Pamela E. Windle

Who is at risk for postdischarge nausea and vomiting after ambulatory surgery

Background: About one in four patients suffers from postoperative nausea and vomiting. Fortunately, risk scores have been developed to better manage this outcome in hospitalized patients, but there is currently no risk score for postdischarge nausea and vomiting (PDNV) in ambulatory surgical patients. Methods: We conducted a prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States from 2007 to 2008. PDNV was assessed from discharge until the end of the second postoperative day. Logistic regression analysis was applied to a development dataset and the area under the receiver operating characteristic curve was calculated in a validation dataset. Results: The overall incidence of PDNV was 37%. Logistic regression analysis of the development dataset (n = 1,913) identified five independent predictors (odds ratio; 95% CI): female gender (1.54; 1.22 to 1.94), age less than 50 yr (2.17; 1.75 to 2.69), history of nausea and/or vomiting after previous anesthesia (1.50; 1.19 to 1.88), opioid administration in the postanesthesia care unit (1.93; 1.53 to 2.43), and nausea in the postanesthesia care unit (3.14; 2.44–4.04). In the validation dataset (n = 257), zero, one, two, three, four, and five of these factors were associated with a PDNV incidence of 7%, 20%, 28%, 53%, 60%, and 89%, respectively, and an area under the receiver operating characteristic curve of 0.72 (0.69 to 0.73). Conclusions: PDNV affects a substantial number of patients after ambulatory surgery. We developed and validated a simplified risk score to identify patients who would benefit from long-acting prophylactic antiemetics at discharge from the ambulatory care center.

Secondary Data Analysis: Is It Useful and Valid?

AS THE VOLUME of available data has increased through online resources over the last 10 to 20 years, interest in using various data libraries to investigateresearchissueshasgrownsteadily.Universities have also encouraged students to use existing data from faculty research to explore different objectives than those proposed for the original study. The use of secondary analysis allows the student or aspiring researcher to complete a project in a shorter period of time than would be necessary for primary data collection and analysis. Professional practitioners have also recognized the value of the large national databases to explore issues within populations of interest to them. Even government agencies have encouraged varied analyses withintheirdatabasestolearnmoreabouttheexisting needs and perceptions of their constituencies.

Perianesthesia nursing advocacy: an influential voice for patient safety.

Perianesthesia nurses are called to advocate for their patients, promote a safe work environment, and contribute to the continued advancement of the nursing profession. Nurses must demonstrate vigilance in their nursing care to protect patients from harm. It is an ethical and legal responsibility to request physicians to review with patients their informed consents when they report they do not understand or have questions about the surgical procedure. Likewise, nurses need to alert managers and administrators when they experience unsafe work environments, such as actual or potential nurse staffing issues, unsafe nurse-to-patient ratios, medication errors, and nurse fatigue. This article focuses on the valuable role perianesthesia nurses play in patient advocacy by: (1) speaking out on behalf of the patient, (2) assuring a safe work environment, (3) assessing for nurse fatigue, and (4) advocating patient safety for the global nursing profession.

The Systematic Review Process: An Overview

OVER THE YEARS, perianesthesia nursing has evolved from the care of postoperative surgical patients to the care of a wide variation of nonsurgical patients who have received anesthetic agents during procedures performed in other specialized departments such as endoscopy, interventional radiology, cardiac catherization laboratory, radiation therapy, and nuclear medicine, etc. In addition, once-simple outpatient procedures have evolved into more complex, advanced, and complicated procedures requiring a higher level of nursing care across the perianesthesia continuum.

ASPAN Perianesthesia Data Elements--the model.

THE CORE PURPOSE of the Perianesthesia Data Elements (PDE) Committee has been to create a comprehensive dictionary that will include the critical data elements crucial for inclusive and consistent perianesthesia nursing documentation. The committee developed a schematic model (Fig 1) to provide a platform showcasing the basic process concepts that converged to form the origins of perianesthesia data elements. This model displays the key characteristics of the informatics structure that best describe the work and language of perianesthesia nurses. Components embedded in this conceptual model include the following: nursing assessments, diagnoses, interventions, outcomes, influential nonclinical elements, critical pathways, care plans, protocols, guidelines, standards, competencies, levels of care, phases of perianesthesia nursing, facilities, quality indicators, and safety. These central components of PDE are critical in laying the foundation for safe communication.

