Spinal cord stimulation for chronic, nonmalignant pain.

Chronic, nonmalignant pain differs from acute pain and cancer pain and can have a significant impact on people's lives. Many therapeutic modalities have been attempted for relief of this pain with varying degrees of success. These include opioid analgesics, relaxation methods, nerve blocks, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). SCS has been successful in decreasing nonmalignant pain when other methods have failed. Nurses play an active role in caring for patients receiving SCS through patient education, psychologic support, and programming the spinal cord stimulator. Because of the active role nurses take in pain management, a knowledge of pain transmission and the techniques and efficacy of spinal cord stimulation is important.

Surgical patients with multiantibiotic-resistant bacteria.

Although antibiotics can cure most bacterial infections, there is an increasing number of bacteria that are resistant to antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly prevalent in US health care facilities. The majority of these infections are found in patients who have extensive burns or surgical wounds. As a result, perioperative nurses must be knowledgeable about MRSA and its implications for the OR. There are many theories on how to control the spread of MRSA but not one definitive set of control measures. Perioperative nurses, in cooperation with infection control practitioners, must develop policies that detail how patients with MRSA will be treated.

Perioperative nursing implications of radical perineal prostatectomy.

Improvements of surgical techniques for radical prostatectomy, including nerve-sparing methods, have made surgery the preferred treatment for prostate-confined tumors. Perineal prostatectomy is tolerated well by patients, especially the elderly and those who are at high risk. Blood loss during perineal prostatectomy versus retropubic prostatectomy is minimal. Additionally, the perineal approach provides the surgeon with better exposure for anastomosing the bladder neck to the urethra. The bowel does not have to be manipulated in the perineal approach, which minimizes paralytic ileus. Perioperative nurses must become familiar with the technique, positioning, and equipment necessary to care for patients undergoing radical perineal prostatectomy.

Gender gaps within management.

Traditional roles need not become self-fulfilling prophecies if managers can bridge the gender gap. Feminine, as well as masculine, characteristics can be incorporated into managerial styles to enhance effective leadership. Autonomy, decision-making and assertiveness are as important as nurturing and caring. What are little girls made of? Little girls are made of sugar and spice and everything nice. What are little boys made of? Little boys are made of rats and snails and puppy dog tails.

A proficiency-based orientation program for perioperative nurses.

One of the primary responsibilities of staff development in the operating room is developing and implementing a comprehensive orientation and assessment program for nurse orientees. This orientation program must be relevant to both the nurse's and the hospital's needs. It must also meet the requirements of accreditation agencies. Proficiency Requirements for Entry-Level Perioperative Practice, a proficiency-based orientation program, meets those needs in a cost effective and simple manner.

P*R*A*I*S*E: professional recognition for achievement in surgical excellence.

1. Professional medical organizations must have a well-defined and properly planned system for rewarding nurses. It must be fair to everyone and reward specific accomplishments. 2. Rewarding OR nurses for working in a highly specialized area and giving them recognition for their contributions and professionalism is important to nurses, patients, and the organization. Such positive reinforcement results in a heightened sense of satisfaction among nurses and loyalty to their organizations. 3. In an era of cost cutting and increased competition among hospitals in employing quality nurses, P*R*A*I*S*E can be an effective method of recruiting and retaining nurses.

Stranger in a foreign land.

Undergoing surgery can be a very daunting process for patients, especially if the surgery is major. As perioperative nurses or anesthesia providers, it is easy to become comfortable with the environment and forget that, for patients, it can be similar to being in a foreign country where everything, including the language, is scary and intimidating. I learned to be more sensitive to my patients when I found myself in an unfamiliar situation and saw some similarities to what my patients were experiencing.

Monitored anesthesia care is not synonymous with low risk.

Monitored anesthesia care can lead operating room (OR) personnel, both perioperative nurses and anesthesia providers, into a sense of complacency. It is not general anesthesia, so there is no stress surrounding intubation and extubation and the patient is in control of his/her own respirations. When used properly, narcotics and sedative drugs sedate and relieve pain, but should not lead to respiratory compromise. As a result, circumstances should be under control when competent staff are present. However, because unanticipated events do happen even under the most benign-appearing occurrences, there must be a sense of vigilance by everyone in the OR as this case study relates.