patients with chronic pain, who is attending pain relief unit in U.K reveals 130 patients were taking narcotic analgesic in which 74 were suffering from cancer, 56 had chronic pain 9 patients were addicted to narcotic analgesics.10 A study on analysis of opium use by students of Medical sciences revealed that 3.9% of the students were admitted using opium once or more during their lives.2% were occasional opium users. These findings can be considered for the clinical practice for the detection of opioid abuse.11
According to United Nations Office on Drugs and Crime, estimates that, substance use are also more prevalent among young people than in older age groups. 2.7 % of the total global population and 3.9 % adolescents of 15 years and above had used cannabis at least once in their life.12The report published by Dr. Hussein A. Gezairy from World Health Organization emphasized that the countries of the Eastern Mediterranean Region faced a growing problem of substance use and dependence and there was a urgent need to intervene. Substance use and dependence and its consequences constitute a major public health threat globally and in the region. This requires an urgent response. Available evidence in countries points to increasing production of drugs like opium as well as increasing consumption of drugs.13
A study was done on nurses knowledge regarding opioid analgesic dose and psychological dependence among 200 nurses by using a questionnaire reveals that only 45% of staff nurses are aware of opioid analgesic and its relation with physical dependence, suggests there is an urgent need for basic education on opioid analgesic in correlation with pain management.14A Nursing study reveals nurses know pain but not narcotics; they tend to have unrealistic fears about the risks of addiction. This lead to under treat pain in patients who needs narcotic pain killer most and they seem to have less knowledge about narcotics and its side effects.15.
A study to evaluate the knowledge and attitudes among health professionals regarding pain issues such as addiction, the assessment of pain, scheduling, use of analgesics, Additionally, to determine whether differences exist based on hospital setting, years of service, clinical practice area, and country of origin: A total of 686 nurses, physicians, pharmacists, and medical/nursing students from three hospitals completed a 17-item survey evaluating knowledge and beliefs about pain. Nurses scored significantly less concordantly than physicians on 11 of the 17 items. Unwarranted fear of addiction is a misunderstood and important concept that needs to be addressed. 16
The investigator had a felt need to do the study among nurses on narcotic policy because when she was working as a staff nurse, she noticed that many of the staff nurses are unaware about the importance of handling narcotics and has misconceptions about addiction and most of the hospitals are not aware of the significance of narcotic policy. This made her to think on educating nurses about narcotic policy.
6.1.1 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured teaching programme on Narcotic policy among staff nurses in selected hospitals at Bangalore”.
6.2 REVIEW OF LITERATURE
Review of literature provides the basis for future investigations, justifies the need for replication, throws light up on feasibility of the study, and indicates constraints of data collection and help to relate findings of one another.
Review of literature is categorized under the following headings:
1. Review related to incidence about narcotic addiction
2. Review related to nurses knowledge
3. Review related to narcotic policy
4. Review related to effectiveness of STP. Review related to statistics about narcotic addiction
The incidence of opioid addiction in physicians has been estimated by the U.S commissioner of Narcotics about 1 addict among every 100 physicians in contrast to rate of 1 in 3000 general population. According to Federal Bureau of Narcotics1, 012 physicians were reported as opioid drug abusers.17
A study shows the prevalence of substance abuse in the nurse population is believed to parallel that in the general population. The American Nurses Association reports that up to 20 percent of nurses may have substance abuse issues. They are in danger of harming patients, the nursing profession, and themselves. The consequences of not reporting concerns can be far worse than those of reporting the issue.18
The constant increase in the quantity of various drugs seized worldwide indicates the increase in the number of addicts. With a turnover of around $500 billion, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other. 5% of the world population consumed illicit drugs at least once in the last 12 months it no longer is an individual or a social problem, but a politico-economic one with the facet of narco terrorism.19
Review related to nurses knowledge on narcotics
