American Society Of PeriAnesthesia Nurses Research Articles

Effectiveness of Pediatric Competency-Based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses

To evaluate the effectiveness of the American Society of Perianesthesia Nurses (ASPAN) pediatric competency-based orientation (PCBO) education program on knowledge, confidence, and early recognition of nursing expertise among perianesthesia nurses in an acute care setting. A quasi-experimental pre/post survey-intervention design. Sixty perianesthesia nurses with experience ranging from less than 5 years to more than 20 years were included. A chapter review survey was completed to assess knowledge before reviewing the chapters and again after reviewing the ASPAN PCBO materials. A presurvey assessing confidence levels, decision making abilities, and early detection of knowledge regarding pediatric patients' expertise were obtained at the beginning of the study. At the end of the study, a post-study survey was completed to evaluate the effectiveness of the intervention. Random codes were assigned to each participant to ensure that the participants' information was blinded. Perianesthesia nurses' knowledge increased from pre to post intervention with one of the three sets of chapters (Set 2) statistically significant. Perianesthesia nurses' confidence and recognition of nursing expertise scores increased statistically significant from pre to post intervention. Both confidence (with 33 items [P value ≤ .001]) and recognition of nursing expertise (with 16 items [P value ≤ 0.001]) were statistically significant. The ASPAN PCBO was shown to be statistically effective at increasing knowledge, building expertise, promoting confidence, and improving decision making skills. The plan is for the ASPAN PCBO to be incorporated into the new-hire perianesthesia orientation didactic and the competency plan.

Effectiveness of American Society of Perianesthesia Nurses (ASPAN) on Maternal and Neonates Outcome during Perioperative Enhanced Recovery after Caesarean Surgery (ERACS)

Introduction. Patient comfort is one of the important components that must be considered in providing nursing care, including perioperative nursing services, one of which is temperature comfort. The purpose of this research is to explain or to study the effect of the ASPAN guideline intervention for normothermia (active and passive warming) on ​​maternal and neonates outcomes during perioperative Enhanced Recovery After Caesarean Surgery (ERACS). Method. This research used a quasi-experimental quantitative research design or a quasi-experiment involving a control group and an intervention group. Measurement of the intervention group for prevention of hypothermia in cesarean section patients was performed perioperatively (pre-intra-post-surgery). Results. The mother's body temperature variable in the intraoperative and postoperative phases was higher in the intervention group than the control group. The shivering condition variable in the control group experienced an increase in shivering during the intraoperative and postoperative phases (1.15 ± 0.41 and 2.17 ± 0.80), while in the intervention group there was a decrease in shivering condition (0.22 ± 0, 42 and 0.20 ± 0.41). In the temperature comfort variable after measuring using Thermal Comfort ERACS, the Mean ± SD value in the intervention group when the intra-operative and post-operative phases was in the neutral category (0.44 ± 0.6 and 0.44 ± 0.65). Discussion & Conclusion. Application of ASPAN Guideline for normothermia during perioperative obtained significant results on the variable of the mother's temperature, the baby's temperature.

A Web-based Educational Intervention to Increase Perianesthesia Nurses’ Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids

The purpose of this study was to determine if a web-based educational intervention increased knowledge, attitudes, and intention of perianesthesia nurses regarding opioid discharge education (including safe use, storage, and disposal of opioids). Secondary outcomes were to determine Perceived Behavioral Control, subjective norms, and familiarity with American Society of PeriAnesthesia Nurses (ASPAN) guidance on opioid education. A pre-test, post-test longitudinal design. An email described the study and had a link for those choosing to participate. The intervention was a web-based voiceover module with patient education scenarios focused on information required for patients before discharge home. Responses to the evidence-based pre-survey, post-survey one, and post-survey two were collected. The survey was developed using components of the Theory of Planned Behavior. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. The participants were invited to complete a pre-test survey (n=672), the immediate post-test (n=245), and the 4-week post-test (n=172). The analysis presented is limited to 245 who completed at least the first post-survey. Most were staff nurses (82%), and the majority had a BSN (62%); participants most typically worked in a hospital-based PACU (73%). For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in all but one of the models. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for Perceived Behavioral Control, attitude, and intention, the degree of increase between baseline and week 4 was not significant. In all cases, both the immediate and 4-week post-test scores exceeded the corresponding pre-test score, though, for three of the TPB constructs, the difference between baseline and week 4 was not significant, while nearly all of the increases between baseline and immediately following the intervention were significant. These findings suggest a more intensive intervention, possibly with the inclusion of booster sessions, may be needed.