Understanding Informed Consent: Significant and Valuable Information

IN THE 1960S, the United States Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) issued rules that required written informed consent from individuals who volunteered to participate in research protocols sponsored by those agencies. These rules focused on clinical studies with an emphasis on safety or efficacy of pharmaceutical products. Eventually, the concept of informed consent expanded throughout other types of health care research protocols, including nursing studies.

Evidenced-based case management practice, part 1: the systematic review.

Objectives This article aims to (1) describe the steps in the development of a systematic review, (2) discuss the use of systematic reviews in developing an evidence base for case management practice, and (3) present listings of agencies that provide systematic reviews on clinical topics and resources to evaluate systematic reviews for application to practice. Primary Practice Settings Evidence-based practice is mandated for all healthcare professionals regardless of setting. For nonacademic settings, a lack of library resources may make this mandate difficult to accomplish. Systematic reviews are available through agency Web sites and, therefore, are accessible to anyone with Internet access. Findings/Conclusions Evidence-based practice supports professionalism, patient safety, and quality care. However, most case managers, have heavy workloads and limited time to complete literature reviews adequate to provide a basis for clinical decision making. For that reason, systematic reviews are developed and published by a variety of professional groups, including clinicians, academics, researchers, and library systems. This article focuses on the systematic review and includes definitions, a comparison of types of reviews, the process for completing systematic reviews, sources of systematic reviews, and tools used to critique them. Implications for Case Management Practice Systematic reviews can be helpful tools to allow busy case managers to provide the safest and most effective care to their patients. They can support the development of guidelines specific to case management such as transitioning care to other institutions or to the patients home, management of the patient in the community, and prevention of recidivism or unplanned return to an acute care setting.

Evidence-based case management practice-part II: meta-analysis: a primer for case managers.

Objectives This article aims to (1) describe the steps in the development of a meta-analysis, (2) discuss the use of meta-analysis in developing an evidence base for case management practice, and (3) provide some basic guidelines for evaluating the meta-analysis. Primary practice settings Evidence-based practice (EBP) is a mandate for all healthcare professionals, regardless of setting. Although many institutions lack library resources, systematic reviews and meta-analyses are available from multiple sites on the Internet. Findings/conclusions EBP is an essential element for professionals in the provision of safe, quality patient care. However, most healthcare professionals, including case managers, have little time to complete the extensive literature reviews and analyses required for evidence-based practice. Literature reviews completed by professional teams provide a solution for caregivers in their efforts to base practice on the best evidence. This article describes the quantitative literature review, meta-analysis, including definitions of terms, a description of the process, sources of meta-analyses, and basic guidelines for determining the quality of the review and applicability of the results to practice. Implications for case management Meta-analyses can provide access to the latest evidence for case managers with little time but great need for the most effective approaches to managing care. Meta-analyses provide a statistical analysis of multiple studies pooled to provide the most definitive interpretation of the data. Correctly analyzed and interpreted, meta-analyses can provide a sound basis for management of patient transitions from hospital to home and community. Meta-analyses describing the impact of various treatments allow the case manager to better prepare the patient and family for the healthcare issues the patient may face in recovering from a diagnosis and/or treatment.

Obstacles and drawbacks to avoid in qualitative nursing research.

QUALITATIVE NURSING RESEARCH has become a key area of interest among nursing professionals and nursing students going for advanced degrees over these past years. This type of research enables the nurse researcher to explore subjective answers to some questions that keep the researcher wondering, stimulated, and intrigued about an area of interest where they have been unable to quantify the response. There are numerous published articles documenting accounts of qualitative research efforts using a variety of techniques. To answer questions of the ‘‘what’’ or ‘‘how,’’ quantitative research is usually used, analyzing numbers or statistics, whereas qualitative research seeks out the ‘‘why’’ of the topic of interest through data analysis of unstructured information from interviews, observations, and open-ended responses.

Research: An Influential Force in Transforming Health Policy

HEALTH CARE IS DYNAMIC and rapidly changing as new and significant challenges to the health care system face an uncertain but promising future. A new era has come, with opposing political parties who will be making future decisions on what health care should be and will be. As President Obama championed the passing of the new health care reform act, multiple health care leaders are wondering what will be the patient, family member, and health care practitioners’ roles in this transition. The geriatric population, more than any other age group, has experienced the most dramatic changes. Likewise, included in this aging population are the more culturally and ethnically diverse as well as those with long-term illnesses and chronic conditions.