Journal of Perianesthesia Nursing最新文献

Purpose: This study evaluated the effect of the health care institution type on the postoperative pain management level of care in surgical patients.

Design: The study was designed as a prospective comparative survey.

Methods: This was a prospective comparative study and was conducted, in parallel, in a tertiary and a secondary center. A 1:1 propensity score matching algorithm was applied based on age, sex, body mass index, American Society of Anesthesiologists, anesthesia technique, analgesia modality, type of surgery, operative approach, and elective status. Multivariable analysis included the performance of ordinal regression. The Greek validated version of the Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire was used.

Findings: Overall, 256 patients were, initially, included in the study. After propensity score matching, 43 cases were retained in each arm. In the matched cohort, a significant difference between centers was noted in terms of pain management (22 vs 26, P < .001), support (5 vs 9, P < .001), and total (50 vs 55, P < .001) subscales. Besides the institutional level (P = .02), patient age (P = .005) and surgical approach (P = .039) were also predictors of total subscale Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire score.

Conclusions: Our study suggested that the institutional level, patient age, and surgical approach significantly impact the postoperative pain management level of care.

Purpose: To explore how educators in postgraduate nursing programs in anesthesia care, operating room care, and intensive care nursing-both in academic and clinical settings-experience teaching digital documentation in theory and practice.

Design: Qualitative descriptive study using thematic analysis by Braun and Clarke.

Methods: Individual interviews were conducted between April and August 2023 with 12 participants, including faculty members at the universities and clinical supervisors (10 women, 2 men). The participants were between 37 and 72 years of age (mean, 52 years) and had between 1 and 15 years (mean, 6 years) of work experience.

Findings: Two themes were identified: (1) "Faculty members' contradictory attitudes and opinions regarding the content, importance, and need for documentation in patients' electronic medical records in perioperative care" and (2) "The relationship between universities, healthcare providers, and individuals." Subthemes included the lack of consensus on teaching digital documentation, factors influencing successful teaching, prioritizing patient-oriented competencies and tasks, and viewing documentation as a potential obstacle to care.

Conclusions: The topic of documentation is often a low priority. Higher education and clinical practice lack a consensus on the purpose, content, and methods for teaching documentation. Thus, greater attention is needed to clarify the purpose of documentation, particularly digital documentation, and to define relevant teaching content. Digital competence can better prepare students for future work and reduce technostress. The goal should be to narrow the gap between "work as imagined" and "work as done."

Purpose: Frailty is a common and serious older adults syndrome in older adult patients with colorectal cancer and is frequently associated with adverse postoperative health outcomes. This study aimed to elucidate the predictive value of preoperative frailty on anesthesia recovery outcomes in this population.

Design: This is a prospective study.

Methods: This prospective study enrolled 125 older adult patients scheduled for curative colorectal cancer resection at the Affiliated Hospital of Zunyi Medical University (Guizhou, China) between December 2023 and October 2024. Participants were stratified using the Fried Frailty Phenotype scale into three distinct cohorts: nonfrail (n = 24), prefrail (n = 55), and frail (n = 46). Comprehensive data collection encompassed baseline characteristics, intraoperative parameters, and four key recovery milestones: spontaneous respiration resumption, consciousness recovery, extubation readiness, and time to full orientation. Statistical analysis incorporated both univariate comparisons and multivariate linear regression modeling.

Findings: At baseline, the nonfrail group was younger than the prefrail and frail groups. Multivariate regression showed that both age and frailty independently predicted prolonged recovery (P < .05), with frailty exerting a stronger effect (β = 0.367 to 0.474 vs β = 0.192 to 0.353). Notably, prefrailty was only associated with delayed return of spontaneous respiration (P < .05). Univariate analysis revealed significantly longer recovery times in frail patients across all metrics (P < .001). Compared to frail patients, prefrail patients had similar times for return of spontaneous respiration and recovery of consciousness (P = .790; P = .029), but shorter times for extubation and orientation recovery (P < .017). Likewise, nonfrail patients showed overall faster recovery than frail patients (P < .001).

Conclusions: Frailty independently predicts prolonged anesthesia recovery in older adult colorectal cancer patients. The differential impact of frailty severity on anesthesia recovery times highlights the necessity of tailored perianesthetic strategies based on frailty stratification to improve recovery trajectories among high-risk older adult patients.