Journal of Perianesthesia Nursing最新文献

Purpose: To formulate and implement a sustainable, structured educational approach for preanesthesia testing (PAT) nurses focused on best practices in conducting preanesthesia interviews and capturing associated charges.

Design: This quality improvement project utilized a pre- and post-implmentation design as well as a retrospective chart review.

Methods: All nine PAT nurses assigned to the PAT clinic at a community hospital in the Southeastern United States were asked to complete online educational modules on preoperative anesthesia interview (PAI) concepts and on proper PAI documentation, charge capture, and the use of a documentation checklist. Pre-/postimplementation data were collected on registered nurse (RN) knowledge and confidence, PAI documentation and subsequent charge capture accuracy, and the financial impact of improper charge capture.

Findings: RN knowledge increased significantly postimplementation from 82.6% to 97.2%, yet RN confidence did not show statistically significant improvement. Four months postimplementation, nursing documentation showed a 3.8% improvement in accuracy from 92.76% preimplementation to 96.25% postimplementation. This change in documentation accuracy led to improved charge capture, which yielded a significant decline (63.6%) in mean monthly monetary discrepancies from $2,962.50 preimplementation to $1,078.13 postimplementation.

Conclusions: This quality improvement project demonstrates a significant impact of structured education and a standardized checklist on PAT nursing practices. These interventions increased RN knowledge of preoperative interview components, improved documentation practices, and increased charge capture accuracy, which was associated with a marked reduction in charge discrepancies. This underscores the importance of thorough documentation practices, the correlation between documentation and institutional revenue, and the fiduciary responsibility of PAT nurses.

Purpose: Hip arthroplasty is a common surgical procedure for end-stage osteoarthritis and other degenerative hip joint conditions. Despite its established efficacy, postoperative complications, such as excessive inflammation, coagulation disturbances, and inadequate pain control, can hinder recovery and increase the risk of adverse outcomes. Mild hypothermia, involving controlled temperature reduction, has emerged as a potential strategy to mitigate these complications, but its impact on hip arthroplasty outcomes remains insufficiently explored.

Design: This study aims to evaluate the effects of mild hypothermia on inflammation, coagulation profiles, pain management, and long-term functional recovery in patients undergoing hip arthroplasty.

Methods: This prospective, single-center, randomized controlled trial included 100 patients undergoing primary unilateral hip arthroplasty. Participants were randomly assigned to either the normothermia or mild hypothermia group, with the latter maintained at 34 °C to 35 °C during surgery. Inflammatory markers, coagulation profiles, and pain scores were measured preoperatively, 24 hours, and 72 hours postoperatively. Long-term functional recovery was assessed at 1-year follow-up using the Hospital for Special Surgery score.

Findings: The mild hypothermia group exhibited a significant reduction in postoperative inflammation, with lower levels of white blood cell count, C-reactive protein, erythrocyte sedimentation rate, tumor necrosis factor-alpha, and interleukin-6 compared with the normothermia group. Coagulation profiles were significantly altered in the mild hypothermia group, evidenced by prolonged prothrombin time and activated partial thromboplastin time. Postoperative pain at 24 hours was significantly lower in the mild hypothermia group, as measured by the visual analog scale, though this difference was not sustained at 7 days. No significant difference in long-term functional outcomes was observed between the two groups at the 1-year follow-up.

Conclusion: Mild hypothermia during hip arthroplasty significantly reduces postoperative inflammation and alters coagulation pathways, promoting faster early recovery. However, it does not provide long-term benefits in functional recovery. These findings support the use of mild hypothermia for improving perioperative outcomes but suggest that further investigation is needed to fully understand its role in orthopedic surgery.

Purpose: To describe the patients' experiences on preoperative telephone education in day surgery.

Design: A descriptive, qualitative approach.

Methods: The data were collected from day surgery patients (n = 31) in 2020 via face-to-face interviews. The themes of interviews were General experiences, Interaction, Patient-centeredness, Goal-oriented treatment, and Development ideas. Deductive-inductive content analysis was used. The Consolidated Quality of Research Reporting checklist was used.

