Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea.

To determine whether aromatherapy can reduce postoperative nausea, the investigators studied 33 ambulatory surgery patients who complained of nausea in the PACU. After indicating the severity of nausea on a 100-mm visual analogue scale (VAS), subjects received randomized aromatherapy with isopropyl alcohol, oil of peppermint, or saline (placebo). The vapors were inhaled deeply through the nose from scented gauze pads held directly beneath the patients' nostrils and exhaled slowly through the mouth. Two and 5 minutes later, the subjects rated their nausea on the VAS. Overall nausea scores decreased from 60.6 +/- 4.3 mm (mean +/- SE) before aromatherapy to 43.1 +/- 4.9 mm 2 minutes after aromatherapy (P <.005), and to 28.0 +/- 4.6 mm 5 minutes after aromatherapy (P < 10(-6)). Nausea scores did not differ between the treatments at any time. Only 52% of the patients required conventional intravenous (IV) antiemetic therapy during their PACU stay. Overall satisfaction with postoperative nausea management was 86.9 +/- 4.1 mm and was independent of the treatment group. Aromatherapy effectively reduced the perceived severity of postoperative nausea. The fact that a saline "placebo" was as effective as alcohol or peppermint suggests that the beneficial effect may be related more to controlled breathing patterns than to the actual aroma inhaled.     

Myths of antiemetic administration

Chemotherapy as a treatment modality for cancer has dramatically improved outcomes for patients. However, to attain therapeutic benefit, side effects and toxicities must be endured. Among the most frequent and distressing side effects are nausea and vomiting. The experience of nausea and vomiting may become so devastating that patients will discontinue curative treatment modalities. The major responsibility of the nurse caring for a patient receiving chemotherapy treatment is to prevent or treat nausea and vomiting effectively. To accomplish this, the nurse needs to understand how nausea and vomiting occur, the action of antiemetics, and how to administer them. There are myths, beliefs, and/or practice behaviors that influence interventions for antiemetic administration. Successful nursing interventions to control nausea and vomiting may be less than optimal when myths instead of correct facts affect the interventions.     

Acupuncture and acupressure for the management of chemotherapy-induced nausea and vomiting

PURPOSE: To review existing research, the National Institutes of Health (NIH) consensus statement, and federal regulations regarding the use of acupuncture and acupressure in the management of chemotherapy-induced nausea and vomiting in order to give nurse practitioners (NPs) the information they need to provide the best care for patients undergoing chemotherapy treatment for cancer. DATA SOURCES: Selected scientific literature and Internet sources. CONCLUSIONS: Research supports the effectiveness of acupuncture and acupressure for the treatment of chemotherapy-induced nausea and vomiting. Used in conjunction with current antiemetic drugs, acupuncture and acupressure have been shown to be safe and effective for relief of the nausea and vomiting resulting from chemotherapy. IMPLICATIONS FOR PRACTICE: Even with the best antiemetic pharmacological agents, 60% of cancer patients continue to experience nausea and vomiting when undergoing chemotherapy treatments. Because the NIH supports the use of acupuncture for nausea and vomiting, the NP is obligated to be knowledgeable about the use of these and other effective complementary treatments in order to provide the best care.     

Intensive nursing care. The ministry of presence

The nurse's presence offers meaningful support to people in critical care situations. Because crisis and suffering dispirit a person, there is an increased sense of vulnerability, isolation, and alienation, as well as a decreased sense of relationship and being heard in an environment that is already overwhelming, often associated with pain, frightening, and unfamiliar. The nurse's presence can lessen these negative effects of suffering as one comes alongside and enters that suffering by listening and being available in a way that involves self-giving. In this way, the nurse is fully attentive with all of self, as opposed to seeming to be. The idea of being present may be threatening to a nurse because it requires exposing one's vulnerability in order to come alongside one who is already very ragged and exposed. The silence also may be intimidating as the nurse chooses to wait with a person who is in turmoil and wrestling emotionally, mentally, physically, or spiritually. Another challenge for the nurse is confronting traditional attitudes about what it means to "be professional" and "therapeutic." The experience of presence is an awesome privilege humbly received as one realizes the personal cost to the one who chooses to share inner wrestling and brokenness. Presence occurs only with the permission or invitation of the one suffering and only when the nurse is willing to accept the invitation and also be that vulnerable. Because suffering often triggers spiritual wrestling in addition to emotional, mental, and physical pain, the nurse may be invited to come alongside a person in a role that interfaces with that of the chaplaincy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Achieving magnet hospital recognition: chief nurse executives and magnet coordinators tell their stories

