According to Steen and Marchant (2007), 60-70% of women will require sutures after vaginal delivery. A common morbidity of lacerations in the perineum is acute pain (Steen et al., 2007). Indeed, many women who have had birth related lacerations have decreased mobility, difficulty sitting comfortably, or fear of defecation due to pain (Steen et al. 2007). Furthermore, this pain may impede a mother from breastfeeding, focusing on newborn care and can lead to increasing irritability (Steen et al., 2007). Nurses have the opportunity to play a pivotal role in addressing perineal pain by assessing lacerations, assessing pain levels and providing pharmacological and non-pharmacological pain relief methods. The most common non-pharmacological …show more content…
Nurses assess patients’ perineal swelling, lacerations, and monitor signs of infection. In conjunction, nurses also assess patient’s pain levels from perineal trauma and can provide pharmacologic and non-pharmacologic pain relief (Steen et al., 2007). Based on the centrality of their role, it is important that nurses have access to evidence based best practices on perineal pain management. Yet, nursing does not exist in a vacuum and there are many factors that may influence the translation of research evidence into a clinical setting. As stated by the Canadian Nursing Association, “Decision-making in nursing practice is influenced by evidence and also by individual values, client choice, theories, clinical judgment, ethics, legislation, regulation, health-care resources and practice environments” (CAN, 2010, p. 3). With this at the forefront, I will explore some of the organizational challenges to implementing Steen et al.,(2007) findings, such as, cost effectiveness, practice environment, standardization and time constraints. I will then explore the application of the evidence to my clinical example by addressing how Steen et al., (2007) evidence might have changed the care I provided to my …show more content…
Research by Steen and Marchant (2007) affirmed that cryotherapy is a safe and effective nursing intervention for treating perineal pain in women. When applying this evidence to practice there are a number of challenges of implementation, such as, the cost of the treatment, practice envrionment and lack of standardization. Moreover, the application of this evidence to a clinical setting should not supplant the clinical judgment of the nurse or the preference of the patient. Finally, before developing best practice guidelines in perineal pain care more exhaustive research needs to be conducted that addresses application time and use for women who have had
There are numerous risks for a patient during the preoperative stage of the perioperative journey. All patients undergoing a surgical procedure are at risk of developing perioperative hypothermia, although there are various factors which also further increase an individual’s susceptibility (Burger & Fitzpatrick, 2009). An individual’s body type can cause them more susceptible to heat loss during the perioperative period. The patient’s nutritional state and being malnourished, if the individual is female and is of low body weight therefore a high ratio of body surface area to weight and limited insulation to prevent heat loss, these are all factors which negatively affect heat loss and therefore increasing the individual’s risk of perioperative hypothermia (Lynch et al.,
Cord clamping has long been practiced to occur immediately after birth of a neonate. There is much discussion and evidence based practice that shows improvements to health when we delay the clamping and cutting of the umbilical cord. Delayed clamping allows for more nutrient rich blood to flow to the infant’s body, which is going through shock at birth. Early clamping is generally done between 10 seconds after expulsion of the fetus to one minute , whereas delayed clamping ranges from two minutes until the cord finishes pulsating. The research collected will analyze early clamping and delayed clamping to see which practice is found to be healthier for mother and child.
Vannie, S. M. D., Braz, J. R. C., Modolo, N. S. P., Amorium, R. B., & Rodrigues, G. R. (2003, March). Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. Journal of Clinical Anesthesia, 15, 119-125.
Pain is not always curable but effects the life of millions of people. This essay examines the Essence of Care 2010: Benchmarks for the Prevention and Management of Pain (DH, 2010). Particularly reflecting on a practical working knowledge of its implementation and its relevance to nursing practice. It is part of the wider ranging Essence of Care policy, that includes all the latest benchmarks developed since it was first launched in 2001.
...tive pain management and Improvement in patients outcomes and satisfaction [Magazine]. Critical Care Nurse, 35(3), 37,35,42. Retrieved from
Assessing and managing pain is an inevitable part of nursing and the care of patients. Incomplete relief of pain remains prevalent despite years of research due to barriers such as lack of kn...
Hinkle, Janice L, Cheever, Kerry H. (2014). Brunner &Suddarth’s textbook of Medical-Surgical Nursing. Philadelphia: Wolters Kuwer/Lippincott Williams &Wilkins.
Certified Registered Nurse Anesthetists (CRNA) are high trained nurses who use their developed training in the use of anesthesia to alleviate patient pain and discomfort due to medical procedures. Nurse anesthetists have been providing anesthesia for more than 125 years, dating back to the early Civil War. ("Nurse anesthetist," 2014). They undergo rigorous training post nursing licensure that allows them to hold a high position in the nursing field working beside surgeons, anesthesiologist, dentists, podiatrist, and many other skilled healthcare professionals ("Nurse anesthetist," 2014). Pain management is one of the main aspects in any procedure, if not the most important to the patient, therefore giving nurse anesthetists a wide spectrum of work settings in the medical field that they can practice in.