Findings: General experiences included six main categories: Usefulness, Contents, Benefits, Emotional support, Unnecessariness, and Other education methods. In the interaction, three main categories were formed: Implementation, Opportunity to ask, and Information access challenges. In patient-centeredness, three main categories were formed: Individuality, Wishes, and Role of loved ones. Goal-oriented treatment included two main categories: Awareness and Accessibility. Development ideas for preoperative telephone education also included two main categories: Nothing to develop and Development content.

Conclusions: Patients express high levels of satisfaction with preoperative telephone education, underscoring the significance of a personalized, individualized, patient-centered, and multichannel approach. To further optimize patient education, innovative strategies and technology integration are needed to enhance communication. These efforts can make telephone education a more effective tool for achieving optimal health outcomes and improving patient experience.

Purpose: Negative preoperative psychological experiences (eg, anxiety, stress) are identified as the worst component of surgery by patients and can be associated with poor outcomes. This exploratory study aimed to examine which stimuli within the operating room (OR) were associated with elevations in patient-reported anxiety, discomfort, or stress, before anesthesia induction.

Design: A retrospective semi-structured interview was performed in the acute postoperative period (mean of 7.5 days, standard deviation = 3.3).

Methods: Adult patients who previously underwent elective surgery under general anesthesia were invited to participate. Participants reported on psychological responses to the cool OR room temperature, music playing, health care provider discussions, bed position, anesthetic mask application, and "other" stimuli (open-ended). Descriptive statistics examined self-reported anxiety, stress, or discomfort associated with each stimulus and a qualitative content analysis identified other provoking elements from open-ended responses.

Findings: Among 300 patients, the most psychologically provoking stimuli were the application of the anesthetic mask (21%), followed by the cool OR room temperature (11%), the bed position (9%), discussions among health care providers (3%), and music playing (0.3%). Other (open-ended) stimuli were reported by 23% of respondents and content analysis revealed themes of staff professionalism, and procedural and OR equipment/surgical instruments impacting adverse psychological responses. Younger patients (t = 2.3, P ≤ .05), patients who were interviewed more recently following surgery (t = 2.0, P ≤ .05), and patients from one of the two hospitals (χ² = 11.8, P ≤ .01) more often reported having "any" adverse psychological response in the OR.

Conclusions: This study examined environmental stimuli within the OR associated with patient-reported negative psychological experiences. Simple modifications of OR factors may be effective for reducing anxiety, discomfort, and stress and improving patient care and satisfaction.

Purpose: Effective pain management in critically ill patients unable to communicate verbally remains a major challenge worldwide, particularly due to limitations in pain assessment. This study focuses on how intensive care unit (ICU) nurses in Turkey approach pain management.

Design: A qualitative study based on descriptive content analysis was conducted.

Methods: Semi-structured, in-depth interviews were conducted with 14 intensive care nurses at a university hospital. The data were coded and categorized following the steps of descriptive content analysis.

Findings: Four categories emerged from the interviews: factors contributing to pain, pain recognition, pain management, and recommendations for improving pain relief. Pharmacological methods were the most frequently used strategies, while nonpharmacological and empathic approaches were reported less frequently. Nurses also highlighted systemic barriers, such as staffing shortages, workload, and environmental stressors in the intensive care unit, that hinder effective pain management.

Conclusions: This study highlights the need for increased education on nonpharmacological painkillers, culturally sensitive approaches to pain expression, and improved intensive care unit working conditions. This information is particularly important for perianesthesia nursing, where timely recognition and holistic management of pain are critical to patient recovery.

Purpose: To determine the effect of white noise on sleep quality, comfort, and satisfaction after lumbar disk hernia surgery.

Design: Open-label, parallel-group, randomized controlled study.

Methods: This study enrolled 60 patients, aged between 18 and 65 years, who were hospitalized for at least 48 hours, had a Glasgow Coma Scale score of 15, and underwent lumbar disk herniation surgery in the neurosurgery ward of a training and research hospital in Istanbul. Patients in the intervention group (n = 30) listened to white noise for 30 minutes before sleeping in addition to routine care on postoperative days 0 and 1, while patients in the control group (n = 30) received no intervention. The primary outcome of the study was the change in sleep quality (assessed by the Richard-Campbell Sleep Scale) on postoperative days 1 and 2. Secondary outcomes were changes in baseline comfort (assessed with the Shortened General Comfort Questionnaire) and satisfaction (visual analog scale) levels on postoperative days 1 and 2.

