THE BACK PAGE
Global Perianesthesia Research: Embrace the Possibilities Vallire D. Hooper, PhD, RN, CPAN, FAAN WE ARE VERY PLEASED to provide you with our first Focus Issue on Global Research. Research forms the foundation for evidence-based practice (EBP), which in turn, serves as the key to the highest level of safe, quality patient care. It is ASPAN’s goal to provide both national and international perianesthesia nurses with standards, practice recommendations, and clinical practice guidelines that are evidence-based. The reality, however, is that adequate evidence to support perianesthesia practice is lacking in many areas.
tation, and surgical procedures frequently evolve, and are routinely implemented abroad before receiving approval for use in the U.S. Use of intravenous acetaminophen was well established overseas before being approved for use in the U.S. The U.S. also falls behind other industrialized countries in many health care statistics, while our cost of care exceeds that of most comparative nations. While we are global leaders in many fields, this does not necessarily hold true in the field of health care.
The basic premise of EBP is that practice should be guided by the highest levels and strongest quality of evidence available. Evidence level is dictated by the type (design) of the research/evidence, with meta-analyses and systematic reviews being ranked as the highest level of evidence in most evidence hierarchies. Quality is dictated by the actual quality of the study design.was the study designed to address the basic premises for that design? The country of origin of the study, however, should not influence the applicability of a study to a practice question.
This month’s issue features five extremely current, international, but also U.S. applicable research studies. The ASA original preoperative fasting guidelines were originally published in 1999, and were most recently revised in 2011. Despite the long time presence of these evidence-based guidelines, U.S. and international studies have long established that anesthesia and perianesthesia health care providers continue to fail to apply these guidelines to practice, as is illustrated in the first study in this issue. The larger question, however, is what is the cost of this lack of guideline adherence to the patient? How much postoperative/post-discharge nausea and vomiting and other complications evolve from this failure to translate solid evidence to practice? And better yet, why are we not implementing these relatively simple, straightforward recommendations? These larger questions have yet to be addressed.
The field of evidence-based practice was not U.S. led, but in fact, evolved globally in Canada and the United Kingdom. While U.S. researchers and institutions are now actively engaged in both Cochrane and Joanna Briggs Institute (JBI) reviews, the primary Institutes for both of these organizations are housed abroad. Medications, instrumen-
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Vallire D. Hooper, PhD, RN, CPAN, FAAN, Manager, Nursing Research, Mission Health System, Asheville, NC. Conflict of interest: None to report. Address correspondence to Vallire D. Hooper, 2300 F Kensignton Place, Asheville, NC 28803; e-mail address: vallire. [email protected]. Ó 2014 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2014.04.002
Journal of PeriAnesthesia Nursing, Vol 29, No 3 (June), 2014: pp 261-262
One may ask why we in the U.S. should care about the clinical utility of an undersized recovery room.and when did we go back to calling a PACU a recovery room? Jan and I debated if we should change the title of the second article in this issue to be more reflective of U.S. practice. The reality, however, is that while the U.S. debated the merits of the name recovery room versus post anesthesia care unit in the mid to late 1980s, the debate about the need for such a unit, regardless of name, exists today outside of the U.S. It is likely hard for U.S. readers to fathom the absence of some type of
261
262
recovery/post anesthesia unit where all patients recovering from anesthesia receive vigilant monitoring and care during that critical postanesthesia period. One may think this study is not truly applicable to U.S. practice, as the need for postanesthesia recovery is well established. But the reality is that while logic dictates that patient safety is enhanced by postanesthesia care, I am not sure that we have true evidence to support our logic. Results from this study clearly support that specialized postanesthesia care contributes to improved patient outcomes. I think the larger question, however, is what is ASPAN’s responsibility in advocating for perianesthesia care and standards across the world? What is our professional obligation as the international leader of professional perianesthesia organizations to support global patient safety efforts? The final three articles of this issue focus on the analysis of moderate sedation scales, comfort and hope, as well as family visitation, all of which is
VALLIRE D. HOOPER
of great applicability to U.S. practice. A reliable and valid instrument for quantifying levels of procedural sedation remains lacking, adversely impacting patient safety around the world. The Comfort Theory, intimately tied to hope and recovery, remains the undergirding framework in which perianesthesia care is organized and provided. And family visitation, although serving as a mainstay of patient-family engagement, remains challenging for perianesthesia providers across the globe. Perianesthesia care is a global phenomenon. As the international leaders of evidence-based perianesthesia care, ASPAN and its members have an obligation to advocate for perianesthesia patient safety around the world. As you review, and perhaps sometimes even question the applicability of some international perianesthesia research to your practice, I encourage you to broaden your perspective.think out of the box. Embrace the possibilities of a world of global perianesthesia practice and research!