Organizational and management characteristics found in hospitals holding magnet hospital recognition are associated with professional nurse practice environments and positive patient and staff outcomes. However, while we know what works, we need a better understanding of "how to get there.' The authors report the stories about "how we did it' told by chief nurse executives and magnet project coordinators from hospitals that have achieved American Nurses Credentialing Center magnet hospital recognition. This article adds to the understanding of how to pursue magnet recognition.     

Comparison of patient-controlled and nurse-controlled antiemetic therapy in patients receiving chemotherapy

The purpose of this quasi-experimental pilot study was to compare the effect of patient-controlled (PCAE) and nurse administered (NCAE) antiemetic therapy for controlling chemotherapy-induced nausea and vomiting in patients receiving moderate emetogenic chemotherapy. Twenty subjects were randomly assigned to either the PCAE group who received IV antiemetic medication via a patient-controlled pump or the NCAE group who received antiemetic medication via nurse administered minibags. Nausea, vomiting, sedation, and drug consumption were measured. There was no difference in nausea scores between the two groups. Subjects in the PCAE group consumed significantly less medication than subjects in the NCAE group.     

Screening for alcohol use and misuse in older adults: using the Short Michigan Alcoholism Screening Test--Geriatric Version

The Short Michigan Alcoholism Screening Test--Geriatric Version (SMAST-G) is often used in outpatient settings to detect "at-risk" alcohol use, alcohol abuse, or alcoholism in older adults. As the number of older adults in the United States grows, those who develop problems of abuse and a dependence on alcohol will grow as well. The availability of accurate, easy-to-use screening tools to detect people in need of counseling can increase the number of older adults whose lives can be improved and even lengthened. To watch a free online video of a nurse administering the SMAST-G, go to http://links.lww.com/A271.     

Predictors of nurse manager stress: A dominance analysis of potential work environment stressors

Background

Nurse managers have important but stressful jobs. Clinical or bedside nurse predictors of stress have been studied more frequently, but less has been done on work environment predictors for those in this first-line leadership role. Understanding the relative importance of those work environment predictors could be used to help identify the most fruitful areas for intervention, potentially improving recruitment and retention for nurse managers.

Objective

Using Role Stress Theory and the Job Demands-Resources Theory, a model was tested examining the relative importance of five potential predictors of nurse manager stress (i.e., stressors). The work environment stressors included role ambiguity, role overload, role conflict, organizational constraints, and interpersonal conflict.

Design and settings

A quantitative, cross-sectional survey study was conducted with a convenience sample of 36 hospitals in the Southwestern United States.

Participants

All nurse managers working in these 36 hospitals were invited to participate. Of the 636 nurse managers invited, 480 responded, for a response rate of 75.5%.

Methods

Questionnaires were distributed during nursing leadership meetings and were returned in person (in sealed envelopes) or by mail.

Results

Because work environment stressors were correlated, dominance analysis was conducted to examine which stressors were the most important predictors of nurse manager stress. Role overload was the most important predictor of stress, with an average of 13% increase in variance explained. The second- and third-most important predictors were organizational constraints and role conflict, with an average of 7% and 6% increase in variance explained, respectively.

Conclusion

Because other research has shown deleterious effects of nurse manager stress, organizational leaders are encouraged to help nurse managers reduce their actual and/or perceived role overload and organizational constraints.     

