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OBJECTIVE: To determine whether we could reduce the time that patients undergoing tonsillectomy are observed postoperatively without decreasing the quality of care, which would eliminate the unnecessary use of resources to monitor those patients. STUDY DESIGN: Prospective cohort. METHODS: Patients undergoing tonsillectomy were recruited for the study prior to their operation. Each patient was then monitored in perianesthesia recovery until clinical indicators for discharge readiness were met (baseline respiratory function, afebrile, ambulation per age, adequate consciousness, absence of nausea/vomiting, adequate pain control, no active bleeding, fluid toleration). Patients were then contacted by phone approximately 24 to 72 hours after discharge to determine if they experienced any postoperative complications. Data analyzed included general demographics and surgical case information such as surgical duration, medications, and timeframes during recovery. RESULTS: Data from 93 patients (age range, 3-34 years) were analyzed. Clinical indicators were met in a mean time of 253.36 (SD ± 79.0) minutes, an average of 93.2 (SD ± 63.4) minutes sooner than average total post-anesthesia recovery time (346.63 minutes). Eight patients experienced minor complications overall (3 in perianesthesia recovery, 5 at home). CONCLUSION: This study demonstrates that using clinical indicators as discharge criteria is both safe and efficient, with a low rate of postoperative complications.

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INTRODUCTION: Although zolpidem is prescribed widely, determining the incidence of adverse drug reactions such as mental confusion is of considerable clinical importance for nursing practice. PURPOSE: The purpose of this study was to examine the use of zolpidem in a hospital setting to determine the incidence of mental confusion for patients receiving the drug. METHOD: A correlational cross-sectional study design was used to examine the effects of zolpidem on hospitalized patients. Data abstraction from medical records was used to collect demographic and variable information. FINDINGS: The first mental status assessment showed no statistical difference of decline in mental status (p=0.08). There was, however, a significant change (p<0.000) after the second mental status assessment. CONCLUSION: Based on the results of this study, caution must be considered for first-time users of zolpidem who are greater than age 50.

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Incorrect surgical counts after surgery are a perplexing problem for nurses working in the perioperative environment. To determine factors associated with an incorrect surgical count, this cross-sectional, correlational study examined explanatory variables (eg, patient and nurse characteristics, intraoperative circumstances, staff involvement) by using data abstracted from perioperative medical records and primary data collected from perioperative nurses. In the final multivariate analysis, six variables were significantly associated with an incorrect surgical count: a higher surgical risk, a lower body mass index, a complicated procedure, an unplanned procedure, an increased number of perioperative personnel involved, and an increased number of specialty teams involved.

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Ensuring that patients remain free of unintended retained foreign bodies is a primary responsibility of perioperative nurses and surgical technologists. However, these incidents continue to occur despite hospital policies and AORN recommended practice guidelines for their prevention. To provide insight into how incorrect surgical counts occur, researchers conducted a qualitative analysis of the tasks and challenges faced by perioperative nurses and surgical technologists in an academic medical center and a community hospital. Using hermeneutic phenomenological methodology, we identified bad behavior, general chaos, and communication difficulties as problems associated with incorrect surgical counts. As point-of-care providers, perioperative RNs are well poised to identify problematic areas and design systems and processes that protect patients. Perioperative RNs should consider using red rules or a code of conduct as tools for improving the manual counting process. These strategies could be developed in the shared governance council or a perioperative staff-led committee to ensure adherence to AORN standards.

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African Americans have disproportionally higher rates of colorectal cancer and higher morbidly. Colorectal cancer screening has been shown to decrease mortality form this largely preventable disease. Despite this fact, preventive screening, particularly colonoscopy, has been underutilized by the general population, especially by African Americans. Identifying barriers to preventive screening among African Americans in central Virginia is an important first step toward increasing the rates of colorectal cancer screening in our community.

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PURPOSE: The purpose of this descriptive study was to determine the feasibility of implementing a Pressure Ulcer Prevention Protocol in the emergency department (ED). METHODOLOGY: Using data abstraction, a descriptive analysis was conducted to examine the relationship between ED length of stay and hospital-acquired pressure ulcers for those patients who were directly admitted to the hospital from the ED. RESULTS: During 2006, 32,664 patients sought medical attention through the ED. Seventy-five percent of the total patient population admitted was admitted from the ED. One hundred twenty-five of those patients developed hospital-acquired pressure ulcers, 99.2% of which had an ED length of stay greater than 2 hours prior to hospital admission. CONCLUSION: Findings of this study suggest early nursing interventions are needed to prevent hospital-acquired pressure ulcers.

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Hospitals as research environments are crucial in advancing evidence-based practice and translational research. The authors discuss issues related to hospital-based nursing research such as institutional review board approval, the HIPAA, structure, unit characteristics, and nurse staffing as well as research-related issues such as study purpose and design, participant recruitment, and research personnel. Strategies and suggestions for nurse executives to assist researchers in overcoming recruitment challenges are presented.

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Today's healthcare environment requires that nurses be prepared for increasingly complex patient populations. Simultaneously, managers and educators are challenged to provide competency verification programs and continuing education opportunities with fewer resources. Hospital clinical educators share a staff development initiative of launching a unique simulation skills laboratory. The laboratory is designed to ensure nurses can meet the needs of patients in today's healthcare arena.

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