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Traditional paper-based educational systems posed significant challenges in centralizing institutional education resources, tracking completion, and referencing back to education presentations, thereby inhibiting seamless access, collaboration, and completion. Our project aimed to improve nursing education by transitioning from paper-based educational items to a digital Learning Management System (LMS) to enhance accessibility, completion, and tracking of educational requirements. Our primary objective was to streamline and consolidate all education materials into one comprehensive digital LMS – a centralized platform of educational resources from multiple sites to give staff easy access to all education materials for easy reference and tracking. We surveyed nurses on previous-existing paper-based educational items and how it affected their overall satisfaction. A fishbone diagram showed us areas of improvement for institutional and unit-based education items. We collaborated with the PACU Leadership and Education Committee nursing teams to identify a suitable LMS platform and organize the educational content and process. We conducted group and individual training sessions to familiarize staff with the new digital system, to ensure a smooth transition. Continuous feedback loops were placed to enhance user experiences and evolving needs. We sought to improve the ability of staff to complete education items by their due dates by 10% and reached 12% improvement. The level of feeling overwhelmed was also reduced by 13%. The successful implementation of the digital LMS resulted in a centralized hub for all nursing education resources, seamless access to assignments, and serves as a tracking system for members and leadership that can ultimately improve patient care outcomes. The digital LMS has significantly reduced time spent searching for paper materials and increased engagement in learning activities, leading to improved efficiency and productivity. The digital LMS has foundationally created a way to leverage advanced technologies and foster a culture of continuous learning, which contributes to improved patient care, enhanced patient safety, and overall advancement of the perianesthesia nursing practice. The success of this transformation highlights the importance of embracing digital solutions to optimize education communication in healthcare. [ABSTRACT FROM AUTHOR]

Sevoflurane is an inhalational general anesthetic that has been used recently to treat chronic, painful lesions, reportedly supporting analgesia and wound healing. The potential for repeated exposure to off-gassed sevoflurane vapor, especially outside the air-conditioned operating theatre environment, is of some concern. This paper explores the qualitative and quantitative pathing of off-gassed sevoflurane from a topically applied liquid source. Using a small, unventilated test-box (total volume 0.5 m3) with infra-red imaging and gas-analysing, we investigated the spatial distribution of sevoflurane vapor following complete vaporization of a 20 mL liquid sample. Utilizing the infra-red absorption of sevoflurane, it was possible to visualize (as an apparent reduction in temperature) the streaming path of the sevoflurane vapor. Sevoflurane levels (%) in the test-box were measured using an infra-red gas analyzer. In keeping with its higher density than air, sevoflurane vapor was seen to "waterfall" from the liquid source and accumulate in the bottom of the test-box. Sevoflurane vapor concentration was minimal above the liquid source. When extrapolated to a larger (unventilated) room, we estimate that the sevoflurane concentration would be less than 10 ppm one centimetre above the liquid pool. With vacuum extraction, these levels would be even lower. Due to sevoflurane's tendency to accumulate on the floor, it is concluded that topical application of liquid sevoflurane posses virtually no risk to off-gas exposure in unventilated spaces. [ABSTRACT FROM AUTHOR]

Japan is dealing with a superageing society found nowhere else in the world. This problem is provoking other complex issues such as aggravation of patients' condition, and a shortage of anesthesiologists leading to overwork. As a solution, our hospital established the PeriAnesthesia Nurse (PAN) for the first time in Japan. Unlike the United States and other developed countries in Europe, Japan did not have a license for nurses specialized in anesthesia. Thus, in collaboration with a graduate school of nursing, our hospital started a perianesthesia nursing course within the advanced practice nurse's training curriculum in 2010. At the graduate school, students take specialized lectures on anesthesia with a curriculum that focuses on risk management. On graduation, they work together with anesthesiologists in the department of anesthesiology and perform anesthesia-related tasks under the medical specialist's supervision. Their main duties include preoperative anesthesiology outpatient, surgical anesthesia, acute pain service (APS) for postoperative periods, and labor analgesia, and they collaborate with various specialists inside and outside of the operating room. Outcomes of patient care after the introduction of PAN have been observed. PAN provides persuasive explanations and guidance seamlessly to the patients by taking advantage of their experience in anesthesia and the scientific thinking they've acquired in graduate school. This paper reports on the training and clinical practice of perianesthesia nurses in Japan as a measure to improve the quality of perioperative medical care as well as the safety of patients. [ABSTRACT FROM AUTHOR]

