The Impact of Scripted Pain Education on Patient Satisfaction in Outpatient Abdominal Surgery Patients.

PURPOSE: Practice guidelines for acute pain management in perioperative patients recommend providing consistent perioperative pain education that includes medication and behavioral techniques to control pain. However, literature indicates that most nurses deliver patient education based on personal preferences, time limitations, and availability of teaching aids. The purpose of this study was to evaluate patient satisfaction with scripted preoperative pain management education for patients undergoing outpatient abdominal surgery. DESIGN: A pretest and posttest design compared patient perceptions of and satisfaction with pain management education before and after the introduction of scripted education. METHODS: An independent t test was applied to measure differences between groups. FINDINGS: The postscripting group responses indicated that pain education was helpful in managing postoperative pain at a significant (P = 0.03) level. CONCLUSIONS: Use of scripted dialog, along with specific written patient education, has a positive impact on postoperative patient satisfaction with pain management.

Creating an "I can do attitude" toward orthopaedic nurse certification: convenient, efficient, and effective.

As hospitals and healthcare have become specialized, so has nursing. Orthopaedic nurse certification is an example of this specialization. The purpose of this article is to describe the outcomes of one specialty hospital's implemented plan designed to encourage and support nurses seeking to demonstrate expertise in orthopaedic nursing practice. A review course was developed with attention to potential barriers and concerns that were identified in the review of literature. Successful resolution of problems encountered with staff nurses becoming orthopaedic nurse certified are described. Participants in the first 2 sessions passed the examination on the first attempt at a rate of 100% and 88%, which exceeds the national rate of 86.5% (Orthopaedic Nurse Certification Board, 2011, retrieved from http://oncb.org/certification-statistics). Since initiation of the program, the number of "orthopaedic nurse certification" nurses has nearly tripled in this orthopaedic specialty hospital.

Implementation of an evidence-based order set to impact initial antibiotic time intervals in adult febrile neutropenia.

PURPOSE/OBJECTIVES: To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. DESIGN: Practice change. SETTING: The oncology unit of an urban hospital in the south-eastern United States. SAMPLE: Adult patients with cancer and febrile neutropenia admitted six months prior to (n = 30) or during the three months following (n = 23) implementation of the order set. METHODS: Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Time intervals were analyzed using SPSS® software, version 18. MAIN RESEARCH VARIABLES: Initial antibiotic times, order-set use, and length of stay. FINDINGS: An overall reduction in time intervals for initiation of antibiotic therapy was observed for presentation (t = 2.25; degrees of freedom [df] = 37; p = 0.031) and order (t = 2.67; df = 40.17; p = 0.012) to antibiotic administration, with an order-set usage of 31% in the inpatient unit and 71% in the emergency department. CONCLUSIONS: Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit-based medication dispensing machines helped reduce time intervals for initial antibiotic therapy. IMPLICATIONS FOR NURSING: The use of an evidence-based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence-based practice changes.

Revision total hip and total knee arthroplasty.

For thousands of patients with advanced degenerative joint disease, total joint arthroplasty provides improved function, decreased pain, and the opportunity to resume a more active lifestyle (Drake, Ace, & Maale, 2002). Although hip and knee replacements are both successful interventions for degenerative joint conditions, complications may arise that require revision of the original surgery. In 1999, approximately 25,000 revisions of knee replacements (ICD Code 81.22) and 30,000 revisions of hip replacements (ICD Code 81.53) were performed in the United States (American Academy of Orthopaedic Surgeons [AAOS], 2002). Approximately 10,000 revision total hip arthroplasty procedures were performed on Medicare patients in 2000. The total cost of revision surgery, including the 10,000 total knee revision procedures performed on this same patient population during that year, exceeds USD 3 billion (Bourne, Maloney, & Wright, 2004). Descriptions of the risk factors and indications for revision total hip and total knee arthroplasty are included in this article. Nursing interventions and patient education specific to these patient populations are outlined, and a discussion of complications following revision total joint arthroplasty is included.

Understanding spinal stenosis.

Spinal stenosis is a progressive condition that represents approximately 5% of all back disease. Symptoms usually appear around age 50 to 60 and lead to increasing pain and disability as the condition progresses. Understanding the disorder, appropriate diagnostic tests, and treatment options is essential to providing appropriate nursing care and education for this patient population. Included in this article is a review of normal spine anatomy, pathology and symptoms of spinal stenosis, treatment options, appropriate nursing interventions, and patient education for the patient with spinal stenosis.