This year a first and second prize of €750 and €500 were awarded to the best electronic posters in ESONT


1st Prize Winner:

Mr. Cooper UK
Audit of postoperative pain associated with enucleation and hydroxyapatite orbital implant surgery

Purpose: Removal of the eye (enucleation) is a surgical procedure which is indicated with patients who have sustained irretrievable trauma, chronic painful blind eye and intraocular tumours. Enucleation creates an orbital volume deficit which can be partially compensated for by the placement of a Hydroxyapatite orbital implant (HAI). The HAI is comprised of calcium phosphate (an organic salt FCl) and is consequently very similar in form to that of human bone. Due to it's porous construction one of its main benefits is the ability for the unit to become vascularised and therefore integrated into the body; reducing the risk of rejection (Nerad 2001). Research and experience has shown one major disadvantage of enucleation with the insertion of the HAI and that is the moderate to severe post-operative pain experienced by patients following surgery (Waterman et al 1998, Coppens et al 2002).

Method: A retrospective audit of the medical and nursing notes of 50 patients who had undergone primary enucleation with the insertion of an HAI between 2005-2006 at Manchester Royal Eye Hospital was undertaken to attempt to ascertain important factors that may influence the incidence of post-operative pain and its management and assessment following surgery. The indication for enucleation, pain experienced prior to surgery, as well as duration of pain prior to surgery were noted. In addition a considerable proportion of the audit was used to ascertain the level of pain experienced post-operatively and how it was assessed, recorded and managed. A combination of the Visual Analogue Score (VAS) and the Verbal Numerical Rating Scale (VNRS) where ascertained to be the only pain assessment tools of use at the Manchester Royal Eye Hospital. Both of these assessment tools are very similar in their respective application, using a scale of between 0 to 10 to indicate the level of pain (zero being no pain and ten being the worst pain imaginable).

Results: Over 80 key questions were asked through the audit's format and therefore a considerable amount of information was collected. The main findings are summerised: 29 Male (58%) and 21 Female (42%) were identified. The ages ranged from 12-87 years, with an average of 39. A total of 94% of the patients had enucleation surgery and the remaining 6% underwent evisceration surgery. Of these 86% had a Hydroxyapatite orbital implant fitted and 4% had an acrylic baseball implant inserted.
Of those patients noted as having either chronic painful blind eye (30%) or acute ophthalmic pain (associated with trauma 12%) only 14% of those had a pre-operative pain score recorded in the notes. Despite all of the patients in the audit receiving some form of intra-operative analgesia what this constituted varied considerably and was very dependant upon the anaesthetist who prescribed them. There appeared to be no standard protocol for the provision of analgesia for enucleation patients in the intra-operative period. Upon arriving back to the ward less than half of the patients (44%) had their pain score (using either VAS or VNRS) assessed within the first hour of returning from the recovery room. Furthermore, pain was still evident in 60% of patients audited in the 9-24 hour period post-operatively and furthermore, 22% of patients had their pain score assessed no less than eight times in the same period. Most patients stayed on average 31 hours post-operatively on the ward to discharge. The longest audited period was 168 hours (over five days) with a patient with severe post-operative pain. In 30% of all cases the length of stay was extended and for 73% of patients this was due to uncontrolled post-operative pain.

Conclusions: This pain assessment/management audit aimed at patients who underwent enucleation surgery and the insertion of a HAI was by far the largest project the two authors had endeavoured to embark upon. It was undertaken in the light of an increasing number of individual instances where patients who had undergone this sometimes distressing, and life changing surgery and had suffered unnecessary discomfort. Over 15 recommendations were made in light of this audit and overall practice in regard to pain in patients who have undergone enucleation surgery has changed


2nd Prize Winner:

Satu Kajander FINLAND
Student nurses' assessments of the quality of their clinical placement learning and assessment of QPL evaluation scale

Purpose: The aim of this study is to provide information on how nursing students assess the quality of their clinical placement learning and to assess the functionality and reliability of the international instrument (QPL)
Setting: Kuopio, Finland.

Methods: The data were processed and analysed using the SPSS 11.5 statistical program. Frequencies and percentage distributions were used for descriptive statistics. The data were analysed by cross-tabulation. In addition, summary variables were computed using different items of the questionnaire, and findings were described also comparing back-ground variables with summary variables by Mann-Whitney U-test and Kruskall-Wallis –test. Cronbach’s alpha was also calculated for each summary variable (.72-.93). Factor analysis was implemented to test reliability of the QPL. Factor scores’ reliability (.77-.91) and Cronbach’s alpha (.67-.88) were calculated for four factors.

Results: The number of students in placements was appropriate compared to the availability of clinical instruction in primary health care places, but only 57 % of students thought that in special health care. Mentors were named for student nurses, but fifth of the students weren’t able to work with their mentor for the stipulated shifts. Half of the student evaluated, that mentors supported them to integrate theory and practice in order to learn. Students were in general satisfied with the reachability and communication of their teacher, but fifth of the students thought the introduction they were given by their teacher wasn’t satisfactory.

Conclusions: The clinical practice places offered appropriate learning opportunities for nursing students, and most of the students evaluated that they achieved confidence in the development of their professional practice. QPL proved to be reliable and valid, which can be used in research and quality assessments of clinical placement learning