This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P =.014), WHO 3; from 22.2% to 42.3%, (P =.002), and aseptic techniques; from 17.5% to 31.6%, (P =.003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care. [ABSTRACT FROM AUTHOR]

The post-surgical transition to home is associated with 4-9% return to the emergency department (ED). Bundles of transitional care (TC) interventions, which include telephone follow ups (TFUs), have been shown to decrease preventable ED visits by effective communication practices. A community hospital post anesthesia care unit (PACU) completed 40% of eligible TFUs secondary to inconsistent nursing workflow and lack of an evidence based TFU script. To implement the evidence-based Re-Engineering Discharge Tool-5 (RED-5) and formal delegation processes in the PACU. Over a 16-week period in the Fall of 2023, the RED-5 script was made available to nursing staff on paper and electronically. Twenty nurses were trained with a 1:1 simulation. Weekly audits of delegation, calls attempted/completed, RED-5 adherence, escalations, and appointment status were completed. Run charts were used to demonstrate process adherence. The new delegation process was documented 40% (n=29) of 72 eligible weekdays. In total, 1435 outpatients were discharged from the PACU. Thirty four percent (n=494) of calls were attempted. Of the 23% (n=324) of calls completed, 71% (n=231) adhered fully or partially to the RED-5 script. Eighteen percent (n=59) required either one or both, clarification of discharge instructions (n=44) and surgeon referral (n=34). No patient was instructed to go to the ED. Of the 213 patients assessed, 30% of patients (n=63) had not scheduled follow up appointments. The RED-5 script standardized post-operative TFU questions improved identification of patient needs. Clarifications or surgeon referral were provided to 18% of patients, compared to 48% of patients nationally who indicated that they did not strongly understand their care at time of discharge. No change was noted in call attempts or completion or workflow delegation. Limitations were technology and leadership turnover. Implementing the RED-5 script improved postoperative communication with patients discharged from a community hospital PACU. Embedding the RED-5 TFU script into the TFU application is under discussion with management. When embedded, the intervention will spread from the PACU to all perioperative staff. This QI project supports standardized postoperative communication with the RED-5 tool. Modifications to workflow processes are needed to support call completion. [ABSTRACT FROM AUTHOR]

Purpose This paper spotlights human capital management, digital technology, and costs control as issues that healthcare leaders will face in redesigning the health care ecosystem in the 21st century. Design The paper was designed to highlight the attributes that make effective leaders. It addresses how nursing leadership can take a lead to redesign the 21st Century health care system, supported by case examples. Methods An expansive literature review was done using MEDLINE, SAGE, Google Scholar, and University of California San Diego Library Catalogs. The selections criteria include recent publications in English within and outside the healthcare industry. Findings Health leadership is viewed as paramount to productivity, capacity and meeting new challenges. Conclusions Effective nursing leadership in a healthcare organization correlates with staff job satisfaction, retention, turnover and quality of care. Nursing leadership development must be supported by appropriate level of educational preparedness, and requisite set of competencies and skills. [ABSTRACT FROM AUTHOR]

