The Effect of Preoperative Nursing Visit on Anxiety and Pain Level of Patients After Surgery

PurposePreoperative education is an important part of surgical preparation. Nursing visits offer nurses the opportunity to provide personalized care. The aim of this study was to determine the effect of nursing visits before laparoscopic surgery on the anxiety and pain levels of patients in the postoperative period.DesignRandomized controlled clinical trial.MethodsData were collected from 135 patients who underwent laparoscopic surgery between March and October 2019 in Istanbul. During the nursing visits, the experimental group (n = 72) was educated by the operating room nurse, while the control group (n = 63) was educated by the service nurse. Data were collected using the State-Trait Anxiety Inventory and the Visual Analog Scale. The CONSORT checklist was followed.FindingsThe pre-education state anxiety scores of the control and experimental groups were similar and at a moderate level (P > .05). The state anxiety score of the experimental group visited by operating room nurses decreased more than that of the control group after education (P < .001). The postoperative state anxiety and pain scores of the control and experimental groups were found to be similar (P > .05).ConclusionsVisits by operating room nurses before laparoscopic surgery can be an effective method to reduce the anxiety level of patients. Obtaining the opinions of operating room nurses on care integration and organization of in-service education programs may be necessary.     

Parental Presence at Induction of Anesthesia to Reduce Anxiety: A Systematic Research and Meta-Analysis

PurposePerioperative anxiety can significantly alter outcomes for pediatric patients. Parental presence at induction of anesthesia (PPIA) is one method of anxiety reduction, but the efficacy remains unclear. This systematic review and meta-analysis aimed to determine if PPIA affects child and caretaker perioperative anxiety levels.DesignSystematic Review and Meta-analysisMethodsThis study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of PubMed, Scopus, CINAHL, PsycINFO, and Cochrane Library databases was performed on June 29, 2021. Search terms were related to parental presence in the operating room, anesthesia or anesthesia induction, and pediatric patients. The literature search identified English-language studies comparing children receiving PPIA to controls or studies examining attitudes toward PPIA.FindingsA total of 21 articles (n = 9573) met inclusion criteria. Seven studies (n = 776) quantified child anxiety with validated scales, and seven studies quantified parent anxiety (n = 621). There was no significant difference in preoperative anxiety between PPIA and controls for patients (P = .27) or caretakers (P = .99). PPIA patients had 8.40 [0.16, 16.64] (P = .05) lower Modified Yale Preoperative Anxiety Scale scores compared to control at induction, and parents had 3.41 [0.32, 6.50] (P = .03) lower State-Trait Anxiety Inventory State scores. Three studies concluded that PPIA did not increase operating room time or induction time. Twenty-three studies examined parental attitudes toward PPIA and found that 98.03% [96.09%, 99.32%] of parents present at induction would like to be present at subsequent surgeries. Contention in support for PPIA was seen amongst healthcare providers, but attitudes increasingly favored PPIA after implementation.ConclusionsPPIA reduces parental and patient anxiety, may increase parental satisfaction, and may not impede operating room efficiency. PPIA should be considered as a valuable tool to improve surgical outcomes and patient and family satisfaction.     

The Effect of an Operating Room Nurse Visit on Surgical Patient Anxiety

PurposeThe purpose of this study was to evaluate the effect of an operating room nurse visit on the anxiety levels of surgical patients.DesignA prospective, interventional, quasi-experimental design.Methods80 patients were divided into the control group (n = 40) and the intervention group (n = 40). The control group was given routine care, and the intervention group was visited preoperatively by the operating room nurse in addition to routine care.FindingsThe State-Trait Anxiety Inventory (STAI TX-1) mean score of the control patients who had information about anesthesia was low, while the STAI TX-1 mean score of the patients who had concerns about surgery was high. The STAI-TX-1 mean score of the control group patients who had information about anesthesia was significantly lower. There was no statistically significant difference in the STAI TX-1 scores between the two groups before and after surgery (P > .05). However, the STAI TX-1 mean score of the control patients was high in the post-operative period.ConclusionsIn an effort to reduce anxiety, the psychological preparation of the patient undergoing urological surgery should involve an anesthesia team member and the operating room nurse together.     

The Effect of Position Support During Orthopedic Surgery on Postoperative Pain: A Randomized Controlled Trial

BackgroundPositional pain affect the patient’s healing process after the operation. Anti-pressure positioning pads are medical products used to support the patient positioning during surgical procedures.AimsThe aim of the study was to examine pain related to positioning when anti-pressure gel pads and current visoelastic sponge support options are used during orthopedic surgical cases.DesignThe randomized controlled experimental study.SettingsThe operating room of an educational research hospital.Participants/SubjectsThe study consisted of 100 patients (50 control group and 50 study group) undergoing surgery in a supine position.MethodsInformation form, McGill Melzack Pain Questionnaire, and Visual Analogue Scale were used for data collection. Routine institutional policy was applied to the control group. Study group patients were additionally supported with antipressure position gel pads on the operating table.ResultsThe rate of pain presence in areas other than the operative area was significantly lower in the patients in the study group (p = .001). The patients in the control group reported that preoperative pain in the waist area increased to unbearable levels during operation. In addition, it was noted that the “addition of the anti-pressure gel pads” resulted in study group patients being mobilized significantly early (p = .001).ConclusionsThe conclusion of this study demonstrated that postoperative pain related to positioning, not the surgical procedure itself, was decreased when antipressure gel pads and viscoelastic sponge support were used together. An unanticipated benefit discovered during the study was earlier mobilization of the study group compared to the control group.     

