Journal of Perianesthesia Nursing最新文献

Purpose: The current study aimed to investigate the long-term preventive and therapeutic effects of health belief model nursing intervention on patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) after surgery.

Design: This was a prospective randomized controlled trial.

Methods: A total of 120 individuals with moderate to severe OSAHS postsurgery were recruited from the inpatient department of the author's hospital from March 2020 to December 2022. All participants underwent surgical treatment and were assigned to either the control group (n = 60) or the observation group (n = 60) based on postoperative care methods. The control group received routine care, while the observation group received a health belief model nursing intervention. Informed consent was obtained from all participants at the beginning of the study, and the baseline data were collected. Polysomnography was employed to assess sleep disturbances following postoperative care intervention. The Pittsburgh Sleep Quality Index scale was utilized to evaluate sleep quality. A questionnaire survey was conducted to compare postoperative self-management abilities. Quality of life was assessed through questionnaires, and the 1-year recurrence rate of OSAHS was calculated. Patient satisfaction with postoperative care was also compared.

Findings: The average age of patients was 53.34 ± 5.27 years. No significant differences were found in baseline data between the two groups (P > .05). The observation group exhibited lower apnea-hypopnea index and average oxygen desaturation index compared to the control group (P < .05). The average Pittsburgh Sleep Quality Index score in the observation group was lower than the control group (P < .05). Scores for knowledge understanding, daily life, and coping strategies were higher in the observation group than the control group (P < .05). Additionally, the observation group demonstrated higher scores for sleep quality, daily function, mental state, and overall satisfaction compared to the control group (P < .05). At 12 months postsurgery, the recurrence rate of OSAHS in the observation group was lower than the control group (P < .05). Moreover, the observation group exhibited higher rates of very satisfaction and overall satisfaction (P < .05), and lower rates of general satisfaction and dissatisfaction compared to the control group (P < .05).

Conclusions: Health belief model nursing intervention yields significant and enduring preventive and therapeutic benefits for patients with moderate to severe OSAHS after surgery. The intervention, by improving respiratory function, sleep quality, self-management abilities, and overall quality of life, effectively reduces the recurrence rate of OSAHS and enhances patient satisfaction with care.

Purpose: The effect of virtual tour as a method of health education to alleviate preoperative anxiety remains controversial. This study aimed to evaluate the effect of Virtual Interactive Video-based Information Support (VIVBIS), which integrates virtual reality technology with information needs-oriented education, on reducing preoperative anxiety in patients undergoing day case hysteroscopy under general anesthesia.

Design: Single-center, prospective, randomized, controlled clinical trial.

Methods: From May to December 2023, a three-arm parallel randomized controlled trial design was conducted. Patients were randomly assigned to one of three groups: VIVBIS (Group A), 2D videos (Group B), and conventional education (Group C) when receiving preoperative education. The primary outcome is the Amsterdam Preoperative Anxiety and Information Scale (APAIS) after the patient entered the operating room before general anesthesia induction. The secondary outcomes are systolic blood pressure, diastolic blood pressure, and pulse rate of patients before general anesthesia induction.

Findings: Ultimately, 233 patients were analyzed. The difference of preoperative anxiety levels (APAIS-A) was not statistically significant between Group A and Group B and Group C (7.99 ± 3.11 vs 9.18 ± 3.83 vs 8.90 ± 3.48, P > .05). The changes in anxiety scores before and after the intervention (∆ APAIS-A) were 0.24 ± 2.97 vs -0.28 ± 3.12 vs -0.16 ± 2.49, P greater than .05. While the impact of VIVBIS on preoperative information desire level (APAIS-I) showed superior to other two groups (Group A vs Group B vs Group C: 4.32 ± 1.95 vs 5.43 ± 2.18 vs 5.23 ± 2.12, P < .01). The changes in information desire before and after the intervention (∆ APAIS-I) were 1.49 ± 2.08 versus 0.67 ± 2.03 versus 0.90 ± 2.19, P < .05. For secondary outcomes, the systolic blood pressure values in the three groups were 122.30 ± 14.70, 120.24 ± 13.82, and 120.90 ± 11.73 mm Hg, respectively (P > .05). Diastolic blood pressure values were 77.86 ± 10.98, 74.39 ± 9.50, and 75.87 ± 8.98 mm Hg, respectively (P > .05). Pulse rates were 72.29 ± 11.80, 70.67 ± 11.34, and 74.27 ± 11.78 bpm, respectively (P > .05).

Conclusions: VIVBIS had a similar effect as 2D video and printed materials in reducing preoperative anxiety in patients undergoing day case hysteroscopy. VIVBIS effectively met the preoperative information needs of patients undergoing day case hysteroscopy.

Purpose: In this study, we investigated the effects of a single preoperative ultrasound-guided thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) on the respiratory function, and the quality of recovery in patients undergoing thoracoscopic lobectomy.

Design: A prospective, randomized, double-blind study.