Handoff is communicating and accepting responsibility for patient care from one caregiver to the next. An inadequate handoff increases the risk of miscommunication and preventable safety events, placing the patient at risk. Stakeholders from within the entity, including nurses from all phases of care, were identified to pinpoint impactful changes that would improve the entity's handoff process and increase patient safety. Pertinent pre-op patient information must be more consistently shared with the OR/Endo circulators. The availability of the Preop RN to give handoff was 25%. The patients' belongings were locked 50% of the time, and staff satisfaction was 25%. The purpose of the study was to improve perioperative communication and ensuring patient safety by sharing pertinent medical information and including the patient in the conversation. The methods used were observations by the stakeholder team for the initial data. The team developed a paper handoff tool and standard work to educate the perioperative staff. The OR/Endo Circulators provided constructive feedback to the stakeholder team to decrease barriers to the improved process. The circulators collected the data during all phases of the improvement project (pre, during, and post-implementation). A decrease in unproductive staff time awaiting handoff was achieved in addition to improved communication and quality of information shared between the perioperative team. Patient belongings were secure 95% of the time. Through reinforced staff education utilizing standard work, there has been improvement with the handoff. The development of the handoff tool was valuable for the team. The impact of the interdisciplinary team showed a great example of working as one in the facility. There was a significant improvement, evidenced by data, in the quality of information shared between phases of care, supporting evidence-based practice and the National Patient Safety Goals. Peri anesthesia nurses can collaborate to implement future workflows with an interdisciplinary team. The handoff work can easily be adapted for positive outcomes in any procedural area. The impact can improve patient care by decreasing communication errors, increasing meaningful interaction with staff and patients, and improving staff satisfaction, while maintaining crucial components in the perioperative environment such as efficient turnover times. [ABSTRACT FROM AUTHOR]

There is a need for a standardized process in pre surgical clippings, involving clipping sheet preparation and best practice use of techniques and tools. The Association of Perioperative Registered Nurses recommends removing patient's hair before going into the OR to decrease contamination of the operative field. Proper hair removal is an important part of surgical preparation; necessary for surgical site exposure, preoperative skin marking, suturing, and application of wound dressings. Increase the accuracy, accessibility, and efficiency of clipping sheets in the pre anesthesia setting. Standardize and digitalize clipping sheets. Educate preoperative nurses in pre surgical hair removal using a clip vacuum assisted device (ClipVac) opposed to paper tape assisted removal. Clipping sheets were previously filled out by nursing staff by flipping through a resource binder in order to find the correct clipping guidelines for the correct surgery to then personally shade in a poorly anatomically marked model. The process took up valuable nursing time and left room for variation and error in shading based on individual interpretation. Clipping sheets were first redesigned to include a more anatomically correct model. New clipping sheets for each relevant procedure were filled out and sent to surgical primary service nurses for adjustments. Updated clipping sheets were uploaded into an electronic format that are now easily accessed and printed. Staff received thorough education and training on the new clipping sheet process as well as proper use of a ClipVac in place of paper tape. There has been positive feedback with implementation of this project; staff appreciate having a process that is now streamlined and easy to use. Staff feel more competent to perform clippings using a clip vacuum assisted device after hands on practice with a BD rep for ClipVac. These measures combined improve patient outcomes by decreasing risk of infection. Clipping sheets are one small part of preoperative patient preparation that can largely impact patient outcomes and staff satisfaction. In starting this project, there was not much found in a literature search for enhancing the presurgical clipping process through digitalization. Sharing this project and the success of improving accessibility while decreasing error via digital format promotes the continuation of using best practices in perianesthesia nursing. [ABSTRACT FROM AUTHOR]

BIDMC is a large academic medical center that has many types of documentation systems. This can make care coordination a challenge. PACU is still on a paper flowsheet until our new universal system is instituted. Critical care patients use a system called Metavision. While boarding patients who need an intensive level of care there was no way for a provider to track patients care and progress unless they came to PACU. To allow universal documentation of critical patients even when they are boarding in a PACU awaiting an intensive care bed. This will allow physician a more comprehensive view of their patient's condition in real time. Coordination of care, sharing information with the right providers and streamlining workflow was the aim of this project. Reducing error and improving patient care, and provider communication was the goal. The hospitals I nformation S ystems department partnered with the PACU to install the Metavision icon on our bedside laptop computers. The patient population who needed this form of documentation was identified as the ICU level patient and the Neuro Intermediate Care Unit patients. Both of these units currently use Metavision, so the transition of documentation from PACU to these units would be seamless. Online teaching was sent to all PACU nurses. Small group sessions were held with super users training the staff. Real time support was implemented in the first several weeks after the roll out. Over seventy nurses have been trained in successful documentation in Metavision for ICU and Neuro Intermediate Care patients. Continuity of care with a single form of documentation was implemented. Physician appreciation for real time information from any location in the medical center was evident. Interdisciplinary communication was enhanced and documentation was standardized. Improved patient care and safety was achieved. Sharing patient information for care decisions in real time across the medical center enhances positive patient outcomes. Improving communication and teambuilding are evident when everyone has access to the same patient information. [ABSTRACT FROM AUTHOR]

