Journal of PeriAnesthesia Nursing RSS feed: Current Issue. The Journal of PeriAnesthesia Nursing provides original, peer-reviewed research for a primary audience that includes nurses in perianesthesia settings, including ambulatory surgery , preadmission testing , postanesthesia care (Phases I and II), extended observation , and pain management. The Journal provides a forum for sharing professional knowledge and experience relating to management, ethics, legislation, research, and other aspects of perianesthesia nursing. Benefits to authors We also provide many author benefits, such as free PDFs, a liberal copyright policy, special discounts on Elsevier publications and much more. Please click here for more information on our author services . Please see our Guide for Authors for information on article submission. If you require any further information or help, please visit our support pages: http://support.elsevier.com http://www.jopan.org/?rss=yesElsevier Inc.en © 2013 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved. Journal of PeriAnesthesia Nursing1089-9472282April 2013 © 2013 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jopan.org/article/PIIS1089947213000245/abstract?rss=yes“There are many ways of going forward, but only one way of standing still.”— Franklin D. RooseveltOne definition of the word progress is that it is “a forward and onward movement.” Or, it has been described as “a gradual betterment.” Florence Nightengale once said about nursing, “For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every week, take my word for it, we are going back…”Progress: Forward and OnwardJan Odom-Forren10.1016/j.jopan.2013.02.001Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Editorial Opinion5557http://www.jopan.org/article/PIIS1089947213000634/abstract?rss=yesJOPAN Editorial Staff 2012-201310.1016/S1089-9472(13)00063-4Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Editorial Staff Photos5858http://www.jopan.org/article/PIIS1089947212005382/abstract?rss=yesBaccalaureate nursing curricula provide minimal exposure to the perioperative specialty area despite the fact that students are often very interested in this area of nursing. Usually the baccalaureate learning experience is that of a single passive observation rather than actively participating in care of perioperative patients. There are many reasons for this lack of exposure including the focus on preparation of nurse “generalists” for practice. This article will highlight the collaborative effort between nursing education and perioperative staff development to meet the essentials of baccalaureate education requirements as well as the challenges and positive outcomes of introducing this course.Collaborative Educational Initiative: Developing and Implementing a Perioperative Nursing Course for Baccalaureate Nursing StudentsLisa A. Ruth-Sahd, Gail Wilson10.1016/j.jopan.2012.07.011Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Original Articles5966http://www.jopan.org/article/PIIS1089947213000208/abstract?rss=yesThe preoperative setting is fraught with many stressors, often increasing in magnitude as patients progress through the perioperative environment. Individuals exposed to traumatic or threatening environments, such as US military personnel involved in combat operations, may be at increased risk of developing altered mental and physical health conditions. Collectively, this may result in a hyperarousal state significantly amplifying psychological symptoms and magnifying physiological alterations. The purposes of this article are to (1) describe stress-related concepts and preoperative stress, (2) discuss potential risk factors for preoperative stress in the adult surgical population, (3) present various psychological and physiological measures of preoperative stress, (4) explore preoperative stress interventions, and (5) discuss potential implications for future preoperative stress research in high-stressed populations.A Preoperative Stress Inquiry and a Vulnerable US Military PopulationEric J. Bopp, Dennis L. Spence, Joseph F. Burkard10.1016/j.jopan.2012.11.007Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Original Articles6776http://www.jopan.org/article/PIIS1089947212005370/abstract?rss=yesPostanesthesia nursing should be documented with high quality. The purpose of this retrospective case–based study on 49 patients was to analyze the quality of postoperative documentation in the two existing templates and, based on this audit, to suggest a new template for documentation. The audit on the template with quantitative data showed satisfactory documentation of postoperative care nursing in 67% (18% to 92%; mean [min-max]) of the scores. The template for documentation using qualitative descriptions was used by 63% of the nurses, but the keywords were used to a varying degree, that is, from 0% to 63% of records. The analysis also revealed noncompliance with clinical guidelines and multiple duplicate entries. Based on this audit, a new template was constructed, with 10 physiological parameters and