A Study was conducted in NIMHANS India, to determine the extent to which nurses are able to correctly identify drugs as narcotics and to ascertain their perception of the addiction potential of opiates when used for pain management. A questionnaire was administered to 86 nurses who attended palliative care workshops in India. Only morphine (95%) heroin (71%) and codeine (75%) were correctly identified as narcotics by the majority of participants. Imipramine (34%), diazepam (20%) and phenobarbitone (39%) were wrongly classified as narcotics by many nurses. Dextropropoxyphene (11%) , pentazocine (21%), buprenorphine (15%) were correctly classified as narcotics by fewer than half the participants. Only 14% knew that that the frequency of psychological dependence due to use of morphine for cancer pain was less than 1%.20
A study to assess the knowledge of opioid analgesic drugs and the incidence of psychological dependence among staff nurses the data obtained from 27 workshops on pain across 14 states (2,459 nurses) to determine current nursing knowledge of pharmacological management of pain. Results indicate that nurses lack knowledge in classification of opioids ranging from 23 to 98% correct response across seven analgesic drugs. Less than 25% of nurses correctly identified the frequency of psychological dependence. Further analysis revealed significant differences in basic versus advanced learners and geographical differences in knowledge. Implications are made for nursing education and practice.21
The purpose of this study was to determine areas of emergency nurses' knowledge deficit regarding pain management, and to identify barriers to pain management as perceived by emergency nurses. Data were collected anonymously in a mail survey using a 52-item knowledge questionnaire addressing pain management principles and asking emergency nurses. A significant deficit existed on 2 domains of knowledge: understanding of the terms "addiction," "tolerance," and "dependence"; and knowledge of various pharmacologic analgesic principles. Nurses with a master's degree or higher, or those who attended a 1-day seminar on pain management, achieved statistically significantly higher scores. The data indicate that emergency nurses may not have a good understanding of the management of pain with drugs, or of such issues with the risk of addiction. 22
Surveys of nurse's knowledge of cancer pain management and narcotics use were conducted in five countries: Australia, Canada, Japan, Spain, and the United States. The results reveal that, in all countries, serious knowledge deficits exist that could adversely affect the care of patients with cancer pain. It appears, however, that longer a country has been engaged in efforts to educate health-care professionals and the public and to establish palliative care programs, the more likely the nurses from that country to posses correct information about cancer pain. And narcotics use to treat .survey results in all countries strongly suggest the need to continue aggressive measures to educate nurses, who are the cornerstone of palliative care.23
A study was conducted among 318 nursing staff members at a teaching care hospital in Canada to identify their knowledge of pain assessment and management. Overall results indicated that nurses lack knowledge and understanding of opioid addiction, equivalent dosing, properties of opioids and differences in acute and chronic pain. 24Other study examined the knowledge, attitude and clinical practice of 120 registered nurses regarding pain management. . The data were collected in the aspect of pain management, scoring of pain, documentation and treatment practice revealed knowledge deficits and inconsistent responses in many areas related to pain.25
Review related to narcotic policy
While the FDA' 1963 regulations concerning drugs for investigational use provide technical instructions to the sponsor and investigator for their external distribution and control, there are no specific instructions for the internal distribution and control of these agents within the local medical institution itself.. These procedures are usually developed along the lines of the "Statement of Principles Involved in the Use of Investigational Drugs in Hospitals," as adopted by the American Hospital Association, the American Society of Hospital Pharmacists, and the American Nurses' Association. In the majority of teaching and research hospitals, the internal procedures for handling investigational drugs are recommended by the local pharmacy and therapeutics committee with implementation and controlled distribution through the hospital' pharmacy service.26
The prescribing of narcotics for chronic pain is a challenge under the best of circumstances due to issues of substance abuse, addiction, legal requirements, the historical high percentage of drug abusers intermingled with the chronic pain population, and other factors. The goal of our medical practice is to provide narcotics when deemed appropriate utilizing the guidelines of the Federation of State Medical Boards. In order to continue prescribing narcotics to patients, it is necessary to have tight controls and rigid rules established to eliminate those who procure narcotics for illegal purposes or for substance abuse, to protect the privileges of our practice to prescribe, maintain the health and welfare of the patients, and to obey the laws under which we operate, both federal andstate27.
