RESUMEN
PURPOSE: As recovery time after oncological surgery can be long, family caregivers often play an important role in the delivery of care after patients' discharge. To prepare carers for this role, we developed a family involvement program (FIP) to enhance their active involvement in post-surgical oncology care during hospitalization. The purpose of this qualitative study was to explore family caregivers experience of participating in a FIP. METHODS: We conducted semi-structured interviews with 12 family caregivers who participated in the family involvement program. The program is comprised of two main components (1) training and coaching of physicians and nurses; (2) active involvement of family caregivers in fundamental care activities. This active involvement included six activities. Data were analyzed using interpretative phenomenological analysis. RESULTS: Family caregivers positively valued the program. Active participation in post-surgical care was experienced as an acceptable burden. The program gave participants the ability to simply be present ('being there') which was considered as essential and improved their understanding of care, although family caregivers sometimes experienced emotional moments. Active involvement strengthened existent relationship between the family caregiver and the patient. Participants thought clinical supervision. by nurses is important. CONCLUSIONS: Physical proximity appeared as an essential part of the family involvement program. It helped carers to feel they made a meaningful contribution to their loved ones' wellbeing. Asking families to participate in fundamental care activities in post-surgical oncology care was acceptable, and not over-demanding for caregivers.
Asunto(s)
Cuidadores/educación , Cuidadores/psicología , Familia/psicología , Atención Domiciliaria de Salud/educación , Atención Domiciliaria de Salud/psicología , Neoplasias/enfermería , Enfermería Posanestésica/educación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación CualitativaRESUMEN
QUALITY PROBLEM: For smokers, hospital admission is accompanied by forced involuntary nicotine abstinence due to smoke-free site/grounds policies. An audit of patients admitted to our surgical wards revealed that identification of smoking status was inadequate and that nicotine addiction management (NAM) was infrequently offered. The project aimed to enhance both these metrics by initiating NAM in the post anesthesia care unit (PACU). INITIAL ASSESSMENT: Out of 744 patients admitted to our PACU in August 2015, 54% had their smoking status documented. The 200 patients (27%) out of the 744 were smokers and only 50% were offered NAM before discharge. CHOICE OF SOLUTION: PACU unit staff to determine the smoking status of every patient before discharge from the PACU (later changed to OR nursing staff) and, if a patient was identified as a smoker, to offer NRT (patch and mouth spray only) and initiate therapy prior to transfer of the patient to the ward. IMPLEMENTATION: Data about number of patients admitted, presence of documented smoking status, number of identified smokers, and number offered/accepted nicotine replacement therapy (NRT) were collected at baseline and thereafter quarterly. Engaging video education sessions addressed the education gaps highlighted in a needs assessment. Identification of smoking status was made part of preoperative checklist and NRT was made available in post-operative recovery room. RESULTS: These interventions resulted in an increase in screening for tobacco use from 54% at baseline to 95% and the offer of NRT to smokers from 50 to 89%.
Asunto(s)
Enfermería Posanestésica/métodos , Mejoramiento de la Calidad/organización & administración , Fumadores/estadística & datos numéricos , Dispositivos para Dejar de Fumar Tabaco/estadística & datos numéricos , Alberta , Lista de Verificación/estadística & datos numéricos , Humanos , Transferencia de Pacientes/organización & administración , Enfermería Posanestésica/educación , Sala de Recuperación/organización & administraciónRESUMEN
Pierre is assigned to the Post-operational Recovery room. The care team comprises two anaesthetic nurses, a trainee anaesthetic nurse, a qualified registered nurse, and a healthcare assistant. In addition, an anaesthetist is available to intervene at any time.