drop-down lists with keywords within each parameter. In this way, implicit knowledge could be converted to explicit documentation. Furthermore, the quality of documentation was improved.Quality Improvement in Documentation of Postoperative Care Nursing Using Computer-Based Medical RecordsSusanne Winther Olsen10.1016/j.jopan.2012.08.006Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Original Articles7786http://www.jopan.org/article/PIIS1089947212005369/abstract?rss=yesClinicians who work in the postanesthesia care unit (PACU), operating room (OR), and intensive care unit (ICU) have a greater opportunity to cross-contaminate patients because of high workloads and frequent patient contact events. Much progress has been made to increase hand hygiene compliance with the introduction of alcohol-based wall, bedside, and pocket dispensers. The introduction of body-worn alcohol-based dispensers to anesthesia and ICU providers has been shown to decrease ICU hospital-acquired infections and ventilator-associated pneumonias, and decrease contamination of the anesthesia workplace. Body-worn alcohol-based dispensers are an improvement in ergonomics, especially for those working in high intensity areas. The unit worn on the belt or scrubs waist is readily accessible, can be activated with one hand, and can be a vital tool to close the gap for hand hygiene.Closing the Hand Hygiene Gap in the Postanesthesia Care Unit: A Body-Worn Alcohol-Based DispenserWilliam Clayton Petty10.1016/j.jopan.2012.06.008Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Continuing Education8797http://www.jopan.org/article/PIIS1089947213000221/abstract?rss=yesConsistent accurate assessment and treatment of pain is an important nursing priority for perianesthesia nurses. Despite the release of comprehensive pain standards by regulatory agencies, such as The Joint Commission, and the widespread dissemination of evidence-based practice recommendations over the past 20 years, pain continues to be undertreated and remains an area for practice improvement. This is particularly true in populations of patients in whom pain may be difficult to assess, such as the critically ill.Pain Management in the Nonverbal Critically Ill PatientMary Beth Flynn Makic10.1016/j.jopan.2013.01.006Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Critical Care Connection98101http://www.jopan.org/article/PIIS1089947213000191/abstract?rss=yesThere are an estimated 75 million individuals with gastroesophageal reflux disease (GERD) in the United States. This disease is not limited to the adult population, with approximately 22% of the pediatric population also affected. Individuals undergoing elective surgery frequently report a history of GERD with 14% to 20% of all adults reporting symptoms associated with reflux disease. Proton pump inhibitors (PPIs) are the first-line pharmacologic treatment for GERD and are among the five top selling drugs, with an estimated 10 billion dollars spent on PPIs in the United States annually. Client preparation for elective or emergent surgery includes assessment and the proactive planning for safe discharge. The perianesthesia care provider needs to have a comprehensive understanding of this common disorder and its surgical and pharmacologic management. The pathophysiology of GERD and evidence-based treatment modalities will be presented in a fictitious perianesthesia patient case study.Gastroesophageal Reflux DiseaseKim A. Noble10.1016/j.jopan.2013.01.004Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Pathophysiology Corner102106http://www.jopan.org/article/PIIS1089947213000178/abstract?rss=yesRecently, a postanesthesia care unit (PACU) manager was advocating for staff during a difficult crucial conversation. The manager offered to continue a phone conversation with an MD as it was evident that an argument was brewing. The staff nurse kept steady and calm and did not hang up until the manager could assist her. A hospitalist was actively resisting ownership of medical direction for care provision in PACU. It was “one of those days,” with multiple intensive care unit (ICU) patients boarding in the room. Some patients were covered by the Anesthesia Department, some by the Department of Surgery, and others by intensivists. However, some patients were “in limbo,” not actually medically covered by anyone, as they had been displaced from the ICU to the PACU out of an urgent need for critical care beds. It was unacceptable to have an ICU patient—one might say, a “bumped” patient, from ICU to PACU with no medical ownership or direction for care. So, the conversation was as follows:MD: “I know nothing about this patient.”Manager: “I'd like to tell you about the patient.”MD: “I'm not taking ownership of this patient.”Manager: “Your name is on the chart; the physician's assistant documented this handoff of care.”MD: “I know nothing of it.”Manager: “Well, now you do—I am a nurse—a damn good one—but I cannot direct medical decision making on my own. I need your help.”The Culture of AccountabilityMaureen