Findings: Although both the intervention and control groups showed statistically significant increases in sleep quality over the first 2 days after surgery (P < .001 for both), this increase was more pronounced in the intervention group. The intervention group also showed significant increases in comfort scores between postoperative days 1 and 2 (P < .001 for all). Between postoperative days 1 and 2, satisfaction scores decreased significantly in the intervention group (P < .001) but not in the control group (P > .05).

Conclusions: White noise was effective in increasing the sleep quality, comfort, and satisfaction levels of patients after lumbar disk hernia surgery.

Purpose: It was aimed to compare the effects of oral carbohydrate administration 3 hours before surgery on perioperative body temperature in pediatric patients with the control group.

Design: This study has a prospective, nonrandomized, and controlled design.

Methods: A total of 40 pediatric patients aged between 2 and 15 who were scheduled for elective surgery were included in the study. The patients were divided into two groups: Group W (patient group given only 5 mL/kg oral water 3 hours before the surgery, n = 20) and Group C (patient group given 5 mL/kg clear carbohydrate-rich liquid orally 3 hours before surgery, n = 20). The body temperatures of the patients were measured perioperative with a tympanic thermometer at regular intervals. Values lower than 36.0 °C were considered as hypothermia. The patients were evaluated in terms of nausea, vomiting, and aspiration in the first 24 hours postoperatively.

Findings: The mean body temperature of the patients in Group C was found to be statistically higher than that of Group W, starting from the 15th minute of the intraoperative period and in all subsequent measurements (P < .05). While hypothermia was observed in three patients in Group W, it was not detected in any patient in Group C. Nausea and vomiting as postoperative complications were found in 15% (n = 3) in Group W, while no patients in Group C had nausea or vomiting.

Conclusions: It was observed that preoperative oral carbohydrate loading in pediatric patients was associated with higher body temperature in the perioperative period starting from the intraoperative 15 minutes and prevented the development of hypothermia.

Purpose: Opioids have long been an integral component of pain management in general anesthesia protocols. However, recent studies have increasingly supported the use of opioid-free anesthesia. This meta-analysis aimed to assess the effects of opioid anesthesia compared with opioid-free anesthesia on postoperative recovery.

Design: A systematic review and meta-analysis of randomized controlled trials, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods: We systematically searched Embase, PubMed, and the Cochrane Central Register of Controlled Trials up to June 18, 2023. Studies were included if they compared opioid-free anesthesia to opioid anesthesia and reported the quality of postoperative recovery. Meta-analyses primarily utilized a random-effects model.

Findings: In total, 13 randomized controlled trials, comprising 1,733 patients, were included in this analysis. The results indicated that opioid-free anesthesia improved the quality of postoperative recovery, with standardized mean difference of 0.46 (95% confidence intervals [CI]: 0.29 to 0.63, I² = 56%, P < .001) for quality of recovery. These benefits were evident in all types of surgeries. However, the clinical significance of these differences is limited. Furthermore, the opioid-free anesthesia group required less postoperative rescue analgesia and had a lower incidence of postoperative nausea and vomiting, with risk ratios of 0.54 (95% CI: 0.37 to 0.78), I² = 0%, P less than .001, and 0.39 (95% CI: 0.27 to 0.57), I² = 0%, P less than .001, respectively.

Conclusions: Combined analyses showed that opioid anesthesia was not superior to opioid-free anesthesia in terms of the quality of recovery, and the risk of nausea and vomiting was higher.

Purpose: To identify registered nurse anesthetists' (RNA) perceptions of learning within the profession and to test the feasibility of the research questions and design.

Design: This was a qualitative empirical study with a phenomenographic approach.

Methods: Interviews with open-ended questions.

Findings: Four descriptive categories were identified: (1) practicing as a clinician, (2) developing comprehensive understanding, (3) developing situational awareness, and (4) trusting in own competence. These descriptive categories indicate the perceptions of conditions for professional learning. Experience, comprehensive understanding of the perioperative process and the patient's situation, and having the courage to trust in own competence were described as essential for learning as a professional RNA.

Conclusions: The study demonstrated the feasibility of the research design and provided preliminary insights into RNAs' perceptions of professional learning. These findings may inform the implementation of a more comprehensive study, facilitate RNA learning in clinical settings, and provide insights into early RNA training.