Mentoring: a call to professional responsibility.
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Humans↗
Biomedical subjects
M Faut-Callahan
Publications and source records attributed to M Faut-Callahan.
The impact of nalmefene on side effects due to intrathecal morphine at cesarean section.
Nalmefene is a long-acting opioid antagonist that provides long-term relief from side effects of intrathecal morphine sulfate. A randomized, double-blind, placebo-controlled study was conducted to determine whether prophylactic nalmefene could decrease side effects of intrathecal morphine given during cesarean section, without affecting analgesia. Sixty parturients were given 0.25 mg of intrathecal morphine, 12.5 micrograms of fentanyl, and 11.25 to 15 mg of bupivacaine. A dose of 0.25 microgram/kg of nalmefene or placebo was given by intravenous piggyback immediately after delivery of the neonate. Nausea, vomiting, pruritus, and level of sedation were assessed for a 24-hour period using a 4-point ordinal scoring system. Pain was assessed by using a 0- to 10-point verbal analogue scale. A 5-point analgesic satisfaction survey also was completed. Subjects who received nalmefene required supplemental analgesia at a median of 6.00 hours after intrathecal morphine, compared with 14.12 hours in the placebo group (P = .037). No differences were found between the groups in the incidence of pruritus, nausea and vomiting, level of sedation, or analgesic satisfaction. We concluded that nalmefene at a dose of 0.25 microgram/kg does not decrease the incidence of side effects but increases the need for supplemental analgesics.
Adult↗
The National Commission on Nurse Anesthesia Education 10 years later--Part 2: Years following the commission (1994 to present).
In 1989, the National Commission on Nurse Anesthesia Education was implemented to reverse a severe shortage of CRNAs. The Commission, charged with scrutinizing all aspects of nurse anesthesia educational programs, developed 8 goals with corresponding strategies that were used by the Commission Implementation Task Force to actualize its charge. These goals and strategies contributed to an increase of annual graduates from nurse anesthesia programs and the development of 10 new programs. These activities were documented in Part 1 of this article, which appeared in the October 2001 AANA Journal. Following completion of the 3-year project, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and the AANA Education Committee began carrying out the final recommendations made by the Commission. Part 2 addresses the accomplishments of the Education Committee and COA in implementing the recommendations of the Commission, discusses current status of educational programs and CRNA manpower, and identifies roles for both educators and practitioners in protecting the future of the profession.
Education, Nursing↗
The analgesic effects of subhypnotic doses of propofol in human volunteers with experimentally induced tourniquet pain.
This double-blind, placebo-controlled study was performed to determine whether subhypnotic doses of propofol have analgesic or sedative effects. Of 48 subjects randomly assigned to 1 of 4 bolus-infusion treatment groups, group 1 (n = 16) received propofol at 16 micrograms/kg per minute; group 2 (n = 16) received propofol at 32 micrograms/kg per minute; and group 3 (n = 8) received 10% intralipids at 16 micrograms/kg per minute; and group 4 (n = 8) received 20% intralipids at 32 micrograms/kg per minute. Following a bolus of the study drug, a maintenance infusion was started and continued throughout the study. Thirty minutes after the study drug began infusing, an Observer's Assessment of Alertness/Sedation Scale was completed, a tourniquet was inflated, and a maximum tourniquet tolerance time (TTT) was obtained. Pain was assessed every 5 minutes while the tourniquet was inflated and immediately before deflation using a 0 to 10 verbally administered numeric rating scale (NRS). No significant differences in TTT were noted between the 2 propofol groups. However, the TTT for both propofol groups differed significantly from the control group (intralipid groups combined) (P < .05). There was a statistically significant difference in the time it took the propofol groups to reach a NRS score of 8 or greater when compared with the control group (P < .05). Sedation scores differed significantly between the control and the propofol at 32 micrograms/kg per minute groups (P < .05). The results of this study suggest that propofol given at subhypnotic doses could serve as a valuable adjunct for acute postoperative pain management.