Global Perianesthesia Research: Embrace the Possibilities Vallire D. Hooper, PhD, RN, CPAN, FAAN WE ARE VERY PLEASED to provide you with our first Focus Issue on Global Research. Research forms the foundation for evidence-based practice (EBP), which in turn, serves as the key to the highest level of safe, quality patient care. It is ASPAN’s goal to provide both national and international perianesthesia nurses with standards, practice recommendations, and clinical practice guidelines that are evidence-based. The reality, however, is that adequate evidence to support perianesthesia practice is lacking in many areas.
tation, and surgical procedures frequently evolve, and are routinely implemented abroad before receiving approval for use in the U.S. Use of intravenous acetaminophen was well established overseas before being approved for use in the U.S. The U.S. also falls behind other industrialized countries in many health care statistics, while our cost of care exceeds that of most comparative nations. While we are global leaders in many fields, this does not necessarily hold true in the field of health care.
The basic premise of EBP is that practice should be guided by the highest levels and strongest quality of evidence available. Evidence level is dictated by the type (design) of the research/evidence, with meta-analyses and systematic reviews being ranked as the highest level of evidence in most evidence hierarchies. Quality is dictated by the actual quality of the study design.was the study designed to address the basic premises for that design? The country of origin of the study, however, should not influence the applicability of a study to a practice question.
This month’s issue features five extremely current, international, but also U.S. applicable research studies. The ASA original preoperative fasting guidelines were originally published in 1999, and were most recently revised in 2011. Despite the long time presence of these evidence-based guidelines, U.S. and international studies have long established that anesthesia and perianesthesia health care providers continue to fail to apply these guidelines to practice, as is illustrated in the first study in this issue. The larger question, however, is what is the cost of this lack of guideline adherence to the patient? How much postoperative/post-discharge nausea and vomiting and other complications evolve from this failure to translate solid evidence to practice? And better yet, why are we not implementing these relatively simple, straightforward recommendations? These larger questions have yet to be addressed.
The field of evidence-based practice was not U.S. led, but in fact, evolved globally in Canada and the United Kingdom. While U.S. researchers and institutions are now actively engaged in both Cochrane and Joanna Briggs Institute (JBI) reviews, the primary Institutes for both of these organizations are housed abroad. Medications, instrumen-
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Vallire D. Hooper, PhD, RN, CPAN, FAAN, Manager, Nursing Research, Mission Health System, Asheville, NC. Conflict of interest: None to report. Address correspondence to Vallire D. Hooper, 2300 F Kensignton Place, Asheville, NC 28803; e-mail address: vallire. [email protected]. Ó 2014 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2014.04.002
Journal of PeriAnesthesia Nursing, Vol 29, No 3 (June), 2014: pp 261-262
One may ask why we in the U.S. should care about the clinical utility of an undersized recovery room.and when did we go back to calling a PACU a recovery room? Jan and I debated if we should change the title of the second article in this issue to be more reflective of U.S. practice. The reality, however, is that while the U.S. debated the merits of the name recovery room versus post anesthesia care unit in the mid to late 1980s, the debate about the need for such a unit, regardless of name, exists today outside of the U.S. It is likely hard for U.S. readers to fathom the absence of some type of
261
262
recovery/post anesthesia unit where all patients recovering from anesthesia receive vigilant monitoring and care during that critical postanesthesia period. One may think this study is not truly applicable to U.S. practice, as the need for postanesthesia recovery is well established. But the reality is that while logic dictates that patient safety is enhanced by postanesthesia care, I am not sure that we have true evidence to support our logic. Results from this study clearly support that specialized postanesthesia care contributes to improved patient outcomes. I think the larger question, however, is what is ASPAN’s responsibility in advocating for perianesthesia care and standards across the world? What is our professional obligation as the international leader of professional perianesthesia organizations to support global patient safety efforts? The final three articles of this issue focus on the analysis of moderate sedation scales, comfort and hope, as well as family visitation, all of which is
VALLIRE D. HOOPER
of great applicability to U.S. practice. A reliable and valid instrument for quantifying levels of procedural sedation remains lacking, adversely impacting patient safety around the world. The Comfort Theory, intimately tied to hope and recovery, remains the undergirding framework in which perianesthesia care is organized and provided. And family visitation, although serving as a mainstay of patient-family engagement, remains challenging for perianesthesia providers across the globe. Perianesthesia care is a global phenomenon. As the international leaders of evidence-based perianesthesia care, ASPAN and its members have an obligation to advocate for perianesthesia patient safety around the world. As you review, and perhaps sometimes even question the applicability of some international perianesthesia research to your practice, I encourage you to broaden your perspective.think out of the box. Embrace the possibilities of a world of global perianesthesia practice and research!
