Journal of Perianesthesia Nursing最新文献

Purpose: Postoperative delirium (POD) is a syndrome that often occurs after surgery. Nursing staff are the first-line personnel who have the most time and close contact with postoperative patients. If delirium is not recognized immediately, it will affect the patient's prognosis and increase clinical care requirements and health care costs. This study explores postanesthesia care unit (PACU) nursing staff's knowledge and ability to recognize POD in patients.

Design: A cross-sectional study was conducted with purposive sampling to recruit nurses from hospital PACUs in central and southern Taiwan. Data were collected from April to December 2019 using a questionnaire survey on knowledge of POD and videos to test delirium recognition abilities.

Methods: A total of 178 nurses from 9 hospitals met the inclusion criteria for participation; 2 participants were unable to attend because of taking leave, resulting in 176 valid questionnaires.

Findings: The percentage of correct answers for POD knowledge was 63.84%, and for recognizing POD was 59.1%, both at a moderate level. Nurses' advanced skills significantly influenced their POD knowledge and recognition abilities. There was a positive correlation between PACU nurses' POD knowledge and recognition abilities (r = 0.23, P < .01).

Conclusions: PACU nurses demonstrated a moderate level of knowledge and ability to recognize POD in patients. Those with higher-level nursing skills showed better POD knowledge and recognition abilities. Nurses with better POD knowledge exhibited higher recognition abilities.

Purpose: To construct a scientific cataract day surgery preoperative assessment program to provide a scientific assessment tool for health care providers.

Design: Literature review, two-round e-Delphi study, and quantitative studies.

Methods: With the recommended opinions of clinical practice guidelines for cataract surgery as the guiding framework, an item pool was formed on the basis of literature review and guideline content analysis, and the dimensions and items of evaluation program were determined by two rounds of correspondence consultation using Delphi expert method. Then, 315 patients from an ophthalmic hospital were selected for investigation to analyze its reliability and validity.

Findings: The positive coefficients for the 2 rounds of correspondence with experts were 100.00% and 95.83%, and the authority coefficients were 0.90 and 0.89. Kendall's coordination coefficient W values of 0.29 and 0.24 for the first and second rounds and the differences were statistically different (P < .05). The coefficient of variation was 0.14 and 0.10, respectively. The formal assessment items included 3 first-level indicators, 12 secondary-level indicators, and 48 tertiary indicators, with an overall Cronbach's coefficient of 0.66 and cumulative variance contributions of 69.19%, 65.84%, and 57.15% for the 3 first-level indicators.

Conclusion: The high reliability of the preoperative cataract day surgery program compiled by applying evidence-based analysis and the Delphi method can provide scientific guidance to clinical nurses for preoperative assessment, which in turn ensures patient safety and improves the quality of patient access services.

Purpose: This study was conducted to determine the relationship between preoperative fear and postoperative comfort in otolaryngology patients.

Design: This is a descriptive study.

Methods: The sample consisted of 282 patients undergoing otolaryngology surgery. Participants scheduled for surgery were administered the Patient Information Form and the Surgical Fear Scale in the preoperative period. In the postoperative period, the Perianesthesia Comfort Scale was administered after leaving the intensive care. Data were analyzed using t test, Mann-Whitney U test, and Kruskal-Wallis tests.

Findings: We found that if patients' preoperative fear was low, their postoperative comfort was high. A positive linear relationship was found between surgical fear and comfort (P < .05).

Conclusions: The study revealed a positive relationship between the postoperative comfort experienced by the patients and preoperative fear in that patients who had a low level of preoperative fear experienced less postoperative pain.

Purpose: To reduce opioid consumption and decrease length of stay (LOS) in bariatric surgical patients by implementing an evidence-based, nonpharmacologic enhanced recovery after surgery (ERAS) intervention bundle.

Design: Evidence-based practice project.

Methods: We developed and implemented a nonpharmacologic ERAS bundle from existing American Society of PeriAnesthesia Nurses Standards and bariatric and subspecialty surgical ERAS protocols to standardize the postoperative nursing care of bariatric patients. The bundle consisted of early ambulation, immediate initiation and prolonged use of oxygenation, prevention of nausea and vomiting, frequent use of incentive spirometry, and application of ice packs to surgical sites. The two project outcomes were opioid consumption and patient LOS. We used descriptive statistics to summarize opioid consumption and LOS among surgical bariatric patients at baseline and post intervention and independent samples t tests to determine the statistical significance of pre- or post-LOS changes.

Findings: After implementing the ERAS bundle in 31 bariatric surgical patients, we found that the percentage of patients given an opioid substantially decreased by 13.8%, with both fentanyl and hydromorphone (Dilaudid) consumption meaningfully decreasing by 11.0% and 25.6%, respectively. The average LOS significantly decreased (P = .015) by 23 minutes per patient following the intervention, from 1 hour and 58 minutes to 1 hour and 35 minutes, representing a 19.5% reduction in total patient time in the PACU.

Conclusions: Use of a nonpharmacologic ERAS bundle and standardizing postoperative care decreased overall PACU bariatric surgical patient opioid consumption and significantly reduced PACU LOS. Optimizing pain management for bariatric patients in the PACU could lead to improved pain control and reduced reliance on opioids during their entire hospital stay, enhancing health care outcomes and improving patient safety. Perioperative leaders and educators can use our example to develop initiatives that decrease opioid use and LOS to improve care for the high-acuity bariatric patient population.

