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Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, and Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
The aim of this research project was to describe the education, competence, and role of nurses working in the postanesthesia care unit (PACU) in 11 countries having an established perianesthesia specialty nursing organization and membership on the International Collaboration of PeriAnaesthesia Nurses, Inc (ICPAN) Global Advisory Council (GAC).
Design
This is a descriptive international cross-sectional study.
Methods
A Web-based survey was distributed to members of the ICPAN GAC to be completed by the GAC representative or another expert perianesthesia nurse member from the organization (n = 11). The GAC has one representative from the following 11 ICPAN organizational members: ACPAN, Australian College of PeriAnaesthesia Nurses (Australia); BRV, Beroepsvereniging Recovery Verpleegkundigen (Belgium/The Netherlands); NAPANc, National Association of PeriAnesthesia Nurses of Canada (Canada); FSAIO, The Danish Association of Anaesthesia, Intensive Care and Recovery Nurses (Denmark); FANA, Finnish Association of Nurse Anaesthetists (Finland); Hellenic Perianesthesia Nursing Organization (Greece); IARNA, Irish Anaesthetic and Recovery Nurses Association (Ireland); PNC of NZNO, Perioperative Nurses College of the New Zealand Nurses Organisation (New Zealand); ANIVA, Swedish Association of Nurse Anesthetists and Intensive Care Nurses (Sweden); BARNA, British Anaesthetic and Recovery Nurses Association (United Kingdom); and ASPAN, American Society of PeriAnesthesia Nurses (USA).
Findings
Perianesthesia nursing was recognized as a professional nursing specialty in 6 of 11 countries, and 8 of 11 have established national guidelines or practice standards for perianesthesia nurses. The Netherlands, Ireland, and Australia are the only countries that have a formal education program for perianesthesia nurses. There were variations in nurse-to-patient ratios between the 11 countries, ranging from 2:1 to 1:3 in the Phase I recovery of critically ill patients; in Phase II recovery (day surgery) it was most common to have up to three to four patients per nurse. Perianesthesia nurses were mainly the only profession stationed in the PACU, with professions such as the anesthesiologist and surgeon on call. The nurses performed many job tasks autonomously; however, this differed between countries.
Conclusions
Perianesthesia nurse education, clinical guidelines, other professions working in the PACU, and job tasks differ between countries. This knowledge can be used in international collaboration to further develop education and training for nurses working in the PACU. Continued international perianesthesia nursing partnership can only bring us closer and strengthen our specialty practice with the focus not on our differences but on our common denominators.
All patients undergoing surgical interventions and anesthesia experience a postoperative recovery period. Recovery can be divided into three phases: Phase I (early recovery) occurs when the patient leaves the operating room (OR) until the patient is discharged from the Phase I postanesthesia care unit (PACU); transition to Phase II (intermediate recovery) occurs when the stable patient is ready to progress toward discharge from the hospital or surgery center
or Phase III (late recovery) generally occurs after the patient is discharged from the hospital, but in some cases the patient remains under the observation of a nurse until usual functions and activities have returned.
To ensure keen observation of the patient at all times, the PACU treatment environment is open, spaced with curtains or foldable walls separating the beds.
Anesthetic drugs and the physical nature of surgery affect the patient's respiratory functions, muscle activity, temperature, consciousness, mental status, and hemodynamic functions, as well as possibly result in postoperative nausea and vomiting (PONV) and pain.
Therefore, the focus of early postoperative care is to detect surgical or anesthetic complications, which require monitoring of respiratory function, cardiovascular function, neuromuscular function, mental status, temperature, pain, PONV, intravenous (IV) fluids, urine output and voiding, and wound drainage and bleeding.
reported in 1947 that preventable postoperative deaths occurred because of inadequate nursing care and that caring for the patient in a PACU after surgery prevented deaths. Lowenthal and Russel
supported those findings in 1951 and emphasized the need for a separate PACU and specialized education in the PACU. However, there is no international consensus regarding the education and role of the nurse working in the PACU. Nurses with different competencies, education, and training provide PACU care, and the role and tasks that can be performed by the nurse differ across the globe. This issue has been illuminated by the International Collaboration of PeriAnaesthesia Nurses, Inc (ICPAN) during delegate forum discussions held at two past ICPAN conferences (2015 in Copenhagen, Denmark and 2017 in Sydney, Australia). One of the top clinical questions discussed by conference delegates was as follows: What are the competencies and training necessary to work in the PACU? Two areas were identified as important in the education and training of PACU nurses: critical care training and the competence to deliver basic and advanced life support.
