Postoperative Nurses Research Articles

Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar.

Pain is a complex and challenging phenomenon. People have different pain experiences, but everyone has the right to effective pain management. Pain assessment and management are integral components of a nurse's role. To assess the knowledge and attitudes of nurses in Qatar about adult post-operative patients' pain assessment and management, and the factors that may be associated with such knowledge and attitudes. Post-operative registered nurses from all peri-operative areas at Hamad Medical Corporation participated in a cross-sectional online survey using a self-administered questionnaire. A knowledge and attitudes (K&A) score was calculated. Associations between K&A and potential explanatory variables were assessed using t-tests and one-way ANOVA. A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 ± 4.5 out of 41 (48%), indicating a large deficit in nurses' knowledge and attitudes about adult post-operative pain. There were no statistically significant differences in the mean K&A scores of participants based on gender, nationality, education level, marital status, workplace facility, current job designation, or hours of pain education. There is a significant deficit in post-operative nurses' knowledge and attitudes about pain across the nursing workforce in post-operative care. Implications for nursing education and policy: Evidence-based, innovative nursing education courses are needed to improve nurses' knowledge and attitudes about pain assessment and management. Health service policy is required to ensure that evidence-based in-service education on pain management is compulsory for all nurses. This study was not registered.

Promoting Clinical and Cultural Competence in the Nursing Care of Transgender Patients: An Educational Module for Postoperative Nurses Caring for Patients After Vulvovaginoplasty.

Transgender women and transfeminine nonbinary individuals may pursue a vulvovaginoplasty to improve their gender dysphoria. The goal of this study was to design, implement, and evaluate an educational module to increase acute care nurses' clinical and cultural skills in the care of the transgender population after vulvovaginoplasty. All nursing staff and patient care technicians working on a hospital unit caring for patients after vulvovaginoplasty attended a 4-hour educational module. Participants completed an anonymous pre- and postsurvey. Survey data were analyzed for significant change in the categories of knowledge, perceived competence, sexuality and gender beliefs, interpersonal comfort, and human value. Significant improvement was noted in the categories of knowledge and perceived competence. Improvements were also noted in the categories of sexuality and gender beliefs and interpersonal comfort, but were not statistically significant. An insignificant decline in scores was noted in the category of human value. Increased knowledge about vulvovaginoplasty and informed, culturally safe care may improve the patient outcome and experience, and nurses may be more confident and comfortable delivering care for this population. This intervention may serve as an exemplar to other institutions that hope to offer gender care surgeries. [J Contin Educ Nurs. 2023;54(11):509-515.].

Nurses’ knowledge and barriers regarding post-operative pain management at teaching hospitals in Erbil city / Iraq

Background and aim: Pain management is an important aspect of patient care and nurses play a significant role in the acute care setting in providing pain assessment and treatment. Objective for this study was to assess nurses’ knowledge and attitude regarding post-operative pain management at Erbil teaching hospitals. Methods: A cross-sectional study was conducted on a non-probability purposive sample of (53) of post-operative nurses. The questionnaire was constructed for data collection consist of three parts; part I included socio-demographical characteristics of nurses, part II about Nurses’ knowledge on post-operative pain management and part III included; barriers of pain management. Data were collected by self-reports by nurses and analyzed through the application of descriptive and inferential analysis measures (frequencies and percentages, chi-square) by using SPSS version 21. Results: The results show that overall correct answer score of nurse’s knowledge on postoperative pain management was 61.76%, and overall level of nurse’s knowledge was fair with 81.1%. Nurses were had many barriers toward pain assessment and management like Lack of protocols & guidelines for pain assessment and management with 90.1% followed by nurse’s workload and patients in ability to communication with 81.1%. Conclusion: Nurses need to follow protocols & guidelines for pain management and continuous courses on pain management.

Understanding Attitudes, Social Norms, and Behaviors of a Cohort of Post-Operative Nurses Related to Pain and Pain Management.

