ASPAN's Delphi study on national research: priorities for perianesthesia nurses in the United States

Delphi Study: ASPAN Adult Patient Pain and Comfort Practices

PURPOSE

The American Society of PeriAnesthesia Nurses (ASPAN) is responsible for establishing evidence-based standards to guide perianesthesia nursing practice. The ASPAN model for evidence-based practice acknowledges the potential for the Delphi technique to identify priorities for perianesthesia research. The purpose of this Delphi study was to generate a consensus on pain and comfort among a panel of experts.

DESIGN

ASPAN convened a panel of experts to provide recommendations based on seven categories, this led to the development of a questionnaire to build consensus.

METHODS

Survey conducted among panel of experts to obtain consensus. Two survey rounds were completed.

FINDINGS

A consensus was obtained reaching a 70% benchmark for an acceptance.

CONCLUSIONS

The results found a consensus on topics required for education and competency among perianesthesia nurses including transfer and discharge criteria related to pain and comfort, resources for perianesthesia nurses, policy guidelines, and the management of the special needs of perianesthesia patients.

Sugammadex Rescue in Avoiding Intensive Care Unit Admission in an Octogenarian Undergoing Emergency Laparotomy

Postlaparotomy management for elderly patients with underlying comorbidities is always a challenge because of poor cardiorespiratory reserves and prolonged effect of anesthetic drugs. For these reasons, such patients usually require intensive care unit (ICU) admission in the postoperative period. We report a case of an 85-year-old chronic smoker with controlled diabetes mellitus who needed an emergency laparotomy for a perforated gastric ulcer. Unfortunately, there was a shortage of ICU backup. With the successful conduct of an early surgery using combined general and regional anesthesia, the use of sugammadex (Bridion, Merck Sharp & Dohme Corp, Oss, the Netherlands) as a reversal agent, a skilled surgeon, and good postanesthesia care, the patient did not require ICU admission. He recovered fast and was discharged home 4 days after surgery. This case study aims to contribute to the literature on experience of a successful conduct of anesthesia in a high-risk geriatric patient when ICU facilities are limited.

Staff Developed PACU Acuity Scoring Grid

PURPOSE

The goal of this project was to design a tool to classify patients in the postanesthesia care unit (PACU) for acuity as defined by nursing interventions.

DESIGN

An instrument development and validation approach was used.

METHODS

A PACU acuity scoring grid was developed using the American Society of PeriAnesthesia Nurses (ASPAN) professional guidelines and Rothman Index concepts to help classify patients by acuity and determine PACU acuity class. The appropriate ASPAN nurse-patient ratio was assigned to the classification. PACU staff were educated on use of the PACU acuity scoring grid. Staff piloted the grid on patients in PACU and then refined the grid. Validity and reliability of the grid were also evaluated.

FINDINGS

Data evaluation showed that 54% of patients fell into classification II, with a ratio of one nurse to two patients. Classification III is the second highest category with 38%, with a ratio of one nurse to one patient. The tool demonstrated validity and the Cronbach alpha measure of reliability for the PACU acuity scoring grid was 0.695 on 73 of the 92 variables on the grid.

CONCLUSIONS

The PACU acuity scoring grid is a tool that can be used to identify patient acuity by assigning acuity points to nursing interventions in five categories. The acuity points can be used to assign a patient to a PACU class, which can then converted to a nurse-patient ratio to allow for the provision of safe and efficient nursing care.

A survey of NAPNAP members' clinical and professional research priorities

INTRODUCTION

The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members' ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age.

METHOD

A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90 statements in two domains: Clinical Priorities and Professional Role Priorities.

RESULTS

Survey respondents strongly supported the top priorities with an average overall mean score of 4.0 or above on a 5-point Likert scale. Only three of the top 10 clinical and professional priorities differed by area of practice. No clinical priorities and only three professional priorities differed by age.

DISCUSSION

The survey results were used to develop the NAPNAP Research Agenda. Both the survey results and the agenda can provide guidance for the NAPNAP Board, committees and interests groups as they develop initiatives and programs.