Review related to effectiveness of STP
A quasi experimental study was conducted among nurses to measure the effectiveness of an educational programme regarding pain management related to use of opioid analgesics, the result revealed there is an improvement in nurses’ knowledge related to opioid analgesic. It suggested more detailed documentation of pain management practices .28
Findings from surveys on addiction reveal that longer the patient receives opioids the more the nurses become concerned about causing addiction., results of current knowledge surveys of nurses suggest that educational efforts probably have been beneficial and should continue. To maximize the impact of educational efforts, content in basic and continuing education courses should be prioritized and critically evaluated for relevance and accuracy, especially content related to addiction. Early in the education of nurses, responsibility for pain assessment and use of analgesics must be instilled.29
A study conducted in Canadian hospital among 514 staff nurses to assess the knowledge and attitudes regarding pain in the acute and long term care settings. Thestudy revealed nurses who attended educational sessions on pain management within last year scored significantly higher scores than those who had not attended. Results indicated that the need for the continuing educational sessions and the need and direction for pain management in the hospitals.30 6.3 OBJECTIVES OF THE STUDY
1. To assess the knowledge on Narcotic policy among staff nurses before structured teaching programme.
2. To assess the knowledge on Narcotic policy among staff nurses after structured teaching programme.
3. To evaluate the effectiveness of structured teaching programme on narcotic policy among staff nurses.
4. To find out the association between knowledge on narcotic policy among staff nurses and selected demographic variables
6.3.1 OPERATIONAL DEFFINITIONS
Effectiveness: Refers to the extent to which the staff nurses have gained knowledge regarding narcotic policy after administering structured teaching progamme as assessed by the correct responses to the structured questionnaire.
Structured teaching progamme: Refers to the systematic teaching on narcotic policy by lecture method for 45 minutes.
Narcotic policy: Refers to information on Narcotic Act, classification of narcotic drugs, its action, and nurse’s responsibilities in storing, administering and documenting the narcotic drugs.
Staff nurses: Nurses who have registered and licensed to practice as GNM or BSc nurses working in selected hospitals.
Selected Hospitals: Sarvodaya &B.G.S Hospitals of Bangalore
6.3.2 ASSUMPTION:-The staff nurses may have lack of knowledge regarding Narcotic Policy.
6.3.3 HYPOTHESIS OF THE STUDY
There will be a significant improvement in knowledge of staff nurses on narcotic policy after structured teaching progamme than before.
6.3.4 SAMPLING CRITERIA
Inclusion criteria:-
1. Staff nurses who are available at the time of data collection
2. The staff nurses who are willing to participate in the study
Exclusion criteria:-
1. Staff nurses who have already attended classes or workshops on narcotic policy
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA: The data will be collected from the staff nurses in selected hospitals at Bangalore
7.2 METHOD OF DATA COLLECTION
i) Research approach : Evaluative approach
ii) Research Design : Quasi-experimental design. One group pre test & post test design
iii) Setting : The study will be conducted in Sarvodaya & B.G.S Hospital in Bangalore
iv) Population : All staff nurses working in
selected hospitals Bangalore
v) Sample : 40 Staff nurses in selected hospitals of
Bangalore who fulfils the inclusion criteria
vi) Sample size : 40 staff nurses
vii) Sampling technique : Simple random sampling.
viii) Method of data collection: Self administered questionnaire
ix) Tool for data collection : Structured questionnaire
Method of data analysis : The researcher will use descriptive and inferential statistics like mean and standard deviation. Level of knowledge will be analyzed by using mean & standard deviation. Association between level of knowledge and selected demographic variables are assessed by chi-square test, and effectiveness of STP will be analyzed by ‘t-test’.
Duration of study : 4 weeks.
VARIABLES:-
Dependent variable: Knowledge of staff nurses on narcotic policy in selected hospitals at Bangalore.
Independent variable: Structured teaching programme on narcotic policy among staff nurses in selected hospitals at Bangalore.