Purpose: The aim of this study was to examine the studies on surgical smoke by bibliometric analysis and science mapping methods.

Design: Bibliometric analysis and science mapping methods study.

Methods: Data were obtained by searching the SCOPUS database. The keywords "surgical smoke," "operating room," "operating room staff," and "nurse" were used. Due to the ongoing scientific flow to the database, the search was performed on December 25, 2023 as a single day.

Findings: As a result of the research, a total of 51 studies were reached. We found 49 research articles and 2 review publications in the field of nursing and medicine. Most publications related to surgical smoke were published in 2021 (21.5% n: 11), and the journals with the highest number of publications were the Journal of Perioperative Nursing (5.9% n: 3) and AORN Journal (5.9% n: 3). The most common keyword in the studies was "surgical smoke." "Surgical smoke" was used in common with all other keywords, the most publications on the subject were made in the United States, the most publications were made in English (92% n: 47), and the most citations were made by Barrett and Garber in 2003 with 250 citations (25.4%).

Conclusions: This study provides a comprehensive overview of the current state of research on surgical smoke, highlighting its prevalence in recent literature. The findings underscore the need for continued investigation and awareness among health care professionals. The results obtained are important in terms of understanding the current situation in the relevant literature and will provide resources for new studies to be carried out by nursing and other surgical team members in the future.

Purpose: We aimed to ascertain if the Duke Activity Status Index (DASI) and its simplified variants predict 30-day mortality and myocardial injury after major non-cardiac surgery in at-risk patients.

Design: Retrospective cohort study.

Methods: We included 4,199 patients to validate the DASI and its variants in predicting the same composite outcome in patients with risk factors for coronary artery disease. Additional outcomes included 30-day severe complications, 1-year survival, and the effect of the Area Deprivation Index (ADI) on the DASI score and subsequent outcomes.

Findings: Patients were a median of 66 years old (interquartile range 57.0, 73.0), 47.9% were male, predominantly Caucasian (71.9%), with an American Society of Anesthesiologists score of 3 or greater (80.7%) and a median National ADI of 54.0 (interquartile range 33.0 to 74.0). The 30-day composite outcome was predicted by the original DASI (area under the curve [AUC] 0.82 [CI 0.73, 0.91], P < .001); modified 4-question DASI (AUC 0.82 [CI 0.73, 0.91], P < .048). The original DASI also predicted the 1-year composite outcome (hazard ratio 0.88 [CI 0.84, 0.93], P < .001), as did the modified 4-question DASI (hazard ratio 0.78 [CI 0.69, 0.89], P < .001), but not severe complications (P = .400 and P = .332 respectively). The ADI showed an inverse relationship with all versions of the DASI; there was a 0.8-point DASI decrease ([95% confidence interval -0.96 to -0.59], P < .001) for every 10-point increase in the National ADI.

Conclusions: The DASI is a reliable predictor of long-term postoperative outcomes.

Purpose: Depression is predicted to be the leading burden of disease worldwide by 2030 with a prevalence of 10% to 60% in the surgical population. Depressive symptoms in the perioperative population are associated with a myriad of grave complications, including higher morbidity and mortality. This systematic review aims to determine whether a single dose of intravenous ketamine can be used prophylactically as a routine resilience-enhancing agent in all high-risk adult patients undergoing surgery to mitigate depressive symptoms postoperatively by appraising evidence of existing literature.

Design: An evidence-based systematic review.

Methods: The databases PubMed, CINAHL, and Scopus were searched, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search and Medical Subject Headings (MeSH) terms used: "ketamine," "surgical procedures," "surgical," "surgery," "depression," and "depressive disorder."

Findings: In 9 randomized controlled trials (RCTs), bolus ketamine doses of 0.1 mg/kg to 1 mg/kg were administered intraoperatively or in the postanesthesia care unit. The primary outcome was the subjective feelings of depression as evaluated by different validated depression screening tools and seven RCTs observed statistically significant findings between the control and intervention (ketamine) groups with postoperative depression scores. Two RCTs did not find a significant change in depression scores.

Conclusions: Research on the use of prophylactic ketamine as an antidepressant in the perioperative population offers insight into changing routine practices and can shape how mental health is viewed in hospitals. Further research is warranted on the safety profile of ketamine, and risk stratification with careful consideration of baseline depressive symptoms, timing, and its use across a wider variety of surgical subspecialties.

Purpose: This study aimed to validate the structure and content of a preoperative nursing consultation model for elective general surgery patients.

Design: A Delphi study was conducted with experts to validate a five-dimension preoperative nursing consultation model.

Methods: A 2-round Delphi study was conducted in 2022 involved 20 experts. The experts were asked to complete an online 48-item questionnaire rated on a 5-point Likert scale, ranging from totally disagree to totally agree. Participants were ensured anonymity and confidentiality. Consensus was identified as 80% agreement. The experts also made suggestions or comments, based on which the questionnaire was reformulated for round 2. Data were analyzed using SPSS software, version 25.0 (IBM SPSS Statistics).

Findings: The response rate was 100% in round 1 and 95% in round 2. After round 1, a consensus was reached on 35 items. The experts submitted the following dimensions for analysis: Requirements for the consultation, Patient welcoming and assessment, Information for the patient (and family member or significant person, if applicable), Summary of the consultation, and Documentation of the consultation.

Conclusions: The consensus among the experts allowed for the development of a specific intervention in the form of a preoperative nursing consultation. The validated intervention should be implemented and its impact on the quality of care assessed, particularly in elective general surgery.