Working in a neurosurgical practice we care for patients that have chronic pain, as well as acute pain due to structural issues. The gate control theory proposes that there are psychological components to pain as well as physiologic (McEwen, Wills, 2014). This theory can be applied on a daily basis with both operative and non-operative patients. Patients in the post-operative setting can have pain attributed to surgical intervention. But, why do patients, which have had the same procedure, experience pain at varying levels? Some patients may have anxiety related to the procedure or may have socio-economic burdens that contribute to fear, anxiety and helplessness when they discharge home. The nurse triaging these calls regarding pain must acknowledge the structural and psychological factors contributing to the pain and provide interventions to address both. Reviewing prescriptive pain options as well as discussing relaxation techniques may help a patient that has underlying anxiety in addition to physiologic pain. Many of our non-operative/chronic pain patients come to our clinic look for a surgical “fix” but often times there is not a structural issue that we can attribute to their pain. Prior to patients being seen they complete an assessment tool that quantifies their depression, anxiety and sleep habits. We use this tool to help determine a holistic care plan. Often times,
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
...amount of pain) is a great teaching tool for the patient who is able to self-report (Nevius & D’Arcy, 2008). This will put the patient and nurse on the same level of understanding regarding the patient’s pain. The patient should also be aware of the added information included with the pain scale: quality, duration, and location of the pain. During patient teaching, it should be noted that obtaining a zero out of ten on the pain scale is not always attainable after a painful procedure. A realistic pain management goal can be set by the patient for his pain level each day.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
Worldwide, the rate of cesarean section is increasing. According to the CDC, in 2012 the rate of cesarean sections comprised 32.8% of all births in the United States (CDC, 2013). Between 1996-2009 the cesarean section rate has risen 60% in the U.S (CDC, 2013). According to the World Health Organization (WHO), more than 50% of the 137 countries studies had cesarean section rates higher than 15% (WHO, 2010). The current goal of U.S. 2020 Healthy People is to reduce the rate of cesarean section to a target of 23.9%, which is almost 10% lower than the current rate (Healthy People 2020, 2013). According to a study conducted by Gonzales, Tapia, Fort, and Betran (2013), the appropriate percentage of performed cesarean sections is unclear, and is dependent on the circumstances of each individual birth (p. 643). Though often a life-saving procedure when necessary, the risks and complications associated with cesarean delivery are a cause for alarm due to the documented rate increase of this procedure across the globe. Many studies have revealed that cesarean deliveries increase the incidence of maternal hemorrhage and mortality and neonatal respiratory distress when compared to vaginal deliveries. As a result, current research suggests that efforts to reduce the rate of non-medically indicated cesarean sections should be made, and that comprehensive patient education should be provided when considering an elective cesarean delivery over a planned vaginal delivery.
The researchers compared the delivery of analgesia within 30 minutes and time from being seen to analgesia of intervention group with standard group. I would say that the results of the study maybe be applied in the field of my speciality as a general if I am going to compare it to the study that was conducted in emergency department. I work in a peritonectomy, liver and lower gastro-surgical ward that caters most of the post-operative patients. Although, the study was conducted in Australia and there can be a similarity with our patients' pain assessment tool, but the setting of the study is different from our ward as we are an in an acute service area and we do not have nurse practitioners. Furthermore, the majority of our patients are coming from intensive care unit or ICU and recovery that had gastrectomy, hemicolectomy, peritonectomy and other gastric surgeries where they have a patient controlled analgesia or PCA pump connected to them, whereas in the study the patients that were mostly treated were from the classification of International Classification of Diseases 10th Revision, Australian Modification or ICD-10AM, such as open wounds in upper extremities, strain or sprain of the ankle, fracture foot and
Unlike vaginal birth delivery, the process of a cesarean delivery is quite different, but just as safe as giving vaginal birth (Taylor, 1). When delivering a baby using the cesarean method, there are two ways anesthetic can be used. The women can be put into an unconscious state using the anesthetic, therefore she will be asleep during the entire operation and her coach may not be present. The other way for the anesthetic to be used would be in an epidural or spinal block to temporarily numb the woman from her waist down. In this case the mother will be awake and her coach may be present to give her extra support. Once the anesthetic is working, an incision is made in the abdomen either horizontally or vertically, depending on the reason for the cesarean delivery. A vertical incision is made when the baby is in trouble and needs to be out as quickly as possible, when there is more time the horizontal incision is used. The baby is then lifted out of the uterus and gone for the APGAP procedure. The placenta is then removed and the mother’s reproductive organs are examined before closing the incision (Taylor, 1).