It is generally accepted that the theatre is a highly technical and complex environment where clinical risks need to be managed effectively to ensure safe practice and to limit liability and litigation. Although anaesthesia and post anaesthesia care has long been the focus of risk management, the potential for errors and adverse events remains high. When errors occur, it is important to analyse the causes, so that preventative measures can be taken and similar incidents do not reoccur. This article sets out to examine and evaluate the process of reflection using a critical incident approach. A model of reflective practice, as suggested by Johns [1996] has been used to structure this paper. A critical incident is described and key issues arising from it are discussed and reflected upon. This incident was chosen because important clinical and risk management issues were highlighted.

Bastien (1950), cited by Horn et al (1998b) first described post anaesthetic shaking over fifty years ago. Although the existence of this phenomenon is well documented, definition, cause and the benefits of individual treatments remain open for debate (Fotheringham 1998). However the mechanism for Post Anaesthetic Shaking (PAS) remains unclear (Sessler and Sessler 1998b), although the literature does suggest hypothermia is a factor, as too might be pain and stress. There are many variables effecting whether a patient will develop PAS. As much controversy remains regarding this condition the rationale for undertaking this paper is to improve care by broadening knowledge and thus allowing rapid and effective treatment to reduce the discomfort and distress experienced by the patient. This article is presented as a critical incident. Implications, for practice arising from this work suggest that more frequent monitoring and early intervention would enhance the available treatments. Further to this it appears that warming patients preoperatively, particularly those groups known to be at risk would reduce the incidence of hypothermia and consequently post anaesthetic shaking. Recommendations for future research would be further investigation in to the suggestion that body temperature need only vary by 0.2°C to affect a bodily response (such as shivering).

Post anaesthetic care nursing was viewed for many years as the ‘poor relation’ of theatre and anaesthetic nursing. This was for a number of reasons, but primarily because recovery of the anaesthetised patient was, until relatively recently ward based. However with the advent of anaesthesia becoming more ‘high tech’ the skill required to look after a patient post anaesthesia has increased and with that increase the need for a high level of education for nurses within this speciality. There is now a long English National Board course for the Post anaesthetic care nurse, and opportunities are arising for nurses working in this area to add to the body of knowledge in post anaesthetic care nursing.

As health care providers our philosophy is to deliver the very highest quality of care to our patients. However within many hospitals there are not firm policies to allow family members to see their loved ones in the immediate postoperative period. Thus parents are routinely not being encouraged to comfort and support their children within the Post Anaesthetic Care Unit. The evolution of ‘family centred’ care should result in parents being encouraged to be with and care for their children during hospitalisation. This has been found to be beneficial to all parties. Whilst parental presence in the anaesthetic room has become more accepted practice the same cannot be said of Post Anaesthetic Care Units despite the recommendations made by the Department of Health [1991] and ‘The Patients’ Charter [1996]. Why does this situation exist? Is it due to preconceived attitudes of the staff involved, parental ignorance or historical reasons? This article will examine available research and attempt to identify possible reasons why such situations exist within many Post Anaesthetic Care Units and suggest possible solutions.

Recent government changes to Critical Care in the Health Service have resulted in an increase in the numbers of critical care patients being nursed in Post Anaesthetic Care Units (PACU). Many recovery nurses have had to increase their knowledge and skills accordingly. This article will analyse the high dependency nursing care given to a patient in the PACU necessitated by the haemodynamic compromise of the patient's cardiovascular system following surgery. The need for admission to a high dependency bed will be discussed along with the assessment of shock, tissue perfusion, fluid replacement, and any pharmacological intervention. Psychological, social and ethical issues relating to the patient and family will also be identified. Concentrating on the first 24 hours post-operatively, a careful discussion and analysis of the clinical management given will be made, with reference to the clinical and physiological measurements. After an evaluation and reflection of the medical and nursing care given to the patient, this article will conclude with a brief reiteration of the key issues.

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.