What is the standard of care for the post-operative patient who received spinal anesthesia?

Searches of PubMed, The Joanna Briggs Institute EBP Database, and the National Guideline Clearinghouse yielded the following practice guideline.

Whitaker Chair, D K, et al. “Immediate post-anaesthesia recovery 2013: Association of Anaesthetists of Great Britain and Ireland.” Anaesthesia 68.3 (2013):288-297.

The abstract states, “The standard of nursing and medical care should be equal to that in the hospital’s critical care units.”

Reviewed 4/8/2014 ldt

What patient education interventions are used in the preoperative care of patients?

A search of Joanna Briggs Institute and PubMed identified the following references.
The PubMed search included terms for these concepts: preoperative period, pain, psychology, adults, patient education.

From Joanna Briggs:

Cabilan C, et al.  Prehabilitation for surgical patients: a systematic review protocol. 2013.
This is protocol for a systematic review, but in the background information, it references several papers on presurgical interventions specifically concerning the outcome of pain.

Stern C.  Knowledge retention from preoperative patient information.  2005 (updated 2010).
This systematic review references several studies investigating usefulness of preoperative education on outcomes such as pain.

From PubMed:
(“Preoperative care”[mesh] OR “preoperative period”[mesh]) AND pain AND (psychology OR anxiety OR fear) AND adults AND patient education

This search may include references cited in the Joanna Briggs reviews.  It also includes a systematic review on outcomes of preoperative patient education in surgical setting:
Ronco M, et al.  Patient education outcomes in surgery: a systematic review from 2004 to 2010.  Int J Evid Based Healthc. 2012 Dec;10(4):309-23.

Are there studies on training programs for clinical care coordinators/patient technicians in communication skills?

Searches of PubMed and CINAHL for your concepts of nurses aides, communication, and education found the following articles.

Fukaya, Yasuko, et al. “Education to promote verbal communication by caregivers in geriatric care facilities.” Japan journal of nursing science 6.2 (2009):91-103.

McGilton, Katherine S, et al. “A systematic review of the effectiveness of communication interventions for health care providers caring for patients in residential care settings.” Worldviews on evidence-based nursing 6.3 (2009):149-159.

Levy Storms, Lené. “Therapeutic communication training in long-term care institutions: recommendations for future research.” Patient education and counseling 73.1 (2008):8-21.

Williams, Kristine N, Teresa BIlten, and HelenBower. “Meeting communication needs: topics of talk in the nursing home.” Journal of psychosocial nursing and mental health services 43.7 (2005):38-45.

Cunningham, Adrian. “Developing a communications course for health care assistants.” Nursing times 100.47 (2004):36-38.

Williams, Kristine Enhancing communication with older adults: overcoming elderspeak. Journal of Gerontological Nursing 2004 vol:30 iss:10 pg:17 -25

Stevens Roseman, Ellen S, and PatrickLeung. “Enhancing attitudes, knowledge and skills of paraprofessional service providers in elder care settings.” Gerontology & geriatrics education 25.1 (2004):73-88.

Counsell, Colleen M, and RoseRivers. “Inspiring support staff employees.” The Journal of nursing administration 32.3 (2002):120-121.

Burgio, L D, et al. “Come talk with me: improving communication between nursing assistants and nursing home residents during care routines.” Gerontologist, The 41.4 (2001):449-460.

McCallion, P, et al. “Educating nursing assistants to communicate more effectively with nursing home residents with dementia.” Gerontologist, The 39.5 (1999):546-558.

Thomas, L H. “A comparison of the verbal interactions of qualified nurses and nursing auxiliaries in primary, team and functional nursing wards.” International journal of nursing studies 31.3 (1994):231-244.

Is there benefit to routinely screening for urinary tract infection (bacteruria) in hospitalized patients without urinary catheters?

The information below pertains to asymptomatic bacteruria because the assumption is if the patient were symptomatic, diagnostic testing would be administered as standard care for the patient.

Here are guidelines for diagnosing and managing asymptomatic bacteruria.

  • Infectious Diseases Society of America (IDSA) guideline on diagnosis and treatment of asymptomatic bacteriuria in adults.  Clin Infect Dis 2005 Mar 1;40(5):643.
    • Based on evidence from at least 1 quality RCT in each case, IDSA recommends AGAINST screening premenopausal, nonpregnant women, women with diabetes, elderly institutionalized persons, older persons living in community, patients with spinal cord injury, patients with indwelling urethral catheter.  Also recommends screening pregnant women.
    • IDSA does recommend screening prior to transurethral resection of prostate (based on at least 1 RCT) and before other urologic procedures (based on descriptive studies and expert opinion)
    • IDSA does not make any recommendation about screening renal or other solid organ transplant recipients
  • United States Preventive Services Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria in adults.  National Guideline Clearinghouse 2008 Aug 4:12619 or Ann Intern Med 2008 Jul 1;149(1):43.
    • Only recommends routine screening for pregnant women.