In the present study, competence is mainly described related to technical skills and more specifically tasks performed by the nurse working in the PACU. Tasks performed by nurses vary depending on context, and tasks are a guide to education and training. Earlier studies have conducted task analysis to guide needs and gaps in education, practice and competence in anesthetists,
To our knowledge there are no earlier studies that have mapped the nurse working in the PACU from an international perspective; therefore the aim of this research project was to describe the education, competence, and role of nurses working in the PACU in 11 countries having an established perianesthesia specialty nursing organization and membership on the ICPAN Global Advisory Council (GAC).
Methods
This is a descriptive international cross-sectional study conducted from March 2019 to July 2019.
Development of Survey
A Web-based survey was developed by an international research team (the authors) with clinical, educational, and research expertise in perioperative care. The development of items was conducted after a review of the literature
Quality of Life: The Assessment, Analysis, and Reporting of Patient-Reported Outcomes. Third ed. John Wiley & Sons Inc,
Chichester, West Sussex, UK2016
questionnaire used to describe the job tasks of nonphysician anesthesia team members in Europe. All authors reviewed the items, wording of the items, and answers until consensus was achieved. The survey was also evaluated for face validity by a researcher in perioperative care who was not part of the research group. No changes were made after the face validity evaluation. The survey was in English and consisted of 96 items covering education and training for nurses working in the PACU, other health care professions in the PACU, nurse-to-patient ratio, and job tasks performed. It also included questions about the preoperative context, which will be reported in a separate article. The 70 items reported in this article can be accessed in Supplementary Appendix 1. Questions were answered yes or no; on a four-point Likert scale such as never,in some PACUs,in most PACUs,in all PACUs; or never, or under direct supervision,supervision on call,autonomous; or free text. All questions had to be answered to submit the survey.
Data Collection
The survey was distributed to members of the ICPAN GAC to be completed by the GAC representative or another expert perianesthesia nurse member from the organization (n = 11). The GAC has one representative from the following 11 ICPAN member organizations: ACPAN, Australian College of PeriAnaesthesia Nurses (Australia), BRV, Beroepsvereniging Recovery Verpleegkundigen (Belgium/The Netherlands), NAPANc, National Association of PeriAnesthesia Nurses of Canada (Canada), FSAIO, The Danish Association of Anaesthesia, Intensive Care and Recovery Nurses (Denmark), FANA, Finnish Association of Nurse Anaesthetists (Finland), Hellenic Perianesthesia Nursing Organization (Greece), IARNA, Irish Anaesthetic and Recovery Nurses Association (Ireland), PNC of NZNO, Perioperative Nurses College of the New Zealand Nurses Organisation (New Zealand), ANIVA, Swedish Association of Nurse Anesthetists and Intensive Care Nurses (Sweden), BARNA, British Anaesthetic and Recovery Nurses Association (United Kingdom), and ASPAN, American Society of PeriAnesthesia Nurses (USA). The survey was distributed via a Web-based survey platform called ORU-survey provided by Örebro University, Sweden. The survey was sent to each GAC member's e-mail, and it was possible to answer the survey using a computer, tablet, or mobile phone. All participants received written information about the study and agreed to participate in the study by answering and submitting the survey. Participants were asked to respond to the survey based on routines and policies in the country that their organization represented. Two reminders to answer the survey were sent out after 3 and 7 weeks. After the data collection, all respondents received a copy of their answers and were offered the opportunity to correct their answers if needed. Seven responded and, of those, five reported minor corrections.
Data Analysis
Data are presented with descriptive statistics and frequencies for nominal data. Responses are reported for each country or as a distribution of answers. The 37 job tasks included in the survey were summarized as frequencies of job tasks performed never, under direct supervision, supervision on call, or autonomous and sorted by number of tasks performed autonomously by the perianesthesia nurse.