Adult↗
TheNational Commission on Nurse Anesthesia Education 10 years later--Part 1: The commission years (1989-1994).
The significant decrease in the number of anesthesia providers during the late 1980s prompted American Association of Nurse Anesthetists (AANA) leaders to establish the National Commission on Nurse Anesthesia Education (NCNAE). The NCNAE was charged with scrutinizing all aspects of nurse anesthesia educational programs and developing strategies to reverse the critical shortage of nurse anesthetists. The tactics outlined by the commissioners were implemented, and they resulted in an increase of annual nurse anesthesia program graduates. Although there has been continued realization of NCNAE strategies, 10 years later the critical shortage of CRNAs has resurfaced. This 2-part article describes the commission years, the years that followed, and the current status of Certified Registered Nurse Anesthetist (CRNA) manpower.
Anesthesiology↗
Education of nurse anesthetists in the United States.
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Certification↗
The use of telemetric oximetry in the clinical setting.
The reliability and ease of use of a combined functions-cardiac telemetry and telemetric pulse oximetry system was evaluated in a four phase investigation. This technology was assessed favorably for use in the care of patients on continuous epidural and patient-controlled analgesia.
Adolescent↗
Preoperative PCA teaching program to manage postoperative pain.
Patient-controlled analgesia (PCA) therapy was designed to provide patients with greater control in managing their pain. However, many patients continue to suffer from moderate to severe pain due to lack of knowledge about how to use PCA therapy. The results of this quasi-experimental study demonstrated that patients who received structured preoperative teaching had statistically significant higher knowledge regarding the use of PCA therapy and more positive attitudes toward using pain medicine. Patients who received the video teaching reported better pain control and satisfaction with pain management 4 and 8 hours following their surgical procedures.
Adult↗
Current perspectives on the perioperative management of the latex-allergic patient.
The increasing incidence of latex allergy necessitates thorough preanesthetic screening for risk factors, which will be delineated in this article, that are associated with latex allergy. The pathophysiology, epidemiology, and testing procedures for latex allergy will be reviewed. This case report will illustrate the management of a patient who was found to be latex-sensitive during surgery and the management of intraoperative anaphylaxis is provided. Safe perioperative care can be provided for latex-sensitive patients if latex avoidance techniques are used consistently.
Adult↗
Meperidine utilization and compliance with Agency for Health Care Policy and Research guidelines in a tertiary care hospital.
The Agency for Health Care Policy and Research (AHCPR) established guidelines for the use of meperidine (demerol), a common inpatient analgesic. These guidelines define standards of care for acute and chronic cancer pain management and address many of the problems with meperidine and its metabolite, normeperidine. The purpose of this study was to determine whether meperidine was prescribed in compliance with AHCPR guidelines, whether patients exhibited any adverse reactions to meperidine, and to determine the analgesic efficacy of meperidine. Three hundred inpatient charts were reviewed and identified meperidine as the primary analgesic in 157 nonobstetric inpatients. Age, sex, weight, dosing interval, route of administration, duration of meperidine use, serum chemistry values, primary diagnosis, associated medical conditions, and medications concurrently being taken with meperidine were the parameters analyzed. An interview was conducted to ascertain medical and drug history, chronicity of pain syndromes, analgesic drug history, and analgesic efficacy. A visual analog scale for pain (range = 0 to 10) and an analgesic satisfaction survey (range = 1 to 5) were used. Of 157 patients, 124 (79.8%) were in conflict with AHCPR guidelines. The most frequent conflict was found to be suboptimal dosing regimen and treatment of chronic pain. Often concurrent analgesics were given with the meperidine to achieve adequate analgesia. Higher analgesic satisfaction scores were noted when meperidine was given with concurrent analgesics. Meperidine also was administered to patients in renal failure or with medications contraindicated with meperidine use. No significant adverse effects were noted with meperidine use in this sample population other than an increased incidence of confusion in the elderly population.
