Translating Evidence into Practice: How Chaplains Used EBP to Improve the Spiritual and Emotional Well-being of Bedside Nurses.

The Pastoral Care department at Mercy Medical Center in Baltimore embarked on an evidence-based practice (EBP) project to identify best practices for improving nurses' well-being. This article describes the EBP model and its application. The project resulted in increased nurse awareness of the chaplain's role, nurses' confidence in using chaplain services, and nurses' well-being.

Patients' Perceptions of Importance for Self-Administered Correct Site Surgery Checklist: A Multisite Study.

Purpose: The purpose of this study was to describe and validate the association between patient's self-administered correct site checklist and perceptions of importance for safe surgery.

Design: A multisite nonexperimental, quantitative, descriptive study.

Methods: A convenience sample of 173 adult patients from four different geographical multisite hospitals was included in the study.

Effectiveness of Buffered Lidocaine for Local Anesthesia During Liver Biopsy.

The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate.

Nonrandomized Clinical Trial of the Effectiveness of a Laxative Treatment Protocol to Time of First Bowel Movement After Uterine Artery Embolization Procedure: A Pilot Study.

Purpose: The purpose of this pilot study was to determine the efficacy of a proactive laxative protocol for constipation prevention in patients undergoing uterine artery embolization (UAE).

Design: A nonrandomized clinical trial.

Methods: A nonrandomized trial study design was piloted using a convenience sample of 35 patients undergoing UAE in the course of 1 year.

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

Purpose: The purpose of this study was to identify current individual practice of perianesthesia nurses regarding assessment and documentation of pain.

Design: Descriptive cross-sectional design using vignette technique.

Methods: Vignettes with questions available via electronic survey offered to attendees of the 2017 American Society of PeriAnesthesia Nurses National Conference.

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.

The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units.

Study Objective: To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs).

Design: Prospective, unblinded cross-sectional study.

Setting: Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually.

Emerging trends and new approaches to acute pain management.

New approaches to the management of acute perioperative pain have focused on ways to improve the risk/benefit profile of various analgesics, enhance the consistency of pain control, address interpatient differences in responses to pain and treatments, and avoid periods of ineffective pain relief (analgesic gaps). Although intravenous patient-controlled analgesia has been the "gold standard" for acute pain management, there are now more analgesic options and compelling data to support combinations of analgesics or multimodal therapy, timing of analgesic interventions, and the use of newer drug delivery systems. Maximizing pain control with preemptive analgesia and multimodal therapy and the availability of transdermal fentanyl by iontophoresis and of extended-release epidural morphine have expanded the armamentarium of effective options for perioperative pain control.

Pharmacotherapy for acute pain: implications for practice.

Effective treatment of perioperative acute pain requires that information about the patient's goals for pain relief, previous history with analgesics, and type of surgical procedure is used to guide decisions about analgesic regimens. Analgesics are selected based on the location of surgery, degree of anticipated pain, and patient characteristics (such as comorbidities), and routes of administration and dosing schedules are determined to maximize the effectiveness and safety of analgesia while minimizing the potential for adverse events. Pain management therapy is then extended into the postsurgical phase of recovery.

Assessment, physiological monitoring, and consequences of inadequately treated acute pain.

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for interindividual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychologic and emotional distress and may lead to prolonged chronic pain states.

Perspective on pain management in the 21st century.

Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiologic, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients.

Emerging trends and new approaches to acute pain management.

New approaches to the management of acute perioperative pain have focused on ways to improve the risk/benefit profile of various analgesics, enhance the consistency of pain control, address interpatient differences in responses to pain and treatments, and avoid periods of ineffective pain relief (analgesic gaps). Although intravenous patient-controlled analgesia has been the "gold standard" for acute pain management, there are now more analgesic options and compelling data to support combinations of analgesics or multimodal therapy, timing of analgesic interventions, and the use of newer drug delivery systems. Maximizing pain control with preemptive analgesia and multimodal therapy, and the availability of transdermal fentanyl by iontophoresis and extended-release epidural morphine have expanded the armamentarium of effective options for perioperative pain control.

