Perioperative Nursing Research Articles

Determinants of Low-Value Testing Before Low-Risk Operation

INTRODUCTION: Routine testing (ie EKG and laboratory tests) before low-risk operation does not prevent adverse events and can lead to harm, including risky care cascades and operative delay. Despite multiple surgical, anesthesia, and general medicine professional societies recommending against routine testing, unnecessary testing remains common and de-implementation has proven difficult. This study describes determinants of such testing. METHODS: We conducted focused ethnography at one academic institution. We directly observed two preoperative clinics and one outpatient surgery center, conducted semi-structured interviews, and collected artifacts including preoperative testing protocols related to low-risk operation. Structured notes were written after each observation and interviews were audio-recorded and transcribed. Themes were identified through narrative thematic analysis. RESULTS: We had conversations with 22 stakeholders including 2 surgeons, 5 anesthesiologists, 3 perioperative nurses, 11 advanced practice providers (certified registered nurse anesthetists and physician’s assistants), and 1 medical assistant. We identified three major themes: highly varied testing preferences illustrated by surgeon- and service-specific protocols, confusion around “intentional” vs “automated” orders leading to verbal verification of orders, and the belief that other providers or services want testing that the ordering provider does not necessarily desire, thus incentivizing reflexive ordering to avoid conflict or confrontation. CONCLUSION: When viewed in its entirety, the preoperative system is cumbersome. However, individual stakeholders behave rationally given roles and associated pressures. Unnecessary preoperative testing is a human problem based in culture and convention. Efforts to reduce low-value testing before low-risk operation should take on a systems lens to optimize each input for efficiency and value.

Non-Technical Skills Training for Nigerian Surgical Teams: Which Way Forward?

INTRODUCTION: The non-technical skills (NTS) of situational awareness, decision making, leadership, and communication and teamwork, are significant for enhancing surgical safety. Considered soft skills, they can be overlooked, particularly in low-income contexts. A survey was designed to explore exposure to NTS in north central Nigeria and identify felt needs for the design of a contextualized curriculum. METHODS: Six institutions with high surgical volumes, including private nonprofit and government-owned teaching hospitals, were purposively identified. Using snowball sampling through surgical team leads, a 19-item, web-based survey was distributed to 71 surgical providers, anesthetists and perioperative nurses between August and November 2021. Data were analyzed using proportions and Fisher’s exact test. RESULTS: The survey had a 95.7% completion rate. Respondents included 17 anesthetists, 21 perioperative nurses, and 29 surgeons. Over half were unaware of the concept of NTS, and 96% had never heard of a NTS framework for variable resource contexts. Only 8% had NTS training. Communication and teamwork was considered the most deficient personal skill (38, 57%), and most needed for team improvement (45, 67%). There was a high demand for training (64, 96%) motivated by expectations of improved patient safety and better team dynamics. Respondents preferred week-long, hybrid training courses with in-person and online components. Perceived barriers to attendance were time conflicts and costs. Facilitators included a desire for self-improvement and patient safety (Table). CONCLUSION: Surgical teams in north central Nigeria are strongly motivated for NTS training believing it can improve patient safety, team dynamics, and personal performance. Implementation should emphasize communication and teamwork. Table. - Barriers and Facilitators to Participating in Non-Technical Skill Training in Nigeria Themes Number Percentage Example phrases Barriers Hindrances from the perioperative and institutional work environment 40 59.7 Challenges with the “Release by my employer “; “Work stress”; Non-technical skills training may “Clash with normal duties” or be limited by “tight schedule of residency training programme”; “Scheduled time of training coinciding with work” Barriers Lack of funding to pay for non-technical skills courses 14 20.9 A barrier is “Cost”; “Financial constraints” Barriers Lack of access to non-technical skills courses, particularly if in-person 10 14.6 Limited access to courses due to the “Insecurity Nigeria is now experiencing”; “Poor Internet services in Nigeria”; “Distance if the program is not online” Facilitators The motivation of improved patient safety 34 50.7 “To improve patient outcomes”; “Quest for improvement in surgical outcome”; “Patient safety and satisfaction”; “achieving global excellence for the maximum patient benefit”; “Desire to improve surgical outcome for my patience”; “prevent errors during surgery” Facilitators A drive for self-improvement 18 26.9 Facilitated by a desire “To add value to myself”; “Skill acquisition “; “personal aim at achieving global excellence “; Desire to “To improve my skills and knowledge” Facilitators The motivation of experiencing an improved work environment 10 14.9 Motivated by “reduce toxicity in the Operating Room”; “Strengthening teamwork”; “To see the change in attitude of my colleagues and other workers”; “A better working relationship with other health professionals”; “Improving interpersonal relationships” Facilitators Funding and financial incentives for training 4 6.0 Non-technical skills training would be facilitated by “Sponsorship”; “Scholarship”; “Financial motivation” Facilitators Support from work hierarchy, and removal of workplace barriers 3 4.5 Facilitated by “Convenience”; “Permission from my work place” Facilitators The award of certificates of training or attendance 1 1.5 The award of a formal “certificate” of attendance or other certification in non-technical skills