Results
We received answers from all 11 organizations. The title of the nurse working in the PACU differs between the countries (recovery nurse, perianesthesia nurse, perioperative nurse, and in some countries the nurses have no specific title). In the results and discussion section in this article, the title is referred to as perianesthesia nurse because this is the formulation used in ICPAN. Perianesthesia nursing was recognized as a professional nursing specialty in 6 of 11 countries, and 8 of 11 had established national guidelines or practice standards for perianesthesia nurses (Figure 1). Local guidelines or policies (hospital or regionally driven) for the nurses working in the PACU existed in 10 of 11 countries.
Figure 1Overview of perianesthesia nursing specialty, national guidelines, and formal education. Perian spec, Perianesthesia nursing recognized as a professional nursing specialty; Formal Edu, formal education for the nurse working in the PACU; NG, national guidelines or practice standards for the nurse working in the PACU; PACU, postanesthesia care unit. This figure is available in color online at www.jopan.org.
Education to practice as a registered nurse (RN) varied between 3 and 4 years. In the USA a 2-year Associate's Degree in Nursing is also available (Table 1). Three countries (3/11) reported that they have a formal education program for perianesthesia nurses (Figure 1 and Table 1). In the eight countries not having a formal education, the training to work as a nurse in the PACU was provided by the hospital or surgical facility and varied between 1 month, 5 weeks, and 7 weeks (n = 3). Four reported that length of training was based on the nurse's earlier experience, competence, and type of hospital, and one reported no answer.
Table 1Education
Length of Education to Qualify for Eligibility to Practice as a Registered Nurse
Formal Education for Perianesthesia Nurses
NL
4 y
Yes
IRL
4 y
Yes
GR
4 y
No
CAN
4 y
No
DK
4 y
No
USA
4 y (2 y Associate's Degree in Nursing)
No
FIN
3.5 y
No
AUS
3 y
Yes
NZ
3 y
No
SWE
3 y
No
UK
3 y
No
AUS, Australia; CAN, Canada; DK, Denmark; FIN, Finland; GR, Greece; IRL, Ireland; NL, The Netherlands; NZ, New Zealand; SWE, Sweden; UK, United Kingdom; USA, United States of America.
The Netherlands and Ireland were the only countries where perianesthesia nurses were the only profession stationed in the PACU, whereas in Sweden perianesthesia nurses worked together with nurse assistants (may also be called auxiliary nurse, assistant nurse, enrolled nurse, or licensed practical nurse. Commonly, these personnel work under supervision of the RN in all PACUs and the anesthesia provider was stationed in most PACUs. Nurse assistants were the personnel most commonly stationed in the PACU (in all PACUs, n = 1; in some PACUs, n = 5), followed by anesthesia provider (in some PACUs, n = 3; in most PACUs, n = 1) and advanced practice nurse (in some PACUs, n = 2; in most PACUs, n = 2). The anesthesia provider, surgeon, and pharmacist were available on call or as consultants in all 11 countries (Table 2).
Table 2Other Professions in the PACU in 11 Countries
Can also be called auxiliary nurse, assistant nurse, enrolled nurse, or licensed practical nurse. Commonly, these professional roles work under supervision of the RN.
CAN GR NL IRL
AUS DK FIN NZ USA
—
SWE
UK
AUS CAN DK FIN SWE NL USA
NZ
—
IRL
GR UK
Pharmacist
AUS CAN DK FIN GR IRL NZ NL
SWE USA
—
—
UK
—
AUS FIN NZ
CAN DK USA
IRL UK
GR SWE NL
Physical medicine/physiotherapist
AUS CAN DK FIN GR IRL NZ NL USA
—
SWE
—
UK
AUS
FIN NZ NL
CAN USA
IRL UK
DK GR SWE
Respiratory therapist
AUS CAN DK FIN GR IRL NZ SWE NL
USA
—
—
UK
AUS DK FIN NZ SWE
—
CAN USA
IRL UK
GR NL
Occupational therapist
AUS CAN DK FIN IRL NZ NL USA
—
—
—
GR SWE UK
AUS DK FIN
NZ USA
CAN
IRL UK
GR SWE NL
Advanced practice nurse
CAN DK IRL NZ NL SWE
UK USA
AUS FIN
—
GR
CAN NZ
USA
AUS FIN
IRL
DK GR SWE NL UK
Other
USA: Social workers, child life specialists (pediatric specific settings), radiology
AUS, Australia; CAN, Canada; DK, Denmark; FIN, Finland; GR, Greece; IRL, Ireland; NL, The Netherlands; NZ, New Zealand; PACU, postanesthesia care unit; RN, registered nurse; SWE, Sweden; UK, United Kingdom; USA, United States of America.
