Journal of Perianesthesia Nursing最新文献

Purpose: This study aimed to develop a feasible and scientifically grounded protocol for the prevention and management of perioperative hypothermia in neonates.

Design: A Delphi method was used to assess the importance of each item in the developed protocol.

Methods: A comprehensive literature review was conducted to generate a preliminary pool of protocol items. Based on expert feedback, preliminary items were revised, removed, or supplemented to establish a scientifically rigorous and clinically applicable protocol.

Findings: Response rates for the two Delphi rounds were 100% and 94.12% respectively. The authority coefficients were 0.86 and 0.92, with the Kendall's coefficients of concordance being 0.127 (P <.05) and 0.122 (P < .05), respectively. The final protocol included a total of 23 items.

Conclusions: The scientifically developed protocol provides effective guidance for the perioperative temperature management of neonates.

Purpose: This study aimed to compare operation time, vital signs, bleeding tendency, and recovery time according to anesthesia methods in hip surgery patients.

Design: This is a retrospective descriptive study.

Methods: A total of 187 patients were included, with 83 receiving general anesthesia (GA) and 104 receiving spinal anesthesia (SA). Data were collected from electronic medical records of patients aged greater than or equal to 65 years who underwent hip surgery at a single tertiary hospital from March 2023 to February 2024. The collected data were analyzed using SPSS 27.0 (IBM Corp., Armonk, NY), employing descriptive statistics, χ² tests, and independent t tests.

Findings: Significant differences were observed between the two groups with regard to the American Society of Anesthesiologists classification, with 66.3% (55 patients) of the GA group classified as American Society of Anesthesiologists III or higher, compared to 51% (53 patients) in the SA group (t = 4.43, P = .038). There were also significant differences in operation time (t = 2.89, P = .004), postoperative diastolic blood pressure (t = 2.23, P = .027), fluid volume (t = 4.05, P < .001), blood transfusion status (χ² = 5.13, P = .036), transfusion volume (t = 2.80, P = .007), estimated blood loss (t = 7.85, P = .008), bleeding volume (t = 2.27, P = .030), D-dimer (t = -3.09, P = .005), and recovery time (t = -2.10, P = .037) between anesthesia groups. GA patients showed higher average operation time, postoperative diastolic blood pressure, fluid volume, presence of bleeding, bleeding volume, need for transfusion, and transfusion volume. Conversely, SA patients had longer recovery times and higher D-dimer level.

Conclusion: This comparative analysis of patient outcomes based on anesthesia methods in hip surgery provides valuable guidelines for anesthesia care and recovery to perianesthesia nurses in Korea.

Purpose: To systematically assess and quantify the relationship between length of anesthesia time and postoperative cognitive and behavioral changes in children, by combining data from published studies to evaluate possible duration-based effects and to use them to support future clinical recommendations.

Design: The study is a systematic review and meta-analysis conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods: The search strategy included a systematic search of Google Scholar, PubMed, Scopus, and Web of Science for publications over the past 15 years. Inclusion criteria included randomized clinical trials and observational studies that included pediatric subjects (0 to 18 years) who underwent surgery under general anesthesia with cognitive or behavioral outcomes reported postoperatively. Studies were placed into groups based on short (<1 hour), moderate (1 to 3 hours), and prolonged anesthesia duration (>3 hours). A random-effects model was utilized for meta-analyses and effect sizes were calculated, heterogeneity was reported using the I² statistic.

Findings: The systematic review and meta-analysis included 15 studies that met inclusion and exclusion criteria. No overall effect of duration of anesthesia was found on verbal, performance, or full-scale intelligence quotient (IQ); however, a significant reduction in verbal IQ was observed in the 1- to 2-hour group (mean difference = -2.00, 95% confidence intervals [CI] = -2.53 to -1.47, P < .00001). Behavior problems were measured by the Child Behavior Checklist total problems score, which showed the strongest increases in failures for the durations of less than 2 hours, while greater durations noted strong associations with attention-deficit hyperactivity disorder (ADHD) (hazard ratio = 1.99, 95% CI: 1.40 to 2.83, P = .0001) and learning disabilities (hazard ratio = 1.71, 95% CI: 1.38 to 2.12, P < .00001). Heterogeneity appeared relatively small across these outcomes, and variability of behaviors was much lower for ADHD and learning disabilities compared with IQ measures and Child Behavior Checklist total problems.

Conclusions: Anesthesia duration has a significant effect on certain cognitive and behavioral outcomes in children. We found that anesthesia exposures of 1 to 2 hours were associated with decreased verbal IQ, and longer durations were associated with ADHD and learning disability. These results demonstrate the importance of planning for anesthesia exposure and standardized approaches in future anesthetic and cognitive studies.