Asunto(s)
Enfermería Posanestésica/métodos , Adulto , Preescolar , Humanos , Capacitación en Servicio , Masculino , Enfermeras Anestesistas/educación , Grupo de Enfermería/organización & administración , Pase de Guardia , Enfermería Posanestésica/educación , Resucitación/enfermería , Estudiantes de EnfermeríaRESUMEN
: Postoperative urinary retention (POUR) is the inability to void when the bladder is full after surgery. It is a common complication in postoperative patients, especially in patients undergoing spinal surgery. At our institution, patients who were discharged from the postanesthesia care unit (PACU) to the inpatient surgical unit typically had bladder distention and a bladder volume of more than 450 mL. In an effort to address this situation, an interprofessional group of advanced practice RNs and physicians formed a team, reviewed the existing literature, examined the PACU nursing practice guideline for evaluating and managing POUR, and devised a quality improvement (QI) project to raise the PACU nursing staff's awareness of the potential for POUR among postoperative patients and to develop an updated nursing practice algorithm for the evaluation and management of POUR in spinal surgery patients. A description of the QI process, including the revised algorithm and pre- and postintervention results, is reported here. In the preintervention group (n = 42), 19 indwelling urinary catheterizations were documented in patient records; no use of intermittent catheterization was documented. In the postintervention group (n = 43), seven indwelling urinary catheterizations were documented in patient records; the use of intermittent catheterization was documented in 11. As a result of our intervention, we decreased the number of indwelling urinary catheters inserted in the PACU, and supported the PACU nursing staff in more frequent and appropriate use of intermittent catheterization in patients undergoing spinal surgery.
Asunto(s)
Enfermería Basada en la Evidencia , Enfermeras Clínicas , Complicaciones Posoperatorias/enfermería , Columna Vertebral/cirugía , Retención Urinaria/terapia , Humanos , Enfermería Posanestésica/educación , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Mejoramiento de la Calidad , Estudios Retrospectivos , Cateterismo Urinario/efectos adversos , Retención Urinaria/diagnóstico , Retención Urinaria/etiología , Retención Urinaria/enfermeríaRESUMEN
The end of the formal unit orientation program is a stressful time of adjustment for nurses hired into critical care without previous critical care experience. Although most units offer reassurance that experienced colleagues will provide the needed guidance, consistent support may not be available for many reasons. Development of a structured postorientation program designed to provide support and ongoing feedback to bedside nurses who have completed orientation is one strategy to assist nurses through this period of adjustment. The experience and expertise of the tele-intensive care unit nurse are excellent resources that can be called on to provide the needed support.
Asunto(s)
Enfermería de Cuidados Críticos/educación , Enfermería de Cuidados Críticos/métodos , Educación a Distancia/métodos , Retroalimentación Formativa , Enfermeras y Enfermeros , Enfermería Posanestésica/educación , Enfermería Posanestésica/métodos , Humanos , Unidades de Cuidados IntensivosAsunto(s)
Planificación de Atención al Paciente/normas , Enfermería Posanestésica/normas , Cuidados Posoperatorios/enfermería , Cuidados Posoperatorios/normas , Educación en Enfermería , Humanos , Comunicación Interdisciplinaria , Grupo de Enfermería/organización & administración , Grupo de Enfermería/normas , Planificación de Atención al Paciente/organización & administración , Enfermería Posanestésica/educación , Enfermería Posanestésica/organización & administración , Sala de Recuperación/normas , Estándares de ReferenciaRESUMEN
OVERVIEW: Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post-critical illness morbidities and improving the ICU survivor's quality of life.