∗ Can also be called auxiliary nurse, assistant nurse, enrolled nurse, or licensed practical nurse. Commonly, these professional roles work under supervision of the RN.
There were variations in nurse-to-patient ratios between the 11 countries, ranging from 2:1 to 1:3 in the Phase I recovery of critically ill patients. In Phase II recovery, it was most common to have up to three to four patients per nurse (Table 3).
Table 3Common Nurse to Patient Ratio in 11 Countries
Phase I Recovery, Critically Ill Patients
Phase I Recovery, Stable Patients
Phase II Recovery (Day Surgery)
GR
2:1-1:1
1:1
1:1-1:2
UK
1:1
1:1
1:1
IRL
1:1
1:1
1:2
CAN
1:1
1:1
1:4
USA
1:1
1:2
1:3
NZ
1:1
1:1-1:3
1:3
SWE
1:1-1:2
1:2
1:4
AUS
1:2 (Unconscious 1:1)
1:2
1:3-4
DK
1:2
1:2
1:2
NL
1:3 (max)
1:3
1:3-1:4
FIN
Depends on unit and nurse experience
Depends on unit and nurse experience
Depends on unit and nurse experience
AUS, Australia; CAN, Canada; DK, Denmark; FIN, Finland; GR, Greece; IRL, Ireland; NL, The Netherlands; NZ, New Zealand; SWE, Sweden; UK, United Kingdom; USA, United States of America
In all countries, perianesthesia nurses cared for pediatric patients, depending on the type of PACU and hospital, except in Ireland where perianesthesia nurses did not care for infants (0 to 1 year).
There were variations between countries regarding how many job tasks were reported as performed autonomously by the perianesthesia nurse, minimum 13 to maximum 31 (Table 4). All responses regarding the 37 job tasks are reported in detail in Supplementary Appendix 2.
AUS, Australia; CAN, Canada; DK, Denmark; FIN, Finland; GR, Greece; IRL, Ireland; IV, intravenous; NL, The Netherlands; NZ, New Zealand; PACU, postanesthesia care unit; PONV, postoperative nausea and vomiting; SWE, Sweden; UK, United Kingdom; USA, United States of America.
∗ Monitoring heart rate, monitoring ECG, monitoring SPO2, monitoring end-tidal CO2, monitoring noninvasive blood pressure, monitoring invasive blood pressure, monitoring CVP (central venous pressure), monitoring PCWP (pulmonary capillary wedge pressure), monitoring ICP (intracranial pressure), pain assessment, PONV assessment, temperature assessment, suction of airways, suction of tracheostomy, insert oropharyngeal airway, remove oropharyngeal airway, insert nasopharyngeal airway, remove nasopharyngeal airway, removal of laryngeal mask, removal of endotracheal tube, CPAP device, patient on ventilator, IV injections, intramuscular injections, injections into an epidural catheter, starting PCA/PCEA, insert IV cannula, insert a central venous catheter, insert arterial line, sampling blood for laboratory analyses, sampling arterial blood gas, bladder scanning, urethral catheters, bladder irrigation, mobilization of the patient in the PACU, connecting and adjusting a pacemaker, informing next of kin.
Job tasks that were most commonly reported as performed autonomously by perianesthesia nurses were suction of airways (11/11), temperature assessment (11/11), pain assessment (10/11), PONV assessment (10/11), monitoring heart rate (10/11), monitoring electrocardiogram (ECG) (10/11), monitoring noninvasive blood pressure (10/11), monitoring SPO2 (10/11), IV injection (10/11), intramuscular injection (10/11), and insert IV cannula (10/11). The following job tasks were most commonly reported as never performed by the perianesthesia nurse: inserting a central venous catheter (10/11), insert arterial line (9/11), connecting and adjusting a pacemaker (6/11), and patient on ventilator (5/11).
Epidural injections, removal of endotracheal tube, continuous positive airway pressure (CPAP) device, patient on ventilator, monitoring pulmonary capillary wedge pressure, and monitoring intracranial pressure were the job tasks that varied the most between the 11 countries (Figure 2).
Figure 2Job tasks performed by the perianesthesia nurse. Overview of job tasks that varied the most between the 11 countries. ∗Do not know (n = 2), ¤Do not know (n = 1).
