Guidance for the psychological care of day case surgery patients

An increase in day surgery activity to 75 per cent of all elective surgery is a central feature of the NHS Plan (DoH 2000). However, patient information provision remains a challenge for all modern surgery as the time spent in hospital is brief and the level of self-care has grown. Effective information provision and an increased emphasis on psychological care are therefore essential to the future of day surgery.

Reprocessing single-use devices--the equipment connection

This is the second in a series of three articles about reprocessing medical devices labeled as "single use" by the manufacturer. The goal of reprocessing single-use devices (SUDs) is to save money and decrease environmental pollution. Reprocessing can be performed on SUDs that have been used on other patients or opened but not used. In this article, the procedures for reprocessing (e.g., cleaning, inspecting, sterilizing, tracking, testing, validating) and establishing a reuse program are discussed. The first article of the series, published in the May 2002 issue of the Journal, discussed the ethical component of reusing SUDs. The third article, to be published in the July 2002 issue, will discuss the roles of the involved regulatory agencies and organizations guiding the process.

Evidence-based practice guidelines--one way to enhance clinical practice

Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.

Ethics in perioperative practice--accountability and responsibility

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this third of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the fourth provision statement, which addresses nurses' accountability and responsibility.

Preoperative hair removal--a systematic literature review

This article describes a systematic literature review on whether, how, and when to perform preoperative hair removal. By searching electronic databases and reference lists of relevant articles, team members identified 20 clinical studies that deal with preoperative hair removal. No strong evidence was found to advocate against preoperative hair removal. Furthermore, there was strong evidence to recommend that when hair removal is considered necessary, shaving should not be performed. Instead a depilatory or electric clipping, preferably immediately before surgery, should be used.

Reprocessing single-use devices--the ethical dilemma

This is the first in a series of three articles about reprocessing medical devices labeled as "single use" by the manufacturer. The goal of reprocessing single-use devices (SUDs) is to save money and decrease environmental pollution. Reprocessing can be performed on SUDs that have been used on other patients or opened but not used. The practice of reprocessing is complex and technical, and it raises concerns about patient safety, ethics, the environment, and costs. Opponents of reprocessing argue that the risks outweigh the benefits and that research has not proven it to be safe. Supporters believe the devices are labeled for single use so that manufacturers can maintain their profit margin and avoid liability. The purpose of part one of this article is to inform nurses about the ethical issues, patient safety issues (e.g., infection control, patient injury), and previously performed research studies regarding reprocessing and reusing products that are intended for single use. The second and third articles in this series will discuss procedures for reprocessing, roles of the regulatory agencies involved, and advantages and disadvantages of using third-party reprocessors.

Ethics in perioperative practice--patient advocacy

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this second of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the third provision statement, which addresses nurses' position as patient advocates.

Ethics in perioperative practice--principles and applications

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this first of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the first statement, which emphasizes respect for people.

Intuition and the development of expertise in surgical ward and intensive care nurses

AIM

The aim of this study was to explore and identify nurses' clinical expertise in surgical ward and intensive care settings in England. One of the objectives of the study and the focus of this paper was the exploration of these nurses' understanding and use of intuition in the context of their practice.

BACKGROUND

Since 1980 many studies have investigated qualified nurses' use of intuition within aspects of their practice. However, it was Benner's (1982, 1984) seminal work that firmly established the relationship between intuition and expert clinical practice. Since that time a possible relationship between intuitive components of decision-making and nonexpert nurses' practice has remained relatively unexplored until recently.

METHODS

This constructivist qualitative study incorporated observation and interview to explore 61 qualified nurses' expertise through their assessment of patients following major surgery.

FINDINGS

Specific findings highlighted refinement in nurses' use of intuitive and analytical elements of decision-making across the four identified levels of expertise. The most fluent and effective use of intuitive and analytical components of decision-making was found in the expert group.

CONCLUDING REMARKS

These results are discussed in relation to current understanding of the components of expert decision-making in nursing practice. Both intuitive and analytical elements should be recognized in any model that seeks to depict the true nature of nurses' decision-making as they develop clinical expertise.

Hepatitis C in perioperative practice

This is the second of a series of three articles which won the Alison Bell Writer's Award this year. Maureen Dyke won second prize for this article, which looks at nurses' knowledge and appreciation of the dangers of the various hepatitis infections. The Writer's Award is sponsored by NATN and Regent Medical.

Postoperative nausea and vomiting in the perioperative setting

Postoperative nausea and vomiting (PONV) is reported to occur in up to 92% of surgical cases. In this article, Agnes Arnold defines the terms, identifies a range of therapies and risk factors, examines the dangers and discusses the management of PONV. The article was originally produced as a study for ENB 183.

Developments in the care of patients who require surgery for an abscess

This is the first of a series of three articles which won the Alison Bell Writer's Award this year. Jill Biggins won first prize for this article which looks at a way of improving the patient's experience of day surgery. The Writer's Award is sponsored by NATN and Regent Medical.

The lived perioperative experience of ambulatory surgery patients

Understanding patients' perspectives is central to providing appropriate nursing care. The purpose of this study was to explore ambulatory surgery patients' perceptions and views of the perioperative experience. A phenomenological study was conducted that included 16 patients who underwent abdominal surgical procedures in the ambulatory surgery center of a large teaching hospital in the northeastern United States. Intensive semistructured interviews were used to collect data. Patients were interviewed one week after surgery. Data analysis was aimed at gaining understanding of the lived experience of ambulatory surgery patients. Themes identified included fear, knowing, and presence. Results indicate that patients in this study were not prepared adequately for the perioperative experience, suffered needlessly due to inadequate pain management, and did not achieve discharge readiness.