Pitfalls in Perioperative Documentation, Compliance with the EMR

<h3>Background Information</h3> In 2018, Perianesthesia nurses at Delnor Hospital embarked on a documentation quality improvement initiative. A team of nurses collaborated to promote consistency in standardized documentation within The American Society of Perianesthesia Nurses (ASPAN) guidelines by enhancing electronic documentation. A workgroup was developed with representation from Pre-op, Phase I, Phase II, Professional Development, and Perioperative Leadership with both surgical areas within Delnor. The team established documentation guidelines based ASPAN standards. Education was developed along with an audit tool to measure compliance. Baseline data from the start of the project in 2018 identified documentation compliance was less than 62% for all areas. A goal was established to improve compliance to 85%. After three months of audits, all three areas achieved the goal and exhibited significant improvement. With continued audits and peer coaching provided by the documentation committee compliance was achieved. However, after the pandemic hit sustainment of the goal decreased in compliance. <h3>Objectives of Project</h3> The committee focused on reeducation of the team and audits to reestablish the expectation, hold staff accountable and get back to the targeted goal. <h3>Process of Implementation</h3> A pre-learning audit was completed to determine baseline data and where reeducation was needed. The education was disseminated to the staff in the three phases of care. The documentation guidelines and education were added to the orientation binder for new staff. Twenty audits were completed monthly per area for three consecutive months. The re-introduction of the project was received positively and the staff felt empowered with knowledge, increased confidence on appropriate assessment/documentation, and improved communication through the Perioperative setting. It was identified that staff who were non-compliant, were the ones who were resistant to the initial project and fell back to old habits. <h3>Statement of Successful Practice</h3> The committee realized that accomplishing the goal is important but identified that sustainment is the most crucial aspect of the project. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The documentation group will continue to monitor documentation, provide additional education for compliance and focus next on case-specific assessment/documentation.

An Educational Intervention to Improve Comfort with Applying and Interpreting Transcutaneous CO2 and End-tidal CO2 Monitoring in the PACU

The purpose of this study was to assess the effectiveness of an educational program about measuring ventilation using devices that assess carbon dioxide levels in patients recovering from a surgical procedure. A pre-post survey of knowledge attainment from an educational intervention about measuring ventilation using end-tidal carbon dioxide (EtCO2) and transcutaneous carbon dioxide (tcPCO2) devices in the postanesthesia care unit (PACU) was distributed to current members of the American Society of PeriAnesthesia Nurses. Participants received a 12-question pre-intervention (five were related to demographics) and a five-question post-intervention survey. Non-demographic survey questions used a one to five Likert scale to assess comfortability or confidence. The intervention created was a voice-over presentation designed to improve PACU RN's comfort and confidence with using and interpreting tcPCO2 or EtCO2 in the PACU. PACU RNs (N=108) reported they 'never' or 'rarely' used EtCO2 (n=57, 52.7%) monitoring or tcPCO2 (n=93, 86.1%) monitoring in the PACU. A paired t test revealed statistically significant differences in the PACU RN's pre-survey and posttest comfortability of applying and interpreting EtCO2 or tcPCO2 monitors (P < .05). Capnography monitoring should be considered a standard of care for PACU patients. Education of registered nurses working in the PACU is critical before implementing EtCO2 or tcPCO2 monitoring.

