Journal of Perianesthesia Nursing最新文献

Purpose: This study examines how pain catastrophizing and pain intensity influence postoperative mobility in patients undergoing laparoscopic abdominal surgery.

Design: The study has a prospective cross-sectional correlational design.

Methods: The study included 92 patients who underwent laparoscopic abdominal surgery. Data were collected using the Patient Information Form, Pain Catastrophizing Scale (PCS), Numeric Rating Scale, Patient Mobility Scale (PMS), and Observer Mobility Scale (OMS). Preoperative pain catastrophizing was assessed. Patients whose vital signs and pain intensity were evaluated during any mobilization after the first mobilization within 48 hours postoperatively were mobilized. The level of pain, difficulty, and dependence experienced during physical movement was assessed.

Findings: The mean age of the patients was 56.12 ± 13.26 years, 54.3% were female, 66.3% underwent laparoscopic cholecystectomy, 19.6% underwent laparoscopic hernia repair, and 14.1% underwent laparoscopic appendectomy. Pain intensity, PCS score, PMS score, OMS score, and body mass index (BMI) were found to be positively correlated (P < .05). After mobilization, there was a significant increase in pulse rate, respiratory rate, mean blood pressure, and pain intensity within the range of clinically normal parameters (P < .01). Medical devices (urinary catheter, drain) were found to cause an increase in PCS, PMS, OMS, and pain severity. In the multivariate regression model, pain intensity, pain catastrophizing, and BMI were found to explain 56% of patient mobility (F_{(4, 87)} = 29.896, P < .01).

Conclusions: The study results showed that pain, pain catastrophizing, and BMI negatively affected postoperative patient mobility. These barriers need to be taken into consideration when making interventions to improve patient mobility.

Purpose: This study aimed to examine the relationship between surgical fear and health literacy in patients undergoing elective open-heart surgery. The primary goal was to determine whether surgical fear and other demographic factors could predict patients' health literacy levels and evaluate how these variables interact in a preoperative cardiac surgical context.

Design: A multicenter, cross-sectional, and correlational study design was employed to investigate the relationship between surgical fear and health literacy among preoperative cardiac surgery patients.

Methods: The study was conducted in the cardiovascular surgery departments of three hospitals in the Aegean region of Turkey. A purposive sampling method was used, and data were collected from 430 patients who were scheduled to undergo open-heart surgery for the first time. Data were gathered through face-to-face interviews using three instruments: a patient information form, the Surgical Fear Questionnaire, and the Turkish Health Literacy Scale. Descriptive statistics, t tests, one-way analysis of variance, Pearson's correlation, and multiple regression analyses were used to analyze the data.

Findings: Among the participants, 86.3% had inadequate health literacy levels, and the average surgical fear score was found to be high (60.91 ± 12.07). A statistically significant negative correlation was found between surgical fear and health literacy (r = -0.492, P < .001). Multiple regression analysis revealed that surgical fear and age were significant predictors of health literacy, collectively accounting for 32% of the total variance. Patients with higher surgical fear and those of older age demonstrated significantly lower health literacy levels. Notably, lower educational attainment and prior surgical experience were also associated with lower health literacy scores.

Conclusions: The findings suggest that surgical fear and health literacy are closely linked in patients awaiting open-heart surgery. As health literacy increases, surgical fear levels decrease. Health literacy is influenced by psychological and demographic factors, particularly surgical fear and age. These results underscore the importance of implementing tailored preoperative educational interventions to enhance health literacy and reduce fear, thereby supporting better surgical outcomes and emotional well-being.

Purpose: About 6.3% to 14% of children undergoing surgery develop postanesthetic shivering (PAS). Many drugs were used to relieve PAS in adults. However, no relevant meta-analyses have been conducted in children. The network meta-analysis (NMA) was performed to evaluate different medical interventions in children.

Design: Systematic review and NMA.

Methods: Randomized controlled trials were retrieved through PubMed, CINAHL, Web of Science, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The outcome was the incidence of PAS. For the NMA, a frequentist Mantel-Haenszel approach was adopted. The common effect model was employed. Results were synthesized into pooled odds ratios (ORs). P scores were generated to rank the treatments.

Findings: Overall, 13 trials were included in the study. In NMA, ketamine was superior to magnesium sulfate, midazolam, and placebo: OR 0.01 (95% confidence interval [CI] 0.00 to 0.09), OR 0.06 (95% CI 0.01 to 0.46), and OR 0.04 (95% CI 0.01 to 0.16). α₂-Adrenoceptor agonists were superior to magnesium sulfate, midazolam, and placebo: OR 0.02 (95% CI 0.00 to 0.21), OR 0.16 (95% CI 0.07 to 0.35), and OR 0.10 (95% CI 0.03 to 0.30). 5-Hydroxytryptamine type 3 receptor antagonists were superior to magnesium sulfate and placebo: OR 0.03 (95% CI 0.00 to 0.38) and OR 0.18 (95% CI 0.06 to 0.51). Ketamine was ranked higher than other interventions.

