Journal of Perianesthesia Nursing最新文献

Purpose: The purpose of this study was to examine dimensions of the perioperative work environment and their associations with the operating room (OR) culture of safety and high-reliability characteristics.

Design: A predictive correlational design using a cross-sectional survey was used.

Methods: A convenience sample of perioperative nurses (N = 96) was used to evaluate strength of associations of their work environment with OR safety culture and high-reliability organizational culture. In addition, the best predictive models for OR culture of safety and high-reliability characteristics were used.

Findings: Findings indicated that the five dimensions of the work environment are significant predictors of a safety culture; however, only Collegial Relationships and Nursing Foundations for Quality of Care significantly predict high reliability.

Conclusions: Due to the extraordinary responsibility perioperative nurses hold to maintain safety standards for surgical patients, it is critical to fortify elements of the nurse work environment.

Purpose: Oral care (brushing teeth) may reduce the risk of hospital-acquired pneumonia. The number of patients completing oral care before elective cardiovascular surgery (CVS) was unknown at the study institution. The aims of this quality improvement project were to determine the baseline of oral care completion before elective CVS and increase the number of patients who self-reported oral care completions through an educational intervention.

Design: Quality improvement project.

Methods: A total of 170 patients were surveyed to obtain a baseline of self-reported oral care completion within 4 to 6 hours before CVS. Preoperatively, the intervention group received dental supplies and written and verbal education about the importance of oral care before CVS. Oral care self-reported completion was compared with those of the preintervention group.

Findings: Surveys were completed by 93 patients in the preintervention group and 77 in the intervention group. All 77 patients receiving the intervention completed oral care before elective CVS, 11% points higher than the 89% (83/93) at baseline.

Conclusions: Nurses increased patient self-reported oral care completion before CVS through a cost-effective intervention of providing dental supplies and written and verbal education.

Purpose: The purpose of this quality improvement (QI) project was to establish and evaluate a process to improve use of positive airway pressure (PAP) therapy on the day of surgery, postoperative day 0 (POD 0), for Veterans using home PAP therapy for obstructive sleep apnea (OSA) admitted to the hospital after surgery.

Design: QI project using a preimplementation and postimplementation design.

Methods: The QI project occurred from June 2023 through November 2023. Nurses added written and verbal preoperative patient education for Veterans with OSA to bring their home PAP equipment on the day of surgery, and a new dedicated continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) inpatient respiratory therapy consult was added in the electronic health record surgery admission order sets.

Findings: From June 2023 through August 2023, 42 Veterans met criteria in the preimplementation group, and from September 2023 through November 2023, 50 Veterans met criteria in the postimplementation group. After project initiation, 97.8% of eligible Veterans received preoperative education, and the number of Veterans bringing PAP equipment on the day of surgery increased from 9.5% to 62% (P < .001). Respiratory therapy consults for PAP set-up on POD 0 increased from 26.2% to 36.0% (P = .371), and 28% of Veterans in the post implementation group had CPAP or BiPAP inpatient respiratory therapy consults ordered on POD 0.

Conclusions: Preoperative nursing patient education resulted in a statistically significant increase in Veterans bringing home PAP equipment on the day of surgery, while adding a CPAP or BiPAP inpatient respiratory therapy consult to the electronic health record did not result in a statistically significant improvement in surgical residents ordering PAP therapy on POD 0. This QI project revealed how interventions that incur nominal cost and have minimal impact on preoperative nursing education workflow can yield statistically significant compliance. Additional research is needed to develop and implement a standardized protocol in all Veterans Affairs (VA) facilities to optimize postoperative care for Veterans diagnosed with OSA undergoing surgery.

Kidney transplantation stands as the favored approach to treat end-stage renal disease in children, offering enhanced survival, improved quality of life, and better neuropsychological development compared to dialysis. Transplanting kidneys en bloc remains a complex procedure, diverging from the conventional single kidney transplantation in several aspects, requiring precise skill and expertise to achieve favorable outcomes. In this paper, we report a successful en-bloc kidney transplantation from a 16-month-old pediatric cadaveric donor to a 5-year-old recipient, the youngest individual to undergo an en-bloc kidney transplant in the country, and the contribution of meticulous anesthetic management to this success story.

The decision to undergo surgery and the significance of the operating theater environment are influenced by several factors, which vary from person to person. Negative perceptions of the operating room environment can influence the decision to undergo surgery and the process of treatment. Virtual reality (VR) technology offers the potential to alter individuals' environmental encounters through the provision of diverse environmental perceptions. This case study evaluates the results of a VR simulation applied during surgery to an individual with no previous surgical experience. A male patient scheduled for arthroscopic meniscus surgery was the subject of a VR simulation. The patient's perception of the simulated environment was transmitted through VR goggles from the time he entered the operating room until he left. However, the VR application was terminated during the administration of anesthesia, and no premedication was administered to the patient. The VR application included nature walks in various regions, including forests, lakeshores, and meadows, accompanied by the sound of birds. Data were collected using a visual analog scale to assess pain levels and a walking test form. The patient, a 35-year-old male, is a high school graduate and is undergoing his first surgical procedure. The patient expressed concerns and fears regarding the decision to undergo surgery. The patient's preoperative anxiety was rated at 9 out of 10 but subsequently decreased to 1 out of 10 following the surgical procedure. The patient rated his satisfaction with the surgical experience as 9 out of 10. The patient did not require sedatives or analgesics during the intraoperative period or for the first 10 hours following the operation. The patient was successfully mobilized at the 15-hour mark following surgery. The patient was highly satisfied with the application. The utilization of VR during surgical procedures has the potential to reduce the necessity for premedication and enhance postoperative compliance among patients.