Demographic variables: Age, sex, Educational qualification, Area of Experience, Previous source of information,. Journals, Magazines, work shop
Projected outcome: The study will help the nurses to acquire knowledge regarding narcotic policy and they will apply the same in their area of practice.
7.3 Does the study require any investigation or intervention to be conducted on patients or other human beings or animals?
YES 7.4 Has ethical clearance been obtained from your institution?
YES, ethical clearance report is here with enclosed
8. LIST OF REFERENCES
1. Narcotics. From Wikipedia, The free encyclopedia Available fromURL: http://en.wikipedia.org/wiki/Narcotics
2. Jane Carlisle Maxwell, Ph.D .Trends in the Abuse of Prescription Drugs. The Center for Excellence in Drug Epidemiology Texas.P.1-14.Available from URL: http://www.utexas.edu/research/cswr/gcattc/documents/PrescriptionTrends_Web.pdf.
3.William J Meehan, MD, Steven A Adelman, MD. Opioid Abuse. July31, 2009.Available from URL: http://emedicine.medscape.com.( July31, 2009).
4. The abuse of legal drugs. Available from URL: http://en.wikipedia.org/wiki/Drug_abuse
5. Anuja Jaiswal. Over 70,000 hooked to drugs in city. Tribune News Service. March 27,2009. Chandigarh, India. Available from URL: http://www.tribuneindia.com/2009/20090327/cth1.htm( March 27, 2009)
6. Dr Emma Wincup, Gemma Buckland , and Rhianon Bayliss. Youth homelessness and substance use: report to the drugs and alcohol research unit. [Online]. 2003 [104 screens]. Available from:URL:http://www.homeoffice.gov.uk/rds/pdfs2/hors258.pdf
7. Neelam Sharma. Region drug abuse statistics way ahead of national average. [Online].8 march 2008 Available from: URL:http://www.expressindia.comlatest-newsRegion-drug-abuse-statistics-way-ahead-of-national-average28665[Mar 20 2008].
8. Narcotic policy. Inpatient Behavioral Health Policy and Procedure Manual .Available from URL: http://www.mcn-policy-library.com/Policy-procedure-documents/41/Narcotics.htm
9. Substance dependence. Available from Wikipedia, the free encyclopedia URL:http://en.wikipedia.org/wiki/Substance_dependence.
10. P.J.D. Evans, MB, BS, FFARCS .Narcotic addiction in patients with chronic pain .Anaesthesia Journal 2007; Volume 36( Issue 6,) :p. 597 – 602 Avialable from URL:HEhttp://www3.interscience.wiley.com/journal/[ Published Online: 22 Feb 2007 ].
11. Ahmadi, Jamshid; Fallahzadeh, Hossein; Salimi ,etal. Analysis of opium use by students of medical sciences. Journal of Clinical Nursing2006 April; Volume 15(Number 4) p.379-386Available from URL http://www.ingentaconnect.com/content/bsc/jcn/[ April 2006]
12.United Nations Surveys of Crime Trends and Operations of Criminal Justice systems. The United Nations International Study on Firearm Regulatio Statistics and Research Sources n Available from URL: . http://www.uncjin.org/Statistics/statistics.html. Last Revised: 28 September, 2000
13.. World Health Organization. Report on the Fourth meeting of the Regional advisory Panel on impacts of Drug Abuse. [Online].2005 [34 screens]. Available from: URL:http://whqlibdoc.who.int/emro/2006/WHO_EM_MNH_175_E.pdf
14.M.McCaffrey, B.Ferrell . Nurses' knowledge of pain assessment and management: How much progress have we made? Journal of Pain and Symptom Management. Online.2003 Feb 02;Volume 14( 3 ) P. 175-188Available from URL: http://linkinghub.elsevier.com/retrieve/pii/S088539249700170X) [Cited Feb 02, 2003]
15. M. McCaffery, E.Robinson.Nursing2002 Study Reveals Nurses Know Pain But Not Narcotics. Pain Management Nursing .2002 10October :p. 36-47.Available from URLhttp://allnurses.com/pain-management-nursing/nursing2002-study-reveals-30453.html .[cited Sep 26, 2006]
16.Se Lebovits, Allen H. Ph.D, Florence, Isaiah M.D.,Bathina Veronica, etal. Pain Knowledge and Attitudes of Healthcare Providers: Practice Characteristic Differences. The Clinica Journal of Pain. September 1997 ; Volume 13 ( 3 )p. 237-243.Availablefrom :URL:http://journals.lww.com/clinicalpain/Abstract/1997/09000/Pain_Knowledge_and_Attitudes_of_Healthcare.9.aspx
17. Roger. S. Cicala. Drug addiction among doctors. Hospital physician. 2003 july; p.39-4.http://www.turner-hite.com/pdf/hp_jul03_know.pdf
18.Jennifer Chait, JC Redmond.Drug abuse among nurses. http://addiction.lovetoknow.com/wiki/Drug_Abuse_among_Nurses. modified in july 2008.
