Journal of PeriAnesthesia Nursing

Another Look at the Future of Nursing

Jan Odom-Forren — 2012-04-01

THE INSTITUTE OF Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” was released in October 2010. Last April (2011), both Dr Vallire Hooper and I took the opportunity to join other editors across the country and write editorials that discussed the report and the implications for perianesthesia nursing. We are participating once again in an effort to disseminate findings of the report.

The Nurse Education Imperative

Risa Lavizzo-Mourey — 2012-04-01

NEARLY 18 MONTHS after the release of the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health,” it makes sense to ask: What changes are occurring? How can we make the most difference? And where can the report’s recommendations take us toward improving patient care?

Reduction of Preoperative Anxiety in Pediatric Surgery Patients Using Age-Appropriate Teaching Interventions

Jennifer Nadine Perry, Vallire D. Hooper, James Masiongale — 2012-04-01

More than 5 million children in the United States undergo surgery annually. Of those 5 million children, 50% to 75% experience considerable fear and anxiety preoperatively. Preoperative anxiety in children is associated with a number of adverse postoperative outcomes, such as increased distress in the recovery phase, and postoperative regressive behavioral disturbances, such as nightmares, separation anxiety, eating disorders, and bedwetting. Preparing the pediatric patient adequately for surgery can prevent many behavioral and physiological manifestations of anxiety. Children are most susceptible to the stress of surgery owing to their limited cognitive capabilities, greater dependence on others, lack of self-control, limited life experience, and poor understanding of the health care system. This article will review the literature on preoperative interventional teaching strategies to reduce preoperative anxiety in children and discuss the methods available for evidence-based preparation of children undergoing surgery.

Stethoscopes as a Source of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus

Abigail Russell, Janet Secrest, Carolyn Schreeder — 2012-04-01

Stethoscopes are potential vectors of methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this project was to determine the presence of MRSA on the diaphragms of personal and unit stethoscopes within a hospital setting before and after cleaning with alcohol prep pads. The sample consisted of 141 personal and unit stethoscopes in adult medical-surgical and intensive care units of a large university hospital in the Southeast. Each stethoscope was cultured once before cleaning and once after cleaning. Cultures were obtained using sterile swabs and inoculated on a selective medium for MRSA. Bacterial growth was noted in the precleaning group, but no MRSA colonies were detected. The postcleaning group had no bacterial growth. There was not enough data to statistically support that isopropyl alcohol is effective in decreasing bacterial counts; however, these findings suggest that current disinfection guidelines are effective in preventing MRSA colonization on stethoscopes in this setting.

Comparison of Manual Compression Alone Versus With Hemostatic Patch in Achieving Hemostasis After Femoral Catheter Removal

Linda Tjiong, Alaina Cyr, Joan Fox — 2012-04-01

This quasi-experimental study compares manual compression and use of hemostatic patch in achieving hemostasis after femoral sheath removal. Patients who agreed to participate were randomly assigned to either control group or study. A majority of the patients (75.3%, n=67) had a diagnostic procedure, and 24.7%, (n=22) had an interventional procedure. The mean compression time for the control group (mean=13.87, standard deviation [SD]=5.6) was 2.5 minutes longer compared with the mean compression time for the study group (mean=11.42, SD=3.17). A statistically significant difference was found between groups, t=2.782, (86, P<.001). No patients developed bleeding or hematoma during their stay or within 48 to 72 hours after discharge. No significant difference was found in pain scores between groups. There was no relationship between body mass index, abdominal girth, or pelvic girth to pressure time.

Nursing Care of Patients Undergoing Isolated Limb Procedures for Recurrent Melanoma of the Extremity

Kathleen S. Ashton — 2012-04-01

Isolated limb perfusion and isolated limb infusion are surgical interventions that provide high-dose regional chemotherapy to patients experiencing a recurrence of melanoma in an extremity. Nurses may be unfamiliar with these treatment options, as they are not available in all hospitals; however, the number of people diagnosed with melanoma is increasing. It is important for nurses to understand these surgical procedures to provide safe high-quality care before and after the surgery. Currently, there are several gaps in our knowledge about patients’ experiences or nurse-sensitive outcomes. There are abundant opportunities for nurses to improve the care of patients who undergo surgical interventions to manage melanoma in the extremity.

Speak Up and Advocate!

Barbara Godden — 2012-02-27

THE DEFINITION OF an advocate is a person who pleads for or on behalf of another. Perianesthesia nurses care for patients and families in the most vulnerable of states, from the preadmission process through discharge from the postanesthesia care unit (PACU) and phase II. Patients in our care need an advocate (someone to speak on behalf of them) to keep them safe and ensure that they get through the process with the best possible outcome.

Hypertonic Saline for Perioperative Fluid Management

Daphne Stannard — 2012-02-27

This is a summary of a Cochrane Review. The full citation and the names of the researchers who conducted the review are listed in the Reference section.QUESTION: WHAT ARE the benefits and harms of hypertonic saline (HS) versus isotonic saline (IS) solutions administered to patients undergoing surgery?