Asunto(s)
Continuidad de la Atención al Paciente/organización & administración , Conducta Cooperativa , Cuidados Críticos/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Grupo de Atención al Paciente/organización & administración , Enfermería Posanestésica/organización & administración , Sobrevivientes/psicología , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/enfermería , Ansiedad/prevención & control , Competencia Clínica , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/enfermería , Disfunción Cognitiva/prevención & control , Curriculum , Educación Continua en Enfermería , Femenino , Servicios de Salud para Ancianos/organización & administración , Hospitales Públicos , Hospitales Universitarios , Hospitales Urbanos , Humanos , Indiana , Enfermedades Pulmonares/enfermería , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Estudios de Casos Organizacionales , Innovación Organizacional , Enfermería Posanestésica/educación , Enfermería Posanestésica/métodos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/enfermería , Trastornos por Estrés Postraumático/prevención & control , Síndrome , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: Postoperative pain should be aggressively treated to decrease the development of chronic postsurgical pain. There has been an increase in the use of Human Patient Simulator (HPS) for teaching advanced courses in pharmacology to medical students, residents, and nurses. The aim of this educational investigation was to pilot the HPS for the training of medical students and surgical recovery room staff nurses in the pharmacology of opioids for the management of postoperative pain. METHODS: The computerized HPS mannequin is fully monitored with appropriate displays and includes a voice speaker mounted in the head. Medical students and Postanesthesia care unit nurses, led by faculty in the Department of Anesthesiology in small groups of 4-6, participated in a 2- to 3-hour HPS course on the use of opioids for the management of acute postoperative pain. Trainees were asked to treat the acute and severe postoperative pain of a simulated patient. Opioid effects and side effects (such as respiratory depression) were presented on the mannequin in real time to the participants. Side effects of naloxone to reverse opioid depression were presented as a crisis in real time to the participants. Participants completed a 10-item course evaluation using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). RESULTS: Twenty-two nurses and nine medical students completed the HPS opioid pharmacology scenario. Almost all participants rated the HPS course very highly and rated every item as either agree or strongly agree. Most participants agreed that the simulator session improved their understanding of opioid pharmacology including opioid side effects and management of opioid complications. Course participants felt most strongly (median, interquartile range) that the simulator session improved their understanding of naloxone pharmacology (5, 0), simulators serve as a useful teaching tool (5, 0), and that they would be pleased to participate in any additional HPS teaching sessions (5, 0). CONCLUSIONS: The HPS provides a novel educational format to teach essential information regarding opioid pharmacology for the management of acute postoperative pain. The HPS provides a realistic format to teach the pharmacology of acute opioid side effects and the management of acute and life-threatening side effects of naloxone therapy.
Asunto(s)
Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Simulación por Computador , Instrucción por Computador , Maniquíes , Dolor Postoperatorio/tratamiento farmacológico , Farmacología Clínica/educación , Depresión Química , Educación de Pregrado en Medicina/métodos , Educación de Postgrado en Enfermería/métodos , Tecnología Educacional , Humanos , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Proyectos Piloto , Enfermería Posanestésica/educación , Cuidados Posoperatorios/educación , Evaluación de Programas y Proyectos de SaludRESUMEN
Patients' feedback about their perianesthesia experience at an acute care 609-bed teaching hospital in Washington, DC, indicated that pain management was an area in need of improvement. A nonexperimental descriptive study related to pain management was conducted in the perianesthesia areas to assess the knowledge and attitudes of health care providers. McCaffrey and Ferrell's 38-item self-report questionnaire was given to anesthesia providers, preoperative nurses, Phase I nurses, and Phase II nurses (N=138). Seventy-two participants responded, yielding a 52% response rate. Results showed a statistically significant difference between the scores of the anesthesia care providers and the preoperative area nurses and between the Phase I nurses and the preoperative nurses. No statistically significant differences were found between the anesthesia providers, and Phase I and Phase II nurses, indicating that at this hospital, nurses who provide postoperative care have similar knowledge and attitudes regarding pain as the anesthesia providers.
Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Personal de Enfermería en Hospital , Dolor Postoperatorio/prevención & control , Enfermería Posanestésica , Cuidados Posoperatorios , Centros Médicos Académicos , Análisis de Varianza , Competencia Clínica , District of Columbia , Retroalimentación Psicológica , Estudios de Seguimiento , Humanos , Enfermeras Anestesistas/educación , Enfermeras Anestesistas/organización & administración , Enfermeras Anestesistas/psicología , Investigación en Educación de Enfermería , Investigación Metodológica en Enfermería , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/psicología , Enfermería Posanestésica/educación , Enfermería Posanestésica/organización & administración , Cuidados Posoperatorios/educación , Cuidados Posoperatorios/enfermería , Cuidados Posoperatorios/psicología , Cuidados Preoperatorios/educación , Cuidados Preoperatorios/enfermería , Cuidados Preoperatorios/psicología , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The aim of this study was to assess nurses' perceptions of their level of competence in their work in the department of anesthesiology, recovery care, and pain management. A second objective was to establish a training strategy after possibly detecting subjectively perceived needs in different areas of competence. MATERIAL AND METHODS: In 2007, 25 nurses belonging to the department of anesthesiology, recovery care, and pain management responded to a questionnaire based on the hospital's professional development plan. The questionnaire included items listing activities performed by anesthesia nurses in various areas of competence (patient relations and communication, health education, nursing process, task delegation, safety and prevention, team work, ethics, teaching and research, administration). RESULTS: A self-assessment of "good" or "very good" was recorded by 87.8% of the nurses, while only 6.3% evaluated their skills as "sufficient" or "insufficient". The main areas in which training was felt to be needed were safety and risk prevention, and teaching and research. CONCLUSIONS: In self-assessment, the anesthesia nurses in our hospital expressed awareness of training needs. The means to correct skill deficits should be provided, through training in theory and practice and attendance at continuing professional development courses for anesthesia nurses. The nurses' interest in further training should be encouraged given the direct effect it has on quality of care.