Perspective on pain management in the 21st century.

Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiological, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients.

Pharmacotherapy for acute pain: implications for practice.

Effective treatment of perioperative acute pain requires that information about the patient's goals for pain relief, previous history with analgesics, and type of surgical procedure is used to guide decisions about analgesic regimens. Analgesics are selected based on the location of surgery, degree of anticipated pain, and patient characteristics such as comorbidities, and routes of administration and dosing schedules are determined to maximize the effectiveness and safety of analgesia, while minimizing the potential for adverse events. Pain management therapy is then extended into the postsurgical phase of recovery.

Assessment, physiological monitoring, and consequences of inadequately treated acute pain.

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for inter-individual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychological and emotional distress, and may lead to prolonged chronic pain states.

Medication errors in the PACU.

A collaborative research group examined seven years of PACU medication errors from the MEDMARX database. Descriptive statistics showed a comparison of medication errors in all ages from pediatric to adult to geriatric groups. Nine categories of medication errors were noted and a total of 3,023 errors were attributed to errors in prescribing, transcribing, dispensing, administering, and monitoring.

Patient safety: perianesthesia nursing's essential role in safe practice.

A safety culture that promotes best practices and best outcomes is important in today's healthcare environment. The perianesthesia environment of care is constantly challenged with the introduction of new technologies, improved medications, and advances in surgical and nonsurgical procedures. This practice is also marked by fast turnover, increasing volume, and, often, high-acuity patients.

Development and initial testing of the perianesthesia safe practices instrument: an ASPAN pilot study.

The perianesthesia environment of care is a unique high-risk health care setting that has a high susceptibility to error because of the vulnerability of patients who are undergoing surgery and anesthesia as well as the high levels of activity in these units. Safe practice in this environment is essential to quality patient care and positive patient outcomes. Consequently, ASPAN conducted a descriptive cross-sectional pilot study to test initial reliability and validity of the Perianesthesia Safe Practices Survey Instrument.

Clinical evaluation of the ASPAN Pain and Comfort Clinical Guideline.

The ASPAN Pain and Comfort Clinical Guideline was created because of the urgent need for a standardized evidence-based approach to the management of patients' pain and comfort in all perianesthesia settings. The purpose of the research presented here was to test the content of the ASPAN Pain and Comfort Clinical Guideline, which included the domains of assessment, intervention, and outcomes. Each domain was rated on clarity, usability, and feasibility using a Likert scale, which ranged from 1 (strongly disagree) to 4 (strongly agree).

A survey of current perianesthesia nursing practice for pain and comfort management.

Widespread dissemination of information and high-profile press coverage about pain and comfort management has resulted in heightened awareness among health care professionals and the public of the need for improvements in the way pain and comfort are managed. Despite significant advances in treatment options for pain relief and comfort, studies show that both phenomena continue to be poorly managed and undertreated. Providing pain relief and comfort to patients are important fundamental components of good nursing care; however, no studies have been performed to evaluate these responsibilities in perianesthesia nursing practice.

Phase II collaborative pilot study: preliminary analysis of central neural effects from exposure to volatile anesthetics in the PACU.

Nurses working in the PACU are occupationally exposed to volatile anesthetics that are exhaled by patients. Few studies have quantified this exposure using breath analysis or have characterized biological effects associated with this exposure. Isoflurane is a widely used anesthetic and is a strong respiratory depressant.

Phase I collaborative pilot study: Waste anesthetic gas levels in the PACU.

The National Institute of Occupational Safety and Health (NIOSH) recommends that exposure to waste anesthetic gas (WAG) be minimized to the greatest extent possible. Current recommendations include 2 parts per million (ppm) for 1 hour sample to halogenated agents level or 25 ppm based on nitrous oxide level or combination of 0.5 ppm for halogenated agents and 25 ppm nitrous oxide.