Despite advances in surgical techniques and peri-operative care, pain is a significant symptom post-operatively. The purpose of this study was to examine the attitudes, social norms, and behaviors of a cohort of nurses of various ethnic and cultural backgrounds regarding pain and pain assessment and management. The design was a descriptive qualitative study guided by Theory of Planned Behavior and the Theory of Transcultural Nursing. The sample included six registered nurses (RNs) (two Hispanic, two African American, and two Caucasian), along with patients of the same and different cultural and ethnic backgrounds in the post-operative unit within 48 h of surgery. The nurses’ results indicated that nurses assess pain severity and patient treatment preferences yet do not conduct a comprehensive pain assessment and have limited knowledge of non-pharmacologic and complementary pain therapies. Despite knowledge of the patient’s pain history, tolerance, and cultural background, the nurses believed that “all patients should be treated the same” and were concerned about the use of opioids beyond the first 24–48 h post-operatively due to the risk of addiction and professional ramifications related to opioid administration. The conclusions are that ongoing education is needed regarding comprehensive pain assessment and pharmacologic, non-pharmacologic, and complementary pain therapies during the post-operative period. Discussion is needed regarding the importance of diversity and equity as it relates to cultural competence within the context of pain assessment and management to provide patient-centered individualized care.

Satisfaction of Postoperative Patients on Pain Management Program its Relationship to the Knowledge and Attitudes of Chinese Nurses: A Cross-Sectional Survey

This study is a cross-sectional survey of the satisfaction of postoperative patients its relationship to the knowledge and attitudes of Chinese nurses on pain management. Data were sourced out from two groups of respondents participated in the study, 75 post-operative patients and 97 in-service nurses from the health institutions China. The study was conducted for five-months. Ethics protocols were observed before and after the conduct of the study. Findings showed that post-operative pain management program among the participating medical institutions in China were assessed to have moderate level of satiation by the patients. All the components namely pain relief experience, care provided by the nurses, education provided as to pain management, and therapeutic dialogue provided by the nurses were all assessed by postoperative Chinese patients at a fair level. Meanwhile, gender and education of post-operative patients can be considered as factors in the planning and implementation of pain management program. Consequently, similar to studies conducted worldwide, Chinese nurses do not establish yet an optimal level of knowledge and attitude towards pain management. Meanwhile age, experience, education are factors on the knowledge and attitude on pain management among nurses. Finally, positive moderate relationship is established between patient satisfaction and knowledge and attitudes of nursing staff towards pain management. The findings of these study call for action and reform in the implementation of pain management program focusing on the major role and development of 21st century nurses. Practical implications of the study are discussed.

KEMAMPUAN MANAJEMEN NYERI ANTARA YANG DIBERIKAN PENKES TEHNIK NAFAS DALAM DAN YANG TIDAK DIBERIKAN PENKES TEHNIK NAFAS DALAM PADA PASIEN POST OF FRAKTUR RSUD H.SAHUDIN KUTACANE TAHUN 2021

Pain complaints in patients post-surgery fractures are the most common complaints we find/get when we are doing our duty as part of a health team. Complaints of pain are related to physiological, psychological, social, cognitive, emotional and behavioral responses, so that in the treatment of pain in postoperative patients not only use drugs but must be collaborated with the provision of pain health education. This study is Quasi Experimentation with cross sectional study design. With the aim to find out and analyze the comparison of pain management capabilities provided by pain management health education with those not given in H.Sahudin Kutacane Hospital in 2021. The sample number in the study was 46. Researchers use observation sheets as guidelines for collecting needed data. Analyze the data using the chi-Square test with a result of P = 0.000 (P< 0.05). The results of this study showed a difference in ability between before and after being given health education with a value of P = 0.000. This shows that there is a difference in pain management ability between those given health education and those not given in postoperative surgery at H.Sahudin Kutacane Hospital In 2021. Based on the results of research conducted researchers are expected to nurses, especially post-operative fracture inpatient room nurses to provide health eduction to postoperative patients.

Implementing a New EMR. How Should We Train the Staff?

