Journal of post anesthesia nursing
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With the increase in the number of critically ill patients needing extended periods of time in the ICU and the subsequent shortage of ICU beds, hospitals have examined ways to use the PACU as an alternative for the short-term critically ill patient. This article identifies common problems encountered by the PACU staff, and the author suggests criteria for establishing and implementing guidelines for successful integration of these short-term critically ill patients without losing sight of the PACU's goals and compromising patient care. The criteria for establishing guidelines were based on the personal experience of the author in developing a program for ICU overflow patients, as well as from experiences of other PACU nurses working in PACUs where successful guidelines currently are used.
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There has been a renewed interest in spinal anesthesia in recent years. However, its use for ambulatory surgery patients has not been as well accepted as its use for inpatients because of the high incidence of postdural puncture headache (PDPH) and uncertain patient recovery time before hospital discharge. Recently, studies indicate that the incidence of PDPH can be lowered to an acceptable level by applying improved techniques such as the use of a 27-g spinal needle or a needle with a tip designed like a pencil point, such as a Whitacre (Becton-Dickinson, Rutherford, NJ) or Sprotte (Pajunk, Geisingen, Germany) needle. ⋯ When considering spinal anesthesia for ambulatory surgery patients, it is important that the postanesthesia care staff be knowledgeable, because nursing care is one of the three integral parts of total patient care that makes ambulatory surgery successful. The other two components are surgery and anesthesia management. This presentation reviews the history, indications, benefits, and complications of spinal anesthesia and recommends nursing care for patients undergoing ambulatory surgery.
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Pain has been difficult to assess because of its multidimensional nature. The primary purpose of this study was to investigate the relationship between the nurse's assessment of behavioral cues to pain and self-reports of pain made by patients using patient controlled analgesia (PCA). This descriptive-correlational study used the PACU Behavioral Pain Rating Scale (BPRS), patient's self-report, and hospital's PCA pain-rating scale to investigate pain measurement. ⋯ Significant relationships (rs = 0.56 to 0.80; P < 0.05) were found between the BPRS scores and the self-reports of pain. The relationship between the hospital's PCA pain rating scores and self-reported pain was significant only during the second assessment (rs = 0.45; P < 0.05). The BPRS consistently showed a moderate to high relationship with the patient's self-report of pain and had a stronger relationship with the patient's self-reported pain than with the hospital's pain scale.
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Nursing in the PACU is an art as well as a science. Development of competent nurses requires a systematic yet creative process. Competency is a measure of professionalism and a guarantee to customers. ⋯ Application of new and changing technology makes skill validation imperative. An appropriate skill validation plan assesses nurses' performance and targets procedures that are high technology, high risk, or infrequently performed. Quality patient care and nurse retention are two potential outcomes dependent on good preceptor programs and skill validation.