Academic Medical Centers↗
The National Practitioner Data Bank: implications for nurse anesthetists.
The National Practitioner Data Bank (NPDB), created by the 1986 Health Care Quality Improvement Act, has been in operation since 1990. Hospitals and other credentialing bodies must query the NPDB when granting and renewing privileges. The NPDB receives about 25,000 reports of adverse actions against health practitioners each year. The NPDB was designed to be a flagging system providing information to licensing or credentialing authorities who would further examine practitioner records. Its purpose is to ensure that decision makers have information that might not otherwise be readily available, especially in the case of incompetent practitioners who move from hospital to hospital or state to state. Access to NPDB information is a concern for consumers and providers alike. Only 2% of matched reports to the NPDB made a difference in hospital privileging decisions. A limitation of NPDB information is that malpractice payments recorded in the NPDB do not necessarily constitute a comprehensive and definitive reflection of actual health care incompetence. All health care providers need to be aware of the NPDB, its mission, potential impact on their ability to be credentialed, and proposed additional uses of its information.
Clinical Competence↗
Credentialing of certified registered nurse anesthetists.
Certified registered nurse anesthetists (CRNAs) have provided anesthesia services in this country since the mid-1800s. As the earliest advanced practice nurse specialists, CRNAs have been leaders in the development of educational programs, accreditation, certification, and recertification. This article will describe the history of credentialing in nurse anesthesia and the achievements in the development of a valid and highly respected credentialing mechanism. Recertification and hospital credentialing are also discussed.
Certification↗
Pain control in hospitalized postsurgical patients.
The purpose of this study was to describe the pain experience of 100 randomly selected postsurgical patients, identify discrepancies between physician, nurse, and patient reports of pain intensity, and characterize the documentation of patients' pain experiences within the hospital record.
Adult↗
The anesthetic management of the trauma patient.
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Anesthesiology↗
Report of the National Commission on Nurse Anesthesia Education. Graduate education for nurse anesthetists: master's versus a clinical doctorate.
The need to establish clinical doctorate nurse anesthesia educational programs is discussed, as is the need for experienced program directors to take a leadership role in attracting qualified applicants to such programs. Holders of such advanced degrees are viewed as critical to meeting the challenges of the profession's future.
Curriculum↗
Efficacy of epidural analgesia for pain management of critically ill patients and the implications for nursing care.
Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient's recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care.
Analgesia, Epidural↗
Factors associated with adequate pain control in hospitalized postsurgical patients diagnosed with cancer.
The inadequate management of pain continues to be a significant problem for persons with cancer. Experts suggest that contributing factors include discrepancies in pain assessment, inadequate administration of opiate therapy, and insufficient documentation of the patient's pain experience. This study, part of a multidepartmental investigation into the adequacy of pain management in hospitalized patients, describes the pain experience of surgical oncology patients. Its correlational ex post facto design (n = 34) was guided by Loeser's model of pain. Randomly selected surgical oncology patients were interviewed using a structured format. The patient's primary nurse and physician simultaneously completed brief assessments of their perceptions of the patient's pain intensity. Data were analyzed using descriptive and correlational statistics, and implications for nursing practice and future nursing research are discussed.
Adult↗
Pain management.
Patients with pain are not a new phenomena. For centuries, the incidence of pain has been well-documented. Responsibility for pain management has not been a universal priority for health care providers; however, pain management must be considered an integral part of the nursing role. The health care system must facilitate the improved management of patient's pain. A better understanding of the factors that underpin the effective management of a patient's pain is necessary. In this article, the theoretical foundation and conceptual model used in the expansion of this knowledge is presented. Further, the physiologic and pharmacologic principles related to this patient care issue are discussed. Appropriate consideration of the nurse's significant part in the management of pain is emphasized.
Analgesia, Epidural↗