Journal of Nursing Administration Assignment

PREOPERATIVE FASTING We were pleased to see the 1999 guidelines of the American Society of Anesthesiologists (ASA) Task Force on Preoperative Fasting1 and our research highlighted in “Preoperative Fasting Doesn’t Mean Nothing After Midnight” (Think Again, September). As author Sue Sendelbach notes, it’s difficult to change the tradition of NPO (the Latin non per os or nil per os, meaning “nothing by mouth”) after midnight, despite strong evidence for liberalizing preoperative fasting. We applaud the staff of the Minneapolis Heart Institute at Ab­ bott Northwestern Hospital for changing the standard NPO order to agree with the ASA guidelines, allowing patients to have clear liq­ uids up to two hours before sur­ gery. We wondered, however, why the policy for solid food wasn’t changed to be congruent with these guidelines (that is, allowing a light breakfast, such as tea and toast, up to six hours before sur­ gery). Scheduling changes are often used as a reason to maintain the solid food policy, as cited in our Point–Counterpoint article with Mark A. Warner in AJN (“Best Practices Shouldn’t Be Optional,” June 2002), which shows that many people overestimate the frequency of these changes. Hard data is needed to determine how common they really are. Perhaps this will be the next step. We agree that liberalizing clear liq­ uids is more important than lib­ eralizing solids. In our research on preopera­ tive fasting, we’ve discovered that policy and practice are quite dif­ ferent. Have the staff members at the Minneapolis Heart Institute interviewed patients to find out which fasting instructions they 12 AJN ▼ December 2010 ▼ Vol. 110, No. 12 were given, and what they actu­ ally did? It’s been over a decade since the ASA guidelines were pub­ lished. The safety and benefits of shortened fasting are clear. We’ve previously addressed the many excuses for clinging to NPO after midnight.2 Everyone advocates evidence-based practice, but words and action don’t match. Is this an­ other ritual that health care pro­ viders won’t change but educated consumers eventually will? Elizabeth H. Winslow, PhD, RN, FAAN Jeannette T. Crenshaw, MSN, RN, LCCE, FACCE, IBCLC, NEA-BC Dallas REFERENCES 1. American Society of Anesthesiologists Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmon­ ary aspiration: application to healthy patients undergoing elective proce­ dures: a report by the American Soci­ ety of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 1999;90(3):896-905. 2. Winslow EH, et al. Best practices shouldn’t be optional. Am J Nurs 2002;102(6):59-63. Author Sue Sendelbach responds: My experience in translating re­ search into practice is reflected in the conclusions of Jo RycroftMalone, PhD, RN, and Christo­ pher Burton, DPhil, RN, who’ve found that “there is a growing body of research to support the assertion that using evidence in practice is a complex and multifactorial process (not event).”1 My colleagues and I had ex­ plored changing the policy for both fluids and solids, but the complexity of scheduling patients for cardiovascular procedures in­ cludes changes in the timing of these procedures. It’s not unusual to re schedule a procedure for earlier in the day, and, if the pa­ tient has eaten solid foods, this can lead to a delay. Journal of Nursing Administration Assignment

I agree with Dr. Winslow and Ms. Crenshaw that changing our liquid policy was the first step in the process. Part of the challenge in chang­ ing the preoperative fasting policy was that Abbott Northwestern is a tertiary care center, which means that it receives many referrals. Presently, more than 40 centers refer their patients to our facility for cardiovascular procedures. When we changed the preopera­ tive fasting policy, we worked with each of these centers to en­ sure that all patients received the same preoperative instructions: they are not to eat solid foods after midnight the day of the pro­ cedure but may drink clear liquids (water, clear fruit juices, carbon­ ated beverages, clear tea, black coffee; no alcohol) up to one hour before they’re scheduled to arrive for the procedure. We’ve not asked patients if these are, indeed, the instructions they received. However, on admis­ sion, all patients are asked when they’ve last had fluids, and their responses consistently indicate that they’ve followed the preop­ erative instructions. REFERENCE 1. Rycroft-Malone J, Burton C. Paying attention to complexity in implemen­ tation research. Worldviews Evid Based Nurs;7(3):121-2. CYSTIC FIBROSIS CAMPS In response to the August issue’s cover photo, described in On the Cover, we wish to clarify the ap­ propriateness of cystic fibrosis camps. Journal of Nursing Administration Assignment