Background Information Transitioning from an existing to a new Electronic Medical Record (EMR) while the surgical schedule of a busy perioperative department keeps running as usual can be daunting for nurses and other staff. While user training is part of the EMR implementation process, and crucial to ensure a smooth transition, its content might not be tailored to the role and responsibilities of the nurses involved. Feedback from perioperative nurses on the Virtual Live Training (VLT) provided by the EMR vendor, and its effectiveness to assist nurses documenting patient care on the new EMR, revealed that additional educational support was required. This project focused on the staff education initiative taken by designated unit EMR super-users to ensure Pre and Postoperative nurses’ readiness to document patient care in the new EMR by Go Live day. Objectives of Project • Identify and meet nurses’ learning needs related to the use of the new EMR after the VLT • Ensure training delivery method is effective for all perioperative areas • Ensure perioperative nurses’ readiness to document patient care independently on the new EMR • Ensure a smooth transition from existing to new EMR, while making sure patient care is not compromised Process of Implementation Developed EMR in-person training curriculum to support vendor's virtual live training. Created a training timeline based on goals. Prioritized super-users in-person training. Tailored in-person training sessions to the nurses’ role, pre and postoperative nurses training was conducted separately. Established training schedules, location and staffing. Developed an EMR resource digital folder. Build a Smart Sheet to capture documentation/workflow issues and view solutions. Use patient case scenarios to assess nurses’ competency documenting patient care from admission to discharge in new EMR. Statement of Successful Practice Increased nurses’ satisfaction with to face-to-face training. Postoperative nurses reported increased satisfaction with in-person class content being tailored to postop care. Improved nurses’ performance documenting most aspects of patient care in the new EMR. Improved understanding of new pre/postoperative workflows. Implication for Advancing the Practice of Perianesthesia Nursing Adjusting EMR training based on nurses’ feedback, tailoring training content to nurses’ role, and prioritizing super-user training, have proved to be effective training strategies to assist our perianesthesia nurses to ensure a successful EMR transition. Transitioning from an existing to a new Electronic Medical Record (EMR) while the surgical schedule of a busy perioperative department keeps running as usual can be daunting for nurses and other staff. While user training is part of the EMR implementation process, and crucial to ensure a smooth transition, its content might not be tailored to the role and responsibilities of the nurses involved. Feedback from perioperative nurses on the Virtual Live Training (VLT) provided by the EMR vendor, and its effectiveness to assist nurses documenting patient care on the new EMR, revealed that additional educational support was required. This project focused on the staff education initiative taken by designated unit EMR super-users to ensure Pre and Postoperative nurses’ readiness to document patient care in the new EMR by Go Live day. • Identify and meet nurses’ learning needs related to the use of the new EMR after the VLT • Ensure training delivery method is effective for all perioperative areas • Ensure perioperative nurses’ readiness to document patient care independently on the new EMR • Ensure a smooth transition from existing to new EMR, while making sure patient care is not compromised Developed EMR in-person training curriculum to support vendor's virtual live training. Created a training timeline based on goals. Prioritized super-users in-person training. Tailored in-person training sessions to the nurses’ role, pre and postoperative nurses training was conducted separately. Established training schedules, location and staffing. Developed an EMR resource digital folder. Build a Smart Sheet to capture documentation/workflow issues and view solutions. Use patient case scenarios to assess nurses’ competency documenting patient care from admission to discharge in new EMR. Increased nurses’ satisfaction with to face-to-face training. Postoperative nurses reported increased satisfaction with in-person class content being tailored to postop care. Improved nurses’ performance documenting most aspects of patient care in the new EMR. Improved understanding of new pre/postoperative workflows. Adjusting EMR training based on nurses’ feedback, tailoring training content to nurses’ role, and prioritizing super-user training, have proved to be effective training strategies to assist our perianesthesia nurses to ensure a successful EMR transition.

Post Anesthesia Care Unit Nurses’ Experience Caring for Opioid Tolerant Patients

<h3>Introduction</h3> Nearly 20% of same-day surgery patients regularly consume opioids, with the majority undergoing orthopedic or neurosurgery procedures for relief from chronic pain. Many have become opioid intolerant and subsequently, experience more pain and consume more opioids postoperatively than opioid naïve patients. Despite higher dosing, their pain is often unrelieved. Evidence-based guidelines include <i>preoperative identification</i> of opioid tolerant patients; however, postoperative nurses often learn of their patient's tolerance only after the patient exhibits an extreme reaction to pain. These experiences can be stressful and lead to nurse compassion fatigue and moral distress, particularly in a fast-paced post anesthesia care unit (PACU). <h3>Identification of the problem</h3> Several studies examine perioperative nurses' experiences with opioid tolerant patients in managing pain, though none explore the day-to-day personal challenges faced by nurses in the care of these patients. <h3>Purpose of the Study</h3> To explore PACU nurses' experiences in caring for opioid tolerant patients. <h3>Methodology</h3> A narrative research design was used. Six full-time PACU nurses with one or more years of PACU experience were recruited in Fall 2020. Subjects were asked to discuss an experience caring for an opioid tolerant patient and how they felt afterward. They were also asked to identify supports that would help them care for these patients. <h3>Results</h3> Interviews will be analyzed inward, outward, back in time, and forward in time to understand the participants' experience through five contexts – personal (feelings, reaction), social (environment, other people), past, present, future, and situation (professional practice). <h3>Discussion</h3> Narrative threads and their interpretation will be discussed to better understand how nurse's feelings are expressed and directed in professional practice. <h3>Conclusion</h3> This study made it possible to think about nursing practice in a new light through honoring experiences that are difficult to share yet are an important source of knowledge. <h3>Implications for perianesthesia nurses and future research</h3> Insights into the nature, causes, and strategies used to handle experiences caring for opioid tolerant patients will be identified as well as ways to better support nurses in the practice environment.