The flow of patients in a fast-paced, high volume, and high acuity area can lead to decreased nurse engagement and satisfaction, along with an increased concern for patient safety. A larger geographical footprint can lead to difficulty in visualizing and caring for patients, causing significant concerns for nursing staff disengagement and decreased satisfaction. The potential for adverse events is greater when nurse's (RN's) proximity to their patients increases. The purpose of this nurse driven quality improvement (QI) study was to identify the barriers of a larger geographical footprint and to improve the nursing satisfaction with staff input on nursing assignments, workflow, and zoning the unit for PreAn and Phase II level care. A paper survey utilizing a 5-point Likert scale, from strongly agree to strongly disagree, was administered to gain knowledge on the nurse's perception of working in a large geographical area. RN's with interest in finding solutions were identified and provided suggestions at taskforce brainstorming sessions to improve buy-in with leadership. A reevaluation survey of the pilot change will be conducted monthly postimplementation to obtain feedback. Survey respondents (n=27/33 or 82% response rate), 17 (63%) rated neutral to disagree with their satisfaction of the current process and flow. All (100%) of the respondents rated strongly agree or agree that better flow promotes patient safety and proximity to the patient as a nurse satisfier. Utilizing a multidisciplinary approach, a large geographical area was divided into smaller "care zones," with nurses assigned to a specific area of 6-7 rooms versus the entire 20 bed unit. Color-coded care zones allowed for equitable teams, accountability, and efficiency being in close proximity to patients. Improving patient assignments and workflow enhanced nurse satisfaction and patient safety by geographically positioning nurses closer in proximity to their patients. A color-coded zoning model allowed nurses to visualize their assigned area and patients more effectively. Improving nurse engagement in this QI study led to better patient flow, safety, and nurse satisfaction that may ultimately improve recruitment, and retention of nurses. [ABSTRACT FROM AUTHOR]

Acupressure is a complementary treatment method performed using fingers and hands to maintain the body's energy balance by stimulating acupuncture points. In recent studies, acupressure has been widely used for minimally invasive procedural (venous assess, intravenous (IV) cannulation, intramuscular injection, heel lancing) pain management in children. This study aims to systematically review the studies that evaluate the effectiveness of acupressure on minimally invasive procedural pain in children. This study is a systematic review of literature. Studies were obtained by screening literature on this topic using the databases PubMed, EBSCO, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials. The keywords "Acupressure," "Child," "Pain," and "Procedural" were used when screening the literature. The studies selected were those published from January 1, 2000 to January 1, 2022 that met the inclusion and exclusion criteria. The PRISMA checklist was used when performing this systematic review. The Oxford Center for Evidence-Based Medicine Levels of Evidence Working Group (2011) table was used to assess the level of evidence. The procedures for this systematic review were preregistered in the PROSPERO (CRD42022320155) database. Of the 12,624 records identified, 10 nursing studies that met the research selection criteria were included in the advanced analysis. These papers were further reviewed for their study design, adequacy of randomization and concealment of allocation, blinding of participants, interventions, and outcome measurements. Acupressure has been shown to be effective in relieving minimally invasive procedural pain in children. This review begins to establish a credible evidence base for the use of acupressure in minimally invasive procedural pain relief in pediatric age groups. The implication for nurses includes incorporating acupressure into their practice as an alternative therapy for children who suffer from minimally invasive procedural pain. [ABSTRACT FROM AUTHOR]

Malignant hyperthermia is an uncommon, but potentially lethal condition that may be encountered during the perioperative period. There is wide variability in the manner in which malignant hyperthermia may manifest. For a patient to survive a malignant hyperthermia crisis, prompt recognition and treatment is of paramount importance. Perioperative nurses play a pivotal role in the successful management of malignant hyperthermia. The fictitious case study presented in this paper describes the identification, presentation, pathophysiology, and treatment of a general anesthesia patient with fulminant malignant hyperthermia. [ABSTRACT FROM AUTHOR]

