Nobody is more aware of the problem of postoperative nausea and vomiting (PONV) than members of BARNA. It is very distressing both for patients and carers and you are dealing with it every day. So, what can you do about it ?

Iam fortunate, if that is the correct word, to have several responsibilities other than those of my day job. One of these is Chairman of the Scientific Programme Committee of the Pain Society. Indeed, as I sit writing this missive with one hand, the other hand is busy packing my bags for this year's annual 4–day meeting in York. The General Synod of the Church of England hold their meeting on the University of York campus every year, so it will be no surprise for those of you who know any members of the Pain Society that it is perfect for their needs.

This phrase although a political statement provides a startling insight into the cultural values of death and dyeing in the modern world. Turner (1996) highlights that since mediaeval times there has been a gradual rationalisation of death and its consequences in contemporary society. Turner remarks that we have moved from one system of public ritual and ceremony characterised by religious funeral rights to new rituals, those of a supposed technologically advanced modern society.

In many ways anaesthesia has become a victim of its own success. In the eyes of many, both clinicians and patients alike, anaesthesia has become safe and predictable. The demands placed upon anaesthesia services in the hospitals is increasing. Anaesthesia provision has diversified into many fields, and the input of the anaesthesia team is noticeable in many areas of the hospital including A&E, wards, radiology and Coronary care units.

In view of recent events regarding paediatric cardiac surgery in Bristol, the medical and nursing profession have been encouraged to embrace clinical governance. Clinical governance ranges from departmental to hospital level and encourages all hospital staff to examine clinical practice by setting standards and measuring up to those standards. Clinical audit can help to achieve this aim

Jane Bovey has long been a member of BARNA, and has recently left her job in the private sector as a recovery nurse to work with an agency. Jane decided to write a column in the journal to express concerns felt by many nurses working in anaesthetics and recovery. Jane also wanted to promote debate on some contentious issues, and welcomes replies to her column. If you have a reply, send to E Mail: [email protected] or BJARN, 6 Bromyard Avenue, Walmley, Sutton Coldfield, B76 IRQ. The views expressed in this column are entirely of the author, and do not necessarily reflect those held by the British Anaesthetic & Recovery Nurses Association.

In a recent publication by the National Association of Theatre Nurses (NATN); their Chairman Vincent (1996, p.3) suggested “Support workers, when appropriately trained, provide tremendous support to operating department professionals, assisting with the provision of a good, cost effective service, cooperating to develop new ways of working in this rapidly changing environment to respond to the needs of the patient and the service.”

When high dependency and intensive care units are full, which occurs more and more often nationally, recovery wards are being utilised to hold critically ill patients. Recovery practitioners are often expected to assist in the care of these patients.

A small study established the views of a sample of recovery practitioners regarding the recovery unit being used as stop-gap, or ICU overflow. There were positive and negative opinions from recovery practitioners who were involved in the care of these critically ill patients. Recovery practitioners often reported feeling inexperienced and ill equipped, with increased levels of stress when working in the ICU bay. Only 20% of recovery practitioners in the study, expressed optimism about working in the ICU bay, and 60% identified that training and development was a strategy which may help to overcome some of their perceived problems.

This paper reports these concerns and identifies strategies which have been implemented to address some of these concerns.

Nursing and the role of the nurse have always been difficult to define (Nightingale 1986). This is especially true in operating theatres where task focused care often takes precedence over holistic patient care (Conway 1995). There is no shortage of literature suggesting that theatre nurses are preoccupied in preparation of instrumentation (Conway 1995, Holmes 1994) and if a non-nurse were to observe staff in some operating theatres it may be difficult to see where the nursing exists.

At departmental meetings, it has long been commonplace for staff to play ‘Lingo Bingo’. The rules of the game are simple; one can play alone, but it is much more fun in a team. First select one word from an apparently endless list of irritating and pompous terminology and then agree a number between 5 and 10. Then sit through the meeting, counting how many times people at the gathering use the selected term. When they reach the number selected, shout Bingo! And wait for the reaction. It seems to me that NHS managers, educational institutions and of course, health ministers are all playing the game.

The workload of the recovery unit can be considerably increased by patients suffering post operative nausea and vomiting (PONV). The unit can often become blocked by patients too sick to discharge back to the main ward. Via a review of the literature and a small research study in the authors own recovery ward, it was concluded that PONV causes patients to stay in recovery longer. In fact the study reveals of those patients who did not receive an antiemetic perioperatively, 31% suffered PONV and those who had PONV spent 29 minutes longer in recovery.

Despite ondansatron being one of the most expensive drugs, it was only successful in 81% of cases. However those people who did receive ondansatron, spent an average of 8 minutes less time in recovery, compared with those who were not given it. These findings potentially have considerable cost implications, relevant in todays current climate of economy saving strategies. These findings and their implications are discussed.

In this care study I will explain the care that SVB received following his admission to the Post Anaesthetic Care unit (PACU) and summarise his discharge to the Intensive Care Unit (ICU). The limitations that this case report presents are that often the care received in the PACU can be quite short in terms of total length of stay in hospital. It is not uncommon that High Dependency patients are received for initial care into the PACU following surgery and to be further discharged and nursed in either a dedicated High Dependency Unit or to the Intensive Care Unit.

It has been a feature of the journal to identify current topics of interest for anaesthetic and recovery nurses from leading periodicals. The explosion of the Internet and the impact this will have for learning in the nursing world has far reaching implications. Added to the usual digest from current journals we will review websites of interest, and pricee their contents. With many of you now on the Internet and using this for research or interest, you will have been surprised at the amount of information there is for the speciality.