Monitoring noise.
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Environmental Monitoring↗
Biomedical subjects
Elizabeth H Winslow
Publications and source records attributed to Elizabeth H Winslow.
Preoperative fasting: old habits die hard.
OVERVIEW: Prolonged preoperative fasting is a time-honored tradition. The typical order of "npo after midnight" (or no liquid or food after 12 am on the day of surgery) has been challenged in recent years-so much so that in 1999 the American Society of Anesthesiology (ASA) revised its practice guidelines for preoperative fasting in healthy patients undergoing elective procedures. The newer, more liberal recommendations, based on studies showing that pulmonary aspiration occurs only rarely as a complication of modern anesthesia, allow the consumption of clear liquids up to two hours before elective surgery, a light breakfast (tea and toast, for example) six hours before the procedure, and a heavier meal eight hours beforehand. There is a well-known lag between the dissemination and implementation of practice guidelines, so the authors sought to determine whether the publication of the revised ASA recommendations had changed preoperative fasting practices. They interviewed 155 patients in one hospital about their preoperative fasting, comparing instructed, actual, and ASA-recommended fasting durations for liquids and solids. Their findings demonstrate that the majority of patients continued to receive instructions of npo after midnight for both liquids and solids, whether they were scheduled for early or late surgery. On average, the patients fasted from liquids and solids for 12 and 14 hours, respectively, with some patients fasting as long as 20 hours from liquids and 37 hours from solids. These fasts were significantly longer than those recommended by the ASA, indicating that inappropriate preoperative fasting is an issue that demands attention. The authors conclude that more collaboration between nurses and physicians is needed to assure that fasting instructions are consistent with the ASA guidelines and that patients understand these directives.
Adult↗
Best practices shouldn't be optional: prolonged fasts aren't more effective -or even safer.
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Adult↗
Can hospitalized patients have a "good death"
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Attitude↗
Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions.
BACKGROUND: Inserting an intravenous catheter (IV) is one of the most frequently performed invasive procedures by nurses. Little research has been conducted on ways to reduce the difficulty and failure, and enhance the ease and success, of IV insertion. We conducted this study to determine variables associated with IV insertion difficulty, failure, and success, and to learn special techniques nurses use to facilitate IV insertion. METHODS: Data were collected on 339 IV insertions in hospitalized patients by 34 registered nurses. The data included information about the nurse (eg, age, education, and self-rated IV insertion skill); the patient (eg, age and race); the IV (eg, site, gauge, and type); and the IV insertion, (eg, duration and difficulty). Data were analyzed to determine the effects of these variables on IV insertion outcome. In addition, nurses were asked to describe special techniques they used to facilitate IV insertion. RESULTS: A total of 77% of the IV insertions were successful. Nurses who were older, had more years of experience, were certified in a specialty, and rated themselves higher in insertion skill had significantly more successful insertions than their younger and less-experienced and less-skilled counterparts (P < .001). Successful IV insertions were significantly faster (mean 32 seconds) than unsuccessful ones (mean 66 seconds) (P < .001), and were rated as significantly less difficult (P < .001). Failed IV insertions were associated with higher degrees of difficulty arising from vein variables, such as vein rolled or vein was resistant to puncture, and patient variables, such as tough or dark skin and patient movement. The nurses described a wide variety of techniques to facilitate insertion success. The most frequently mentioned were getting self and patient in a comfortable position, using mechanical stimulation such as tapping the vein, and stabilizing the vein. CONCLUSION: Approximately one fourth of the 339 IV insertions in this study were unsuccessful. Repeated insertion attempts are painful and costly. This study identified nurse, patient, and IV variables associated with IV insertion success and failure. Future research is needed to confirm and expand these findings and to develop interventions to improve IV insertion skills and outcomes.
Adult↗
Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth.
OBJECTIVES: To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting. DESIGN: One group, nonexperimental, comparative, descriptive. SETTING: Nonprofit private medical center in Texas with 6,000 births/year. PATIENTS: Convenience sample of 51 hospitalized postpartum women. INTERVENTIONS: Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information. MAIN OUTCOME MEASURES: Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger. RESULTS: The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale. CONCLUSION: Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.
Attitude to Health↗