Severe needle phobia in the perianesthesia setting.

Needle phobia is a peculiar type of specific phobia, with unique clinical features, that may be encountered in some surgical patients. It may present a serious acute problem to the perianesthesia care team and requires careful psychological and/or pharmacological management. This article provides a clinical report and detailed discussion of severe needle phobia in the perianesthesia setting.     

Domestic violence awareness in the perianesthesia setting.

Identification of victims of domestic violence is the first phase in the intervention of stopping the cycle of violence. Phase two is acting on that information and assisting the victims to help themselves. Nurses have the unique opportunity of being "present" at the bedside for the victim of abuse. This article reviews the signs and symptoms of domestic violence. Keen patient assessment tools and support can make a world of difference in the outcome of abuse.     

Adapting charting by exception to the perianesthesia setting.

Many acute care settings are experiencing a shift toward ambulatory patient care and are being pressured to decrease patient length of stay. Meanwhile, there is increased pressure to remain patient centered and to become more customer oriented. This article describes how the authors adapted charting-by-exception principles to develop a single ambulatory surgery nursing record for use from admission to discharge. The authors' goals were to condense documentation, to decrease time spent on documentation, and to diminish the variance in quality of documentation. This article also details how the new nursing record measures achievement of patient outcomes, with a focus of promoting street readiness.     

Research in the perianesthesia setting: the basics of getting started.

Research can be defined as a process that systematically investigates a situation with the objective of expanding the existing knowledge of a profession. Research asks the question "Does what we do as nurses help or hinder?" The purpose of this article is to provide a brief history of nursing research and to review basic research methods. In addition, examples of potential research projects focused in the perianesthesia practice arena will be explored. Practical steps will be outlined to guide novice nurse researchers in their early endeavors.     

Healing pathways through energy work in the perianesthesia care setting

Energy-medicine therapy such as healing touch is a powerful way to promote relaxation and enhance the healing process. Healing touch is a sacred healing art and a way of caring in which practitioners use their hands as channels to assess and balance the energy field that encircles the body in order to promote the innate ability to heal. A collection of energy-based treatment modalities are used to assess and treat the human energy system. The energy system that is life is influenced by healing touch, which is used extensively in the nursing profession. This energy-medicine therapy is used in all areas of nursing. This article discusses the concepts of healing touch, the human energy field, and applications of healing touch in professional practice in the perianesthesia setting.     

Medication use in the elderly patient: Focus on the perioperative/perianesthesia setting

As the population ages, the use of multiple medications also increases. Polypharmacy (taking multiple drugs at a time) presents concerns to the perianesthesia nurse who is caring for the geriatric patient. The pharmacokinetics and pharmacodynamics of drugs are often altered in older adult patients. Adverse drug reactions and drug interactions occur more often in geriatric patients than in younger patients. For these reasons, the benefits and risks of multiple medications and the administration of certain types of drugs must be carefully considered in the elderly patient. The selection of any medication should be individually based on the benefits and risks. Adverse drug reactions play a significant role in hospitalization for the general population, and the elderly are more susceptible to these. These drug reactions often contribute to significant morbidity as well as mortality. Medications need to be considered carefully in the older adult patient, but perhaps more so in the perioperative/perianesthesia period. Drug interactions are diverse. The type of anesthesia may influence the patient's outcome, depending on the medications the patient is currently taking. The patient's response to the stress of surgery is also affected by individual medical conditions as well as medications the patient is currently receiving Polypharmacy, inappropriate medications, adverse drug reactions, drug-disease issues, and drug interactions in the geriatric population are concerns in the perioperative/perianesthesia setting.     

Managing do-not-resuscitate orders in the perianesthesia period.

Perianesthesia care often involves the use of pharmacologically potent drugs, increasing the risk of cardiopulmonary depression and arrest. For patients with terminal diseases, it may be difficult to decide whether cardiopulmonary arrest in the perianesthesia period is a result of anesthetic medications, surgical intervention, or the disease process. It is imperative that the patient maintains autonomy and is treated according to his or her wishes regarding do-not-resuscitate (DNR) orders. Some hospitals automatically suspend DNR orders for patients undergoing surgery, whereas others provide patients the option of no, limited, or full resuscitation. This article promotes the premise that all DNR orders should be reviewed and reconsidered with patients before consent for surgery.     

U-500 concentrated regular insulin: Practical application in the outpatient setting

ABSTRACT: Administering large insulin doses to patients with severely insulin-resistant diabetes is often ineffective, expensive, and painful. U-500 regular insulin is absorbed better, less painful, and more cost-effective due to the reduced volume. This article describes the most recent guidelines for U-500 insulin in the clinical setting.     

A practical application of Katharine Kolcaba's comfort theory to cardiac patients

Nursing approaches to care as based on Katharine Kolcaba's (2003) middle range nursing theory of comfort are discussed in reference to patients' suffering from symptoms related to the discomfort from cardiac syndromes. The specific intervention of “quiet time” is described for its potential use within this population as a comfort measure that addresses Kolcaba's four contexts of comfort: physical, psychospiritual, environmental and sociocultural. Without realizing it, many nurses may practice within Kolcaba's theoretical framework to promote patient comfort. Explicit applications of comfort theory can benefit nursing practice. Using comfort theory in research can provide evidence for quiet time intervention with cardiac patients.     

Ethical issues in perianesthesia nursing.

Ethical issues have historically been a significant focus in perianesthesia nursing. Issues of safety, privacy, and informed consent are never far from the consciousness of the perianesthesia nurse. As the national organization that serves as a clearing ground for issues and goals of perianesthesia nursing practice, ASPAN has begun the process of developing a code of ethics for perianesthesia nursing practice. This report is designed to provide a brief review of the important definitions and principles that are used in the discussion of ethics, review the contemporary forces that mandate and justify the development of an ethical code, and explore how such a code may function to aid and guide nursing practice.     

The perianesthesia experience from the patient's perspective.

The purpose of this study was to investigate the perianesthesia experience from the patient's perspective. An existential phenomenological approach using Pollio's interpretive framework was used. Interpretations were conducted, in part, in a research group. The purpose of the interpretation was to recognize patterns or themes in an experience. Participants were asked to describe specific experiences that stood out for them because experiences which stand out are those that are meaningful. Ten participants (5 males, 5 females) ranging in age from 23 to 66 years were interviewed using phenomenological techniques. The interpretation found the perianesthesia experience to be grounded in self, others, and time, which become figural through experiences of control. Each participant relinquished control, lost control, or strove to gain or maintain control during their surgical experience. The perception of death lurking crossed into figural experiences as well. Images of death, while grouped predominantly with self, were interpreted as the ultimate loss of self, others, and time. Loss of control of self, the relinquishing of control to others, and the temporal experience of control may contribute to perianesthesia stress and anxiety. Nurses in the perianesthesia period have many opportunities to help patients with issues of control.     

Cross-cultural comparison of perianesthesia nursing: challenges encountered in the PACU.

Nurses often consider caring for the pediatric patient in the PACU stressful. This stress may be compounded when providing this care in a foreign country. This article compares and contrasts the challenges experienced by one nurse when working in both Russia and China as a PACU nurse for the volunteer group, Operation Smile. Topics discussed in this article include the physical setup of the PACU; safety issues within the PACU; and the importance of communication, pain management, and parents within the PACU. The author elaborates on how to provide safe, competent, and culturally sensitive care to children within the PACU setting.