Asunto(s)
Competencia Clínica , Enfermeras y Enfermeros/psicología , Personal de Enfermería en Hospital/psicología , Enfermería Perioperatoria , Autoevaluación (Psicología) , Adulto , Educación en Enfermería , Educación de Postgrado en Enfermería , Hospitales Universitarios , Humanos , Relaciones Interprofesionales , Persona de Mediana Edad , Enfermeras Anestesistas/psicología , Grupo de Enfermería , Enfermería Pediátrica/educación , Enfermería Perioperatoria/educación , Enfermería Posanestésica/educación , España , Adulto JovenAsunto(s)
Comunicación , Continuidad de la Atención al Paciente/organización & administración , Educación Continua en Enfermería/organización & administración , Relaciones Interprofesionales , Errores Médicos/prevención & control , Administración de la Seguridad/organización & administración , Competencia Clínica , Humanos , Investigación en Educación de Enfermería , Enfermería de Quirófano/educación , Enfermería de Quirófano/organización & administración , Transferencia de Pacientes , Enfermería Posanestésica/educación , Enfermería Posanestésica/organización & administración , Desempeño de Papel , Gestión de la Calidad Total , Estados Unidos , United States Agency for Healthcare Research and QualityRESUMEN
Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiological, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients. Thus, techniques for effective acute pain management (APM) represent unmet educational needs. The significance of these unmet needs is reflected in the number of journal and textbook publications dedicated to disseminating research, evidence-based guidelines, and clinical information. Acknowledging the importance of APM, health care accrediting agencies and professional societies have become increasingly focused on ensuring that patients receive prompt and acceptable pain relief.
Asunto(s)
Necesidades y Demandas de Servicios de Salud/organización & administración , Dolor Postoperatorio/terapia , Atención Perioperativa/métodos , Enfermería Posanestésica , Enfermedad Aguda , Analgesia/métodos , Analgesia/enfermería , Actitud del Personal de Salud , Costo de Enfermedad , Predicción , Conocimientos, Actitudes y Práctica en Salud , Humanos , Evaluación de Resultado en la Atención de Salud , Dimensión del Dolor/métodos , Dimensión del Dolor/enfermería , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/economía , Dolor Postoperatorio/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Atención Perioperativa/enfermería , Enfermería Posanestésica/educación , Enfermería Posanestésica/métodos , Guías de Práctica Clínica como Asunto , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiologíaAsunto(s)
Analgesia Epidural/enfermería , Catéteres de Permanencia , Rol de la Enfermera , Dolor , Guías de Práctica Clínica como Asunto , Autonomía Profesional , American Nurses' Association , Analgesia Epidural/instrumentación , Analgesia Epidural/métodos , Protocolos Clínicos , Curriculum , Esquema de Medicación , Monitoreo de Drogas/enfermería , Humanos , Licencia en Enfermería , Evaluación en Enfermería , Dolor/tratamiento farmacológico , Dolor/enfermería , Enfermería Posanestésica/educación , Enfermería Posanestésica/organización & administración , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/enfermería , Sociedades de Enfermería , Estados UnidosAsunto(s)
Competencia Clínica , Enfermeras Clínicas/organización & administración , Enfermeras Clínicas/psicología , Enfermería Posanestésica/organización & administración , Adaptación Psicológica , Actitud del Personal de Salud , Educación Continua en Enfermería , Humanos , Capacitación en Servicio , Enfermeras Clínicas/educación , Enfermería Posanestésica/educaciónRESUMEN
Recognizing the advantages of the advanced practice nurse (APN), an urban medical center of 500+ beds created an innovative position. The decision was made to hire a nurse practitioner to manage patients seen in the busy PACU. This article is a description of the program. The article includes background, objectives, qualifications of the practitioner, collaborative practice agreement, delineation of privileges, and educational plan. The role description and daily practice plan of the practitioner are also discussed.