Tracking educational progress of close to 200 staff members becomes long and tedious when completed on paper. Often, educators spend hours of time, sifting through orientation and annual competency checklists to assess the progress of employees. It was necessary to develop a simplified process to track competencies in real time. Digitize orientation and competency checklists to make staff education tracking easier. Utilizing the Research Electronic Data Capture (REDCap) program, orientation checklists, initial competencies, and annual competencies were digitized and made accessible to users through QR code technology. Use of the electronic program was piloted with a small group of PACU trainees and preceptors. Prior to initiation pilot testing, users received an in-service and reference guides on program use. After the pilot group's successful usage of digital checklists, all staff members received training prior to using the electronic program for the annual perianesthesia nursing competencies. After implementation of the use of digitized forms, it has been shown that educators spend less time monitoring progress. By logging into the REDCap program and viewing the Record Status Dashboard, educators can see progress in real time. Upon completion of annual competencies, 133 users completed a survey regarding the use of digitized forms. 90.2% agreed that digitized competency forms were easy to use. 89.5% agreed that they would like to see more items such as forms, educational resources, and surveys digitized. Additional anecdotal evidence from end-users suggests that keeping up with a QR code on a badge buddy is easier than carrying folders with competency checklists, and educators have noticed a significant decrease in lost paperwork. The use of QR code technology has resulted in a more effective process for perianesthesia nurse educators to track and assess the learning progress of staff. In the future, QR code technology will advance the practice of perianesthesia nursing by making educational resources such as recorded in-services, TipSheets, and reference guides readily available to nurses and staff. Through the incorporation of digitized education, perianesthesia nurses will gain up-to-date knowledge to help them provide quality care to patients. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) are the leading cause for post-operative readmissions. Despite the routine use of prophylactic antibiotic therapy, SSIs continue to be the most consequential source of morbidity and mortality in both inpatient and ambulatory settings. Increased SSI infection rates for abdominal hysterectomy patients were identified. Over 95% of the cases were completed as an elective surgery. Process review highlighted a potential gap in pre-operative education. The pandemic changed the operational function of the Pre-Admit Testing (PAT) department; all patients were transitioned to phone preassessments. This eliminated the opportunity to provide the presurgical shower scrub and printed education regarding SSIs. Among abdominal hysterectomy patients receiving face-to-face preoperative education (how to prepare for surgery and care for surgical site at home), compared to previous practice of phone preoperative education, will there be a decrease in 2021 SSI rate? The Plan-Do-Study-Act (PDSA) methodology was utilized to reinstate face-to-face PAT visits and initiate implementation of the SSI prevention checklist. PAT education tasks in the checklist included the following: pre-op shower, nutrition, glucose management, smoking cessation, and incision care at discharge. Daily auditing of documentation was completed and reinforced as needed. The standardized infection ratio (SIR) for the first quarter of 2021 was measured at 6.68. After the PDSA, quarters two, three and four were 0, 3.88 and 0, respectively. There have been zero SSIs for this patient population in 2022. During the initial PDSA cycle, supply chain issues decreased the availability of Hibiclens/CHG soap. A second PDSA cycle was completed to transition paper checklist documentation to the electronic health record. Electronic documentation allowed for more efficient auditing and identification of opportunities during case reviews. Reinstatement of face-to-face preoperative education helped to decrease SSIs in abdominal hysterectomy patients. As patients have various methods of entry to the perioperative setting, work must continue around standardization of patient care processes to reduce SSIs. This includes ensuring proper onboarding of perianesthesia nurses being educated on their roles/tasks as it relates to SSI prevention. [ABSTRACT FROM AUTHOR]

