Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study

Aim : To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory.

Background : Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist present means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances where nurse-administered procedural sedation and analgesia is used in the cardiac catheterization laboratory.

Methods : A sequential mixed methods design was used. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised according to responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterization laboratory nurses. All but one of the draft recommendations met the predetermined cut-off point for inclusion with 59 responses to the second round. Consensus was reached on all recommendations.

Implications for nursing : The guidelines that were derived from the Delphi study offer 24 recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Postprocedural patient assessment and monitoring.

Conclusion : These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterization laboratory setting.

Performance analysis and prediction in triathlon

Performance in triathlon is dependent upon factors that include somatotype, physiological capacity, technical proficiency and race strategy. Given the multidisciplinary nature of triathlon and the interaction between each of the three race components, the identification of target split times that can be used to inform the design of training plans and race pacing strategies is a complex task. The present study uses machine learning techniques to analyse a large database of performances in Olympic distance triathlons (2008–2012). The analysis reveals patterns of performance in five components of triathlon (three race “legs” and two transitions) and the complex relationships between performance in each component and overall performance in a race. The results provide three perspectives on the relationship between performance in each component of triathlon and the final placing in a race. These perspectives allow the identification of target split times that are required to achieve a certain final place in a race and the opportunity to make evidence-based decisions about race tactics in order to optimise performance.

Associations between firefighters' physical activity across multiple shifts of wildfire suppression

The aim of this study was to examine the associations between firefighters' physical activity levels across consecutive shifts during a multi-day emergency wildfire and to determine whether sleep duration moderated these associations. Forty volunteer firefighters (31 males, 9 females) wore an activity monitor to concurrently measure physical activity and sleep duration. Sedentary time and time spent in light- (LPA), moderate- (MPA), and vigorous-intensity physical activity (VPA) during each shift were determined using monitor-specific cut points. During any given shift, every additional 60 min spent in LPA was associated with 7.2 min more LPA and 27.6 min MPA the following shift. There were no other significant positive or negative associations. No significant moderating effect of total sleep time was observed. Firefighters are able to maintain and/or increase their physical activity intensity between consecutive shifts. Further research is needed to understand firefighters pacing and energy conservation strategies during emergency wildfire deployments. Practitioner Summary To examine associations between firefighters' physical activity levels across consecutive shifts during a multi-day emergency wildfire and determine whether sleep duration moderated these associations. Firefighters are able to maintain and/or increase their physical activity intensity between consecutive shifts. No significant moderating effect of total sleep time was observed.