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Exploring the Nursing Culture of a Post Anesthesia Care Unit
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with the recommended beta blocker therapy the day of surgery. It stresses the importance of the preoperative phone call as a means to accomplish this goal; therefore, contributing to optimum, evidence based care. The Johns Hopkins EvidenceBased Practice Model was used to guide the evidence into practice. Investigation into alternative venues for the preoperative assessment is considered for the future.
EXPLORING THE NURSING CULTURE OF A POST ANESTHESIA CARE UNIT Primary Investigator: Amy L. Dooley, MS, RN, CPAN Institution: Lahey Clinic, Burlington, Massachusetts Co-Investigator: Kim M. Climo, BSN, RN, CPAN
Introduction: The repetitive theme of great “teamwork” among Post Anesthesia Care Unit (PACU) staff was frequently stated in the self evaluations of the RN’s. The staff used words like “got your back”, “there for you”, ‘help whenever you need it”, and “support from everyone”. The multitude of RN’s describing this phenomenon led us to question if this is unique to our institution or common in PACU’s. Finding no published articles about nursing culture in the PACU led us to begin our own study. Purpose: The purpose is to make a baseline assessment of the PACU work group culture. Culture is the deep underlying assumptions, beliefs, & values that are shared by members of the organization and typically operate unconsciously (Casida 2007). This assessment is accomplished by identifying the cultural norms (behaviors) which are important to the work group, identifying the cultural norms which the group has differences of opinions, and identifying the cultural norms that the group would like to change. Method: This non-experimental, cross-sectional study was conducted in a Phase I PACU at a tertiary care facility in the Northeast. The Nursing Unit Cultural Assessment Tool-3 (NUCAT-3) (Coeling, 1993), was administered to 39 Registered Nurses over a 3 week period via a secure online link. The NUCAT-3 is a 50 item instrument that asks respondents to rate, using a 5 point scale, my preferred behavior and my groups’ typical behavior. The survey also included nine demographic questions and five visual analogs that asked questions related to satisfaction with leadership, staffing, environment, job satisfaction, and nursing care. Results: A 69% response rate was achieved. The data revealed behaviors important to the respondents: understanding patients’ feelings, make patients comfortable, and promote group morale. The three behaviors the respondents most wants to avoid were: staying angry with someone longer than a day, refusing to help your co-worker when asked, and going along with peer pressure. Behaviors the group wanted changed were: telling someone indirectly instead of directly that you dislike their behavior, staying angry with someone longer than a day, and to be nonjudgmental of someone else’s behavior. Discussion/Conclusion: The NUCAT provided the basic assessment of the PACU’s work group culture. Exploring the nursing culture within the PACU was important because it identified behaviors that are important to the group, behaviors to avoid, and those behaviors that demonstrate differences of opinion which may cause group conflict. Using this knowledge can offer
ASPAN NATIONAL CONFERENCE ABSTRACTS the group the opportunity to identify what changes to make within the unit. Implication/Future Research: Results from this study identified cultural behaviors that are important to a PACU. This knowledge will be useful in identifying important behaviors that contribute to the nursing culture. Future research should focus on studying the nursing culture within other PACU’s and Ambulatory Surgery Units to delineate any similarities or differences.
POSTOPERATIVE NAUSEA AND VOMITING RESCUE USING AROMATHERAPY Primary Investigators: Amanda Hudgens, BSN, RN, CAPA Carolinas Medical Center-University Hospital, Charlotte, NC Ronald Hunt, MD Southeast Anesthesiology Jacqueline Dienemann, PhD, RN, UNC Charlotte, H. James Norton, PhD, Wendy L. Hartley, MSN, RN Carolinas Medical Center, Thomas Stern, MD, CMC-University, George Divine, MD, Henry Ford Health System, Detroit, MI
Postoperative nausea and vomiting (PONV) is a common complication of surgery and occurs in 20-30% of patients. Antiemetic mediation reduces incidence, but does not reliably prevent PONV that can lead to dehydration, electrolyte imbalance, prolonged recovery, and decreased patient satisfaction. Thus, effective rescue treatment for PONV that occurs after surgery is needed. The negative effects of conventional pharmacological approaches (sedation, hypotension, and cost) have spurred researchers to explore alternative therapies. The purpose of the study was to investigate the effectiveness of aromatherapy agents on the treatment of PONV for patients after receiving surgery. A randomized controlled trial of 3 aromatherapy agents (ginger, isopropyl alcohol, and a blend of oils) and Normal Saline as the control at one surgical site was completed. IRB approval received. Eligibility was adult patients, ability to give consent, no history of coagulation problems, and no allergies to the aromatherapy agents. Before surgery, demographic information, risk factors, and any antiemetic medications received was collected. After surgery, participant’s nausea was rated using a Likert Scale of 0-3. Those reporting nausea were randomly given one of the agents on a gauze pad and instructed to inhale the aroma. After 5 minutes they were asked to rate their nausea again. Antiemetic mediation was given as requested. Analysis used SAS software for descriptive statistics and the Wilcoxan rank sum test to compare the intervention aromatherapy agents to the control, along with 95% confidence level and a Bonferoni adjustment for multiple comparisons. There was a final sample of 1151 consenting patients with 301 reporting PONV (26.15%). Nausea rate for those at moderate or high risk receiving preventative medication was 35.53%. Change in nausea was significant for the aromatherapy blend (p5.0001), ginger (p5.0006), and not significant for alcohol compared to Normal Saline. The number of antiemetic medications requested after aromatherapy was reduced significantly by the type of aromatherapy. In conclusion, aromatherapy for rescue treatment of PONV is a valid alternative. Aromatherapy offers many benefits over pharmaceutical agents alone. It reduces PACU length of stay,
with the recommended beta blocker therapy the day of surgery. It stresses the importance of the preoperative phone call as a means to accomplish this goal; therefore, contributing to optimum, evidence based care. The Johns Hopkins EvidenceBased Practice Model was used to guide the evidence into practice. Investigation into alternative venues for the preoperative assessment is considered for the future.