Implementing an Enhanced Recovery After Surgery Joint Replacement Program in a Small Acute Hospital Using a Multi-Disciplinary Approach

<h3>Introduction</h3> The facility began doing elective surgeries in 2017 without a standard joint program to regulate practice. To deliver highest standard of care, the need to systematize the process and develop a program was identified. This can only be done with the support of leadership while using a multi-disciplinary approach, implementing a program using the latest evidenced based practice (EBP) and clinical practice guidelines (CPGS). A joint program was created to initiate an Enhanced Recovery after Surgery (ERAS) program in a small acute care setting. <h3>Identification of the problem</h3> Without the structure of a formal joint program, several orthopedic surgeons were not standardizing their practices when it came to optimization of patients, spinal anesthesia, or ERAS medications. The program identifies these barriers that promote the need for change. <h3>EBP Question/Purpose: PICO question. Databases utilized</h3> In patients undergoing joint surgery, what is the effect of implementing ERAS in reducing length of stay visits, reducing post- operative complications? Research began using EBSCO host to find articles no later than 2010 for ERAS implementation and EBP. Current guidelines referenced from the American Academy of Orthopedic Surgeons, National Association of Orthopaedic Nursing, American Society of PeriAnesthesia Nurses, and the Association of periOperative Registered Nursing were used. Guidelines for the hospital program were created based on research findings. <h3>Methods/Evidence</h3> To initiate the program, EBP and CPGs were first used to support the rationale for the program. Key stakeholders and leadership used a multi-disciplinary approach to develop the program and explain the rationale for the program with each surgeon. Key stakeholders decided to then create a pre-admission testing clinic to screen patients appropriately. Education for hospital-wide staff for joint specific patients was implemented. <h3>Significance of Findings/Outcomes</h3> After three years, of implementing the joint program, the program has had 92% discharges on postoperative day one along with reduction in post-operative complications. <h3>Implications for perianesthesia nurses and future research</h3> Using EBP and CPG to standardize care ensure best practices, in which a majority of the ERAS bundle happens within the perianesthesia department. As ERAS is the gold standard, the next step is Advanced Certification.

Perianesthesia Nurses Pain Management Practices: Findings and Recommendations From a National Descriptive Study of Members of the American Society of Perianesthesia Nurses

PurposeThe purpose of this study was to identify current individual practice of perianesthesia nurses regarding assessment and documentation of pain. DesignDescriptive cross-sectional design using vignette technique. MethodsVignettes with questions available via electronic survey offered to attendees of the 2017 American Society of PeriAnesthesia Nurses National Conference. FindingsTotal of 1,680 perianesthesia nurses participated; 41.4% reported assessment of pain compared with 36.7% who reported documentation of pain assessment. The numeric (0 to 10) pain intensity score was the most commonly used assessment method. Only 16.4% assessed for and documented pain location, 14.4% assessed for and documented quality of pain. ConclusionsPain assessment should include intensity, location, quality, and functional impact. The gap between nurses' practices in assessment and documention of pain may be related to system barriers. Embedding evidence-based best practice within electronic health records may improve both. Prior literature, as well as our findings, indicate these trends (missed documentation and assessment) are more global than only perianesthesia nursing.

AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care

<scp>AORN</scp> Position Statement on Managing Distractions and Noise During Perioperative Patient Care

Perioperative Pain Management Strategies in the Age of an Opioid Epidemic

According to the US Department of Health and Human Services 2016 and 2017 data, an estimated 130 people per day died from opioid-related drug overdoses; 42,249 people died from overdosing on opioids; and 2.1 million people had opioid-use disorder. Health care organizations such as the American Association of Nurse Anesthetists, the Association of periOperative Registered Nurses, the American Society of PeriAnesthesia Nurses, the American Society of Anesthesiologists, the American College of Surgeons, and the American Medical Association have information related to pain management and/or the opioid epidemic on their Web sites. It is imperative for health care providers to be cognizant of, and use low-dose opioid/opioid-free pain management therapies. This article reviews the pain process and outlines low-dose opioid/opioid-free pain management modalities.

Preventing Hypothermia during Cesarean Birth: An Integrative Review.