The infection control rec­ ommendations for people with this disease include the discontinu­ ation of all cystic fibrosis–specific ajnonline.com camps.1 These are based on pub­ lished research documenting the transmission of deadly pathogens in social settings. The Cystic Fi­ brosis Foundation (CFF) Web site (www.cff.org) provides recom­ mendations and information about how people with this dis­ ease can avoid germs. Nurses are key in educating people with cystic fibrosis and their families about the risks of acquiring deadly pathogens when socializing with others who have this condition. The basic principles of infection con­ trol are effective in minimizing the spread of germs between people with cystic fibrosis, with one addition: those with cystic fibrosis should stay a minimum of three to six feet away from AJN welcomes letters to the editor regarding recently published articles, although critiques of original research may be submitted at any time. Submissions must be typed, contain fewer than 300 words, and list the correspondent’s name, ad­ dress, and phone number or e-mail address; include no more than three references for any statistics or studies cited. Letters will be edited for length, clarity, and accu­ racy. Submission of a letter will constitute the author’s permission to publish it, al­ though it doesn’t guarantee publication. Letters become the property of AJN and may be published in all media. Send letters to AJNLetters@wolterskluwer.com, or AJN Letters Lippincott Williams & Wilkins 333 Seventh Avenue, 19th Floor New York, NY 10001, or (212) 886-1206 (fax) ajn@wolterskluwer.com another person with the disease. By teaching people with cystic fibrosis and their families about these principles and the risks of socialization, nurses can influence the life—and thus the survival— of someone living with this deadly disease. Thankfully, the Internet and technology now provide a wealth of resources and an opportunity for people with cystic fibrosis to connect and find support virtu­ ally. The CFF’s Web site contains information in multiple formats— including Webcasts and videos— to help nurses educate patients and families about this disease. Additionally, on this Web site, nurses can read about the cystic fibrosis practice guidelines and the latest research. Leslie Hazle, MS, RN Cynthia George, MSN, FNP Cystic Fibrosis Foundation Bethesda, MD REFERENCE 1. Saiman L, Siegel J. Infection control recommendations for patients with cystic fibrosis: microbiology, impor­ tant pathogens, and infection control practices to prevent patient-to-patient transmission. Infect Control Hosp Epidemiol 2003;24(5 Suppl):S6-S52. Dana Munsey responds: I’m a 51-year-old with cystic fibrosis and the president of Sunny Shores Sea Camp, a photo of which ap­ peared on AJN’s August cover. For 31 years, we’ve offered an alternative to the traditional camp setting, serving more than 1,000 cystic fibrosis patients and nearly 2,500 family members. Journal of Nursing Administration Assignment

