IARNA Conference 2014, Dublin, Ireland

Posted on 1 December 2014 by Manda Dunne

It was a lovely sunny day at the beginning of October when Markku and I set off to the IARNA (Irish Anaesthetic and Recovery Nurses Association Conference), in Dublin, Ireland. Everything was going to plan until Ryan Air was unexpectedly delayed due to fog at the other end! That was very evident when we landed on a non-visible runway (an experience not to be repeated!) and to a lot of rain. We boarded the airport bus which was to connect us with our train at Heuston station. We weren’t really sure where we were heading but knew we had to get there!

Eventually, we arrived at a delightful spot, The Heritage Resort, Killenard, Co Laois. We appeared to be basically in the middle of nowhere, but beautiful just the same even though it was a tad wet. Well, if golf is your thing this had to be the most stunning resort I have ever seen. The scenery was magnificent, the air fresh and golfers a plenty!

Having met up with our colleagues from IARNA we had a very good evening with much conversation, catching up and expectations of the next day.

It is always a privilege to be invited as a guest to a conference and I have to say how wonderful it was to be back in Ireland. We received such a warm welcome and were made to feel so very much part of the anaesthetic and recovery family which our organisations have the fortune to share.

The conference was very well attended which was fantastic to see. An amazing amount of organisation goes into planning and running a National Conference and much of the stress is caused by the worry of attendance. There is no-one to bail you out if the attendance is low so I was so happy for Ann Hogan, chair of IARNA when more delegates than anticipated turned up on the day. The hotel coped so well with the increased numbers and the day was a huge success. There was the most exciting buzz and enthusiasm which filled the exhibition area during our registration coffee. The companies were very supportive and keen to demonstrate their wares and had devised some interesting methods to engage the delegates! One of these was in the form of a bingo card, collecting stickers to indicate that you had spoken to them. A full house went into a draw for a prize at the end of the day. This in itself was a hugely compelling exercise!

The day started with an excellent Keynote address, given by Professor Anne Scott, Dean, Faculty of Education, John Moore’s University Liverpool, and she spoke about the Importance of Nursing to the Irish Health Service. The talk focused very much on care and quality and explored humanising safety, care and experience for patients and families.The question was asked as to what was so important in nursing, and how the United States of America have invested heavily in nursing, particularly in nurse to patient ratios.The research demonstrated that there is a definite link to understaffing and higher surgical mortalities, particularly where there is a lower level of graduate nurses. This sees poorer patient outcomes as does a poor working environment, leading to a worse patient outcome and a lower level of quality care.It is not a surprise then to hear that investment in improving the hospital environment increases patient outcomes, as has been shown in the Magnet Hospitals in the USA. Aiken et al RN4 CAST Nurse forecasting in Europe 2009 – 2011 shows that better education lowers mortality at the 30 day post discharge. This doesn’t seem like rocket science so I wonder why we are not insisting on a higher educated workforce and an increase in numbers of trained nurses to tackle the failings and shortfalls in our Health Service.

Aileen O’Brien is the lead nurse for the National Clinical Programme in Anaesthesia (NCPA) and has twenty years experience as a grade 2 clinical nurse manager in anaesthesia. She was talking about identifying the level of competencies and education within peri- operative and peri- anaesthesia nursing, and the level of competence in anaesthetic and recovery nurses, and was delivering NCPA survey results. 46 HSE hospitals were surveyed and the response to the survey was outstanding with 100% return of survey documents. The results were collated and a gap analysis conducted. The results will be instrumental for making recommendations in relation to education and training nationally.It was established however that there is enormous variability in the education and training of anaesthetic nurses/midwives due to the absence of a national education and core competency programme. A working and steering group has been established to look at this training but the crux is that it must be affordable, achievable and accessible.The take away message from this session came from patients: ‘They may forget your name but they will never forget how you made them feel’.