The purpose of this integrative review was to assess common warming measures used for prevention of hypothermia during the perioperative period for women having cesarean birth and to determine their efficacy. A literature search was conducted via electronic databases EBSCO, PUBMED, Academic Search Premier, Google Scholar, and CINAHL using keyword search terms hypothermia, cesarean, and warming. Inclusion criteria were articles written in English and published between 2006 and 2018. Seventeen articles were included in the review, covering three common warming measures; intravenous (IV) fluid warming, forced-air warming, and combined IV fluid and forced-air warming. Several other warming modalities were noted including warming mattresses and various combinations of interventions. Maternal hypothermia risk is increased during the perioperative period for women having cesarean birth without use of warming measures. Warming modalities that are beneficial in preventing maternal hypothermia in women having cesarean birth are IV fluid warming, upper body force-air warming, ambient OR temperature, and warming mattresses. National standards and guidelines from the American Society of PeriAnesthesia Nurses, the Association of Perioperative Registered Nurses, and the Association of Women's Health, Obstetric, and Neonatal Nurses are consistent with current evidence and should be in place and followed in every maternity unit caring for women having cesarean birth.

Effect of the ASPAN Guideline on Perioperative Hypothermia Among Patients With Upper Extremity Surgery Under General Anesthesia: A Randomized Controlled Trial

PurposeTo evaluate the effect of using the evidence-based hypothermia guideline developed by the American Society of PeriAnesthesia Nurses on body temperature, shivering, thermal discomfort and comfort, and incidence of hypothermia. DesignRandomized controlled trial with 54 patients undergoing upper arm surgery with general anesthesia in the Republic of Korea. MethodsParticipants in the experimental group received a head turban, sleeping socks, a heated blanket, a Bair Hugger for forced-air warming, and a Mega Acer kit (ACE Medical Co, Seoul, Korea) for warming intravenous fluid. Participants in the control group received a typical hospital cotton blanket. FindingsBody temperature, shivering, thermal discomfort, and thermal comfort showed significant improvements in the experimental group compared with the control group. ConclusionsThe American Society of PeriAnesthesia Nurses guideline is applicable for preventing hypothermia under general anesthesia, which, in turn, aids in patient recovery through the suppression of various hypothermia-related complications.

Burnout and Resiliency in Perianesthesia Nurses: Findings and Recommendations From a National Study of Members of the American Society of PeriAnesthesia Nurses

Describe prevalence ofburnout in perianesthesia nurses, explore risks, mitigating factors. Cross-sectional descriptive. Survey containing Maslach Burnout Inventory, Short Form-12, and Social Support and Personal Coping was emailed to American Society of PeriAnesthesia Nurses. Regression analysis examined relationships between burnout and health, social support, personal coping, substance use, and demographics. Of 2,837 respondents, 18% were currently and 35% were formerly burned out, with lower incidence in those >40 years. Currently burned out nurses had worse health and also perceived a lack of advancement opportunities and organizational investment in the individual. Lower burnout was associated with regular participation in physical (P < .001), creative (P = .004), or mindfulness hobbies (P<.001) and ease in discussing work problems with spouse or partner (P= .001). Despite burnout nurses' empathy for their patients is maintained. Interests outside of work, personal and work support, healthy work environment, and regular physical activities can improve burnout.

Delphi Study: ASPAN Adult Patient Pain and Comfort Practices

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. ASPAN convened a panel of experts to provide recommendations based on seven categories, this led to the development of a questionnaire to build consensus. Survey conducted among panel of experts to obtain consensus. Two survey rounds were completed. A consensus was obtained reaching a 70% benchmark for an acceptance. 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.

The Effects of Prayer as a Coping Strategy for Nurses

To determine the effects of prayer as a coping strategy for nurses. Quantitative descriptive design. The population was the 15,000 members of the American Society of Perianesthesia Nurses. Twelve hundred fifty nine subjects completed a demographic questionnaire and the Prayer Functions Scale. The surveys were available on SurveyMonkey.com for 2weeks in the fall of2014. Results indicated at α=0.05 that the nurses surveyed experienced the effects of prayer, providing assistance, providing acceptance, providing calm, and deferring as benefits of use of prayer as a coping strategy. Reduction of nurses' stress through prayer is one way to ameliorate the ill effects that can impact nurses through stress. Nursing administration, nursing organizations, and academics could consider use of prayer as an effective coping mechanism in teaching, studying, and exploration of methods to help nurses cope with the inherent stressors of their profession.

