Is meta-analysis clinically useful for perianesthesia nurses?

Meta-analyses can provide clinicians with the evidence-based information necessary to effect change in patient care delivery. Meta-analysis, the application of statistical techniques to condense data from a group of individual studies, is the most sophisticated summary of research evidence. An example meta-analysis study of inadvertent surgical hypothermia is used in this article to describe how nurses can locate, evaluate, and apply synthesized research data for perianesthesia clinical practice. Without data to support decisions, nurses will increasingly be faced with decisions made by others based on cost-cutting measures alone. Although meta-analysis may resolve a controversy or solve a clinical problem, it will not provide simple statistical answers for complex problems or obviate the need for sound and compassionate clinical judgment.

Family Caregivers' Motives for Helping Scale derived from motivation-to-help theory.

The literature does not contain a measure of family caregivers' motives for helping provide daily complex home care. Such a measure will permit nurses to assess and provide interventions specific to each caregiver's motivation for helping. The purpose of this study was to apply Batson's empirically derived helping pathway theory to the measurement of caregiver motives for helping and develop a short form that does not add to the burden of caregiving. A Principal Components factor analysis (N = 93) of Family Caregivers' Motives for Helping Scale is used. Criterion-related validity is ascertained using a triangulated, independent validation procedure with qualitative data from a subsample (N = 41). Subsample subjects' interview data were categorized, based on Batson's theoretical pathway definitions, by coders blinded to caregiver Motives for Helping Scale scores. Three of Batson's four helping pathways (reward seeking, altruism, and punishment-avoidance) were extracted during factor analysis. This three-factor solution explained 66.6% of the variance and was confirmed by a 97% agreement between three of Batson's pathways and caregivers' helping motive score. The content analyses of the descriptive interview data also coincide with the 3-factor solution. The scale items representing Batson's fourth helping pathway, distress reaction, were not retained due to cross loading. The Family Caregivers' Motives for Helping Scale accurately measures three of four theoretically derived motivations for helping another. The scale should be reanalyzed in a larger sample of caregivers. Aligning nursing interventions to caregiver motives for helping can provide reinforcement for caregivers and potentially enhance home care outcomes.

Challenges of measuring intraoperative patient outcomes.

The Perioperative Patient Focused Model incorporates AORN s patient outcomes standards of perioperative care. Although the outcomes were designed for perioperative practice, it is difficult to judge which outcome standards an intraoperative nurse might appropriately use to determine if the patient has achieve the desired result at the time of discharge from the OR. The purpose of this article is to explore whether intraoperative nurses can implement the new model by substituting intermediate patient outcomes to evaluate the effect of nursing care delivered during a surgical procedure.

Self-reported at-home postoperative recovery.

Although 75% of elective surgery is performed on an outpatient basis, no measures of patients' at-home postoperative recovery were found in the literature. The postdischarge surgical recovery (PSR) scale was designed to serve as a dependent variable capable of measuring variations in perceived recovery in patients dismissed within 24 hours of their surgical procedure. Five concepts: health status; activity; fatigue; work ability; and expectations, derived from an ethnographic analysis, are represented in the 15-item 10-point semantic differential scale. The PSR scale exhibited strong internal consistency in two samples (alpha=.88-.91). The concurrent validity coefficient between the PSR scale and the previously tested Wolfer-Davis Recovery Inventory (1970) was .76 (n = 163; p< or =.001). Construct validity was supported by the relationship (r=.72, p< or =.001) between patients' reported percentage of recovery (0-100%) and PSR scores. Construct val idity was also supported by correlations between the PSR scale and in-home assessment by a master clinical nurse specialist (r=.77, p=.003, n=12) and by trained in-home observers (r=.71, p< or =.001, n=59). Clinicians or researchers interested in the extent of perceived at-home Postoperative recovery may now search for symptom patterns and changes over time in a variety of ambulatory surgery patients using the PSR scale.

Dimensions of perioperative nursing for a national specialty nomenclature.