Asunto(s)
Educación Continua en Enfermería/organización & administración , Capacitación en Servicio/organización & administración , Enfermeras Practicantes , Rol de la Enfermera , Enfermería Posanestésica , Centros Médicos Académicos , Certificación , Continuidad de la Atención al Paciente/organización & administración , Curriculum , Humanos , Perfil Laboral , Privilegios del Cuerpo Médico/organización & administración , Ciudad de Nueva York , Enfermeras Practicantes/educación , Enfermeras Practicantes/organización & administración , Investigación en Evaluación de Enfermería , Objetivos Organizacionales , Selección de Personal , Enfermería Posanestésica/educación , Enfermería Posanestésica/organización & administración , Guías de Práctica Clínica como Asunto , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludAsunto(s)
Medicina Basada en la Evidencia/organización & administración , Modelos de Enfermería , Rol de la Enfermera , Investigación en Enfermería/organización & administración , Enfermería Posanestésica/organización & administración , Sociedades de Enfermería/organización & administración , Certificación/organización & administración , Diversidad Cultural , Humanos , Innovación Organizacional , Enfermería Posanestésica/educación , Estados UnidosRESUMEN
A descriptive correlational study was designed to evaluate ASPAN's continuing professional development (CPD) offerings by determining the modalities that ASPAN members use to obtain specialized perianesthesia education and their level of satisfaction with these offerings. An electronic survey developed by the researchers was used to query members of ASPAN with active email addresses. Participation in CPD offered by ASPAN varies considerably by modality. The respondents in this study preferred and were most satisfied with traditional delivery systems of lecture/seminar that provided clinical information. Participants were also sensitive to cost and location.
Asunto(s)
Actitud del Personal de Salud , Educación Continua en Enfermería/organización & administración , Personal de Enfermería , Enfermería Posanestésica/educación , Sociedades de Enfermería , Desarrollo de Personal/organización & administración , Adulto , Anciano , Certificación/organización & administración , Costos y Análisis de Costo , Educación a Distancia/organización & administración , Empleo/organización & administración , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación en Educación de Enfermería , Investigación Metodológica en Enfermería , Personal de Enfermería/educación , Personal de Enfermería/psicología , Sociedades de Enfermería/organización & administración , Encuestas y Cuestionarios , Enseñanza/organización & administración , Estados UnidosRESUMEN
This article will look at the implementation of the National Service Framework (NSF) for children, young people and maternity services with specific reference to the segregation of children from adult patients, and the requirements for appropriately trained staff in the care of children, within the Post Anaesthetic Care Unit (PACU).
Asunto(s)
Servicios de Salud del Niño/organización & administración , Reforma de la Atención de Salud/organización & administración , Atención Dirigida al Paciente/organización & administración , Sala de Recuperación/organización & administración , Medicina Estatal/organización & administración , Niño , Conducta Cooperativa , Toma de Decisiones en la Organización , Implementación de Plan de Salud/organización & administración , Política de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Interdepartamentales , Liderazgo , Rol de la Enfermera , Innovación Organizacional , Enfermería Pediátrica/educación , Enfermería Pediátrica/organización & administración , Enfermería Posanestésica/educación , Enfermería Posanestésica/organización & administración , Guías de Práctica Clínica como Asunto , Competencia Profesional , Reino UnidoRESUMEN
The purpose of this article is to share a recovery room practitioner's experience using reflection and to explore the issues surrounding extubation in the post anaesthetic care unit (PACU). Currently there are no national standards of practice for practitioners' learning and safe practice of extubation techniques within the PACU. Therefore, the possibility of an adverse incident is significantly increased, potentially causing harm to the patient and damage to any hospital's reputation as well as the practitioners' profession. The authors wish to identify the concerns by citing a clinical incident that lead to reflection and sharing of the experience through this article.