Purpose: Perioperative care requires health care professionals with more competencies and skills in clinical assessment, patient education, and advocacy to respond to current and future challenges in health care. Advanced practice nurses (APN) in Anesthesia may represent an approach to improve perioperative care. Specialization in anesthesia care already exists in many countries, but rarely on advanced practice level. An APN Anesthesia is an additional role with expanded skills and competencies and is not yet established in all countries. Therefore, defining the role of APN Anesthesia is necessary. To establish the role of APN Anesthesia effectively, the current evidence on the competencies and scope of practice (SOP) of established roles of APN Anesthesia was summarized.

Design: A scoping review according to the framework by Arksey and O'Malley and the JBI reviewer's manual.

Methods: We conducted a scoping review by searching the PubMed, PsycINFO, CINAHL, and Scopus databases. The literature search included papers from 2010 to 2023 dealing with the prerequisites and SOP of APN Anesthesia. Descriptions of APN Anesthesia from the United States of America, Asia, and Europe were assessed.

Findings: A total of 1,749 papers were identified of which 24 were included in this review. There is no uniform SOP for APN Anesthesia. The certified registered nurse anesthetist as an established Advanced Practice role in the United States of America, with a high degree of autonomy, is best described. Some APN Anesthesia focus on specific medical conditions such as dementia or autism. APN Anesthesia also works in postoperative care, outpatient clinics, pediatric day surgery, or palliative care settings. Practice development, clinical assessment, education, and family involvement encompass the expanded role of an APN Anesthesia compared with the specialist nurse in Anesthesia.

Conclusions: The APN Anesthesia is a complementary role in anesthesia because they possess both nursing expertise and advanced medical knowledge. APN Anesthesia provides preoperative assessments with patient and family education, intraoperative care for specific patient populations, and expanded duties in the postanesthesia care unit and palliative care.

Purpose: Patients experience pain after surgery, an expected symptom, and a common and important care problem. The purpose of the study was to determine the effect of patient education on pain level and fear of pain in orthopedic trauma patients.

Design: The study is a randomized controlled trial research design.

Methods: A total of 52 patients, 26 in the experimental group and 26 in the control group, were included in the study. The experimental group received patient education about the operative process and pain management the day before the operation and the morning of the surgery. The Information Form, Fear of Pain Scale-III, and Visual Analog Scale were used to gather data.

Findings: We found that the patients' pain levels were low. Patients had a fear of severe pain above the average level, fear of mild pain below the average level, and fear of medical pain at the time of hospitalization and discharge. The medical pain level of the patients in the experimental group at the time of discharge was lower than the fear of medical pain at the time of hospitalization.

Conclusions: Preoperative pain management education for orthopedic trauma patients is effective in reducing the fear of medical pain. We identified that pain management patient education to orthopedic trauma patients before surgery was effective in decreasing the fear of medical pain.

Trial registration: The study was registered with ClinicalTrials.gov. Identifier: NCT05887596.

Purpose: To explore the application effect of a comprehensive intervention program for postoperative delirium (POD) prevention.

Design: Descriptive and comparative study.

Methods: This study included 82 elderly patients who underwent cardiac surgery as the control group to receive routine perioperative care. Seventy seven elderly patients who underwent cardiac surgery were selected as the observation group and received a comprehensive intervention program for POD prevention. This study further compared the length of stay in the hospital, nutritional status, pain score, and sleep quality between the two groups after intervention.

Findings: The postoperative length of stay in the hospital of the observation group was shorter than that of the control group (12.60 ± 2.97 vs 17.30 ± 7.10), and the incidence of POD was lower than that of the latter group (24.68% vs 47.56%, X² = 8.976, P = .003). The pain scores of the observation group were lower than those of the control group (F = 195.381, P < .001). There was significant difference that the sleep quality score of the observation group was higher than that of the control group (F = 219.20, P < .001). The levels of albumin and hemoglobin in the observation group were higher than those in the control group (54.38 ± 5.87 vs 38.40 ± 3.11; 124.64 ± 13.18 vs 109.00 ± 10.20). The observation group had shorter mechanical ventilation duration, intensive care unit stay, and lower total hospital expenses compared with the control group (P < .05).

Conclusions: The comprehensive intervention program for POD prevention based on evidence-based medicine has a positive effect. In addition, it can also improve patients' pain, sleep quality, and nutritional status.