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Moving Forward
EDITORIAL OPINION
Moving Forward Jan Odom-Forren, MS, RN, CPAN, FAAN I WAS PRIVILEGED to attend a dinner last week in honor of all certified nurses in the hospital where I work. The speaker was a chaplain from the hospital who did a beautiful job relating to nurses how important we are to patients, patients’ families, and also to each other.
work. We depend on each other. We reassure each other through family illnesses, personal crises, and moments of triumph. The example the chaplain gave during her talk was of a nurse who showed compassion to her at a moment when it was most needed. We are there for each other.
Sometimes I think we forget how much a reassuring word or touch on the shoulder is comforting to a patient or family member. And they give back to us. In Daily Miracles, Irene Arcibal relates the following story: ‘‘I had taken care of her since she was placed on a respirator. When the respirator finally came off, I told her how happy I was to hear her voice. Later, in the middle of my shift, while I was turning her, she said, ‘Thank you for your help. You are a beautiful person.’’’1
This Issue
In the PACU, critical thinking skills allow the nurses to make a quick assessment on admission and to evaluate patient needs. This continues during the entire stay of the patient. Competence is required for care of patients ranging from minor surgery to critical care and in many hospitals, from pediatric to geriatric. In Phase II recovery, our skills and discharge education allow the patient to go home with a family assured that they will be able to care for the patient. Answering questions about a medication, discussing how the incision will look when the bandage is removed, and instructing a patient how to empty and measure drainage from a bulb syringe all serve to make the patient and family member competent to care at home. We as nurse colleagues also are friends to each other. Think of the amount of time spent at Journal of PeriAnesthesia Nursing, Vol 23, No 2 (April), 2008: pp 75-76
Florence Nightingale once said, ‘‘For us who Nurse, our Nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it, we are going back.’’2 That Nightingale quote reminded me of a particularly quotable (said with a smile) past Vice-President who once said, ‘‘It’s a question of whether we are going to go forward into the future, or past to the back.’’3 This issue of JoPAN is filled with articles that move us forward and allow us to progress in the knowledge and skills we require for our specialty. Penelope S. Villars and others discuss use of the Observe, Orient, Decide, and Act (OODA) Loop to reduce postoperative nausea and vomiting in a high-risk outpatient oncology population. The OODA Loop provided an effective system for developing a collaborative The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Jan Odom-Forren, MS, RN, CPAN, FAAN, is a Perianesthesia Nursing Consultant in Louisville, KY, a PhD candidate at the University of Kentucky, Lexington, KY, and a staff nurse in the Phase II Recovery at Baptist Hospital East, Louisville, KY. Address correspondence to Jan Odom-Forren, MS, RN, CPAN, FAAN, 800 Edenwood Circle, Louisville, KY 40243; e-mail address: [email protected]. Ó 2008 by American Society of PeriAnesthesia Nurses. 1089-9472/08/2302-0001$34.00/0 doi:10.1016/j.jopan.2008.02.002 75
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plan for PONV prophylaxis. Developed for use with Air Force pilots, this application of immediate feedback resulted in improved patient outcome. Patricia Kidik and Kathleen Holbrook discuss the role of the nurse practitioner in evidencebased medication strategies. It is heartening to see articles that are defining roles for advanced practice nurses within the perianesthesia community. In an article in August 2007, the author discussed the role of the NP managing patient care in the PACU.4 The article in this issue discusses nurse practitioners who work in preoperative evaluation and how they use an evidence-based guideline to identify patients who meet criteria for perioperative beta blockade and deep vein thrombosis prophylaxis. Nerrisa Bonifacio and Geertje Boschma discuss family visitation in the PACU in a review of the literature from 1984 to 2006. Their review shows the progression of thought concerning family visitation over the years with the latest literature challenging the old paradigm of ‘‘no visitors.’’ They conclude that further study is required for a better understanding of impeding factors for change. Gloria Young and others take a look at workload in the perianesthesia setting. Some of the factors contributing to medical errors are increased workload, fatigue, cognitive overload, ineffective interpersonal communications, and faulty information processing. These au-
thors survey uses of the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), a tool that evaluates subjective workload and looks at the uses for the tool in the perianesthesia setting. Mary K. Clark gives us a cutting edge continuing education article about the use of lipid emulsion as rescue for anesthetic-related cardiotoxicity. Recent case studies have shown successful resuscitation from cardiac arrest in patients with local anesthetic-related cardiotoxicity. This off label use of lipid emulsion is research in progress, and Clark has alerted us to the significant difference that can be made in this specific situation. Our columnists discuss development of a perioperative integrative care committee, use of beta-blockers in the perioperative setting, a discussion of healthcare-associated and community-associated MRSA, and the pathophysiology of airway restricted patients. These articles and columns should give us the tools needed to make sure that we ‘‘make progress’’ this month and not ‘‘go past to the back.’’
References 1. Arcibal I. Kind words. In Briskin A, Boller J, eds: Daily Miracles: Stories and Practices of Humanity and Excellence in Health Care. Indianapolis, IN: Sigma Theta Tau; 2006:51. 2. Ulrich BT. Leadership and Management According to Florence Nightingale. Norwalk, CT: Appleton & Lange; 1992:13. 3. Dan Quayle Quotes. Available at: http://www.quotesfamous.com/person/Dan-Quayle-quotes.html. Accessed February 22, 2008. 4. Federico A. Innovations in care: The nurse practitioner in the PACU. J Perianesth Nurs. 2007;22:235-242.