Methods: Ninety patients undergoing elective thoracoscopic lobectomy under general anesthesia were randomly allocated into the control (the C group), TPVB (the T group), and ESPB (the E group) groups. The primary observation indicators were postoperative pulmonary function. Secondary observation indicators included the quality of recovery-15 scale score, postoperative visual analog scale (VAS) score, postoperative sufentanil dosage, and postoperative adverse reactions.

Findings: Compared with those in the C group, patients in the T and E groups had higher forced expiratory volume in 1 second/forced vital capacity, forced expiratory flow between 25% and 75% of vital capacity, and arterial partial pressure of oxygen at 24 and 48 hours postoperatively, and quality of recovery-15 scale scores at 12, 24, and 48 hours postoperatively (P < .05), as well as lower perioperative sufentanil dosage and VAS scores at 1, 6, and 12 hours postoperatively (P < .05). In addition, there was no statistically significant difference in VAS scores at 24 and 48 hours postoperatively among the three groups (P > .05).

Conclusions: These results indicated that preoperative ultrasound-guided single TPVB and ESPB could all effectively protect respiratory function, enhance analgesic effect, improve quality of recovery, and promote the rapid recovery in patients undergoing thoracoscopic lobectomy.

Purpose: Optimizing communication during patient handoff is essential to reduce errors and provide quality patient care. The purpose of this quality improvement project was to standardize handoffs between the operating room (OR) and the postanesthesia care unit (PACU) based on a revised White's Fast Track Score (WFTS) handoff tool.

Design: This project design included second and third plan-do-study-act (PDSA) cycles on improving the WFTS tool and its use. The first cycle modified the WFTS, the second cycle measured sustainability, and the third cycle introduced further revisions to the tool. Based on feedback, the tool was reinforced with a memory aid, keyword prompts, and training. Functionality and OR and PACU nursing satisfaction with revisions were then assessed.

Methods: Fidelity to the handoff process was observed in PDSA 2. Revisions to the WFTS were then made, with training sessions conducted for OR and PACU nurses, followed by the implementation of the revised handoff tool in PDSA 3. Satisfaction surveys were administered.

Findings: Compliance with the WFTS handoff elements significantly improved in PDSA Cycle 3 (M = 85%, standard deviation [SD] = 20%) compared to PDSA Cycle 2 (M = 48%, SD = 8%), U = 55.00, Z = -4.83, P less than .001. Specific elements such as anesthesia details, level of consciousness, hemodynamic stability, and respiratory stability, which were previously reported infrequently, showed notable increases in documentation. Staff satisfaction among OR nurses remained neutral, with median scores of 2 across all survey items. However, PACU nurses' satisfaction was more positive, indicating an improvement in the perceived quality of information transfer. Qualitative feedback highlighted ongoing challenges, including redundant information and workflow inefficiencies.

Conclusions: The revised handoff tool implemented in PDSA 3 significantly improved compliance with essential communication elements but introduced perceived workflow inefficiencies and redundancy. To enhance adoption and usability, it is recommended to differentiate required elements based on case complexity, reduce redundant reporting, address workflow barriers, and increase frontline nursing engagement in the revision process. Balancing standardization with efficiency is crucial for optimizing postoperative handoff communication.

Purpose: To explore the application effect of the IDEAS model combined with supportive psychotherapy in da Vinci robot-assisted preoperative visits for radical cancer surgery.

Design: Randomized controlled clinical trial.

Methods: Seventy patients who underwent robotic radical cancer surgery between May 2024 and May 2025 were selected as the study subjects and were randomly divided into 35 cases each in the experimental group and the control group. The control group conducted routine preoperative visits, and the experimental group implemented the IDEAS model combined with supportive psychotherapy on the basis of routine visits. The anxiety and depression scores, quality of life, and physiological stress indicators of the two groups were compared before and after the intervention.

Findings: After the intervention, the anxiety and depression scores of the experimental group were significantly lower than those before the intervention, and the scores of the experimental group were lower than those of the control group (P < .001); the quality of life was higher than that of the control group (P < .05), and the physiological indicators of the experimental group were more stable than those of the control group (P < .001).

Conclusions: IDEAS model combined with supportive psychotherapy can not only reduce the preoperative physiological stress, anxiety, and depression level of patients undergoing da Vinci robot-assisted radical cancer surgery, but also improve the patients' quality of life.

Purpose: Bariatric surgery is an effective treatment for obesity, but postoperative nausea and vomiting (PONV) and pain remain significant challenges despite advances in anesthesia. This study aimed to compare total intravenous anesthesia (TIVA) with volatile anesthesia regarding PONV and pain outcomes from a patient-reported perspective in bariatric surgery.

Design: A randomized controlled trial comparing the effects of TIVA and volatile anesthesia on PONV and pain in bariatric surgery.

Methods: A total of 233 bariatric patients were randomized to receive either TIVA or volatile anesthesia. Patient-reported outcomes for PONV and pain were assessed using a numeric rating scale. Additional data on medication use and time to discharge were collected. Thirty-four patients were lost to follow-up, resulting in a final analysis based on data from 199 patients.

