ABSTRACT

The University of Hertfordshire is currently setting up the largest medical simulation centre in UK and it is being presented in this article with some background information. This new centre includes a range of simulated clinical and community environments and makes use of modern patient simulators that will enhance the students' learning experience.

Pre-operative assessment (POA) has been advocated for use to achieve a number of goals including reducing cancelled operations on the day of surgery, and therefore waiting lists. POA has historically been provided by junior doctors, but the change in focus of their role in addition to the new roles being taken on by nurses has led to nurse-led POA. The aim of this review was to determine whether nurse-led POA reduces the cancellation rate of elective surgical in-patient procedures. The Cochrane Library, Medline, Cinahl and Embase databases were searched for systematic reviews, randomised control trials and cohort studies examining nurse-led POA. After applying inclusion criteria only four cohort studies were deemed to be suitable to be critically appraised. One study had no cancellations in either the doctor or nurse-led POA groups. Another study had low cancellation rates in the nurse-led POA group, but the control group was not suitably defined for adequate verification as to whether the cancellation rates were lower because they had been pre-assessed. The final two studies revealed similar absolute risk reductions, number needed to treat and odds ratios. In summary nurse-led POA appears to reduce cancellation rates on admission, but the evidence for this is relatively weak, primarily because study samples have been small. Further trials are needed which have samples that are sufficient to detect a true difference between the intervention and control group if one exists.

Within this article the author critically reviews the theories surrounding clinical decision making and judgement while discussing a clinical incident, and his experiences of decision making within his own practice setting. Exploring the works of Elstein and Schwarz, Benner, Hammond and Hamm, the author discusses how aspects from each of their theories relate to his practice and clinical reasoning before concluding on the clinical decision-making process and factors that can influence their successful application.

Background: Postoperative hypothermia is stressful and elevates blood pressure and heart rate. This study evaluated the effects of warming IV fluids on the perioperative hemodynamic situation.

Methods: Perioperative hemodynamic parameters were measured in 60 patients undergoing orthopaedic surgery. Patients were divided into two groups according to the temperature of intraoperative IV fluids.

Results: Core and skin temperature of the two groups decreased during surgery but reduced more in the hypothermic group (p < 0.005). Postoperative mean arterial blood pressure increased more in the hypothermic group versus normothermic group (p < 0.005). Shivering was observed in 21 of 30 hypothermic and 11 of 30 normothermic group (p < 0.005) and recovery time was lower in normothermic group (36 ± 5 vs. 26 ± 3 min, p < 0.005).

Conclusion: Warming of intraoperative IV fluids reduces perioperative changes in hemodynamic parameters.

ABSTRACT

On the basis of hypothesis from our own practice, a study dealing with postoperative urine retention (PUR) in patients in the recovery ward was completed during 2006 in Odense University Hospital.

Three hundred and seven patients took part in the study with a view to monitoring the occurrence of PUR and to identify the relationship between risk factors and the development of PUR. Defining PUR as >300 mL in the bladder with the inability to urinate, the study showed that 28.7% of the patients had PUR at arrival to the recovery ward.

The study showed a positive correlation between patients with ascending age, rising anaesthesia duration, regional anaesthesia (RA) and developing PUR.

PUR occurred in half of the patients with diabetes and approximately half of the patients treated with ephedrine. Furthermore, the type of surgery had significance, as considerably more patients with plastic and orthopaedic surgery developed PUR. On the other hand, the study showed no correlation between subjective symptoms, e.g. like a strong desire to void, and the occurrence of PUR.

The results highlight the necessity for greater attention to screening patients for PUR.

Chestnutt and Everhart [2007] describe how the nursing shortage has led to an influx of new graduate nurses into the acute care nursing setting. Georgetown University Hospital (GUH) is experiencing this influx in all nursing specialties including the post-anesthesia care unit (PACU). The New Graduate Nurse Program started in 2001 and the PACU has participated in the New Graduate Program since 2002. On average, GUH hires 90 new graduate nurses a year; the PACU acquires four to seven new graduate nurses each year. In 2006, the American Association of Critical-Care Nurses (AACN) conducted a national survey and found that 80% of the respondents had a structured critical care orientation program for newly licensed nurses [Thomason, 2006]. Since the PACU is a critical care area, leadership desired a standardized program to create the optimal PACU nurse. This article explores the Perianesthesia New Graduate Orientation Program at GUH and presents the charactertics of such a program. In addition, the successes and challenges of the program will be discussed.