Implementation Orientation for Post-Operative Nurses

<h3>Background and Information</h3> Orientation to PACU encompasses a nurse's ability to confidently and safely cares for patients based on standardization of care as outlined by ASPAN. At the end of orientation for new hires, there was no documentation of progress or opportunities in which both the preceptor and orientees can speak to. Each preceptor did their orientation based on their daily assigned surgical cases. A review of the orientation process was done, and it was evident that, it was disorganized, unstructured and provided inadequate resources for the new hire. <h3>Objectives of Project</h3> 1. Creation of orientation binder that is user friendly along with detailed competencies 2. ASPAN clinical information was placed in a binder as a resource for new hires 3. Bring together a cohort of consistent preceptors who are acquainted with the flow and expectation of orientation 4. Track and maintain progress reports <h3>Process of Implementation</h3> An orientation binder was created to set an organized standard of care and resource guideline for incoming nurses to PACU (regardless of skills and experiences). Binders were rearranged and reviewed during the orientation process by preceptors. Preceptors attended a workshop on how to demonstrate a successful and proficient mentorship. Preceptors were given an orientation binder. A record reference resources binder was created which included categories and guidelines related to Recovery care (from pre-anesthesia care to discharge from anesthesia care <h3>Statement of Successful Practice</h3> Orientees have reported increased confidence and satisfaction after orientation. Orientees can now recover patients independently with confidence with minimal supervision and support. As a result, after orientation preceptees demonstrate consistency and knowledge gained during precepting. <h3>Implication of Advancing the Practice of Perianesthesia Nursing</h3> Preparing a standardized and comprehensive orientation package and resource binder has proven to contribute to a successful orientation. Preceptees demonstrated confidence and autonomy while using the new orientation process. This has proven to be extremely effective in the PACU at Montefiore Medical Center.

Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic-assisted surgery.

To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic-assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic-assisted laparoscopic surgery (RALS). The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. A qualitative descriptive study. Semi-structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April-24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well-trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and willultimately impact patient outcomes.

Standardized Orientation for Post-Operative Nurses

Standardized Orientation for Post-Operative Nurses

Assessment of Postoperative Nurses' Practices Concerning Care of Fracture Treated by External Fixation.

Objectives: to assess nurses' practice level toward care of fracture treated with external. Methodology: A descriptive study was carried out at orthopedic wards in Al-Zhrawi Surgical Hospital -Missan Governorate. The study started in November 11th, 2014 to June15th, 2015. A non-probability sample of (50) orthopedic nurses (male &amp; female) who were working in orthopedic wards. The data were collected through the use of questionnaire, which consists of three parts, part (1) Demographic data form that consists of (8) items, part (2) concerning nurses' practices level toward patient treated with external fixation consist of (25) items, part (3) consist of (9) items concerning with external fixation device care. Checklist was used to collect data for orthopedic nurses. The validity of the checklist was determined through presenting it to (15) specialist expert and its reliability were determined through a pilot study which was carried out through the period of (22 Jan to 10th Feb, 2015). Descriptive statistical analysis procedures inferential analysis procedures were used for the data analysis. Results: Discussions of the study result indicated that the majority of items had low M.S (less than1.66) Conclusion: the results show that it conclude that the orthopedic nurses have inadequate or deficit in some aspects related to postoperative care for patient undergoing external fixation surgery in orthopedic wards. Recommendations: The researcher recommend a special training sessions should be designated and presented to all orthopedic nurses that include specific training programs about nurses' intervention concerning care of fracture treated with external fixation. Authorizing and distributing a manual handbook or pamphlet to all nurses who work in orthopedic wards including nursing interventions in postoperative.