V. Iacono10.1016/j.jopan.2013.01.002Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Perianesthesia Culture107109http://www.jopan.org/article/PIIS108994721300018X/abstract?rss=yesIn the 1860s, conjecture gave way to scientific methodology that confirmed or discounted the effectiveness of commonly used medicines. Drugstores operated by pharmacist chemists who prepared medicinal tinctures, extracts, spirits, oils, pills, and liniments from plant extracts and bulk substances began to emerge. As the demand for prescription medications grew, compounding pharmacists started drug manufacturing companies (eg, Eli Lilly, George Merck, and Charles Pfizer). Drug products, however, may not be manufactured in the strength or dosage formulation that best meets the needs of the patient. From preparing topical creams to sterile injectable products, pharmacists compound medications to meet specific patient needs for surgery, chemotherapy, total parenteral nutrition, end of life, veterinary medicine, etc. Pharmaceutical compounding is an art and a science, relying on the relationship of the physician, patient, and pharmacist. Pharmaceutical compounding is performed in hospital, home-care, and retail pharmacies.Safe Medication CompoundingJulie A. Golembiewski, Sheena Farragut Babin10.1016/j.jopan.2013.01.003Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Pharmacology Facts110112http://www.jopan.org/article/PIIS1089947213000166/abstract?rss=yesQuestion: What is American Society of PeriAnesthesia Nurses’ (ASPAN) position on starting a patient-controlled analgesic (PCA) pump in the Phase I postanesthesia care unit (PACU)?Patient Controlled Analgesia—Safe PracticesTheresa Clifford10.1016/j.jopan.2013.01.001Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4Practice Corner113114http://www.jopan.org/article/PIIS108994721300021X/abstract?rss=yesIt is not what you are thinking from the title. Thirty-something years as a clinical nurse have provided priceless moments to care, tend, teach, mentor, lead, and to learn, at times conforming to the “lesson” from the textbook and at other times contradicting the “rules.” I cherish the opportunity to reflect on the immeasurable experiences I have been privileged to have and to have shared in a wide variety of clinical settings. I treasure the opportunity to remember the countless nurses and providers whose knowledge, interactions, and communications helped mold me into the nurse I am today, whether in the clinical setting or networking with perianesthesia colleagues across the globe. In the late 1980s, the institution I worked for created a professional advancement program to recognize the clinical “bedside” nurse. The program was informed by the interpretations of nursing descriptions provided by Patricia Benner, PhD, RN, FAAN, as outlined in From Novice to Expert. Dr. Benner's pioneering work helped to describe the ways in which nurses advance from novice to expert practitioners. Reviewing dozens of clinical portfolios developed by my peers, I was acutely aware that, even within the scope of the novice nurse, or the proficient nurse, or the expert nurse, there was a continuum of “know-how.” My vision for this continuum created a conundrum during the peer review process. Benner's work was not exactly objective or measurable, black or white. Although some of our advancement applicants had provided clinical notebooks that painted high-grade practice pictures, I knew the authors to struggle at times with change, with seeing “the big picture,” with “thinking outside the box,” myself at times included! I also saw portfolios from nurses with the utmost clinical expertise who barely could spell and struggled with representing their practice on paper. I wondered about how to measure subjective practice, critical thinking, and common sense. What skills are needed for critical thinking? Are we born with common sense? Can these traits be learned? Then, walking through an airport one day, a book title caught my attention, Practical Intelligence: The Art and Science of Common Sense, written by Karl Albrecht. It gave me cause to stop and think about thinking.Shades of Gray: Guest EditorialTheresa Clifford10.1016/j.jopan.2013.01.005Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4The Back Page119121http://www.jopan.org/article/PIIS1089947213000270/abstract?rss=yesInformation for Readers10.1016/S1089-9472(13)00027-0Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4FrontmatterA1A1http://www.jopan.org/article/PIIS1089947213000282/abstract?rss=yesEditorial Board10.1016/S1089-9472(13)00028-2Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4FrontmatterA2A2http://www.jopan.org/article/PIIS1089947213000300/abstract?rss=yesTable of Contents10.1016/S1089-9472(13)00030-0Journal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4FrontmatterA5A6http://www.jopan.org/article/PIIS108994721300083X/abstract?rss=yesInformation for Contributors10.1016/S1089-9472(13)00083-XJournal of PeriAnesthesia Nursing 28, 2 (2013)2013-04-01Journal of PeriAnesthesia Nursing2013-04-01282S1089-9472(13)X0002-4FrontmatterA7A7