Jane Jackson came from the UK to talk about the day in the life of Clinical Nurse Specialist in pre-operative assessment, where she shared a snapshot view of the expectations of her day. The emphasis was very much on the need for the appropriate training being delivered with the ability for the nurse to be flexible, adaptable, versatile and independent and to expect the unexpected! Accurate record keeping and documentation is paramount, which we are all very aware of in our nursing roles. Importance is given high priority where investigations are concerned. It was possible to feel Jane’s passion for her speciality and you could sense her drive for thoroughness and ensuring an excellent patient experience. I very much enjoyed listening to her and hearing how competently she gave you a peek into her everyday work in an extended inter-professional team.

I have heard about the dangers of waste anaesthetic gas in the UK and in fact have trailed the ISO Guard mask where I work, but there is nothing so powerful as watching the video which can show you what you are exposed to. Dr. John Moenning (who has an uncanny resemblance to the actor Steve Martin) and is a maxillofacial surgeon from Indiana USA, gave a very interesting talk and described how he came to invent said mask. Hospital operating rooms and dental treatment rooms have developed scavenging systems to collect waste anaesthetic gas (WAG) to decrease occupational exposure and minimize health problems, but few studies have addressed the issue in the PACU. Have you ever thought how tired you feel after a day in the PACU? This may be because of the expired waste anaesthetic gas you are breathing in. As an older anaesthetic nurse, I remember the ‘good old days’ of Halothane and nitrous oxide – you felt tired then, and no wonder, hovering over your patient supporting their jaw for what sometimes felt like forever, and all the time, breathing in their WAG! The film shows one of Dr. Moenning’s patients before and after surgery using a very unique technique. Infra red videos using a flir camera accompanied by the Miran sapphire ambient analyser enabled you to actually see the gases. This was the most powerful visual tool and really demonstrated how much waste anaesthetic gas you are exposed too. I wondered what kind of impact this would have had if it had been available 25 years or so ago when I recall, after a holiday saying, you will get used to the gases again after a few days! Imagine if we had this technology then!

John Sweeny and Lynne Marsh gave a joint presentation on caring for the intellectually disabled patient in the peri-anaesthetic domain. People with intellectual disabilities are two and a half times more likely to develop health problems in comparison to their peers in the general population. Due to their increased health needs they are in greater need of more nursing/medical/surgical interventions. This presentation focused very much on the safety aspect for the patients and the need for the experience to be a good one for everyone involved, ensuring that support for these patients in a general hospital setting was positive.

No one ever wants to be in a situation where they cannot intubate or ventilate a patient especially as the consequences can be quite horrendous. It is always a stark reminder of the need for teamwork and to listen to each other in an emergency situation, no more so than hearing the ‘can’t intubate can’t ventilate’ scenario (CICV) recounted during this session. Even with all the expensive and varied equipment we have nowadays this can still be a life changing issue for the patient, their families and the health care professionals involved in their care. We all know that the key to success in managing this scenario is focusing on maintaining oxygenation, use of the DAS guidelines (Difficult Airway Society - UK), teamwork coupled with maintaining skills and knowledge in the use of rescue equipment. The DAS CICV algorithm should be available in every anaesthetic room and recovery area. Sometimes it is not always the obvious person who can see a solution which is why the emphasis is so much on the teamwork factor. Everyone has a part to play.

I really enjoyed the session on pain which was very interesting. I liked the innovative way it was presented, talking about the jigsaw of pain, which really did show you how everything could fit together. Joanne discussed managing patient’s pain in the PACU (post anaesthetic care unit) and the multiple challenges faced everyday by the nursing staff. She explored what options are available and indeed, how to put it all together!

All too soon the day was drawing to a close, and what better way for this to be done by the Immediate Past President of ASPAN (American Society of Perianaesthesia Nurses), Twilla Shrout. She had travelled a long way to deliver her close but it just goes to show how tight the perianaesthesia environment can be and how supportive we are of each other.

It is always so good to share our own experiences and really to discover, that no matter where you are in the world, we all share the same problems and issues, but we all to share the same passion for our patients and our speciality.

It just remains for me to thank everyone involved for organising such a wonderful day!

Manda Dunne Winter 2014

Barna. British Anaesthetic and Recovery Nurses Association