19. Helping Families Afflicted by Addiction Worldwide. Available from URL: http://www.yourcause.com/canaaninfo
20. Geetha Desai, Santhosh Chaturvedi .Perception and knowledge about narcotics among nurses Indian Journal of Palliative Care, 2003 AvailablefromURL:http://www.jpalliativecare.com/articles/2003/9/2/images/IndianJPalliatCare_2003
21. McCaffery M, Ferrell B, O'Neil-Page E, Lester M, Ferrell B. Nurses' knowledge of opioid analgesic drugs and psychological dependence. Pubmed.com Cancer Nursng. 1990 Feb;13(1):21-7. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/
22. Emergency nurses knowledge of pain management principles " Journal of Emergency Nursing, Volume 26, Issue 4, P.299-305.Available from URL:http://linkinghub.elsevier.com/retrieve
.23 M. M/ Journal of Pain and Symptom Management cCaffery, B. Ferrell.Nurse's knowledge about cancer pain: A survey of five countries. Volume 10, Issue 5,[ P. 356-369].Available from URL: http://linkinghub.elsevier.com/retrieve.
24. A survey examining nurses" knowledge of pain control Journal of Pain and Symptom Management, Volume 7, ( 1 )P.18-26.Available from URL: http://linkinghub.elsevier.com/retrieve/
25. Pain management knowledge, attitudes and clinical practice: The impact of nurses" characteristics and education Journal of Pain and Symptom Management, Volume 11, (1): P.18-31.Available from URL: http://linkinghub.elsevier.com/retrieve/pii.
26. David F. Burkholder Pharm.D, Jerry B. Johnson B. S. Institutional Controls in the Handling and Use of Investigational Drugs . The Journal of Clinical Pharmacology and the Journal of New Drugs, 1967; 7:p.193-197 Available from URL:http://jcp.sagepub.com/cgi/content/abstract/7/4/193.
27. Narcotic prescribing policy. Available from URL: http:// www.painchas.com/wp-content/uploads/2009/10/
28. Changing the relationship among nurses" knowledge, self-reported behavior, and documented behavior in pain management: does education make a difference? Journal of Pain and Symptom Management, Volume 12, ( 5)P. 308-319.Available from URL: http://linkinghub.elsevier.com/retrieve/pii/
29. Emerging Practices in Pain and Chemical Dependency: 2010 Update on Opioid Therapy Available from URL: NYhttp://www.stoppain.org/for_professionals/content/education/education.asp
30. G.Brunier, G.Carson, D.Harrison.What do nurses know and believe about patients with pain? Results of a hospital survey. Journal of Pain and Symptom Management, Volume 10, Issue 6, [P.436-445] Available from URL: http://linkinghub.elsevier.com/retrieve/pii/..
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9. Signature of the candidate :
10. Remarks of the guide :
11. Name and designation (in block letters) :
11.1 Guide :
11.2 Signature :
11.3 Head of the department :
11.4 Signature :
12.
12.1 Remarks of chairman / principal :
12.2 Signatures :
PRoforma for registration
of subject for dissertation