Suicide

QUESTION: WHAT ARE best practice guidelines for conducting suicide assessments? Any recommendations for a course of action when a patient admits to suicidal ideation? Theresa Clifford, MSN, RN, CPAN, CAPA, FASPAN, Perioperative Services, Mercy Hospital, Portland, ME and Former President of the American Society of Perianesthesia Nurses from 2009 to 2010.

Staffing Ratios

QUESTION: WHAT ARE THE CURRENT recommended staffing ratios for a preoperative unit, phase I postanesthesia care unit (PACU), and phase II PACU? What is the recommendation for staffing on call? Should there always be at least two nurses in phase I PACU? Theresa Clifford, MSN, RN, CPAN, CAPA, FASPAN, Perioperative Services, Mercy Hospital, Portland, ME and Former President of American Society of Perianesthesia Nurses from 2009 to 2010

Developing Family Visitation Guidelines to Enhance the Patients Perioperative Experience

Facilitating family visitation throughout perioperative phases of care has been controversial due to obstacles inherent of this setting. However, literature demonstrates facilitating family visitation can be beneficial to patient outcomes and is supported by the Centers for Medicare and Medicaid Services, Institute of Medicine and the American Society of Perianesthesia Nurses. Consequently, hospitals are challenged to develop and implement policies and procedures supporting family visitation.

Incentive Spirometry Adherence: A National Survey of Provider Perspectives.

Patient adherence is a critical factor for success of patient-administered therapies, including incentive spirometry (IS). Patient adherence with IS is not known, so we sought to evaluate providers' perspectives on the current state of IS adherence and elucidate possible factors hindering patient adherence. Respiratory therapists (RTs) and nurses across the United States were surveyed via social media and online newsletters. Surveys were distributed to the relevant national RT and nursing societies: the American Association for Respiratory Care, the Academy of Medical-Surgical Nurses, the American Society of Peri-Anesthesia Nurses, and the American Association of Critical-Care Nurses. Responses from 1,681 (83.8% completion rate) RTs and nurses were received. The clear majority of all providers agreed that patient adherence is poor (86.0%; 1,416 of 1,647 respondents) and should be improved (95.4%; 1,551 of 1,626 respondents). Providers believe that IS adherence is hindered by various factors. The most common reasons cited were that patients forget to use their ISs (83.5%; 1,404 of 1,681 respondents), do not use them effectively (74.4%; 1,251 of 1,681 respondents), and do not use them frequently enough (70.7%; 1,188 of 1,681 respondents). These findings from a large national survey of health care providers highlight the need for improved IS adherence and indicate that patient forgetfulness may be a large contributor to nonadherence. Efforts aimed at improving IS adherence are warranted.

Dress Code in the Perianesthesia Setting

QUESTION: DOES THE AMERICAN Society of Perianesthesia Nurses (ASPAN) make any recommendations on whether postanesthesia care unit (PACU) nurses should wear hospital-issued and hospital-laundered scrub attire? Theresa Clifford, MSN, RN, CPAN, CAPA, Perioperative Services, Mercy Hospital, Portland, ME and Former President of American Society of Perianesthesia Nurses from 2009 to 2010.

2017-2018 Perianesthesia Standards

QUESTION: I UNDERSTAND that the 2017-2018 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements 1 American Society of PeriAnesthesia Nurses2017-2018 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements. ASPAN, Cherry Hill, NJ2016 Google Scholar were released in January 2017. What are the new highlights for this edition? Theresa Clifford, MSN, RN, CPAN, CAPA, is the Nurse Manager for Perioperative Services at Mercy Hospital, Portland, ME and a Former President of American Society of Perianesthesia Nurses from 2009 to 2010.