Conclusions: While ketamine, α₂ adrenoceptor agonists, and 5-hydroxytryptamine type 3 receptor antagonists all demonstrate significant efficacy in preventing PAS, the extreme effect size observed for ketamine is particularly vulnerable to small-study effects.

Purpose: To evaluate the effects of personalized music therapy on perioperative anxiety, physiological stress responses, postoperative pain, sedation, and recovery quality in patients undergoing knee arthroscopy.

Design: A prospective, randomized, double-blind, controlled trial.

Methods: Sixty-four American Society of Anesthesiologists I to III patients (aged 18 to 75 years) scheduled for elective knee arthroscopy were randomized to either a music therapy group (MTG, n = 32) or a control group (CG, n = 32). The MTG received personalized receptive music therapy during the preoperative holding phase and postanesthesia care unit (PACU) stay, while the CG wore identical headphones delivering silence. Outcomes included the State-Trait Anxiety Inventory-6, Numeric Rating Scale for pain, Observer's Assessment of Alertness/Sedation, Quality of Recovery-15, and continuous physiological monitoring (blood pressure, heart rate, respiratory rate, and oxygen saturation).

Findings: Compared with the CG, the MTG demonstrated significantly lower postoperative state anxiety scores (P < .001), reduced pain intensity across all postoperative timepoints (all P < .001), and shorter PACU stay (33.44 ± 4.30 vs 41.56 ± 7.77 minutes, P < .001). A greater proportion of MTG patients achieved full alertness in the PACU (96.9% vs 59.4%, P < .001). Quality of Recovery-15 scores at 24 hours were also higher in the MTG (86.19 ± 3.05 vs 73.94 ± 6.49, P < .001). Additionally, the MTG exhibited more stable hemodynamic parameters throughout the perioperative period.

Conclusions: Personalized music therapy is a safe and effective nonpharmacological intervention that reduces perioperative anxiety and pain, enhances physiological stability, accelerates postoperative emergence, and improves recovery quality in patients undergoing knee arthroscopy. Its integration into Enhanced Recovery After Surgery pathways may provide substantial benefits for perioperative care.

Purpose: Effective postoperative pain management is a cornerstone for optimizing patient outcomes and enhancing overall patient satisfaction. The purpose of this quality improvement (QI) project was to decrease postoperative pain in the postanesthesia care unit (PACU) for patients undergoing exploratory laparotomy, noncervical spine, gynecologic, and prostatectomy surgeries by implementing a PAIN management checklist into clinical practice. This QI project aimed to implement a PAIN management checklist to reduce postoperative pain scores among four surgical populations at a large level two hospital.

Design: The Plan-Do-Study-Act QI model was used to guide the project.

Methods: The target population was adult patients aged 18 and older, undergoing noncervical spine, gynecologic, prostatectomy, and exploratory laparotomy procedures at level two trauma center. The participants were physician anesthesiologists, Certified Registered Nurse Anesthetists, and PACU registered nurses. After orienting the participants to the project, the PAIN checklist was implemented, and retrospective chart reviews were conducted to gather 3 months of pre- and postimplementation data. The primary outcome measure for this project was pain scores in the immediate postoperative period, as measured by the Numeric Rating Scale.

Findings: A total of 1,584 cases were reviewed, 813 preimplementation and 771 postimplementation. The mean pain score upon arrival to the PACU decreased from 1.66 preimplementation to 1.29 postimplementation (P = .03). The mean pain score upon discharge from the PACU increased from 1.94 preimplementation to 2.21 postimplementation (P = .008).

Conclusions: Implementation of the PAIN management checklist resulted in improved pain scores upon arrival to the PACU but did not result in improved pain scores upon discharge from PACU. Future Plan-Do-Study-Act cycles will focus on improving the use of preemptive analgesia by anesthesia staff and the assessment and treatment of pain by PACU staff.

Spinal anesthesia (SA) is a commonly used technique in urological surgery and is generally regarded as a reliable, safe, and effective method of anesthesia. However, non-traumatic spinal subdural hematomas (NTSSH) that develop following SA are extremely rare and potentially life-threatening complications if not diagnosed and treated promptly. This case report describes a 66-year-old male scheduled for holmium laser enucleation of the prostate. His medical history included mitral valve replacement, for which he was receiving oral warfarin 10 mg once daily. Fifty-two hours after receiving nontraumatic SA, the patient developed progressive motor weakness, urinary retention, and fecal incontinence. Clinical examination revealed complete motor paralysis below the T₁₀ level (0/0) and total sensory loss, including vibration, proprioception, pain, temperature, and touch. At the 72nd postoperative hour, magnetic resonance imaging revealed an NTSSH extending from the T₁₂ vertebral level to the filum terminale, compressing the spinal cord and cauda equina. Despite urgent surgical decompression, evacuation of the hematoma, and intensive medical management, no neurological recovery was observed. This case highlights the critical importance of thorough preoperative evaluation, a multidisciplinary approach, individualized patient management, vigilant postoperative monitoring, and the prompt diagnosis and treatment of rare but severe complications. Perioperative nurses play a vital role in caring for patients with NTSSH, contributing significantly to recovery, ensuring patient safety, and optimizing clinical outcomes.

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.