Findings: Patients receiving TIVA experienced significantly lower PONV in the postanesthesia care unit (P ≤ .001) but required significantly higher opioid doses (P = .013) and had longer postanesthesia care unit stays (P = .017) compared to those receiving volatile anesthesia. No significant differences in pain scores were observed between the groups, and no differences were found in postoperative ward outcomes.

Conclusions: TIVA reduces early PONV but increases opioid requirements compared to volatile anesthesia in bariatric surgery. These findings underscore the importance of tailored anesthetic protocols that balance early recovery benefits with opioid-related risks.

Purpose: This quality improvement (QI) project aimed to examine the influence of a fall risk protocol implementation in an Ambulatory Surgery Center (ASC) on staff nurses' compliance with fall prevention practices and knowledge of falls.

Design: This QI project implemented a pretest and post-test design. The Johns Hopkins Evidence-based Practice model guided this project.

Methods: This QI project implemented a fall risk protocol in an ASC in Northern California. The protocol included screening for fall risk based on the Morse Fall Scale and measured use of fall prevention practices on a 5-point frequency Likert scale. The project was introduced to all staff at the ASC in an in-person staff meeting. The nurses who worked in both the preoperative and postoperative units were invited to attend an educational session that included a PowerPoint presentation. To examine the protocol, 21 nurses participated in the presurvey and 22 nurses participated in the postsurvey (N = 43). The survey included the Agency for Healthcare Research and Quality's fall knowledge test and fall prevention practices.

Findings: The compliance with fall prevention practices showed statistically significant improvement after intervention (P < .001). Postsurvey participants had higher practice scores (95.73/105) compared to the presurvey (81.24/105). RN compliance with the fall risk protocol screening revealed strong consistency, where RNs screened 97% of patients compared to a baseline of zero screening before the protocol. Approximately 25% of patients scored high-risk every week, and 97.75% of these patients received targeted interventions. However, there were minimal changes observed in fall knowledge scores.

Conclusions: The results demonstrated a high rate of staff nurse compliance with screening and implementation of fall prevention practices as part of the fall risk protocol. Nurses' knowledge about falls slightly improved but did not meet statistical significance. An increase in fall prevention practices demonstrated that the protocol closed the gap between knowledge and practice, helping the nurses identify and communicate patient fall risk status using evidence-based strategies.

Purpose: The purpose of this quality improvement project was to implement a prewarming protocol to reduce rates of inadvertent perioperative hypothermia (IPH).

Design: Quality improvement project using the Johns Hopkins Model for Evidence-Based Practice as a framework.

Methods: An interdisciplinary team implemented an evidence-based prewarming protocol using forced-air warmers to reduce rates of IPH. We collected preintervention data for 30 days before implementation and 30 days during implementation. Anesthesia technicians prewarmed patients for a target time of 30 minutes before surgery. We measured protocol adherence, temperature trends, and unintended costs or delays due to prewarming. Data were analyzed using descriptive statistics, the independent t test, χ², and Pearson correlation.

Findings: A total of 63 patients were observed during the preintervention and intervention phases of the project over 2 months. Prewarming was associated with a 42.8% drop in IPH. Prewarmed patients experienced significantly less IPH and were warmer on arrival to the postanesthesia care unit than non-prewarmed patients. Prewarmed patients who experienced IPH recovered to normothermia significantly faster than non-prewarmed patients.

Conclusions: Prewarming is an evidence-based intervention associated with a reduction in the incidence of IPH across the perioperative care continuum. Implementing prewarming as a part of preoperative care can be done successfully as a quality improvement project with the aid of an evidence-based practice model.

Purpose: To systematically review nonpharmacological interventions to prevent postoperative delirium and agitation among children.

Design: A systematic review.

Methods: Our systematic review used specific criteria to identify randomized controlled trials and quasi-experimental research focused on postoperative delirium and agitation among children. From the period 2000 to January 25, 2025, six databases, namely Web of Science, Scopus, PubMed, EMBASE, Cochrane, and Google Scholar, were searched through search strategy and the use of Boolean operators.

Findings: We screened 1,300 titles and abstracts, which resulted in the review of 21 full texts, and inclusion of 10 studies in the final analysis. Several nonpharmacological interventions, such as lollipop sucking, maternal voice recordings, eye-covering techniques, and bispectral index-guided anesthesia, significantly reduce postoperative delirium in children. However, methods like tablet use and virtual reality exposure have not shown significant benefits (P > .05). More research is necessary to confirm whether acupuncture electrical stimulation of the heart 7 acupuncture point can effectively prevent emergence delirium in children.

Conclusions: Based on these findings, nonpharmacological interventions like lollipop sucking, maternal voice, bispectral index-guided anesthesia, and eye covering may effectively reduce postoperative delirium in children, while others like tablets and virtual reality need further study. More research is necessary to confirm whether acupuncture and other interventions can effectively prevent emergence delirium in children.