Preadmission testing visits have historically been in-person and or via phone calls facilitated by nurse practitioners and registered nurses. Due to the pandemic, a change in process was required to address national and state social distancing recommendations. Project was conducted at a 171-bed community teaching hospital in the Northeast United States. To implement a smooth transition from onsite preoperative evaluations via phone or in-person visit, to 100% virtual visit. In October of 2020 the interdisciplinary leadership and Chief NP made the decision that all permanent RN staff would work from home and that all NP visits would become virtual. The Chief NP and Project Manager collaborated and created a Microsoft Teams account, revised paper resources, and uploaded them so that staff could access electronically. The Telecommunications team transferred existing telephone numbers and linked them with hospital provided laptops, head- sets and Jabber accounts for RN staff. They also provided cameras for the desktops utilized by the NPs. The Clinical Business Analysis team updated and created new appointment types to facilitate phone screens. The Chief NP updated the After Visit Summary which included, Covid screening, visitor restrictions and safe patient commitment. Education was provided to all staff regarding the change in process and available updated resources by the Chief NP and one staff NP. In November 2020 100% of all preoperative visits became remote or virtual. Staff are utilizing a messaging app for internal communication to communicate patient concerns, inquire with clinical questions, scheduling changes. Positive feedback from nursing staff regarding new process. High satisfaction and safety for patients and clinicians are the driving force behind these visits. To aid in addressing the long-standing concerns surrounding location and availability, telehealth provides greater flexibility to both patients and clinician while closing the service gap. Having local resources more broadly available via a common online resource, provides the clinician access to the most current clinical information while integrating care efforts that improve health outcomes. [ABSTRACT FROM AUTHOR]

Research supports the practice of preprocedure warming as a method to prevent the development of unplanned perioperative hypothermia. ASPAN defines hypothermia as a core temperature lower than 36°C. The purpose of this quality improvement project was to explore the idea that preprocedure warming maintains perioperative normothermia. Information was obtained through retrospective chart reviews (n = 148). Temperatures were compared for patients who received standard preprocedure care versus patients who were warmed with a warming gown for one hour preprocedure. Before the institution of warming, about 50% of the patients received in the PACU were hypothermic. After the warming was instituted, only 12% of patients were received in a hypothermic state in the PACU. Concepts discussed in this paper include preprocedure warming, postprocedure hypothermia, and complications associated with hypothermia. [Copyright &y& Elsevier]

In the perianesthesia setting, the chest X-ray has become an essential diagnostic tool to help direct the optimal care of critically ill patients. The ordering of medical tests, the interpretation of the results, and the determination of an appropriate medical plan of care remain within the role of the physician. In many United States acute care hospitals, however, the perianesthesia nurse is taught to implement emergency standing orders including obtaining a chest X-ray for unexpected respiratory distress, unexplained hypoxemia, or unequal breath sounds. This article will offer the perianesthesia nurse the basic knowledge to rapidly and systematically read chest radiographs and compare the findings with the patient''s previous films and current clinical presentation. The assessment tool outlined in this paper may be combined with the clinical picture the patient presents to ensure that the nurse implements needed interventions in a timely manner. [Copyright &y& Elsevier]

Malignant hyperthermia (MH), a potentially fatal disorder triggered by certain types of general anesthesia, has received much attention in the scientific literature. From the first case report in 1960 until the present, hundreds of studies have been conducted. The diagnosis of MH has evolved from subjective assumptions by family history and clinical diagnosis to more sophisticated laboratory testing. A genetic basis for MH was recognized in the early 1990s and, since then, complex genetic pathways have been demonstrated. The purpose of this paper is to summarize the research literature on what is known scientifically about the diagnosis and genetic basis of MH. [Copyright &y& Elsevier]

Control is a word used frequently with many connotations and nuances. It has emerged as thematic in recent qualitative studies of patients’ experiences of the perianesthesia period. The purpose of this paper was to conduct a concept analysis of control in the perianesthesia period, using Walker and Avant''s eight-step method. The literature was reviewed, which identified the defining attributes. Model, borderline, contrary, and illegitimate cases are presented, and antecedents and consequences are identified. Control in the perianesthesia period is defined as the perception of the power of choice. Sometimes that choice is to relinquish control to others. The purpose of this concept analysis of control was to clarify the concept and to provide insight into the patients’ perspective, enabling nurses to assess and approach patients from a different viewpoint—one that seeks to help the perianesthesia experience become a less threatening, frightening one and instead a partnership that enhances the well-being of the individual. [Copyright &y& Elsevier]