手术室病理标本管理方法的改进及效果

病理标本检查结果是医生诊断和治疗疾病的重要依据,针对以往工作中存在的问题,制定了相应管理制度,加强病理标本的环节管理,建立了严格的签名制度,设计了合理的病理标本收取登记本,保证将病理标本安全送达病理科。     

Impact of the modified SESAME ultrasound protocol implementation on patients with cardiac arrest in the emergency department

IntroductionPoint-of-care (POC) ultrasound protocols are commonly used for the initial management of patients with cardiac arrest in the emergency department (ED). However, there is little published evidence regarding any mortality benefit. We compared and studied the effect of implementation of the modified SESAME protocol in terms of clinical outcomes and resuscitation management.MethodsThis was a single-center retrospective observational study. We conducted a pre- and post-intervention study to evaluate changes in patient outcomes and management after educating emergency medicine residents and the faculty about the modified SESAME protocol. The pre-intervention period lasted from March 2018 to February 2019, and the post-intervention period lasted from May 2019 to April 2020. The modified SESAME protocol education was initiated in March 2019. Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes.ResultsA total of 334 patients were included in this study during a 24-month period. We found no significant differences between the two groups for the primary outcome of survival to hospital admission (pre-intervention group 28.9% versus post-intervention group 28.6%; P = 0.751), survival to hospital discharge (12.1% vs. 12.4%; P = 0.806), and good neurologic outcome at discharge (6.0% vs. 8.1%; P = 0.509). The proportion of resuscitation procedures of thrombolysis, emergency transfusion, tube thoracotomy, and pericardiocentesis during resuscitation increased from 0.6% in the pre-intervention period to 4.9% in the post-intervention period (P = 0.016).ConclusionWe did not discover any significant survival benefits associated with the implementation of the modified SESAME protocol; however, early diagnosis of specific pathologies (pericardial effusion, possible pulmonary embolism, tension pneumothorax, and hypovolemia) and accordingly a direct increase in the resuscitation management were seen in this study. Future studies with larger sample sizes are required to examine the clinical outcomes as well as to identify the most effective POC ultrasonography protocols for non-traumatic cardiac arrests.     

Utilizing Clinical Microsystems to Improve Mislabeled Specimen Occurrences in the Emergency Department

IntroductionMislabeled specimen collection in the emergency department has the potential to significantly harm patients. Studies suggest that improvement efforts can reduce specimen rejection from the laboratory and reduce mislabeled specimens in emergency departments and hospital-wide.MethodsThe clinical microsystems approach was used to understand the problem of mislabeled specimens in an emergency department that is part of a 133-bed community hospital in Pennsylvania. Plan-Do-Study-Act cycles were implemented with the help of a clinical microsystems coach.ResultsSignificant reductions in mislabeled specimen collection were observed over the study period (P < .05). Sustainable improvements were achieved over the >3 years since the improvement initiative began in September 2019.DiscussionImproving patient safety in complex clinical settings requires a systems approach. Using the established framework of clinical microsystems, along with a tenacious and persistent interdisciplinary team, helped create a reliable process for minimizing mislabeled specimens in the emergency department.     

The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center,Controlled before-after Study in China

BackgroundEffective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.AimsThe current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.DesignA single-center, propensity score-matched, controlled before–after study.MethodsThe patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses’ pain knowledge and attitude between group A and group B.ResultsA total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).ConclusionOur study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.     

Evaluation of a Safety Protocol for the Management of Thirst in the Postoperative Period

PurposeTo associate medications, anesthetic techniques, and clinical conditions that interfere in the time of patient approval in the safety protocol for thirst management.DesignA quantitative, analytical, and longitudinal study conducted in Southern Brazil.MethodsA nonprobabilistic sample, of 203 adult patients in the immediate postoperative period, evaluated every 15 minutes for 1 hour.FindingsA general prevalence of thirst of 67.7%, and mean intensity of 6.38. Fentanyl, morphine, rocuronium, and sevoflurane increased lack of approval in the protocol within 30 minutes (P < .05). General anesthesia (P < .0001) and level of consciousness (95.4%) presented the highest nonapproval rates.ConclusionsAnesthetics and general anesthesia delayed protocol approval; however, after 30 minutes, 75.4% of patients had been approved. Level of consciousness was the main criterion of disapproval. The protocol identified crucial clinical conditions that made it impossible for the patient to receive thirst relief strategies and demonstrated that thirst can be satiated precociously with safety.     