Development of a Performance Appraisal Tool for Postoperative Anesthesia Care Unit Nurses

Purpose: The purpose of this study was to develop a performance appraisal tool (PAT) for postoperative anesthesia care unit (PACU) nurses. Methods: This study was a descriptive, non-experimental methodological study. The PAT was developed through a literature review and tests for validity and reliability. Results: Subsequent to a review of the literature on nursing performance of PACU nurse, a 63 item questionnaire was developed. Through factor analysis, 61 items in 3 domains with 8 factors were derived. Cronbach’s ⍺ coefficient of the final instrument was .99. Conclusion: This tool is an efficient PAT for PACU providing meaningful feedback for professional growth in PACU nurses.

Assessment of Postoperative Nurses' Interventions for the Patients with Laparoscopic Cholecystectomy at Baghdad Teaching Hospitals

Objective: The study aimed to assess the postoperative nurses' intervention for the patients with laparoscopiccholecystectomy and to determine the relationship between Nurses' interventions and their demographiccharacteristics.Methodology: Quantitative design (a descriptive study) was started from 20th November 2012 up to 1stSeptember 2013. Non-probability (purposive sample) of (50) nurses, who were working in surgical wards, wereselected from Baghdad teaching hospitals (Baghdad Teaching Hospital, Digestives System and Liver TeachingHospital, AL-Kindy Teaching Hospital, and AL-Kadhimiyia Teaching Hospita). The data were collected throughthe use of a constructed questionnaire, which consisted of two parts; the first part includes the page ofdemographic data which contains (10) items and the second part which includes (5) domains in (46) subdomainof postoperative nurses' interventions for the patients with laparoscopic cholecystectomy, throughdirect observant approach by the mean of the designed interventions checklist, Reliability of the questionnairewas determined through a pilot study and the validity through a panel of (12) experts. Descriptive statisticalanalysis procedures (frequency, percentage, mean of score, Standard Deviation and Relative Sufficiency), andinferential statistical analysis procedures (Reliability Coefficient, contingency coefficient and chi- square test)were used for the data analysis under application of the statistical package of social science (SPSS) ver. (10.0).Results: The findings of the study indicated that there is a weak assessment of postoperative nurses'interventions for the patients with laparoscopic cholecystectomy at Baghdad teaching hospitals, and thefindings indicated that the most of study items responding of questionnaire were (84.78%) significantdifferences. There was no significant relationship between nurses' gender, age, years of experience and theirassessment, while there was significant relationship between the level of education, sharing in training sessionswhich established (by the hospital, by other hospitals, or by other institutions), duration of the training session,Number of training sessions and assessment of postoperative nurses' interventions&#x0D; Recommendations: The study recommended that special training session, concerning all nurses' surgical wardsfor postoperative nursing interventions (Laparoscopic Cholecystectomy Patient) at inside or outside Iraq, andbooklets should be designated and presented to all nurses' surgical wards, in addition to increasing the numberof professional nurses' graduate from the colleges of nursing to the enrolled in surgical wards.

Anesthesia Patient Safety Foundation Consensus Conference Report

Anesthesia Patient Safety Foundation Consensus Conference Report

Exposure of Postoperative Nurses to Exhaled Anesthetic Gases

Department of Anesthesia, University of California-San Francisco, San Francisco, California; Ludwig Boltzmann Institute for Clinical Anesthesia and Intensive Care; Outcomes Research and Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria; and Perioperative Services, Department of Anesthesia, Cook Children's Medical Center, Fort Worth, Texas