Purpose: Traditional acupuncture provides sedative and analgesic effects but is invasive and requires skilled practitioners. Transcutaneous electrical acupoint stimulation (TEAS) is a noninvasive alternative with advantages such as ease of use and reproducibility. This study aimed to evaluate the impact of TEAS on preoperative anxiety and related outcomes.

Design: A systematic review and meta-analysis of randomized controlled trials.

Methods: Randomized controlled trials from eight databases were analyzed using RevMan5.4 (Version 5.4; Cochrane Collaboration, Oxford, England). The outcomes assessed included anxiety, heart rate, mean arterial pressure, and sleep quality, all of which were measured preoperatively, while pain was the sole outcome evaluated postoperatively.

Findings: A total of 1,026 patients across 12 studies were included. TEAS significantly reduced preoperative anxiety (standardized mean difference [SMD] = -1.07, P = .0002), heart rate (mean difference [MD] = -8.61, P = .02), mean arterial pressure (SMD = -1.53, P = .04), and postoperative pain (SMD = -1.89, P < .0001). The effect on sleep quality was not significant (SMD = 0.72, P = .13).

Conclusions: TEAS may reduce preoperative anxiety, heart rate, mean arterial pressure, and postoperative pain, but its effect on sleep quality is inconclusive. Further well-designed randomized controlled trials are needed.

Purpose: Clinical reasoning is essential in nursing for making informed decisions in complex health care environments. Frameworks such as Script Theory assist nurses in organizing knowledge into "scripts," which support pattern recognition, data interpretation, and uncertainty handling. While Script Concordance Tests have proven effective in nursing education, their application in the ongoing professional development, particularly in specialized areas such as postanesthesia care, has not been widely explored. The purpose of this study was to develop the Postanesthesia Nursing Script Concordance Test (PaNSCT) and to assess its validity.

Design: Multimethod methodological study.

Methods: The study was conducted in three phases: Phase I focused on construction and construct validity; Phase II assessed reliability, acceptability, and appropriateness through PaNSCT scores and qualitative feedback from two groups-clinical experts and nurses in perioperative settings; and Phase III concentrated on sustainability, including intellectual property registration. Data analysis included descriptive statistics, Pearson's correlation, Cronbach's α, and content analysis.

Findings: The contruct validity of the PaNSCT, with 20 cases and 60 items on postanesthesia care, was established through expert consensus, making only minor semantic adjustments. PaNSCT exhibited Cronbach's α of 0.92 and effectively differentiated mean scores of clinical experts (44.8 ± 4.7) from nurses (39.9 ± 6.1, P = .01). Nurses' scores showed a positive correlation with postanesthesia care unit experience (r = 0.58, P = .009), while no significant correlations were found for experts. Panelists highlighted PaNSCT's value in clinical training, the importance of preliminary Script Concordance Tests education, and opportunities for expanding vignettes. PaNSCT showed strong reliability and validity in assessing clinical reasoning under uncertainty in postanesthesia care, with clinical experts outperforming nurses, emphasizing the importance of advanced training and specialization. Nurses with more postanesthesia care unit-specific experience scored higher, highlighting the value of context-specific knowledge.

Conclusions: PaNSCT is a valuable tool for assessing clinical reasoning under uncertainty, with the potential to advance nursing education and foster the development of reasoning skills in postanesthesia care.

Purpose: The study was conducted to determine the experiences of patients who underwent total knee arthroplasty regarding the noise they were exposed to in the operating room and recovery unit.

Design: The study employed a mixed-methods design.

Methods: The study was conducted between March and June 2024 in a public hospital located in the Mediterranean region of Turkey. The sample consisted of 20 patients who underwent total knee arthroplasty. Quantitative data were collected using the Patients' Descriptive Characteristics Form, Surgical Fear Questionnaire, Surgical Period Data Collection Form, and Numerical Rating Scale. Qualitative data were obtained through a Semi-Structured Interview Form. The data were analyzed using MAXQDA 2022 and SPSS (24.0) software.

Findings: The mean age of the patients participating in the study was 66.4 ± 7.72 years and 75% were female. Preoperative anxiety was present in 70% of the patients, whereas 60% stated that they were not disturbed by intraoperative noise. The mean total score of the Surgical Fear Questionnaire was 36.15 ± 14.81, indicating a moderate level of surgical fear. Patients who were disturbed by intraoperative noise had a higher mean total score on the Surgical Fear Questionnaire. In the qualitative phase of the study, three main themes and nine codes related to these themes were identified, reflecting the patients' experiences of noise. The main themes were defined as "Sounds," "Emotions," and "Coping."

Conclusions: This study revealed that patients with high preoperative anxiety experienced more surgical fear during surgery and were more disturbed by auditory stimuli. Motor and hammer sounds increased feelings of fear in some patients, while music was found to be disturbing and associated with headaches by some participants. Some patients were observed to turn to spiritual coping strategies to cope with these stimuli.