EXPLORING THE NURSING CULTURE OF A POST ANESTHESIA CARE UNIT Primary Investigator: Amy L. Dooley, MS, RN, CPAN Institution: Lahey Clinic, Burlington, Massachusetts Co-Investigator: Kim M. Climo, BSN, RN, CPAN
Introduction: The repetitive theme of great “teamwork” among Post Anesthesia Care Unit (PACU) staff was frequently stated in the self evaluations of the RN’s. The staff used words like “got your back”, “there for you”, ‘help whenever you need it”, and “support from everyone”. The multitude of RN’s describing this phenomenon led us to question if this is unique to our institution or common in PACU’s. Finding no published articles about nursing culture in the PACU led us to begin our own study. Purpose: The purpose is to make a baseline assessment of the PACU work group culture. Culture is the deep underlying assumptions, beliefs, & values that are shared by members of the organization and typically operate unconsciously (Casida 2007). This assessment is accomplished by identifying the cultural norms (behaviors) which are important to the work group, identifying the cultural norms which the group has differences of opinions, and identifying the cultural norms that the group would like to change. Method: This non-experimental, cross-sectional study was conducted in a Phase I PACU at a tertiary care facility in the Northeast. The Nursing Unit Cultural Assessment Tool-3 (NUCAT-3) (Coeling, 1993), was administered to 39 Registered Nurses over a 3 week period via a secure online link. The NUCAT-3 is a 50 item instrument that asks respondents to rate, using a 5 point scale, my preferred behavior and my groups’ typical behavior. The survey also included nine demographic questions and five visual analogs that asked questions related to satisfaction with leadership, staffing, environment, job satisfaction, and nursing care. Results: A 69% response rate was achieved. The data revealed behaviors important to the respondents: understanding patients’ feelings, make patients comfortable, and promote group morale. The three behaviors the respondents most wants to avoid were: staying angry with someone longer than a day, refusing to help your co-worker when asked, and going along with peer pressure. Behaviors the group wanted changed were: telling someone indirectly instead of directly that you dislike their behavior, staying angry with someone longer than a day, and to be nonjudgmental of someone else’s behavior. Discussion/Conclusion: The NUCAT provided the basic assessment of the PACU’s work group culture. Exploring the nursing culture within the PACU was important because it identified behaviors that are important to the group, behaviors to avoid, and those behaviors that demonstrate differences of opinion which may cause group conflict. Using this knowledge can offer
ASPAN NATIONAL CONFERENCE ABSTRACTS the group the opportunity to identify what changes to make within the unit. Implication/Future Research: Results from this study identified cultural behaviors that are important to a PACU. This knowledge will be useful in identifying important behaviors that contribute to the nursing culture. Future research should focus on studying the nursing culture within other PACU’s and Ambulatory Surgery Units to delineate any similarities or differences.
POSTOPERATIVE NAUSEA AND VOMITING RESCUE USING AROMATHERAPY Primary Investigators: Amanda Hudgens, BSN, RN, CAPA Carolinas Medical Center-University Hospital, Charlotte, NC Ronald Hunt, MD Southeast Anesthesiology Jacqueline Dienemann, PhD, RN, UNC Charlotte, H. James Norton, PhD, Wendy L. Hartley, MSN, RN Carolinas Medical Center, Thomas Stern, MD, CMC-University, George Divine, MD, Henry Ford Health System, Detroit, MI
Postoperative nausea and vomiting (PONV) is a common complication of surgery and occurs in 20-30% of patients. Antiemetic mediation reduces incidence, but does not reliably prevent PONV that can lead to dehydration, electrolyte imbalance, prolonged recovery, and decreased patient satisfaction. Thus, effective rescue treatment for PONV that occurs after surgery is needed. The negative effects of conventional pharmacological approaches (sedation, hypotension, and cost) have spurred researchers to explore alternative therapies. The purpose of the study was to investigate the effectiveness of aromatherapy agents on the treatment of PONV for patients after receiving surgery. A randomized controlled trial of 3 aromatherapy agents (ginger, isopropyl alcohol, and a blend of oils) and Normal Saline as the control at one surgical site was completed. IRB approval received. Eligibility was adult patients, ability to give consent, no history of coagulation problems, and no allergies to the aromatherapy agents. Before surgery, demographic information, risk factors, and any antiemetic medications received was collected. After surgery, participant’s nausea was rated using a Likert Scale of 0-3. Those reporting nausea were randomly given one of the agents on a gauze pad and instructed to inhale the aroma. After 5 minutes they were asked to rate their nausea again. Antiemetic mediation was given as requested. Analysis used SAS software for descriptive statistics and the Wilcoxan rank sum test to compare the intervention aromatherapy agents to the control, along with 95% confidence level and a Bonferoni adjustment for multiple comparisons. There was a final sample of 1151 consenting patients with 301 reporting PONV (26.15%). Nausea rate for those at moderate or high risk receiving preventative medication was 35.53%. Change in nausea was significant for the aromatherapy blend (p5.0001), ginger (p5.0006), and not significant for alcohol compared to Normal Saline. The number of antiemetic medications requested after aromatherapy was reduced significantly by the type of aromatherapy. In conclusion, aromatherapy for rescue treatment of PONV is a valid alternative. Aromatherapy offers many benefits over pharmaceutical agents alone. It reduces PACU length of stay,