Wait times in same day surgery can create added stress to patients who are already anxious. Perianesthesia nurses understand the importance of patient satisfaction as they continually return to the bedside, answer questions, and meet patients’ needs. Nursing interventions to involve the patient and family can help decrease stress and dissatisfaction that occur when the patient is not updated about time changes. Defining quality care can be difficult when consumers and providers view things differently. Frequently, patients associate hospital stay satisfaction with the respect nurses demonstrate for their needs. Timeliness regarding surgical times is an important aspect when meeting consumers’ care expectations. The purpose of this paper is to describe the problems patients might have with surgical wait times and to suggest ways to enhance patient satisfaction. [Copyright &y& Elsevier]

Postoperative nausea and vomiting (PONV) can complicate and delay patient recovery from general and neuraxial anesthesia. Even with a new generation of anesthetic drugs and antiemetics, a high number of patients are affected by PONV. PONV has a multifactor etiology, but there are ways to reduce its occurrence. Although it is not a traditionally recognized method, stimulation of acupressure points, specifically P6, has been identified as a potentially effective method of reducing PONV. This study is a state of the science paper reviewing research on both pharmacologic and nonpharmacologic prophylaxis and various methods of acupressure. It was conducted to add information to the currently available knowledge regarding PONV in hopes of stimulating the use of acupressure for treatment of PONV. The study is divided into six categories: pathophysiology of PONV, background studies of PONV, nonpharmacologic prophylaxis, pharmacological prophylaxis, acupressure and related techniques, and benefits of routine antiemetic prophylaxis. [Copyright &y& Elsevier]

More than half of gastric bypass patients take antidepressants preoperatively, presenting some unique considerations with this patient population. The challenges associated with antidepressant medications are experienced both preoperatively and postoperatively. As the gastric bypass option becomes more readily used in the treatment of obesity, the requirement for understanding the effect of this procedure on any alteration of medications will become more clinically important. The purpose of this paper is to present an overview of the potential challenges in providing optimal patient care for the gastric bypass patient who is taking antidepressant medications. [Copyright &y& Elsevier]

The paper stresses the importance of cultural competence in perianesthesia nursing, both in terms of caring for the patient and in dealing with the patient’s family. Cultural variations in gender, decision-making, family, communication, and time orientation are presented. A distinction is made between generalizations (potentially useful) and stereotypes (potentially harmful). Several suggestions for specific ways to provide more culturally appropriate care are presented, and resources for further study are provided. [Copyright &y& Elsevier]

Pulmonary artery catheter (PAC) technology has changed significantly and use has decreased over the last 20 years. Barriers to use include: (a) increased patient risk with placement; (b) ability to measure similar variables via less invasive measures; (c) increased cost; (d) inaccurate measurement leading to misuse of PAC-derived variables; (e) incorrect interpretation and clinical application; and (f) lack of proven benefit for patient management. Advances in technology have allowed for continuous trending of hemodynamic parameters measured via the PAC. Patient risk is similar to that of central line placement; however risks associated with pulmonary artery infarction and rupture are inherent to the PAC. Less invasive assessment of cardiac output equals that of the PAC, whereas pulmonary capillary wedge pressure and mixed venous oxygen saturation monitoring are unique features of the PAC. Effective use of PAC data will require ongoing standardized education. More studies are needed on the cost-effectiveness of PAC monitoring as well as outcome benefits. Much of the data available from the PAC can be obtained via less invasive methods. However, the PAC continues to be useful in specific situations and remains the gold standard for comparison of new technologies. This paper discusses use of the PAC during the past 2 decades and reviews studies affecting its use in clinical practice. [Copyright &y& Elsevier]

Postdischarge nausea and vomiting (PDNV) is a serious threat to the recovery of ambulatory surgical patients. Pharmacological interventions available before discharge are not readily available to the patient after discharge; therefore, the activities that patients perform to manage new-onset PDNV may affect their surgical recovery. Assembled from a comprehensive study of PDNV, this paper describes the self-care activities that ambulatory patients use to manage new-onset nausea and vomiting after discharge. The findings have implications for patient education and future research. [Copyright &y& Elsevier]