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Special report from the International Conference for Peri-anaesthesia Nurses

Dublin hosted second global gathering of peri-anaesthesia nurses for ICPAN 2013

The second International Conference for Peri-anaesthesia Nurses (ICPAN) was held in Dublin in 2013. The first conference was hosted by Canada in 2011.

Almost 400 peri-anaesthesia and post-anaesthesia care nurses gathered from across the globe for the event including approximately 45 representatives from Ireland. Other countries represented were the US, Canada, Australia, Belgium, Croatia, Denmark, Finland , Greece, the Netherlands, New Zealand, Norway, Singapore, Saudi Arabia and the UK.

The full educational programme delivered included presentations, posters , interactive sessions and opportunities to network. The opening ceremony was a colourful event with all participating nations flags presented on stage.

Sue Fossum, chairperson of ICPAN, then addressed the gathering and celebrated the sharing of peri-anaesthesia knowledge, expertise, contributions and innovative practice.

A very big fáilte go h’Éireann (welcome to Ireland) was extended by Ann Hogan, conference chairperson of ICPAN 2013.

The keynote address was provided by Ellen O’Sullivan, president of the College of Anaesthesia of Ireland, who spoke about the importance of airway management.

She said: “One skill, above all else, is to maintain airway impeccably. The failure to plan for failure and poor airway assessment are among the problems that we need to address.

“Awake is safer than asleep for example. Difficult airway rescue trolleys should all be uniform in operating rooms, recovery, emergency departments and intensive care units.”

Jamie Mann - Farrar , president of the Australian Society of Post Anaesthesia and Anaesthesia Nurses ( ASPAAN ) gave a talk , entitled ‘Can’t Intubate, Can’t Oxygenate’ (CICO).

Mr Mann-Farrar presents CICO crisis management workshops throughout Australia for the Australian College of Nursing, espousing the development of a management system that utilises human factors and design to address this potential crisis. In his talk, he highlighted the importance of pre-assessment and a plan for failure.

A presentation, entitled. ’Nausea and vomiting in the ambulatory surgery (day case surgery) population’ was presented by Jan Odom-Forren, who is the co-editor of the Journal of Perianesthesia Nursing.

According to Ms Odom- Forren, 35-50% of patients experience post-operative nausea and vomiting (PONV) after leaving a facility, with 37% experiencing it after 24 hours.

Patients who expected PONV were more likely to experience it again. As well as anti-emetic use to manage this, Ms Odom-Forren found that non-pharmaceutical methods can work. These include acupressure, aromatherapy, carbonated drinks and the patient lying down.

Ms Odom-Forren told the conference that i t is also vitally necessary to provide the patient with a prescription for anti-emetic medication on discharge, with consideration given to per rectum administration.

Kris Wyatt, a nurse unit manager with the Kyneton District Health Service in Melbourne, spoke on ‘Mobile pre-admission meeting diverse needs’.

She said that ill-prepared patients lead to problems and that perhaps we are not ready for ‘mobile’, pre-admission assessments yet. She also said that there is evidence that pre-assessment of patients prevents elective operation appointments being cancelled on day of surgery.

Allison O’Connell, from the Executive Council of the INMO, attended the second International Conference for Peri-anaesthesia Nurses, which took place in Dublin in 2013

Pain assessment
Kim Litwack, family nurse practitioner and author of Clinical Coach for Perianesthesia Nursing, presented on ‘Pain assessment across the life span’.

She said that pain assessment is more than a ‘1-10’ assessment, particularly when dealing with children, the cognitively-impaired and nonverbal patients.

According to Ms Litwack, patients’ fears include diagnosis, prognosis, pain, puke and cold. She said that all patients can be assessed and, intubated or not, that there is a universal tool for this. However, the nurse remains the best assessment tool.

Lara Henningsen, a nurse at the peri-anaesthesia care unit (PACU) of Copenhagen University Hospital in Denmark gave a talk called ‘Continuous positive airway pressure (CPAP) from intermittent to continuous’.

Ms Henningsen presented the findings of her imaginative research on patients, who require CPAP for treatment of respiratory complications after abdominal surgery.

She suggested that when CPAP is made more efficient, its quality is improved, it is non-invasive, economical and user-friendly.

Challenges for the future
Meanwhile, Prof Laserina O’ Connor from the UCD School of Nursing, Midwifery and Health Systems in Dublin, delivered the final presentation, entitled ‘Who’s who in peri-anaesthesia nursing: Challenges for the future’.

Prof O’Connor said that there are various nursing roles and elements of care involved in peri-anaesthesia, which all fit together like a jigsaw.

The pieces of this jigsaw include: patient safety; assessment ; nurse-led services; patient surveillance; high-tech analgesia systems; critically ill; prevention; education; acute pain management; advanced practice; chronic pain management; fast track; outreach; ambulatory surgery; cancer pain; research for nursing practice; research agenda; patient advocate; special populations; neuromodulation; tele-health; audit; and interventional radiology.

