ABSTRACT
PURPOSE: Describe the impact of the implementation of an evidence-based pediatric preoperative risk assessment (PPRA) checklist on the frequency of postanesthesia care unit (PACU) nursing assessments and interventions in children at risk for respiratory complications during emergence from anesthesia. DESIGN: Prospective pre-/postdesign. METHODS: Pediatric perianesthesia nurses assessed 100 children preintervention according to current standard. After nurses received pediatric preoperative risk factor (PPRF) education, another 100 children were assessed postintervention using the PPRA checklist. Pre-/postpatients were unmatched for statistical purposes due to two different groups. Frequency of PACU nursing respiratory assessments/interventions was evaluated. FINDINGS: Demographic variables, risk factors, frequency of nursing assessments/interventions were summarized in pre-/postinterventions. Significant differences (P < .001) were noted between pre-/postintervention groups with increased frequency of postnursing assessments/interventions that correlated with increased risk factors and weighted risk factors. CONCLUSIONS: By identifying total PPRFs, PACU nurses used their plan of care to frequently assess and pre-emptively intervene with children who had increased risk factors to prevent or mitigate respiratory complications on emergence from anesthesia.
Subject(s)
Checklist , Quality Improvement , Humans , Child , Prospective Studies , Risk Assessment , DocumentationABSTRACT
PURPOSE: This article reviews state of the science of preoperative risk factors associated with postanesthesia care unit (PACU) pediatric respiratory complications. DESIGN: An integrative review. METHODS: A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, Cochrane, and Joanna Briggs Institute databases was performed. Thirty-one articles, published between 2006 and 2018, were appraised for quality and the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice Model. FINDINGS: These articles were grouped into the following categories: age, American Society of Anesthesiologists status, gender, airway comorbidities, syndromes, anomalies, pulmonary comorbidities, ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities. CONCLUSIONS: Evidence identified significant preoperative and anesthesia risk factors that are associated with PACU pediatric respiratory complications. This article reveals the importance for the perioperative team to identify, assess for, communicate, and develop a management plan for pediatric respiratory complications.
Subject(s)
Postanesthesia Nursing/trends , Postoperative Complications/etiology , Respiratory Tract Diseases/complications , Humans , Postanesthesia Nursing/methods , Postoperative Complications/prevention & control , Preoperative Care/methods , Respiratory Tract Diseases/physiopathology , Risk FactorsSubject(s)
Data Collection/methods , Documentation/methods , Evidence-Based Medicine/methods , Nursing Research/methods , Postanesthesia Nursing/methods , Vocabulary, Controlled , Databases as Topic , Humans , Internet , Nursing Assessment/methods , Nursing Diagnosis , Nursing Records , Outcome Assessment, Health Care , Patient Care Planning , Research DesignABSTRACT
Postanesthesia nursing care and standards are continually evolving. ASPAN has the professional responsibility to develop standards of nursing practice to promote a safe environment of care. Currently, ASPAN's recommended staffing ratios are based on the best available evidence: expert opinion and consensus. Our Society believes that these nurse-to-patient ratios have served to provide safe, quality patient care. In 2006, the ASPAN Safe Staffing Strategic Work Team was charged with conducting a national PACU Safe Staffing Evidence-Based Practice (EBP) project. The purpose of this EBP staffing project was to search the scientific staffing evidence in an attempt to validate ASPAN's staffing ratios. This expert panel critically weighed the nursing evidence on staffing ratios, workload intensity, patient acuity, nursing-sensitive outcomes, and nursing-sensitive indicators, including appropriate critical care studies because of the scarce number of postanesthesia studies. The outcome of this dynamic initiative revealed the need to develop nursing-sensitive perianesthesia indicators that can provide patient outcomes used to assess the effectiveness of staffing ratios. Finally, research gaps were identified and the next steps in the generation of knowledge needed to build safe staffing evidence were identified in ASPAN's Strategic Research Staffing Plan.
Subject(s)
Evidence-Based Medicine/organization & administration , Nursing Administration Research/organization & administration , Nursing Staff, Hospital/supply & distribution , Personnel Staffing and Scheduling/organization & administration , Postanesthesia Nursing , Safety Management/organization & administration , Benchmarking , Consensus , Guidelines as Topic , Humans , Needs Assessment , Planning Techniques , Quality Indicators, Health Care/organization & administration , Quality of Health Care , Sensitivity and Specificity , Societies, Nursing/organization & administration , Total Quality Management , United States , Workforce , WorkloadABSTRACT
Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV.
Subject(s)
Complementary Therapies , Postoperative Nausea and Vomiting/prevention & control , Acupuncture Therapy , Aromatherapy , Zingiber officinale , Humans , Music Therapy , Phytotherapy , Plant Preparations/therapeutic useABSTRACT
The perianesthesia nurse is continually challenged to provide safe and effective pain management. This task becomes more difficult when working with an aging population. Success begins with understanding the challenges in controlling surgical pain and in communicating information regarding pain management prior to the surgery. Sharing of information between the patient, nurse, and other members of the health care team is essential. To provide quality pain care for geriatric patients, who are at greater risk for developing potentially life-threatening side effects of commonly used analgesics, the perianesthesia nurse must be knowledgeable about factors that affect pain management in this population. Common factors affecting pain control in the older adult patient include misconceptions regarding use and effects of analgesics, preexisting cognitive impairment, impaired communication, cultural differences between the nurse and the patient, and physiologic changes in aging that affect how drugs are metabolized.
Subject(s)
Pain, Postoperative/therapy , Perioperative Nursing/methods , Aged , Geriatrics , Humans , Nurse-Patient Relations , Pain Management , Pain Measurement/methods , Patient Care TeamABSTRACT
The practice continuum of perianesthesia nursing interacts in concert with other nursing and medical professional organizations. Professional standards of care establish frameworks that guide these practitioners in the delivery of care. ASPAN is charged with the ethical responsibility of defining and promulgating minimum standards of perianesthesia nursing practice. This article discusses the various definitions and uses of standards, as well as the vital importance of using ASPAN Standards. How standards differ from position statements, laws, and regulations, and how standards advocate for patient safety and protect the nurses in their specialty practice are also discussed. In addition, case scenarios will be presented to show how the American Society of Anesthesiologists' (ASA) standards play a major role in the surgical patient's care.