Comparison of inhaled isopropyl alcohol and intravenous ondansetron for treatment of postoperative nausea

Postoperative nausea, a common complication in patients receiving general anesthesia, was studied in this randomized investigation to compare the efficacy of 70% inhaled isopropyl alcohol and intravenous ondansetron. For the study, 100 healthy women, ASA physical status I or II, scheduled for outpatient gynecologic laparoscopic procedures randomly received 4 mg of intravenous ondansetron or isopropyl alcohol for the treatment of postoperative nausea. Nausea was measured on arrival to the postanesthesia care unit, at first complaint of nausea, every 5 minutes after initiation of therapy until nausea resolution, and every 15 minutes thereafter using a 0 to 10 verbal numerical rating scale. At 5, 10, and 15 minutes, the median verbal numerical rating scores between the ondansetron and alcohol groups were 6.00 and 3.00, 5.00 and 3.00, and 5.00 and 2.00, respectively (P = .002, .015, and .036, respectively). No statistically significant differences were found at any other time interval. Mean times from initiation of therapy to a 50% reduction in nausea between the ondansetron and alcohol groups were 6.3 minutes and 27.7 minutes, respectively (P = 0.022). Based on this study, it seems postoperative nausea can be resolved quicker using 70% inhaled isopropyl alcohol compared with intravenous ondansetron in women undergoing outpatient gynecologic laparoscopic procedures.     

Food safety in the workplace: a practical approach.

The occupational health nurse in a large manufacturing facility arrives at work early one Monday morning to find three ill employees in the clinic waiting room and a message from several plant supervisors that multiple employees have called in sick. The supervisors are concerned. The employees have reported similar symptoms, including nausea, vomiting, diarrhea, and fever Furthermore, two supervisors who rarely miss work have also called in sick and other employees are complaining of stomach cramps and diarrhea. The occupational health nurse promptly begins completing a nursing assessment and health history. She discovers that all sick employees attended the company picnic, catered by the facility's food service vendor, the day before. After notifying the local public health department, the occupational health nurse begins to investigate further. The occupational health nurse visits the cafeteria to speak with the manager and inquire about the food served at the picnic. The menu included ham and cheese sandwiches with mayonnaise, hamburgers, potato salad, and cake. The beverages were milk, non-bottled water, and lemonade. All leftover food was discarded, so nothing is available for testing. The manager mentions that yesterday was particularly hot, with a high of 93 degrees F. He states the local health department conducts regular, stringent food inspections. However, he admits they have been short staffed recently and, although he tries to provide adequate training and oversee all food service operations, a few new employees worked at the company picnic. He also mentions his holding temperature logs are "not exactly up-to-date." While talking to the manager the occupational health nurse notices one of the food service employees cutting raw vegetables on a wooden cutting board just used to cut raw chicken. The cutting board was wiped with a damp, visibly soiled sponge, rather than washed, after cutting the meat. It is abundantly clear that food safety training deficiencies exist in this food service. Seventy percent of the employees who attended the company picnic are too ill to work, and absenteeism leads to production shutdown. The culprit? Salmonella. Because of the number of cases, the local health department initiates an investigation and the facility is issued a citation.     

When the family asks, 'what happened?'

Because of the high level of acuity of hospitalized patients, untoward events can and do occur. Very often, nurses develop a caring relationship with the families of these patients. As a result, the family may approach the nurse about this negative turn of events. The questions that the family raises may create an ethical dilemma for the nurse. The nurse may wonder how to respond, feel powerless and "caught in the middle," and experience moral distress because of constraints in the health care system. This article discusses the ethical perspective of caring and the "nurse in the middle" phenomenon. Several strategies to help nurses manage this issue include consulting with a mentor, consulting with the institutional ethics committee, and promoting an ethical climate within the health care setting.     

Nurse prescribing and in-patient alcohol detoxification

The role of nurses within the field of addictions, and alcohol in particular, has developed considerably in recent years. This is best illustrated through their role in detoxification both in the home and at specialist centres. This paper reviews the literature on nurse prescribing which has developed significantly in other areas of health care. A typology of current prescribing and administration protocols is presented before discussing issues that this raises which relate to alcohol detoxification. The advantages and disadvantages of nurse prescribing for alcohol detoxification are considered in relation to residential and hospital alcohol treatment centres (ATCs) and a preferred model of nurse prescribing is suggested. Barriers to nurse prescribing are highlighted and conclusions are drawn for the future of nurse prescribing in the area of in-patient alcohol detoxification.     

