Cannulation in adults

This article will: •Provide clinical guidance on performing cannulation on an adult •Discuss site and equipment selection •Demonstrate the clinical procedural technique of cannulation •Provide an awareness of the dangers and complications of this invasive techniqu

‘Myth or reality?’ Preoperative pain planning and management: A critical ethnographic examination and exploration of day surgery preoperative practices

The assessment and management of surgical pain are paramount to good quality perioperative care. Regrettably, patients still declare inadequate satisfaction levels within this important area of practice. Holistic preoperative pain planning and education is a useful strategy to address this issue which has never been fully studied in day case surgery. This thesis has used a critical ethnographic research approach to explore and examine preoperative cultural practices and provide insight into what influences and shapes pain planning, management strategies and interactions with day surgical patients. This methodology observed healthcare interactions in the day case unit through a critical lens, underpinned by critical social theory and a transformative paradigm. Using Carpspecken’s (1996) analytical enquiry framework, the preoperative practice of one department was investigated over nine months. Both qualitative and quantitative data collection methods were used, including observations, interviews and timings of interactions. One hundred and twenty-four patients and thirty-three healthcare professionals took part in the study, one hundred and thirty hours of practice were observed, and twenty in-depth interviews with healthcare professionals took place. Data were analysed using reconstructive and statistical analysis, and four main themes were identified as having an impact on preoperative interactions. These four themes were: • The prioritisation of patient safety over pain management. • A production line culture which negatively impacted on holistic practice. • The existence of paternalism and power that affected staff and patient autonomy. • Unconscious gender and surgery bias, which had a direct impact on the levels and depth of preoperative pain conversations and management strategies. These were explored further in relation to Bourdieu's (1977) sociological theory of habitus and capital, in an attempt to raise awareness of practice culture and increase transparency, in order to challenge the status quo

Unconscious bias: the hidden culture underpinning preoperative pain planning and day surgery practices

Cultural research studies attempt to explore the shared practice of a specific group of individuals and try to explain human behaviour and the social interactions which are often deemed as the norm. However, the ‘cultural portrait’ of a specific sphere of practice can often be mispresented, as the surface image is only the tip of the iceberg and it is the invisible internal culture, found beneath the surface, which represents the greatest influence on clinical practice

Participatory Grantmaking: A Test of Rubric Scoring Versus Popular Voting Selection in a Blinded Grantmaking Process

Because small, community-based organizations play a critical role in delivering services and expressing diverse community values, it is important to find ways to minimize disparities in their access to philanthropic resources. Participatory grantmaking is widely viewed as a practice with good potential to mitigate this tendency. This article addresses the design of this approach to grantmaking and, specifically, whether changing the decision-making process in addition to changing the decisionmakers has an effect on how grants are allocated. It examines the design of two grant review processes — one based on popular voting, the other a more traditional rubric approach — and compares their outcomes to learn whether a more open and discursive process based on popular voting for grantee selection helps to overcome bias against small organizations. The article concludes with research implications for participatory grantmaking and grantmaking practice. It is hoped that these findings will contribute to the growing body of empirical knowledge around the design of participatory grantmaking processes

Care of the surgical patient—part 2: oral anticoagulants

Part two of this series on the care of the surgical patient introduces readers to some of the additional risks associated with patients who are undergoing surgery and taking oral anticoagulants. It explores the use of vitamin K antagonists and heparin. Some of the management strategies and additional considerations that need to be addressed during the perioperative care continuum will also be discussed

Oxygen therapy in a hospital setting

This article will: •Provide clinical guidance on how to deliver oxygen to an individual safely •Discuss delivery options and equipment selection •Demonstrate the clinical procedural technique for the application and administration of oxygen via a non-rebreathe oxygen device •Provide an awareness of the dangers and complications associated with oxygen therap