Guidelines suggest further research is needed to address management of asymptomatic bacteruria in these populations:  chronic kidney disease, indwelling urinary devices other than catheters (eg, urinary stents, nephrostomy tubes), selected immunocompromised patients (eg, neutropenia, transplant recipients), and patients undergoing prosthetic implantation (orthopedic or vascular procedures).

Evidence from the guidelines includes hospitalized and non-hospitalized patients.  Details of the evidence are provided in the guidelines.

Searches of Medline and CINAHL using combinations of these terms did not identify any papers on routine testing of hospitalized patients.

Urine analysis
Routine, screening
Hospitalized, inpatients
Transplant, immunocompromised

Nursing care for a patient with externalized shunt

Hill, Michelle A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit. Journal of Neuroscience Nursing, 2012 Aug; 44 (4): 188-93.

Henman, Lita Checklists and Bundles-Not Just for Central Lines Anymore: Using a Standardized Insertion and Maintenance Approach to Eliminate External Ventricular Drain Infections. American Journal of Infection Control, 2011 Jun; 39 (5): E195.

Orsi GB Hospital-acquired infection surveillance in a neurosurgical intensive care unit. Journal of Hospital Infection, 2006 Sep; 64 (1): 23-9.

Cummings R Understanding external ventricular drainage. Journal of Neuroscience Nursing (J NEUROSCI NURS), 1992 Apr; 24 (2): 84-7.

Lwin, Sein, et al. “External ventricular drain infections: successful implementation of strategies to reduce infection rate.” Singapore medical journal 53.4 (2012):255-259.

Littlejohns, Linda R, and BrettTrimble. “Our policy on external ventricular drainage systems includes the procedure for priming the system. Does it really have to be primed?.” Critical care nurse 25.3 (2005):57-59.

Criddle, Laura M. “Is it an expected practice for critical care nurses to irrigate an external ventriculostomy drainage (EVD) system with tissue plasminogen activator (tPA) to break up blood clots in the tubing to facilitate drainage, thereby preventing increased intracranial pressure?.” Critical care nurse 27.3 (2007):78-78, 81.

Searched PubMed & CINAHL. Keywords: external shunt, externalized shunt, (nursing or nurse)

Have professional practice models in nursing increased nursing engagement?

A search in PubMed and CINAHL  using search terms professional development models AND nursing engagement produced these results:

Carter, Matthew R, and Ann ETourangeau. “Staying in nursing: what factors determine whether nurses intend to remain employed?.” Journal of advanced nursing 68.7 (2012):1589-1600

Bargagliotti, L A. “Work engagement in nursing: a concept analysis.” Journal of advanced nursing 68.6 (2012):1414-1428.

Spence Laschinger, Heather K, et al. “Predictors of new graduate nurses’ workplace well-being: testing the job demands-resources model.” Health care management review 37.2 (2012):175-186.

Adams, Jeffrey M, DebraDenham, and Irene RNeumeister. “Applying the Model of the Interrelationship of Leadership Environments and Outcomes for Nurse Executives: a community hospital’s exemplar in developing staff nurse engagement through documentation improvement initiatives.” Nursing administration quarterly 34.3 (2010):201-207
Lai, Hui-Ling, et al. “Intensive care unit staff nurses: predicting factors for career decisions.” Journal of clinical nursing 17.14 (2008):1886-1896.

More PubMed Results

Reviewed 4/22/14 AA

What is the efficacy of sheepskin and phenytoin for treating or preventing pressure ulcers in acute care patients?

Joanna Briggs Institute EBP Database includes many systematic reviews and evidence summaries on interventions to prevent or treat pressure ulcers.

Sheepskin

Pressure ulcers a prevention of pressure related tissue damage.   2011.  [Technical Reports – Joanna Briggs]]
Reviews studies on use of sheepskin

McInnes E, et al.  Support surfaces for pressure ulcer prevention.  Cochrane Database Syst Rev. 2011 Apr 13;(4):CD001735. doi: 10.1002/14651858.CD001735.pub4.

Studies in PubMed published since these systematic reviews

Phenytoin

A search of PubMed retrieved some systematic reviews and original studies evaluating use of phenytoin in pressure ulcer management.

pressure ulcers AND phenytoin

Systematic reviews in the search results include:

Reddy M. Pressure ulcers. Clin Evid (Online). 2011 Apr 28;2011. doi:pii: 1901.
Review. PubMed PMID: 21524319; PubMed Central PMCID: PMC3217823.

Mao CL, Rivet AJ, Sidora T, Pasko MT. Update on pressure ulcer management and
deep tissue injury. Ann Pharmacother. 2010 Feb;44(2):325-32. doi:
10.1345/aph.1M315. Epub 2010 Jan 5. Review. PubMed PMID: 20118142.

Cullum N, Petherick E. Pressure ulcers. Clin Evid (Online). 2008 Mar 19;2008.
doi:pii: 1901. PubMed PMID: 19450317; PubMed Central PMCID: PMC2907959.

Reviewed 4/20/14 AA