Prof O’Connor spoke about the need to ascend medications for chronic pain and descend it for acute pain.

She said: “Peri-anaesthesia nursing is an art and all I can do is be a counsellor and a coach, while the patient with pain runs the race”.

She spoke of four components of MISSION: research, leadership, education and clinical, and highlighted the need to develop scholars who will influence the future, creating a better tomorrow for its inhabitants.

She argued that peri-anaesthesia nursing needs to be at the frontline, helping shape the landscape of the healthcare system.

Prof O’Connor quoted Cecily Saunders, who in 1995 said: “It is humbling to see what simple acts of courtesy can do and distressing to realise how often these are omitted.

“Pain cannot easily be divided from emotion. Apprehension, loneliness and hopelessness enhance it.”

Finally, she quoted Margaret Mead, who said: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has”.

Poster competitions
Posters were on display throughout the international conference, with the authors, researchers and presenters on hand to discuss and answer queries from delegates.

Huge credit is due to the organising committee of the conference, which included Sue Fossum, Ann Hogan, Josephine Hegarty, Sinead Hanley, Manda Dunne, Pat Smedley, Angie Winter, Joni Brady, Markku Viherlaiho, and photographer, Gráinne McPolin.

The poster winners for innovative practice were:

  • First prize: Cindy Rizzoli, from Canada – ‘Supraclavicular nerve blocks: Future practice for pain control, saving time and saving money
  • Joint second prize: Wanda Rodriguez, US – ‘Culture of feedback’; and Carol Deriet, Canada – ‘Development of a peri-anaesthesia care pathway: Bridging the gaps from pre-admission clinic to 24 hours post procedure’.

The poster winners for research were:

  • First prize: Phyllis J Mesko, US: Establishing reliability and validity of the Mesko- Eliades Pain Area Locator tool(PAL) in paediatric postoperative patients’
  • Second prize: Elizabeth Card, US: ‘Incidence and risk factors for emergence and PACU delirium’.
Lucinda Sugars ( pictured above ) and Sinead McLoughlin , f rom Tallaght Hospital, presented their poster at the International Conference for Peri-anaesthesia Nurses. Their poster was called ‘The Pre-operative assessment pathway in Tallaght Hospital’

Irish entries
The Irish nurses’ contribution to the poster presentation included:

  • Gavin Mulhall and Rachel O’Connell, Tallaght Hospital: ‘You wouldn’t put a patient asleep without medical notes, would you?’

This poster showed the importance of having a ‘log book to record daily checks of anaesthetic machines.

  • Lucinda Sugars and Sinead McLoughlin, Tallaght Hospital: ‘The Pre-operative assessment pathway in Tallaght Hospital’

This poster is used to prevent admission to hospital of patients for elective surgery, who require interventions prior to surgery.

  • Michelle Hennebry, Waterford Regional Hospital, which was presented by Tess Treanor: ‘Audit on anaesthesia handover in Waterford Regional Hospital’
  • Yakubu A Shaaibu: ‘Patient experience of the Perioperative journey’
  • Lisa Herrity: ‘Perceptions of safety climate in the operating room (OR) setting: An Irish Perspective’
  • Maram Alnemer presented a poster by Saudia Arabia nurses: ‘The Integration of Saudization in post-anaesthesia nursing in Saudi Arabia’.

There was much interest in this poster, which evolved from the need to introduce Saudi nurses in PACU in the 1,000-bed hospital at King Abdulaziz Medical City, Riyadh.

The poster told of how the traditional role for Saudi females is to be mothers and wives and how Arabian patients follow traditional healthcare practices of their culture and religious way of life.

Saudi Arabia has a population of 16 million, plus nine million registered expatriates. In 2011, 8% of their PACU nurses were Saudi. This figure rose to 11% in 2013 and the aim is to have 50% Saudi nurses in PACU by 2020.

  • Maureen Iacono: ‘PACU or family nurse liaison’

This poster discussed the development of the role of the PACU nurse, which has proved to be invaluable, as it meets the needs of relatives and frees nursing time for caring for patients.

Gathering of nations forum
Between presentations, conference attendees enjoyed the ‘Gathering of Nations’ forum, which discussed policies, criteria, issues and uniting global practices.

The forum moderator was Pat Smedley, president of the British Anaesthetic and Recovery Nurses Association (BARNA).

The discussions were very interesting and informative. One issue discussed was the fact that there are 50 states in the US and they all differ in their approach to the role of the nurse and what the job involves.

Staffing was highlighted as a major global issue, with workload fatigue and team dynamics also of universal concerns.

Advanced nurse practitioners and their under development in Ireland, the crisis of overcrowding, and 24/7 staffing guidelines were also subjects on the agenda for discussion during in the forum.

– Allison O’Connell,
INMO Executive Council

Special report from the International Conference for Peri-anaesthesia Nurses


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