Prevention and management of postoperative nausea and vomiting.

PURPOSE: To identify factors associated with the occurrence of postoperative nausea and vomiting and to identify the effectiveness of independent and interdependent nursing interventions for the prevention and management of postoperative nausea and vomiting. DESIGN: Descriptive. SAMPLE: A convenience sample of 300 patients, 18 years or older, who had surgery with general anesthesia (excluding persons having ear or gastrointestinal surgery), at either campus of a large metropolitan medical center. METHOD: A combination of closed chart review and data collection by staff nurses assigned to the patients in the postoperative period using a standardized data collection tool. FINDINGS: Data was analyzed using a combination of descriptive and parametric statistics. There was a 39% incidence of nausea and vomiting overall. Women were two times more likely to experience nausea and twice as likely to experience severe nausea (statistical significance of p = .0001). In addition, persons with surgery lasting 2 hours or greater were twice as likely to experience nausea (statistical significance of p = .002). Independent nursing interventions, such as placing a cool washcloth on a patient's forehead, were used more often than medication as an initial strategy. The most frequently used interventions were increasing the i.v. fluids and having the patient take deep breaths. There was no pattern to the nursing assessments. CONCLUSION: Women and those patients with surgery lasting greater than 2 hours should be assessed for nausea in the postoperative period more frequently. Assessments need to be done during the first 2 hours after surgery, at 7-8 hours after surgery, and when there is an increase in activity, such as the first time out of bed. Nurses do not routinely document assessments for postoperative nausea. In addition, some misconceptions exist. Formal and informal education for nurses, physicians, and patients on the incidence, predisposing factors, and treatment options for postoperative nausea needs to occur. This should include reflection on the misconceptions, the need for ongoing patient assessment, and a review of drug and nondrug therapies. IMPLICATIONS FOR NURSING RESEARCH: Further research is needed to better describe the present practice patterns in the treatment of postoperative nausea and vomiting, including a comparison of inpatient and outpatient settings. The relative effectiveness of specific nursing interventions should be measured, such as i.v. fluids, deep breathing, and antiemetic use. In addition, the evaluation of the effectiveness of the use of a research protocol would be useful.

A survey of 636 staff nurses: perceptions and factors influencing the CNS role.

The specific aim of this investigation was to document the perceptions of the CNS role and the factors influencing the role. The Clifford Clinical Specialist Functions Inventory was used to survey staff nurses at two affiliated medical centers. A 38% response rate was obtained. A total of 636 surveys were returned. Analysis of the data indicated: the CNS was perceived as valuable; physical presence of the CNS on the nursing unit enhanced role enactment; and a list of CNS role expectations could be developed based on perceptions of staff nurses. The results indicated that perceptions of the CNS role did not vary among staff nurses at the two medical centers.

Orthopedic nursing practice guidelines. The NAON Standards Task Force.

The NAON Standards Task Force has revised Orthopaedic Nursing: Process and Outcome Criteria for Selected Nursing Diagnoses published jointly by the American Nurses' Association (ANA) and NAON in 1986. The new document is entitled Orthopaedic Nursing Practice Guidelines. It contains guidelines for the care of orthopaedic patients with 11 selected nursing diagnoses and is an important decision-making tool for orthopaedic nurses. This article contains excerpts from the new guidelines with suggestions for its use.