Claudia P. Barone

Use of complementary and alternative therapies to promote sleep in critically ill patients

The efficacy of complementary and alternative therapies for sleep promotion in critically ill patients is largely unexamined. We found only seven studies (three on environmental interventions and one each on massage, music therapy, therapeutic touch, and, melatonin) that examined the effect of complementary and alternative therapies. A number of studies, however, have shown that massage, music therapy. and therapeutic touch promote relaxation and comfort in critically ill patients, which likely leads to improved sleep. Massage, music therapy, and therapeutic touch are safe for critically ill patients and should be routinely applied by ICU nurses who have received training on how to administer these specialized interventions. Environmental interventions, such as reducing noise, playing white noise such as ocean sounds, and decreasing interruptions to sleep for care, also are safe and logical interventions that ICU nurses should use to help patients sleep. Progressive muscle relaxation has been extensively studied and shown to be efficacious for improving sleep in persons with insomnia; however, progressive muscle relaxation requires that patients consciously attend to relaxing specific muscle groups and practice these techniques, which may be difficult for critically 11 patients. We do not currently recommend aromatherapy and alternative sedatives, such as valerian and melatonin, for sleep promotion in critically ill patients because the safety of these substances is unclear. In summary, we recommend that ICU nurses implement music therapy, environmental interventions, therapeutic touch, and relaxing massage to promote sleep in critically ill patients. These interventions are safe and may improve patient sleep, although randomized controlled trials are needed to test their efficacy. Aromatherapy and alternative sedatives require further investigation to determine their safety and efficacy.

Training health care providers in the treatment of tobacco use and dependence: pre- and post-training results

RATIONALE Health care providers have an extended reach into the population of tobacco users. Increasing the number and variety of health care providers that deliver the evidence-based, brief interventions for tobacco use prescribed by the Public Health Service Clinical Practice Guideline is likely to result in more tobacco users exposed to evidence-based treatments and more successful quit attempts. Effective training is key to increasing provider performance and proficiency in this regard. METHOD A 1-hour didactic training was delivered to 1286 health care providers (185 physicians, 359 nurses, 75 dental providers and 667 other health-related professions). Pre- and post-training tests assessed provider attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. Analysis of variance was used to test for significant differences among professional groups. RESULTS Prior to training, physicians engaged in more interventions and reported more knowledge and more positive attitudes towards treating tobacco use than the other professions. Post-training, differences among physicians, nurses and dental providers were minimal. All professions reported significantly more knowledge and more positive attitudes on nearly all measures. CONCLUSIONS A large potential benefit can be garnered from a brief, targeted, 1-hour training in the brief, evidence-based interventions for treating tobacco use and dependence. Increases in perceived knowledge and positive attitudes towards treatment among the professional groups suggest that trainees will perform interventions at higher frequency post-training. Overall gains were highest for dental providers and nurses.

Training Nurses in the Treatment of Tobacco Use and Dependence: Pre- and Post-Training Results

AIM This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. BACKGROUND   Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. METHOD   A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. RESULTS   Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. CONCLUSION   Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

A history of the PACU

The specialized intense nursing care provided in the PACU is now well recognized as crucial to optimize outcomes for the patient undergoing modern anesthesia and surgical techniques. However, this fact has not always been recognized. Although anesthetic techniques have evolved since the mid-1800s, the widespread establishment of PACUs only began about 50 years ago, shortly after World War II. This article provides an historical review of the development of the PACU in the United States.

Emergency Department-Initiated Tobacco Dependence Treatment

OBJECTIVE To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. METHODS The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. RESULTS Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. CONCLUSIONS An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.

Preventing postoperative nausea and vomiting: refresh your knowledge of how to recognize and respond to this common complication.

For surgical patients, postoperative nausea and vomiting (PONV) is one of the most undesired complications of anesthesia and surgery.1–3

Tobacco-Cessation Interventions and Attributes of Individual and Organizational Excellence in Acute Care

Background Despite years of reducing tobacco use, few studies describe to what extent evidence‐based tobaccocessation interventions are a standard of acute and critical care nursing practice using the US Public Health Service 5 As framework: ask, advise, assess, assist, and arrange. Objectives To identify relationships between the 5 As framework, attributes of individual and organizational excellence, and intention to integrate tobacco‐cessation interventions as a standard of daily practice among nurses. Methods Nurses attending the American Association of Critical‐Care Nurses National Teaching Institute were invited to complete a 21‐item survey. Data were gathered in Boston, Orlando, and Chicago in a 3‐year period. Descriptive statistics and logistic regression were used for data analysis. Results Among 1773 completed surveys, nurses from organizations with standing orders for tobacco dependence were 5 times more likely to have high confidence in their 5 As skills (odds ratio, 5.037; 95% CI, 3.429‐7.400; P<.001) and 3.4 times more likely to have high intentions to integrate tobacco cessation into their daily practice (odds ratio, 3.421; 95% CI, 1.765‐6.628; P<.001). Nurses with certifications were more likely to want to learn how to integrate tobacco‐cessation interventions (odds ratio, 1.676; 95% CI, 0.990‐2.836; P = .05). Conclusions Opportunities abound to create strategies leveraging attributes of nursing and organizational excellence to promote evidence‐based approaches to improve health outcomes in acutely and critically ill tobaccodependent populations.