The objective of this study was to evaluate the effect of immersive virtual reality (IVR) distraction therapy during painful wound care procedures in adults on the amount of opioid medications required to manage pain. A convenience sample of consenting, adult inpatients requiring recurrent painful wound care procedures was studied. Using a within-subject, randomized controlled trial study design, 2 sequential wound procedures were compared, 1 with IVR distraction therapy and 1 without IVR. Total opioid medications administered before and during the wound procedures were recorded and pain and anxiety were rated before and after the 2 wound procedures. The IVR intervention included the wearing of virtual reality goggles and participation in an immersive, computer generated, interactive, 3-dimensional virtual world program. Data were analyzed with Student's t test and chi-square analysis, with P < 0.05 considered significant. A total of 18 patients were studied, with 12 completing both study wound procedures and 6 completing a single wound procedure. The amount of opioid administered before each of the 2 wound procedures was similar with and without IVR. Total opioid administration during the dressing procedures with IVR was significantly less than when no IVR was used, 17.9 ± 6.0 and 29.2 ± 4.5 mcg/kg fentanyl, respectively (t = -2.7; df = 14; P = 0.02). Two of 15 patients (11%) requested more than 1 opioid rescue dose with IVR and 9 of 15 patients (60%) requested more than 1 rescue dose without IVR. Seventy-five percentage of participants stated that they would want to use IVR with future dressing changes. Pain and anxiety scores were similar for the wound procedures with and without IVR (P > 0.05). IVR significantly reduced the amount of opioid medication administered during painful wound care procedures when IVR was used compared with no IVR. Since pain scores were similar before and after the wound procedures with IVR and without IVR, the 39% reduction in opioid medication during IVR supports its use as a pain distraction therapy during painful procedures.

Glucose values obtained with a point-of-care device differ significantly from those obtained by laboratory analysis. The magnitude of these differences calls into question the widespread practice of using point-of-care glucose testing to guide insulin titration for tight glucose control. Errors in dosing could easily be made because of the large bias and precision associated with a point-of-care device.

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The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis. Among the 15 patients with H1N1 influenza A treated with ECMO, 4 patients received the therapy simultaneously. The role of ECMO in supporting patients with severe respiratory failure due to H1N1 influenza is described, followed by discussions of the nursing care challenges for each body system. Variations from standards of care, operational considerations regarding staff workload, institutional burden, and emotional wear and tear of the therapy on patients, patients’ family members, and the entire health care team are also addressed. Areas for improvement for providing care of the critically ill patient requiring ECMO are highlighted in the conclusion.

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Achieving perioperative hemostasis is vital to surgical success. Inadequate control of bleeding is associated with serious adverse outcomes, including extended duration of surgery, unanticipated blood transfusions, shock, infection, impaired wound healing, longer hospital stays, and mortality. Appropriate clinical management of bleeding in the surgical and trauma settings requires careful collaborative planning and coordination by the entire perioperative team. Perioperative nurses, because of their strategic role in patient care, must be familiar with risk factors for excessive bleeding and the fundamental roles of hemostatic agents, environmental temperature, and blood transfusion in controlling bleeding in the surgical patient. Knowledge of the characteristics, safety, efficacy, and costs of available topical hemostatic agents promotes their appropriate selection in the OR. By incorporating evidence-based approaches into practice, perioperative nurses can support effective intraoperative hemostasis, thereby improving patient outcomes.

Today's nurses must provide care that is based on the best available evidence. Creating a program that supports the routine use of evidence-based practice (EBP) can seem complicated and time-consuming. This article provides a practical description of the critical elements to consider when starting an EBP program. A successful program includes built-in organizational supports for clinical inquiry, functional and efficient processes for EBP activities, and added details to sustain momentum and interest over time. Strategies for making EBP part of everyday care are identified, along with suggestions for overcoming barriers to change and ideas for acknowledging nurses for EBP work.

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