During resuscitation, heart compressions were performed autonomously by the perianesthesia nurse in 9 of 11 countries, ventilation in 8 of 11 countries, and defibrillation in 5 of 11 countries (Figure 3).
Figure 3Perianesthesia nurse during resuscitation, N = 11.
Perianesthesia nurses discharged patients from the PACU autonomously or with supervision on call, according to the protocol in both Phase I and II (from day surgery unit) recovery. The most common discharge scoring criteria used in Phase I recovery was the Aldrete or Modified Aldrete Scoring System (6/11), whereas local or national guidelines were the most common in Phase II recovery (6/11; Table 5).
Table 5Overview Over Discharge Criteria's Used in Phase I and II Recovery and Discharge From the PACU
Scoring/Discharge Criteria
Discharge
Phase I recovery
Phase II recovery
From PACU, Phase I recovery
From day surgery unit, Phase II recovery
AUS
Aldrete. Pain score, GCS
FAS, ABC, activities scoring
Supervision on call/according to the protocol
Supervision on call/according to the protocol
CAN
Modified Aldrete
Criteria laid out by the management
Supervision on call/according to the protocol
Supervision on call/according to the protocol
DK
National recommendations
National recommendations
Autonomous
Autonomous
FIN
Local discharge criteria
Local discharge criteria
Supervision on call/according to the protocol
Supervision on call/according to the protocol
GR
Spontaneous breathing
Good level of consciousness, hemodynamic stability and pain score <5
Autonomous
Autonomous
IRL
Aldrete
Aldrete
Autonomous
Autonomous
NL
Aldrete, VRNS
Aldrete, VRNS
Autonomous
Autonomous
NZ
Apgar/adjusted Apgar
Discharge score.
Supervision on call/according to the protocol
Supervision on call/according to the protocol
SWE
Local guidelines
Local guidelines
Supervision on call/according to the protocol
Supervision on call/according to the protocol
UK
Alderete/NEWS2
Depending on hospital
Autonomous
Autonomous
USA
Aldrete/local specific elements
PADSS/local specific elements
Supervision on call/according to the protocol
Supervision on call/according to the protocol
ABC, airway, breathing, circulation; AUS, Australia; CAN, Canada, DK, Denmark; FAS, functional assessment screening; FIN, Finland; GR, Greece; GCS, Glasgow Coma Scale; IRL, Ireland; NEWS2, national early warning score; NL, The Netherlands; NZ, New Zealand; PACU, postanesthesia care unit; PADSS, Postanesthetic Discharge Scoring System; SWE, Sweden; UK, United Kingdom; USA, United States of America; VRNS, visual numeric rating scale.
Communication handover tools (ie, structured and standardized communication) were used in 10 of 11 countries, and the following communication handover tools were reported with some respondents reporting the use of multiple handover tools: SBAR (situation, background, assessment, recommendation; n = 3); ISBAR (identify, situation, background, assessment, recommendation; n = 2); iSoBAR (identify, situation, observations, background, agreed plan, read back; n = 1); AIDET (acknowledge, introduce, duration, explanation, thank you; n = 1); digital scoring list (n = 1), IPASS (illness severity, patient summary, action list, situation awareness and contingency planning, synthesis by receiver; n = 1); I PASS the BATON (introduction, patient name, assessment, situation, safety the background, actions, timing, ownership, next; n = 1); IDRAW (identify patient and most responsible practitioner, diagnose current problems, recent changes, anticipated changes, what to watch for; n = 1).
Discussion
To our knowledge, this is the first study describing the education, competence, and role of the nurse working in the PACU from an international perspective. The findings in this study demonstrate that there are similarities and differences between the 11 countries having membership in the ICPAN GAC. Without this information, it is challenging to discuss future international collaboration and development of education. Cross-country differences were reported by Meeusen et al,
where large variations among education, length of education, job descriptions, responsibilities, and job tasks were observed. International similarities and differences regarding routines in a day surgical context are also described, such as preoperative assessment, which was performed by nurses in all or most of the reporting units in the United Kingdom and Finland, but never performed by a nurse in Denmark and Sweden.
The preoperative context has also been explored by the research team and will be reported and further discussed elsewhere.