All of the professionals who work at our camp—including nurses, physi­ cians, and therapists—donate their time and services. Here, the word camp is sym­ bolic of fun and camaraderie but not of the bunk beds, tents, and cabins associated with tradi­ tional sleepaway camps. One label doesn’t describe all organizations, and it should be recognized that responsible socialization among people with cystic fibrosis is ac­ ceptable if basic principles of infection control are identified and maintained. Our camp has a screening policy for deadly pathogens, which can be found on our Web site (www.ssscamp. org). I’m aware of the vital infection control recommendations for peo­ ple with cystic fibrosis—among them the CFF’s advice to discon­ tinue all cystic fibrosis–specific camps to avoid the spread of germs and deadly pathogens— but textbooks, technology, virtual friends, and information can’t re­ place in-person communication. The fear associated with a diag­ nosis of cystic fibrosis is replaced by hope, as families at our camp meet and discuss the daily ritu­ als that can improve our lives. We educate campers, teaching them how to survive interactions with other people with cystic fibrosis during their visits to clinics and during hospitalizations. They also learn how to avoid the deadly pathogens that can be acquired in the community. Throughout my life, I’ve attended and supported CFF functions where I’ve actively socialized with other people with cystic fibrosis. Like the CFF, our camp agrees that education and knowledge are pathways to pre­ vention. Sunny Shores Sea Camp has taught me that I can safely so­ cialize with people who, like me, suffer from this deadly disease if I take adequate precautions. The greatest gift I can give to the cys­ tic fibrosis community is to use my knowledge, which has come from several sources—including the CFF and our camp—and my personal experience, to perpetu­ ate and fulfill the mission state­ ment of Sunny Shores Sea Camp: “Helping families and mentoring children with cystic fibrosis.” ▼ AJN ▼ December 2010 ▼ Vol. 110, No. 12 13 N5343 Leadership in Complex Healthcare Systems Letter to the Editor Guidelines and Grading Criteria Directions Write a letter to the editor of a peer reviewed professional nursing, medical, or health care administration journal (that publishes letters to the editor) in response to an article or study published within the last month. Do not select an editorial or a regular column. Choose an article or study on a topic that you are passionate about. Journal of Nursing Administration Assignment

The letter should be brief, substantive, and succinct, and present a perspective that is different and contributes to the literature. The topic should be related to leadership and leadership strategies to improve health care quality and patient or client outcome (e.g., leadership, evidence-based decision-making, patient-safety culture, workforce and workplace issues, conflict management, team building, staffing, nurse fatigue, creating a culture that supports evidence-based management, leading effective teams). Upload your letter to the assignment drop box by the scheduled due date with a copy of the author’s guidelines for the selected journal. Submit your letter to the selected journal after reviewing your graded assignment. . Paste a copy of the submitted version, with the name of the journal and the date submitted on the Final Letter to the Editor DB. Please notify your faculty and coach if your letter is accepted for publication and add the publication to your resume. Guidelines: • Write articulately in response to a publication within the last month. • Use no more than one double-spaced page (or the word limit specified in the selected journal). • Write a letter that is brief, substantive, and succinct. • Follow the published guidelines for letters to the editor in the selected journal (e.g. word limit, to whom to submit, how to submit, and reference guidelines). If the journal does not provide guidelines for letters, refer to the journal’s guidelines for authors. • Write the letter in the style used by the journal you selected (e.g., APA, MLA, AMA). • Include at least one primary reference in addition to the reference for the article to which you are a responding. Include a copy of the journal’s letter to the editor publishing guidelines when submitting the assignment. University of Texas at Arlington College of Nursing April 29, 2019 Page 1 of 2 N5343 Leadership in Complex Healthcare Systems • • • • • • • • • Establish your expertise and platform for responding. Your expertise includes your clinical and/or administrative experience. Do not specify that you are writing as a student in your signature. Identify why you’ve chosen to respond to this article (e.g. dissenting view point, alternate perspective, additional perspective). Journal of Nursing Administration Assignment

Do not indicate that you are writing to complete a school assignment. Present a perspective that is different and contributes to the literature. Provide supporting documentation from the literature for your rationale and/or perspective. Identify why your response is important to nursing leadership or leadership in health care Offer a suggestion(s) for further action. Demonstrate critical thinking skills. Demonstrate effective writing principles (e.g., spelling, grammar, punctuation). Follow appropriate business letter standards (e.g., include the correct name, credentials, and email address of the editor; include your name, credentials, and email address.) Note: refer to the sample Letter to the Editor in Blackboard and sample letters in journals that publish excellent letters to the editor (e.g., Journal of Nursing Administration (JONA), American Journal of Nursing (AJN), Journal of Nursing Scholarship, New England Journal of Medicine (NEJM), and Journal of the American Medical Association (JAMA). Note: A title page is not required for the Letter to the Editor assignment. University of Texas at Arlington College of Nursing April 29, 2019 Page 2 of 2 …Journal of Nursing Administration Assignment