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AORN values the role our industry partners play in the care of our patients. Table 3 is an example of a policy on the health care representative in the OR. This article is meant to assist perioperative nurses in writing policies that enhance the role of the health care industry representative in the OR, promote collegial relationships with an important player on the team, and preserve patient safety and privacy.

Patients with severe abdominal trauma injuries can have improved outcomes if a priority-oriented approach is taken to surgical intervention. This includes temporary abdominal closure and planned reoperation to complete complex, lengthy procedures when the patient is stabilized. Temporary abdominal closure can be achieved safely and cost-effectively by using a presterilized 3-liter cystoscopy fluid IV bag. This article discusses the rationale for temporary abdominal closure and planned reoperation, physiologic considerations in abdominal compartment syndrome (ACS), abdominal injuries or conditions leading to ACS, and manifestations of ACS. It compares and contrasts various materials used for temporary abdominal closure, illustrates bag preparation and silo application and removal, and analyzes complex intraoperative and postoperative nursing activities. AORN J 69 (March 1999) 530–541.

Perioperative nurses have acquired greater responsibility for patients' and family members' postoperative education. Recent nursing research indicates that patients may not be getting specific information about dealing with the everyday practical matters they encounter while recovering at home from their surgical procedures. This article addresses some of these issues (e.g., food, sex, driving, bathing, wound care, return to work, limits on activities). The authors answer questions most often asked by patients and their family members.

he historical roots of the word nieiitor originate in Greek mythology. In T Homer's The OOyssey, Mentor was a guide. protector. tutor, and advisor to Telemachus, the son of Odysseus and Penelope. Mentor motivated Telemachus to achieve his life's tasks. History notes other mentoring relationships: Socrates and Plato. Lorenzo de Medici and Michelangelo, Verrocchio and Leonard0 da Vinci, Sigmund Freud and Carl Jung, Ruth Benedict and Margaret Mead, and Anne Sullivan and Helen Keller.' This article describes mentoring as applied to the nursing profession with specific reference to the RN first assistant (RNFA) role. We will review the research on mentoring relationships

Nutritional support must be an integral part of the management of trauma victims. This article compares the stress response, a maladaptive response, and starvation, an adaptive process, examines the clinical research regarding total parenteral nutrition and total enteral nutrition, provides an evidence-based approach to initiating nutritional support in critically injured patients, and discusses considerations in selecting nutritional formulas.

Perioperative nurses have options in advanced practice instead of leaving the acute care setting. One of the newest advanced practice roles is the acute care nurse practitioner (ACNP). This role may be ideal for perioperative nurses who want to remain in perioperative practice and grow clinically by pursuing advanced practice. This article presents two collaborative practice examples for the ACNP in the perioperative setting. The authors describe new frontiers in advanced perioperative practice and analyze the emerging advanced practice role of the ACNP. This challenging and exciting role is well suited to perioperative practice in a general and trauma surgery practice. The academic preparation, certification, and credentialing necessary to practice as an ACNP are explained. AORN J 72 (Aug 2000) 241–253.

A 38-year-old, morbidly obese woman underwent surgery for debridement of necrotizing fasciitis of the abdominal wall. A pulmonary artery catheter was placed because of increasing fluid requirements. Despite multiple debridements and fluid resuscitation, the patient exhibited severe systemic inflammatory response. It was discovered that fluid placed in the introducer had extravasated into the subcutaneous tissues. In this obese patient, the pulmonary artery introducer was too short.

The success of the procedure is evaluated by the number of bowel movements the patient has in a 24-hour period. Nine or more in 24 hours is considered poor; the average postoperative patient has five to six. As the patient's functional results improve, he is generally more at ease in social and work environments. He can govern his own routine to a great extent, rather than being tied to the bathroom. Usually, the patient can return to work in about four weeks after the ileostomy takedown. Generally, these patients seem to be satisfied with the results of their surgery. One study noted that 92% of the patients studied stated they would not hesitate to have the same operation again if faced with the same options. For the first few months postoperatively, Billy was somewhat apprehensive that he would have an "accident." He did not report any, though. He also did not leak any stools, even at night. Now, more than a year after the surgery, Billy has about four to six bowel movements a day and continues to take psyllium hydrophilic mucilloid daily. He has occasional mild irritation of the perianal skin. He has also gained 15 pounds. Billy returned to college to complete his senior year six months postoperatively. He took a full course load and planned to graduate in August 1987 with a degree in computer science. He reported that, "I'm doing very well. I just forget I had surgery."

The document is the critical element in developing an exam that reflects current perioperative nursing practice. The test specifications ensure that each phase of perioperative nursing practice is adequately measured at a proficient level of care. In addition to developing test specifications, the NCB:PNI has recommended that A Job Analysis could be used in the following situations. 1. Nurse managers could use the document in refining job descriptions, evaluating employee performance, creating clinical ladder criteria, and establishing standards of patient care. 2. Perioperative nurse educators could use it in developing self-directed learning contracts, designing curriculum for students or staff development. 3. Researchers could use the document in justifying the existence of registered nurses in the OR. 4. Perioperative nurses could use it for peer review and self-evaluation.

Unless RNs are willing to accept this responsibility, less trained people will be more than happy to do so. We have given away many of our technical skills in the past, such as allowing technicians to become firmly entrenched in the scrub role. I hope we don't let this opportunity slip through our hands because we have lost the pioneering spirit of our nursing heritage. Thirty years ago, the issue was whether or not nurses could take blood pressures. More recently, it has been whether nurses could use the defibrillator. Now both are accepted without a thought. Those of us who have chosen to expand our practice must be patient with our colleagues who have not had an opportunity to work through both sides of the issue, and encourage them to do so. There will be those who choose not to function in this role, and I believe that first assisting is not for everyone. But in order to have a choice, the option must be there.