Three countries reported that they had a formal education process for perianesthesia nurses. However, it is possible that the nurses had other specialty postgraduate education such as anesthesia care or intensive care, which are common specialty educations among nurses working in Swedish PACUs although not mandatory.
We could not see that the three countries having formal education reported a higher frequency of performing tasks autonomously. Rather it implies that we have organizational differences between countries that cannot be described solely in relation to education. In the present study nurses performed many tasks autonomously, whereas none of the job tasks included in this study were reported as never performed by all 11 responders. As mentioned previously, we did not ask for information about postgraduate education other than perianesthesia nursing, which can be one explanation why the nurses in the present study performed most tasks autonomously. We found that perianesthesia nurses typically were the only profession stationed in the PACU, with other professions such as the anesthesia provider and surgeon on call. This indicates that the perianesthesia nurse has an independent role and has to make judgments related to the patient's condition and when other health care professionals should be contacted. Furthermore, cultural differences
This implies that education for perianesthesia nurses is an area that needs further development. Compared with other nurse professions in the perioperative context, RNA and OR nurses in Europe have 1 to 4 years of additional education.
On the basis of the factors mentioned previously, we recommend the development and proliferation of a foundational perianesthesia nursing education program to be cultivated through expert collaboration from all countries participating in the ICPAN GAC.
Two of the nontechnical skills described for the perianesthesia nurse are communication and crisis management. During Phase I recovery, crises such as respiratory distress or hemorrhage can occur and place demands on the perianesthesia nurse to prioritize what actions to take and the need to use structured communication tools to enhance interaction with colleagues and other health care professionals.
Structured and standardized communication handover tools are essential for increasing patient safety in the process of transferring a patient and delivering patient-specific information to the receiving nurse.
Communication tools were reported from all countries in this study; however, variations existed in the tools that were used. The most common tool was SBAR (used in three countries) or modified versions of SBAR, ISBAR,
SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: A prospective intervention study.
In the present study, the following nurse-to-patient ratios were reported: Phase I recovery 2:1 to 1:3 (critically ill) and 1:1 to 1:3 (stable patients). This is congruent with what has been described earlier during Phase I recovery—that nurse-to-patient ratios should be between 2:1 and 1:2 depending on acuity of the patient, competency of the nurse, and flexibility of patient throughput.
Perianesthesia nurses discharge patients autonomously or with supervision on call, according to the protocol from the PACU and Phase II recovery. Nurse-led discharge is described in the literature, and to enhance a safe recovery and discharge, it is important to assess recovery and use discharge criteria.
All study participants reported that they use discharge criteria, and Aldrete or the modified Aldrete scoring was the most common assessment of recovery and discharge criteria. The Aldrete score has been widely used internationally since it was developed in the 1970s.
In this study, all skills related to perioperative competencies are not described, rather the focus was on technical skills and job tasks. Analyzing tasks are important when describing nursing in different contexts, what is expected of the nurse, and to develop education.
highlighted, it is important to gain knowledge and understanding about perianesthesia nursing between different countries. Nurse competence is often studied using self-assessed questionnaires.
With a self-assessed questionnaire it is possible to gather information about how often tasks were performed, the importance of different tasks, and if nurses feel they have sufficient knowledge and education to perform the tasks. This inquiry should be included in future studies.
Implications for Global Practice
The International Council of Nurses has advocated for global nurse education standards for over a century, but this goal remains elusive despite being a shared professional nursing vision. Today, international nursing regulation and education continues to differ in complexity and scope.
Institute of MedicineCommittee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing The Future of Nursing: Leading Change, Advancing Health.
requires the education and clinical skills needed to keep patients safe during a most vulnerable time after anesthesia administration. Since its inception in 2011, the International Conference for PeriAnaesthesia Nurses has connected professional nurses on five occasions and three continents to share research and best clinical practices through education sessions, global delegate networking, and information gathering. The analysis of data collected during two delegate forums by Poole
p 761 concluded that “although there appears to be consensus among forum attendees on perianesthesia nurse competencies, there remains a need for standardization and proliferation.”
Currently, ICPAN and its 11 country members are commissioning an international team of experts to develop evidence-based perianesthesia nursing curriculum that can be tested through implementation in high-, middle- and low-income countries based on existing access to health care education and care delivery resources. Innovative use of technology can be designed to interact and share knowledge
National Academies of Sciences, Engineering, and Medicine Improving Health Professional Education and Practice through Technology: Proceedings of a Workshop.
with nursing students using a multimedia approach while guiding skills development through the use of in-person or videotaped clinical exemplars. This ambitious initiative supports the International Council of Nurses goal to standardize nurse education and can be accomplished because we share a world that is more connected than ever before through rapid travel options and virtual technology.