手术室气动传输系统送检新鲜病理标本应用研究

目的:探讨手术室实施自动传输系统送检新鲜病理标本的方法与效果。方法:将原有病理标本送检方法进行改进,病理标本离体后30min内由巡回护士封装好,交给病理标本专管工人用自动传输系统直接送达病理科。结果:实施新鲜病理标本送检管理后,标本在手术室的滞留时间从(11.58±3.64)h缩短到(0.38±0.14)h,手术标本差错发生率从5.13‰下降至0.49‰,差异有统计学意义(P<0.001)。结论:实施自动传输系统送检新鲜病理标本,能缩短标本在手术室滞留时间,提高病理标本质量,减少差错事故发生。     

Effect of interesting games on relief of preoperative anxiety in preschool children

PurposeTo evaluate the effect of interesting games on reducing preoperative anxiety and improving compliance with anaesthesia in children.MethodsNinety preschool-aged children undergoing elective surgery were randomly assigned to two groups. The children in the control group were admitted to a general preoperative room with one parent for 15–20 min, and were then taken into the anaesthesia room. During anaesthetic induction, the nurse attracted the children's attention using an interesting game with encouragement and attention diversion. The children's anxiety was assessed using the Modified Yale Preoperative Anxiety Scale (mYPAS) when they entered the operating room, while they were waiting to undergo s0urgery, and during anaesthetic induction. Moreover, the children's compliance with anaesthetic induction was assessed using the Induction Compliance Checklist (ICC).ResultsNo statistically significant differences in the mYPAS scores were observed between the two groups upon entering the operating room (p > 0.05). The mYPAS scores were significantly lower in the experimental group than in the control group while waiting for surgery and during anaesthetic induction (p < 0.05), while there were no significant differences in the mYPAS scores upon entering the operating room. The children's compliance with anaesthetic induction was significantly higher in the experimental group than in the control group (p < 0.05).ConclusionEngagement in an interesting game can reduce preschool-aged children's preoperative anxiety and improve their compliance with anaesthetic induction.     

Development of the University Postoperative Obstructive Sleep Apnea Protocol (UPOP)

PurposeThe purpose of this project was to retrospectively analyze medical records to determine the relationship between surgical patients with obstructive sleep apnea (OSA) risk factors and the occurrence of a critical respiratory event (CRE) in the postanesthesia care unit (PACU), and to subsequently develop a protocol for postoperative care. Although OSA is prevalent among the surgical population, research has primarily focused on preoperative identification and tailored perioperative care with limited application of standardized postoperative OSA management.DesignSurgical charts were retrospectively reviewed between April 1, 2019 and June 31, 2019. Medical records were reviewed to identify surgical patients who had a diagnosis of OSA or two or more OSA risk factors. For patients who met initial inclusion, PACU charts were reviewed for the occurrence of a CRE while in PACU. Data analysis involved use of both Microsoft Excel 2011 and IBM SPSS Statistics Base, version 26.MethodsMedical records were reviewed to identify patients in PACU who had two or more documented OSA risk factors (body mass index >35, snoring, alcohol use, diabetes mellitus [DM], hypertension [HTN], or male) or a diagnosis of OSA (n = 1,361). This sample was further refined to determine the patients who had a CRE (oxygen saturation less than 92%; respiratory rate less than 10, Modified Aldrete Respiratory Score of 1 and/or lesser) while in the PACU (n = 200).FindingsThere was a statistically significant relationship between one CRE in the PACU and a pre-existing diagnosis of HTN, DM, snoring, alcohol use, and male gender (P < .001 for each variable). There was a statistically significant difference in body mass index between patients who experienced a CRE and those who did not (P = .004). HTN and DM (n = 16) were associated with the highest occurrence of a CRE.ConclusionsThe University Postoperative Obstructive Sleep Apnea Protocol was designed based on results and current evidence-based practice. Development of a postoperative OSA protocol will positively impact patient outcomes and may reduce health care expenditures. Next steps include protocol implementation and analysis.     

Cohort Study on the Implementation of a Surgical Checklist from the Operating Room to the Postanesthesia Care Unit

PurposeTo provide evidence of a well-structured information transfer that prevents the loss of information relevant to patient care.DesignPre-post cohort study on the implementation of a surgical checklist from the operating room to postanesthesia care unit.MethodsMain variable was the transfer of relevant and correct information. The secondary variables include time, interruptions, and satisfaction.FindingsIn the prechecklist stage, 59 transfers were collected; with an average time of 68.5 seconds, 41.7% of the transfers encountered interruptions, and only 8.5% of the reports were complete with all data. After instituting the checklist, 63 transfers were analyzed with an average time of 96.4 seconds, no interruptions occurred in 71.3% of the transfers, and all the items were transmitted in 92.1% of the cases. Number of interferences decreased. Transfer time increased significantly, but 80.3% of staff found the checklist useful.ConclusionsA written and structured checklist minimizes the loss of relevant information, thus improving safety in the process.