This article is the first in a series which will explore the identification and management of cardiac arrhythmias within the peri-operative care setting. To improve patient safety, the number of patients who are monitored within the recovery room is rising, whilst cardiac monitoring remains a fundamental requirement for patient care during the anaesthetic phase. Therefore, the role of the peri-operative care nurse requires an ability to interpret cardiac arrhythmias and to subsequently instigate the appropriate management.

The purpose of this preliminary article is to establish the basic principles that underpin the identification and management of arrhythmias. Cardiac physiology is reviewed and then applied to the derivation of the waveforms of the normal ECG. The article continues with a summary of accurate electrode placement and some tips for troubleshooting in the presence of ‘artifact’. A systematic analysis tool, which can be easily applied to clinical practice, completes the article.

Decision making in post-anaesthetic care practice is an underresearched area. The patient undergoes rapid and profound physiological change in the early stages of recovery. The practitioner is required to assimilate information about the patient, assess his clinical status, plan proactive care and provide an immediate reactive intervention depending on his/her condition. Knowledge and understanding of the standard risks of anaesthesia and surgery ensure that the practitioner is able to prevent complications arising in the routine recovery. This article investigates the role that risk assessment plays in clinical decision making and planning care in the post-anaesthetic care unit.

Chicago Illinois, home to both IFNA and AANA, this year hosted the 6th world congress for nurse anaesthetists. The largest convention for this nursing speciality the world has ever seen. Over 3000 delegates from over 22 countries attended this 5-day conference, encompassing clinical workshops/ presentations, management/education forums, political debates together with an impressive commercial exhibition and a poster presentation. I was fortunate indeed to replace Clara Bradshaw on this occasion as the UK National Representative and it was an experience that I will not forget.

This article continues the series on cardiac monitoring in the peri-operative area by reviewing those arrhythmias that are classified as atrial or supraventricular. Whilst these arrhythmias are rarely life threatening, their haemodynamic effects can be significant and may not be tolerated in conjunction with the concurrent operative procedures. These arrhythmias are however, very commonly seen in perioperative practice and may be associated with anaesthetic procedures, surgical techniques and the recovery phase. In this increasingly technological age, it is imperative that perioperative practitioners can recognise and respond appropriately to the rhythms observed on the cardiac monitor.

The purpose of the study was to describe the day-surgery patients’ shoulder operation counselling from the patients’ perspective. The aim was to produce information for patient counselling on the day-surgery unit. For the study, nine patients who had shoulder operations as day-surgery patients were interviewed during spring 2012 using thematic interviews approximately one week after the operation. As a method of a qualitative study, inductive content analysis was used.

The results indicate that, as a result of counselling, patients experience feelings of safety and trust as long as they receive enough information and are included in decision making. Professional staff and a positive care environment promote the feeling of safety and trust. The results also demonstrate that lack of counselling and factors that affect the patients’ internalisation of the counselling leads to feelings of insecurity. The study showed that patients possess their own individual coping mechanisms, which support counselling.

With regard to counselling in relation to shoulder surgery the results produce new knowledge, as there is no previous research regarding patients’ experiences of counselling for shoulder surgery in the day-surgery setting in Finland. The results indicate that the patient's personal counselling experiences are wide ranging, and the findings call for a new approach when developing nursing care in the future.

Recommendations from this study produce information that can be incorporated into post-graduate nurses’ induction, training, and the results can also enhance written patient instructions.

Laryngospam is a relatively common airway emergency. Mevorach [1996] cites Olsson and Hallen [1984] who found a mean incidence of 8.6/1000 in adults and 27.6/ 1000 in children. From these figures it can be assumed that most post anaesthetic care nurses at some time in their career will encounter it. Prompt action is required, and knowledge of the physiological processes involved along with an appreciation of the treatment options available. This article will aim to discuss laryngospasm and will examine briefly the phenomenon of post laryngospasm induced pulmonary oedema.

With regard to the problematic use of opioid analgesic drugs, attention is focused not only on those who began using opioids for recreational purposes, but also on those who may become iatrogenically addicted to opioids administered for pain control. It has been suggested that narcotics opioids cause psychological and physical dependence after relatively small therapeutic doses, for a relatively short period of administration Glatt 1974 and that physical dependence may even start to manifest after a single therapeutic dose Qones 1980. Despite these claims, some patients report that they are able to benefit from relatively long-term opioid analgesia without experiencing the effects of problematic drug use that are associated with recreational drug users (Cowan et al 2001, 2002). This issue has obvious implications for anaesthetic and recovery room practitioners who routinely administer opioids to patients in their care. In view of this, the following case study report may be of interest to such practitioners.