Obstructive Sleep Apnea and Coronary Artery Disease: Are They Connected?

Kim A. Noble — 2012-04-01

OBSTRUCTIVE SLEEP APNEA (OSA) is a paradoxical, sleep-related collapse of the posterior pharynx that leads to the cessation of breathing. The incidence of OSA is estimated to be 2% to 5% in women and 3% to 7% in men, but the estimated prevalence increases to 41% in obese patients and 78% in persons with morbid obesity scheduled for bariatric surgery. The World Health Organization’s prediction of 700 million obese adults by the year 2015 places obesity at an epidemic status, and the incidence of OSA will continue to increase. Improvement in the identification of OSA has been seen but is lacking in the perioperative patient where approximately 93% of women and 80% of men with moderate-to-severe OSA go undiagnosed. OSA leads to activation of the inflammatory cascade, which may cause coronary dysfunction and an increase in the perioperative morbidity and mortality of perioperative patients. A case study of a fictitious patient presenting for elective surgery will be used to highlight the connection between OSA and coronary artery disease (CAD). Alterations in normal physiological function in both the disorders and the disease relationship will be described.

Rivaroxaban: A New Oral Anticoagulant

Julie Golembiewski — 2012-04-01

UNTIL RECENTLY, WARFARIN was the only oral anticoagulant available in the United States. Indications for warfarin therapy include reducing the risk of systemic embolism (deep vein thrombosis and pulmonary embolism) in patients with a bioprosthetic or mechanical heart valve or atrial fibrillation. Warfarin exerts its anticoagulant effect by inhibiting the production of vitamin K-dependent coagulation factors. Warfarin has a highly variable dose response and a narrow therapeutic index, necessitating frequent monitoring of the international normalized ratio (INR).

Pediatric Vital Signs

Theresa Clifford — 2012-04-01

QUESTION: WHAT ARE the practice standards for obtaining perianesthesia vital signs during the preoperative, phase I, and phase II levels of care for a child? Response: This frequently asked question was carefully reviewed during a recent meeting of the American Society of PeriAnesthesia Nurses (ASPAN) Standards and Guidelines strategic work team. Current nursing literature lacks clinical research on outcomes and vital sign frequency. In the absence of scientific evidence, the Clinical Practice Committee as well as the Standards and Guidelines committee members must seek an “expert” opinion. Although many clinical practice experts were present, the team considered seeking the additional input of perianesthesia nurses with a self-identified interest in the care of the pediatric patient. Because members of the Specialty Practice Groups (SPGs) voluntarily join to participate in networking and education related to a common professional interest, members of the Pediatric SPG were queried on the topic of “Pediatric Vital Signs.” Using the online SurveyMonkey subscription (www.surveymonkey.com), the link to a number of pediatric questions was e-mailed to the 264 members of the SPG. A total of 76 responses were returned and collated. Respondents were asked to describe the percent of pediatric patients they cared for. Nearly three-fourths identified that they worked in an “all pediatric facility” ().

Acknowledgment of Reviewers

2012-04-01

The Journal of PeriAnesthesia Nursing thanks its reviewers for helping make the Journal a success. The following individuals are gratefully acknowledged for their time and effort in reviewing manuscripts in 2011.

Congratulations New CPANs and CAPAs!

2012-04-01

ON BEHALF OF the American Board of PeriAnesthesia Nursing Certification, I would like to extend our congratulations to the following nurses who have achieved CPAN® or CAPA® certification during the Fall 2011 examination cycle.

The IOM Report One Year Later: Have You Evaluated Your Options?

Vallire D. Hooper — 2012-04-01

LAST APRIL, JAN and I joined other nursing editors around the country in a coordinated effort to provide our readers with an introduction to the Institute of Medicine’s (IOM) report: The Future of Nursing: Leading Change, Advancing Health. This April, we join our editor colleagues once again in examining where we are one year later. The four primary recommendations of the IOM report include:

Masthead

2012-04-01

Editorial Board

2012-04-01

Information for Contributors

2012-04-01

Journal of PeriAnesthesia Nursing

Another Look at the Future of Nursing

The Nurse Education Imperative

Reduction of Preoperative Anxiety in Pediatric Surgery Patients Using Age-Appropriate Teaching Interventions

Stethoscopes as a Source of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus

Comparison of Manual Compression Alone Versus With Hemostatic Patch in Achieving Hemostasis After Femoral Catheter Removal

Nursing Care of Patients Undergoing Isolated Limb Procedures for Recurrent Melanoma of the Extremity

Speak Up and Advocate!

Hypertonic Saline for Perioperative Fluid Management

Obstructive Sleep Apnea and Coronary Artery Disease: Are They Connected?

Rivaroxaban: A New Oral Anticoagulant

Pediatric Vital Signs

Acknowledgment of Reviewers

Congratulations New CPANs and CAPAs!

The IOM Report One Year Later: Have You Evaluated Your Options?

Masthead

Editorial Board

Table of Contents

Information for Contributors