护理程序在排便异常患者护理中的应用

目前,“系统化整体护理”模式已成为国际护理专业发展的方向。而掌握“护理程序”是实施整体护理成败的关键。我们根据整体护理模式,运用护理程序这一科学的工作方法对排便异常患者进行护理,取得了良好的效果。本文简要介绍了“护理程序”“排便异常的类型”等概念,着重阐述了排便异常患者中存在的“护理问题”和采取的“护理措施”。     

The change process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing

Despite being constantly cited as a critical intervening variable in the recovery from alcohol problems, there is a paucity of literature on client motivation. This paper reviews the current literature which impacts on motivation and its importance in treatment and develops in a stepwise manner the revised expectancy/motivation hypothesis, tentatively explaining both motivation and denial as a natural process in behavioural change. Because of the revised expectancy/motivation hypothesis' distinctly defined stages which closely relate to the process of nursing and the qualitative and quantitative measurement it entails which the nursing process demands, it offers a particularly appropriate model for treatment within nurse practice.     

Gender, ethnicity, and cardiovascular disease

Although the influence of gender and ethnicity on cardiovascular disease has been understudied, cardiovascular nurse researchers have contributed significantly to the existing body of knowledge. This article distinguishes between the constructs of "gender versus sex' and "ethnicity versus race,' acknowledging that the terms are often used interchangeably in research. A sampling of the substantial contributions of cardiovascular nurse researchers related to gender and ethnicity in the areas of symptoms of cardiovascular disease; risk factors and prevention; delay in seeking care, diagnosis, and treatment; recovery and outcomes; and cardiac rehabilitation is highlighted. Recommendations for future research include publishing research data by gender and ethnicity subgroups even though statistical comparisons may not be feasible, and increasing cardiovascular disease research in minority populations such as Asian Americans, Pacific Islanders, Native Americans, and Hispanics. Finally, we challenge cardiovascular nurse researchers to shift from the documentation of disparities toward designing and testing of interventions to eliminate health disparities.     

The transport of ciguatoxin: a case report

Ciguatera fish poisoning has been responsible for as many as half of all food poisonings in the United States due to fish. Because the initial symptoms often include gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and abdominal pain, patients may be discharged from the Emergency Department with a diagnosis of "acute gastroenteritis," only to return soon thereafter. This is a case report of such a patient who was evaluated and discharged only to subsequently return because of worsening of symptoms.     

Counseling the alcoholic client

In all helper-helpee relationships, the experiencing of the uniqueness of each person is crucial. Each alcoholic is a person and alcohol dependence is but one plane of that person's being. Obtaining current information about alcoholism enables the professional nurse to deal with the disease in a systematic fashion. The personhood of each alcoholic must be met with creativity that focuses on the entire scope of potential as the conflict "I can't drink" changes to resolution, and increasing fullness of life becomes the issue.     

Australian clinical nurse supervisors' ethical decision-making style

This paper explores clinical nurse supervisors' ethical styles with regard to supervision in healthcare. Eighty-six registered nurses, all with experience of supervising clinical nurses and students in nursing, completed a specifically designed questionnaire. A qualitative interpretative content analysis identified three core themes: (i) 'Is it safe?'; (ii) 'Is it right?'; and (iii) 'Is it kind?', describing the clinical nurse supervisors' ethical styles. The first core theme 'Is it safe?' covered the supervisors' rules, codes and values that guide their supervisory actions, as well as two sub-themes: (i) empowerment and (ii) integrity. The second core theme 'Is it right?' described the supervisors' responsibility and advocacy as well as the ethical dilemmas experienced in the supervisory process. The third core theme 'Is it kind?' included the supervisors' relationships with patients, professionals and supervisees. The results demonstrate the value of offering a support system, such as clinical supervision, which helps nurses to explore their professional identity for the benefit of the patients.     

Combination povidone-iodine and alcohol formulations more effective, more convenient versus formulations containing either iodine or alcohol alone: a review of the literature.

Topical antiseptic formulations containing single active ingredients of alcohol and iodine are recognized by the Food and Drug Administration as "generally safe and effective" for "preparation of the skin prior to surgery" or "prior to an injection" including "catheter care, ostomy hygiene, and intravenous site preparation" (Federal Register, 1994). However, a synergistic effect results from the combination of ethyl or isopropyl alcohol and povidone-iodine. Because each active ingredient has different modes of action and performance characteristics, these combination formulations are faster acting with a broader spectrum of antimicrobial activity than formulations containing povidone-iodine alone, and more persistent than formulations containing ethyl or isopropyl alcohol alone.