Complementary and Alternative Medicines for the Postoperative Patient.

The Medical-Surgical Nursing Certification Board (MSNCB) is a professional organization whose mission is to validate excellence in medical-surgical nursing. MSNCB administers the Certified Medical-Surgical Registered Nurse (CMSRN®) and Certified in Care Coordination and Transition Management (CCCTM) certification programs because certification is the recognized path for registered nurses to build and demonstrate commitment, confidence, and credibility. Certification provides an added credential beyond licensure. It demonstrates, by examination, that the registered nurse adheres to specialized nursing standards and has acquired a core body of specialized knowledge in his or her practice or specialty. The topic of this article is part of the comprehensive examination given by MSNCB. The following scenario and questions offer an example that potential certificants may use to test their knowledge. For more information about MSNCB, visit www.msncb.org.

Guideline implementation: local anesthesia.

It is not uncommon in perioperative settings for patients to receive local anesthesia for a variety of procedures. It is imperative for patient safety that the perioperative RN has a comprehensive understanding of best practices associated with the use of local anesthesia. The updated AORN "Guideline for care of the patient receiving local anesthesia" provides guidance on perioperative nursing assessments and interventions to safely care for patients receiving local anesthesia. This article focuses on key points of the guideline to help perioperative personnel become knowledgeable regarding best practice as they care for this patient population. The key points address patient assessment, the importance of having an overall understanding of the local agent being used, recommended monitoring requirements, and potential adverse events, including life-threatening events. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

A study of clinical and information management processes in the surgical pre-assessment clinic.

BACKGROUND: Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. METHODS: As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team. RESULTS: The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team. CONCLUSION: Successful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial - yet unfulfilled - potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes.

Treating patients with smallpox in the operating room.

Recent events around the world have emphasized the need for health care facilities to prepare to deal with biological threats, including smallpox. At Walter Reed Army Medical Center, Washington, DC, administrators recognized the need for a policy on handling patients with smallpox in the OR and asked a group of students to create a template policy for care of patients with smallpox in need of surgery. This article provides a brief history of smallpox, concerns surrounding smallpox today, and smallpox characteristics with which perioperative personnel should be familiar, as well as a guideline for treating patients in the OR who have smallpox.

Hospitalized children's descriptions of their experiences with postsurgical pain relieving methods.

The purpose of this study was to describe children's (aged 8-12 yr) experiences with postsurgical pain relieving methods, and their suggestions to nurses and parents concerning the implementation of pain relief measures in the hospital. The data were collected by interviewing children (N = 52) who were inpatients on a pediatric surgical ward in the university hospital of Finland. Content analysis was used to analyze the data. The children rated the intensity of pain on a visual analogue scale. The results indicated that all of the children used at least one self-initiated pain relieving method (e.g. distraction, resting/sleeping), in addition to receiving assistance in pain relief from nurses (e.g. giving pain killers, helping with daily activities) and parents (e.g. distraction, presence). The children also provided suggestions, especially as it relates to nurses (e.g. creating a more comfortable environment), regarding the implementation of effective surgical pain relief. However, some cognitive-behavioral and physical methods were identified that should be implemented more frequently in clinical practice. Furthermore, most children reported their worst pain to be severe or moderate, which indicates that pain management in hospitalized children should be more aggressive.

A deficit in care. The educational needs of thoracic patients.

1. There is a need for increased educational input for thoracic surgical patients. 2. Information and health education are important aspects of holistic care. 3. Care plans should aim to help the patient regain and maintain a level of independence. 4. Discharge planning should ideally begin prior to admission for surgery.

Practical points in the assessment and management of postoperative pediatric pain.

Pain assessment is a complex yet essential aspect of holistic care of the pediatric patient during the postoperative period. Because children cannot verbalize pain, the PACU nurse is faced with the challenge of assessing pain. This article attempts to provide guidelines in assessing postoperative pediatric pain and reviews common analgesic drugs.