Limitations
The survey was not evaluated for content validity; it is possible that more or less items and answers would be found relevant if a content validity evaluation was conducted. If conducting a similar study, a content validity evaluation can be considered.
In the present survey we did not ask if the nurses working in the PACU had any other formal education other than in perianesthesia nursing, meaning that we have no information about other postgraduate education in specialist nursing, which is a limitation. However, the main focus of this study regarding type of education was to identify countries with existing perianesthesia education for nurses.
Participants were asked to respond to the survey based on routines and policies in the country that their organization represents. However, it is important to consider that there are variations within each country, depending on type of hospital and type of patients cared for in the hospital. In-country differences regarding day surgery routines in Europe have been reported earlier,
and therefore, the results should be interpreted with that in mind.
Conclusions
Perianesthesia nurse education, clinical guidelines, other professions working in the PACU, and job tasks differ between countries. This knowledge can lead to more awareness of and insight into our different contexts and be used in international collaboration to further develop education and training for nurses working in the PACU. Continued international perianesthesia nursing partnership can only bring us closer and strengthen our specialty practice with the focus not on our differences but on our common denominators.
Supervision on call/according to the protocol (magnet device)
Never
Never
Never
Never
Never
Supervision on call/according to the protocol (specialized PACU care. reworking in cardiac unit)
Do not know
Never
Do not know
Supervision on call/according to the protocol (variable based on location, dependent on patient type, procedures performed (cardiovascular surgery center vs freestanding ambulatory surgery center), skill and training of nurses).
Informing next of kin
Supervision on call/according to the protocol (with Dr orders. Depends on what information you are giving. We only inform that the patient is in the PACU)
Autonomous
Autonomous
Never
Supervision on call/according to the protocol
Supervision on call/according to the protocol
Autonomous (in some PACUs)
Autonomous
Never
Autonomous
Supervision on call/according to the protocol (Depends on the content that is being shared with the next of kin)
Monitoring heart rate
Autonomous
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Monitoring ECG
Autonomous
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Monitoring SPO2
Autonomous
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Monitoring end-tidal CO2
Never
Autonomous
Never
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Never
Autonomous
Autonomous
Monitoring noninvasive blood pressure
Autonomous
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Monitoring invasive blood pressure
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Monitoring central venous pressure
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Never
Autonomous
Autonomous
Monitoring pulmonary capillary wedge pressure
Supervision on call and/or accordingto the protocol
Never
Never
Supervision on call and/or according to the protocol
Under direct supervision
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Never
Do not know
Autonomous
Monitoring intracranial pressure
Supervision on call and/or according to the protocol
Autonomous
Never
Autonomous
Under direct supervision
Never
Autonomous
Supervision on call and/or according to the protocol
Under direct supervision
Do not know
Autonomous
Intravenous injections
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Intramuscular injections
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Injections into an epidural catheter
Never
Never
Supervision on call and/or according to the protocol
Autonomous
Under direct supervision
Never
Autonomous
Autonomous
Autonomous
Never
Supervision on call and/or according to the protocol
Starting PCA/PCEA
Supervision on call/according to the protocol
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Under direct supervision
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
Autonomous
Temperature assessment
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Pain assessment
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
PONV assessment
Autonomous
Autonomous
Autonomous
Autonomous
Do not know
Autonomous
Autonomous
Autonomous
Supervision on call and/or according to the protocol
Autonomous
Autonomous
IV, intravenous; PACU, postanesthesia care unit; PONV, postoperative nausea and vomiting; APRN, advanced practice registered nurse; PCA, patient controlled analgesia; PCEA, patient controlled epidural analgesia.
Quality of Life: The Assessment, Analysis, and Reporting of Patient-Reported Outcomes. Third ed. John Wiley & Sons Inc,
Chichester, West Sussex, UK2016
SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: A prospective intervention study.
Jan Odom-Forren, who is co-editor of Journal of PeriAnesthesia Nursing, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by Vallire D. Hooper, the other co-editor of this journal.
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