Moving Forward Jan Odom-Forren, MS, RN, CPAN, FAAN I WAS PRIVILEGED to attend a dinner last week in honor of all certified nurses in the hospital where I work. The speaker was a chaplain from the hospital who did a beautiful job relating to nurses how important we are to patients, patients’ families, and also to each other.
work. We depend on each other. We reassure each other through family illnesses, personal crises, and moments of triumph. The example the chaplain gave during her talk was of a nurse who showed compassion to her at a moment when it was most needed. We are there for each other.
Sometimes I think we forget how much a reassuring word or touch on the shoulder is comforting to a patient or family member. And they give back to us. In Daily Miracles, Irene Arcibal relates the following story: ‘‘I had taken care of her since she was placed on a respirator. When the respirator finally came off, I told her how happy I was to hear her voice. Later, in the middle of my shift, while I was turning her, she said, ‘Thank you for your help. You are a beautiful person.’’’1
This Issue
In the PACU, critical thinking skills allow the nurses to make a quick assessment on admission and to evaluate patient needs. This continues during the entire stay of the patient. Competence is required for care of patients ranging from minor surgery to critical care and in many hospitals, from pediatric to geriatric. In Phase II recovery, our skills and discharge education allow the patient to go home with a family assured that they will be able to care for the patient. Answering questions about a medication, discussing how the incision will look when the bandage is removed, and instructing a patient how to empty and measure drainage from a bulb syringe all serve to make the patient and family member competent to care at home. We as nurse colleagues also are friends to each other. Think of the amount of time spent at Journal of PeriAnesthesia Nursing, Vol 23, No 2 (April), 2008: pp 75-76
Florence Nightingale once said, ‘‘For us who Nurse, our Nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it, we are going back.’’2 That Nightingale quote reminded me of a particularly quotable (said with a smile) past Vice-President who once said, ‘‘It’s a question of whether we are going to go forward into the future, or past to the back.’’3 This issue of JoPAN is filled with articles that move us forward and allow us to progress in the knowledge and skills we require for our specialty. Penelope S. Villars and others discuss use of the Observe, Orient, Decide, and Act (OODA) Loop to reduce postoperative nausea and vomiting in a high-risk outpatient oncology population. The OODA Loop provided an effective system for developing a collaborative The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Jan Odom-Forren, MS, RN, CPAN, FAAN, is a Perianesthesia Nursing Consultant in Louisville, KY, a PhD candidate at the University of Kentucky, Lexington, KY, and a staff nurse in the Phase II Recovery at Baptist Hospital East, Louisville, KY. Address correspondence to Jan Odom-Forren, MS, RN, CPAN, FAAN, 800 Edenwood Circle, Louisville, KY 40243; e-mail address: [email protected]. Ó 2008 by American Society of PeriAnesthesia Nurses. 1089-9472/08/2302-0001$34.00/0 doi:10.1016/j.jopan.2008.02.002 75
JAN ODOM-FORREN
76
plan for PONV prophylaxis. Developed for use with Air Force pilots, this application of immediate feedback resulted in improved patient outcome. Patricia Kidik and Kathleen Holbrook discuss the role of the nurse practitioner in evidencebased medication strategies. It is heartening to see articles that are defining roles for advanced practice nurses within the perianesthesia community. In an article in August 2007, the author discussed the role of the NP managing patient care in the PACU.4 The article in this issue discusses nurse practitioners who work in preoperative evaluation and how they use an evidence-based guideline to identify patients who meet criteria for perioperative beta blockade and deep vein thrombosis prophylaxis. Nerrisa Bonifacio and Geertje Boschma discuss family visitation in the PACU in a review of the literature from 1984 to 2006. Their review shows the progression of thought concerning family visitation over the years with the latest literature challenging the old paradigm of ‘‘no visitors.’’ They conclude that further study is required for a better understanding of impeding factors for change. Gloria Young and others take a look at workload in the perianesthesia setting. Some of the factors contributing to medical errors are increased workload, fatigue, cognitive overload, ineffective interpersonal communications, and faulty information processing. These au-
thors survey uses of the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), a tool that evaluates subjective workload and looks at the uses for the tool in the perianesthesia setting. Mary K. Clark gives us a cutting edge continuing education article about the use of lipid emulsion as rescue for anesthetic-related cardiotoxicity. Recent case studies have shown successful resuscitation from cardiac arrest in patients with local anesthetic-related cardiotoxicity. This off label use of lipid emulsion is research in progress, and Clark has alerted us to the significant difference that can be made in this specific situation. Our columnists discuss development of a perioperative integrative care committee, use of beta-blockers in the perioperative setting, a discussion of healthcare-associated and community-associated MRSA, and the pathophysiology of airway restricted patients. These articles and columns should give us the tools needed to make sure that we ‘‘make progress’’ this month and not ‘‘go past to the back.’’
References 1. Arcibal I. Kind words. In Briskin A, Boller J, eds: Daily Miracles: Stories and Practices of Humanity and Excellence in Health Care. Indianapolis, IN: Sigma Theta Tau; 2006:51. 2. Ulrich BT. Leadership and Management According to Florence Nightingale. Norwalk, CT: Appleton & Lange; 1992:13. 3. Dan Quayle Quotes. Available at: http://www.quotesfamous.com/person/Dan-Quayle-quotes.html. Accessed February 22, 2008. 4. Federico A. Innovations in care: The nurse practitioner in the PACU. J Perianesth Nurs. 2007;22:235-242.