Dimensions of perioperative nursing for a national specialty nomenclature Before nurses can develop a clinical database capable of evaluating quality of care or validating their impact on health or illness, they must describe the basic dimensions of their specialty. The purpose of this study was to define the dimensions of clinical perioperative nursing practice. Experienced perioperative nurses (n=239) were mailed a survey and asked to rank the frequency with which specific patient diagnoses occurred in their daily practice (1=never occurs; 5=occurs almost all the time) and the priority of treatment each diagnosis required (1=never requires attention of the nurse; 5=demands immediate attention of the nurse). Completion of the form indicated consent to participate in the study. Following a principal component analysis and theoretical discussion by perioperative experts, four dimensions of perioperative practice were delineated: (a) patient and family behavioural responses to surgery (26.7% of variance, alpha=0.92); (b) perioperative patient safety (10.1% of variance, alpha=0.89); (c) perioperative physiological response to surgery (5.7% of variance, alpha=0.87); and (d) the health systems required to deliver perioperative care. Dimensions extracted in this analysis served as the domains for the new perioperative nursing nomenclature.

Development of the Perioperative Nursing Data Set.

Nursing practice is a major component of health care. Yet, it remains undervalued and essentially invisible because little data exist to substantiate the influence of nurses on patient outcomes. The research-based Perioperative Nursing Data Set (PNDS), with an easily automated nomenclature capable of describing the specialty practice of perioperative nursing, was designed to fill this gap. Four domains (i.e., safety, physiologic response to surgery, patient and family behavioral response to surgery, health system) form the foundation of the PNDS. Each domain, with accompanying desired outcomes, nursing interventions, and nursing diagnoses, has reliability, content validity, and evidence of construct validity. The purpose of this article is to introduce the conceptual framework, taxonomy, and potential clinical applications of the PNDS.

A criterion-referenced measure of latex allergy knowledge.

The exponential use of latex products has increased patients' and health care workers' sensitization to natural rubber latex. The purpose of this research study was to develop and test a set of items designed to measure professional nurses' knowledge about natural rubber latex reactions and interventions appropriate for latex precautions. The items were developed from research reports in the literature and changed to reflect the suggestions offered by experienced perioperative nurses (pilot = 8) and three nationally known experts in latex allergy responses. The revised form was mailed to the home or distributed at the workplace of perioperative nurses (n = 158). Criteria for item retention were < .90 difficulty index and clinical relevance. Certified nurses (i.e., CNORs) scored significantly higher than other nurses who took the test at the same time (t-test = 2.00, P = .05). A pretest and posttest evaluation of the revised 20 items was conducted before and after a latex allergy continuing education program during the spring of 1998. The current knowledge test (i.e., version 1.1) has reliability (alpha = .80); content validity (CVI = .92); and accumulated evidence of construct validity (preinstruction mean = 14.16, postinstruction mean = 17.15, t-paired = 10.54, df = 70, P = < .001). An empirically developed professional nurse latex allergy competency test suitable for clinical use was the outcome of this research study.

Patients as peer preceptors for orthopedic oncology rehabilitation patients.

This article describes a peer preceptor program that trains patients who have experienced limb preservation surgeries and managed long-term rehabilitative therapy to support and teach newly diagnosed patients through their rehabilitation. This preceptor program was designed to complement the professional counseling and support that rehabilitation staff provide to patients and their families. Training includes communication techniques, practice sessions using videotaped scenes of patients and their families, as well as role-playing. Experienced patients who became preceptors as a result of this program were orthopedic oncology patients who had completed limb preservation surgery, chemotherapy, grafting, and physical therapies. After their training, preceptors exhibited improved communication skills in terms of empathy, listening, and voice expressions. Initiatives designed to make the preceptor program self-sustaining by having staff nurses manage the training still have to be tested.

The prevalence of perioperative nurse clinical judgments.