Exposure of Postoperative Nurses to Exhaled Anesthetic Gases

The National Institute of Occupational Safety and Health (NIOSH) has established recommended exposure limits of 25 parts per million (ppm) as a time-weighted average for nitrous oxide and a ceiling of 2 ppm for volatile anesthetics. We quantified exposure of postanesthetic nurses to exhaled anesthetic gases. This study was conducted in the postanesthesia care unit (PACU) of a medium-sized hospital. PACU air exchanges averaged 8 vol/h; however, much of this air was recirculated. We evaluated 50 adults anesthetized with either isoflurane (n = 19) or desflurane (n = 31). Roughly half the patients were tracheally extubated in the operating room, whereas the others were extubated just after admission to the PACU. Exhaled anesthetic gases were sampled through a 20-m hose attached to the participating nurses' shoulders (breathing zone). We also evaluated nursing exposure to exhaled anesthetic gases during recovery of 15 patients who had been anesthetized with nitrous oxide. Exposure was quantified with lapel dosimeters. Anesthetic and recovery durations were each approximately 1 h, with most patients being tracheally extubated in the PACU. Breathing-zone anesthetic concentrations in the patients given isoflurane exceeded NIOSH recommendations in 37% of the patients, representing 12% of recovery time. Breathing-zone anesthetic concentrations in the patients given desflurane, however, exceeded NIOSH limits in 87% of the patients, representing 49% of recovery time. Altogether, noncompliant episodes were detected in 68% of these patients, representing 35% of the entire recovery duration. Breathing-zone anesthetic concentrations in the patients given nitrous oxide exceeded NIOSH limits in 53% of the patients. Our data suggest that postoperative nurses' exposure to exhaled anesthetic gases exceeds NIOSH limits under some circumstances. Implications: Some epidemiological evidence suggests that exposure to waste anesthetic gases may be associated with reproductive toxicity. Accordingly, the National Institute of Occupational Safety and Health has established recommended exposure limits for nitrous oxide and volatile anesthetics. Our data suggest that exposure of healthcare personnel may exceed recommended levels in poorly ventilated postanesthesia care units. (Anesth Analg 1998;87:1083-8)

Exposure of postoperative nurses to exhaled anesthetic gases.

The National Institute of Occupational Safety and Health (NIOSH) has established recommended exposure limits of 25 parts per million (ppm) as a time-weighted average for nitrous oxide and a ceiling of 2 ppm for volatile anesthetics. We quantified exposure of postanesthetic nurses to exhaled anesthetic gases. This study was conducted in the postanesthesia care unit (PACU) of a medium-sized hospital. PACU air exchanges averaged 8 vol/h; however, much of this air was recirculated. We evaluated 50 adults anesthetized with either isoflurane (n = 19) or desflurane (n = 31). Roughly half the patients were tracheally extubated in the operating room, whereas the others were extubated just after admission to the PACU. Exhaled anesthetic gases were sampled through a 20-m hose attached to the participating nurses' shoulders (breathing zone). We also evaluated nursing exposure to exhaled anesthetic gases during recovery of 15 patients who had been anesthetized with nitrous oxide. Exposure was quantified with lapel dosimeters. Anesthetic and recovery durations were each approximately 1 h, with most patients being tracheally extubated in the PACU. Breathing-zone anesthetic concentrations in the patients given isoflurane exceeded NIOSH recommendations in 37% of the patients, representing 12% of recovery time. Breathing-zone anesthetic concentrations in the patients given desflurane, however, exceeded NIOSH limits in 87% of the patients, representing 49% of recovery time. Altogether, noncompliant episodes were detected in 68% of these patients, representing 35% of the entire recovery duration. Breathing-zone anesthetic concentrations in the patients given nitrous oxide exceeded NIOSH limits in 53% of the patients. Our data suggest that postoperative nurses' exposure to exhaled anesthetic gases exceeds NIOSH limits under some circumstances. Some epidemiological evidence suggests that exposure to waste anesthetic gases may be associated with reproductive toxicity. Accordingly, the National Institute of Occupational Safety and Health has established recommended exposure limits for nitrous oxide and volatile anesthetics. Our data suggest that exposure of healthcare personnel may exceed recommended levels in poorly ventilated postanesthesia care units.

The nurse's role in immediate postoperative care.

From the time that a patient leaves the care of the anaesthetist after an operation until he wakes in the ward his physiological state should be continuously and expertly supervised. Postoperative nurses are provided only when the operating theatre has a recovery room. A survey among consultants and nurses in one region showed that many surgical units did not have recovery rooms and that inexperienced ward nurses were often sent to collect patients. The survey showed that most nurses were competent to care for unconscious patients so long as an emergency did not arise. In many hospitals the facilities for the safe nursing of postoperative patients were totally inadequate. The very least that is needed is good communications with the anaesthetist, adequate lighting, and a source of oxygen and suction. Because of the shortage of nurses likely to have to care for postanaesthetic patients early on and to train them accordingly. Nevertheless, recovery nurses, whose sole responsibility is to care for a patient until be has recovered from anaesthesia, should be appointed for all busy surgical units.