This consensus statement presents a comprehensive and evidence-based set of guidelines for the care of postoperative nausea and vomiting (PONV) in both adult and pediatric populations. The guidelines are established by an international panel of experts under the auspices of the American Society of Enhanced Recovery and Society for Ambulatory Anesthesia based on a comprehensive search and review of literature up to September 2019. The guidelines provide recommendation on identifying high-risk patients, managing baseline PONV risks, choices for prophylaxis, and rescue treatment of PONV as well as recommendations for the institutional implementation of a PONV protocol. In addition, the current guidelines focus on the evidence for newer drugs (eg, second-generation 5-hydroxytryptamine 3 [5-HT3] receptor antagonists, neurokinin 1 (NK1) receptor antagonists, and dopamine antagonists), discussion regarding the use of general multimodal PONV prophylaxis, and PONV management as part of enhanced recovery pathways. This set of guidelines have been endorsed by 23 professional societies and organizations from different disciplines (Appendix 1).Guidelines currently available include the 3 iterations of the consensus guideline we previously published, which was last updated 6 years ago; a guideline published by American Society of Health System Pharmacists in 1999; a brief discussion on PONV management as part of a comprehensive postoperative care guidelines; focused guidelines published by the Society of Obstetricians and Gynecologists of Canada, the Association of Paediatric Anaesthetists of Great Britain & Ireland and the Association of Perianesthesia Nursing; and several guidelines published in other languages.The current guideline was developed to provide perioperative practitioners with a comprehensive and up-to-date, evidence-based guidance on the risk stratification, prevention, and treatment of PONV in both adults and children. The guideline also provides guidance on the management of PONV within enhanced recovery pathways.The previous consensus guideline was published 6 years ago with a literature search updated to October 2011. Several guidelines, which have been published since, are either limited to a specific populations or do not address all aspects of PONV management. The current guideline was developed based on a systematic review of the literature published up through September 2019. This includes recent studies of newer pharmacological agents such as the second-generation 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, a dopamine antagonist, neurokinin 1 (NK1) receptor antagonists as well as several novel combination therapies. In addition, it also contains an evidence-based discussion on the management of PONV in enhanced recovery pathways. We have also discussed the implementation of a general multimodal PONV prophylaxis in all at-risk surgical patients based on the consensus of the expert panel.

Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting.

Biofield therapies such as Healing Touch and Reiki increase relaxation, decrease anxiety and stress, and improve mood. Understanding the efficacy of these therapies in terms of mental health wellness is important for nurses interested in complementary and integrative care. The goal of the present integrative review was to investigate the state of knowledge regarding biofield therapies and the impact on anxiety, mood, and mental health wellness. Electronic databases were searched for articles available in English and published from 2014 to 2016. Biofield therapies show safety and promise in reducing anxiety, improving mood, and cultivating mental health and wellness.

Mental Health Wellness and Biofield Therapies: An Integrative Review

The complexity of pain requires nurses to conduct in-depth assessments, be knowledgeable about influential factors (ie, age, culture, health status), and treat pain with the least harmful and most beneficial interventions. The monotherapy use of analgesics, the fifth vital sign, and a 1-dimensional scale have fallen short of satisfactory results. Pain is the most frequent reason individuals seek health care and cost billions of dollars. Nurses are pivotal in the management of pain. Nurses who are knowledgeable about pain and pain management improve patient outcomes and patient satisfaction scores. Research results indicate the need to advance nurses' knowledge in pain management through various educational offerings.

Complexity of Pain, Nurses' Knowledge, and Treatment Options.

In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant. Previous articles in this column of Critical Care Nurse provided an overview of complementary health approaches that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses, as well as important legal, ethical, safety, quality, and financial implications that acute and critical care nurses should consider when integrating complementary health approaches with conventional care. This column provides the acute and critical care nurse with key information about validation of credentials, experience, and competence of nurses and volunteers providing complementary health approaches, as well as about institutional policies and scope of practice.

Complementary Health Practitioners in the Acute and Critical Care Setting: Nursing Considerations

The epistemological standpoint of this thesis is the theory of the lifeworld where the lived body is seen as a unity of body and soul. The overall aim of this thesis was to explore the experiences of caring touch interventions, such as tactile massage or healing touch, in an emergency care context, from the perspective of nurses and patients. The concept of ‘caring touch’ was used to capture the meaning, in order to explore the phenomenon of receiving and giving caring touch, and not the treatment per se. This thesis consists of four exploratory studies of which three are qualitative and one a mixed-methods study. The findings of study I indicate that tactile massage may help nurses and assistant nurses working in a short-term emergency ward to deal with a very stressful work environment and improve staff wellbeing. In study II, it is pointed out that admissions to short-term emergency ward for acute illness or disease is often associated with increased stress, anxiety and pain. Caring touch was offered to patients as a complement to usual nursing care. The patients’ lived experience indicated that caring touch resulted in an existential togetherness characterised by a non-verbal peacefulness, trust, consolation, safety, and a restoration of what it means to be a human being. Notably, some patients also expressed ambivalence toward caring touch. In study III, it is suggested that given the current high-tech healthcare system with overcrowded units and a shortage of nurses, including tactile massage as a caring tool may create a more holistic approach to caregiving, allowing nurses and assistant nurses to act with compassion for both the patient and themselves. In study IV, which is a longitudinal observational study, qualitative and quantitative perspectives are combined. Patients with minor or no physical injury after a motor vehicle accident were invited to an intervention with caring touch. Findings from individual interviews and questionnaires indicate that a caring touch intervention improve patients ́ wellbeing, and sense of security and pain ratings over a period of six months after the accident. This thesis draw the attention to the potential of caring touch interventions in an emergency context with the overall conclusion that introducing caring touch interventions of tactile massage and healing touch in the short-term emergency ward context seem to benefit patient’s integrity, wellbeing, and sense of security. The caring touch interventions give nurses a tool to increase their patients’ and their own wellbeing in a stressful environment in general. Patients sustaining a motor vehicle accident with minor or no physical injury in particular, highly appreciated a follow-up to the hospital after discharge by the invitation to a caring touch intervention and this was also associated with reduced pain ratings.

Nurses´ and patients´ experiences of caring touch interventions in an emergency context

This study examined the concomitant use of 2 complementary and alternative medicine modalities, Healing Harp and Healing Touch, to reduce pain, anxiety, and nausea in the postoperative patient population. The results demonstrate the effectiveness of using concomitant Healing Touch and Healing Harp to significantly reduce moderate to severe pain and anxiety in this patient population. Further research is warranted.

Impact of healing touch with healing harp on inpatient acute care pain: a retrospective analysis.

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Impact of healing touch with healing harp on inpatient acute care pain: a retrospective analysis.