A clinical judgement about a patient situation precedes the selection of appropriate nursing actions and the identification of patient outcomes. The North American Nursing Diagnosis Association nomenclature (i.e., nursing diagnoses) is the accepted language for naming nurse's clinical judgements. Two hundred thirty-nine members of the Association of Operating Room Nurses, Inc, rated the frequency and treatment priority of 60 nursing diagnoses. They rated two diagnostic labels (i.e., risk for perioperative positioning injury, risk for infections occurring in more than 50% of the clinical judgments they make about perioperative patient situations that require immediate nursing action. These data reinforce perioperative nurses' primary role in protecting surgical patients from harm.

In search of perioperative nursing data elements.

A 14-member task force appointed by the AORN Board of Directors began the process of identifying perioperative nursing data elements in November 1993. During the ensuing two years, the task force members identified perioperative nursing intervention data elements, linked these data elements to specific patient outcomes, and asked 232 AORN members to validate the list of intervention data elements. This article explains the value of data elements to perioperative nurses, describes the consensus process used by the task force, and presents the Perioperative Nursing Data Elements: Interventions, Version 1.0.

Outpatient recovery after laparoscopic cholecystectomy.

Economic incentives and technologic advances have encouraged health care providers to shift an increasing portion of postoperative care out of the hospital. Selected patients undergo complex outpatient surgical procedures and are discharged within 24 hours of surgery. Because this trend is relatively new, published accounts of patients' experiences with at-home recovery are rare. Consequently, the authors conducted a qualitative study of 19 patients who underwent laparoscopic cholecystectomy procedures on an outpatient basis. Using semistructured postoperative telephone interviews, the authors monitored the patients' recovery processes. One theme (ie, toward a usual self) with two patterns (ie, progressive activity, self-management) emerged. The results reveal patients' definitions of recovery, understanding of postoperative instructions, willingness to ask questions, and advice for patients undergoing similar procedures. Nursing implications for discharge instructions and follow-up care also are discussed.

Patient outcomes. Are they linked to registered nurse absenteeism, separation, or work load?

Using a correlation design, the authors explored the possible associations between patient outcomes and staff registered nurse absenteeism, separation from the work unit, and work load. Data analysis included a search for consistent patterns of relationships across acute care hospitals and over time. Nosocomial urinary tract and bloodstream infections correlated positively with absenteeism. The authors discuss clinical and methodological issues related to the findings.

What future will perioperative nurses choose by 2010?

The future does not just happen. Events of yesterday provide the brick and mortar for today. The future of perioperative nursing practice depends on how we arrange the brick and mortar today. We cannot predict the future; the future is chosen based on what actions we plan for tomorrow. Health care, surgical care, and illness care will change a great deal as we enter the twenty-first century. Our specialty cannot afford to be preoccupied with past accomplishments, reacting only to daily events rather than creating a chosen future. AORN has taken a major step by establishing the Project 2000 teams to analyze the present and plan for the future. Members must be willing to abandon the status quo. Looking beyond current practice to the expanding edges of perioperative nursing offers new opportunities. Where will we be in 2010? The future is ours to choose.

A place to be yourself: empowerment from the client's perspective.

This article describes a focused ethnography of a group of chronically mentally ill clients who were involved in a client-run drop-in center. Spradley's (1979) Developmental Research Sequence guided the research. Data were obtained from interviews, participant-observation and documents review. The qualitative analysis identified the major theme of empowerment, which had four process domains: participating, choosing, supporting and negotiating. These domains represented four levels of empowerment for this group. From the client's perspective, empowerment meant they participated more in the community, their choices were increased, they provided support for each other and they negotiated on a more equal basis with staff. A fifth domain, personal significance, described the effects of empowerment for each individual.

Surgery trends change nursing care: operating room nurses share new procedures that will affect home healthcare.

The word "surgery" does not mean what is used to. Community nursing care means something different now, too.

Poster sessions bring research to the OR.

Placing posters that report valid nursing research results to staff members in a convenient area in the surgical suite could be the first step toward elevating nursing practice in your operating room. Plan to start small, include interested volunteers, and spend time educating each other about the research process. A first-year goal of one poster per quarter is a realistic and positive step.