Targeted Perioperative Nursing Combined with Propofol and Fentanyl for Gynecological Laparoscopic Surgery.

Objective The aim of this study is to investigate the clinical effects of targeted perioperative nursing combined with propofol and fentanyl in gynecological laparoscopic surgery. Methods Patients who were admitted to our hospital for gynecological laparoscopic surgeries from October 1, 2019 to November 30, 2021 were included in this retrospective study. Patients in group A received routine propofol and fentanyl. Patients in group B received targeted perioperative nursing on the basis of interventions in group A. The anesthetic effects, clinical indicators, mental health status, and adverse reactions were compared between the two groups. Results A total of 84 qualified patients were retrieved. The total effective anesthesia rate, extubation time, operation time, consciousness recovery time, intraoperative blood loss, hospital stay, SAS score, SDS score, health status indicators, and adverse events in group B were all significantly better than those in group A (P < 0.05 for all comparisons). Conclusion Combined intervention (propofol + fentanyl + targeted perioperative care) for gynecological laparoscopic surgery patients has a significant anesthesia effect, which can effectively improve the patient's clinical indicators and mental health status and can also reduce the occurrence of adverse events. It has good safety and can be widely used in clinical practice.

Application Status of Enhanced Recovery After Surgery in Perioperative Nursing of Neurosurgery

Enhanced recovery after surgery (ERAS) is a strategy of perioperative management aimed to accelerate the rehabilitation of patients through various optimized perioperative managements as well as ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. ERAS is a good reflection of the perioperative value-based care, which has been widely applied in many surgical fields and shown quick recovery and low morbidity when applied on patients. However, there is a lack of attention on ERAS in neurosurgery. This review aims to describe the current application status of ERAS in neurosurgery and to provide readers with the commonly accepted principles in the perioperative nursing of neurosurgery.

Improved Resource Utilization Using WALANT Hand Surgery in Adolescents.

Cost, efficiency, patient preference, and safety have driven utilization of wide awake, local anesthesia, no tourniquet (WALANT) in hand surgery. This is not well documented in adolescents. We hypothesize that the use of WALANT with adolescents reduced time spent in the operating room (OR) and in the hospital when compared with patients who underwent surgery with traditional anesthesia (TA). After institutional review board approval, we performed a retrospective review of patients aged 10 to 17 who underwent surgery at a regional hospital system including the level 1 pediatric trauma hospital. Operative notes were assessed for use of WALANT. We excluded those operations not traditionally amenable to WALANT. Using a propensity matched cohort, hospital time, OR time, and perioperative complications were recorded and compared to evaluate efficiency and perioperative safety. There were 28 cases in the WALANT group and 28 cases in the TA group after excluding cases not amenable to WALANT, and cases were propensity matched. Although the operative time (incision to closure) was similar, for WALANT patients, the in-room to procedure time (15 vs 22 minutes), procedure end to out-room time (5 vs 10 minutes), total room time (52.81 vs 63.68), and length of hospital stay (222 vs 342 minutes) were shorter than patients in the TA group. Our case series demonstrates time-savings both in the OR and in the hospital overall. Avoiding TA when WALANT is feasible may result in significant savings to hospital systems, patients, and payers while also freeing up anesthesia staff and perioperative nurses.

The Fast Track Surgery in Perioperative Nursing of HoLEP Operation

Objective: The Fast-track surgery for transurethral holmium laser prostatectomy a perioperative nursing research study.&#x0D; Methods: We performed a retrospective analysis of transurethral holmium laser enucleation of the prostate in 89 patients with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) who were admitted to and treated at our hospital between 2018 and 2019. Measures such as early postoperative feeding and early catheter removal, adequate preoperative preparation, psychological counseling, intraoperative warming, unobstructed lavage, ensuring postoperative sleep, indwelling analgesic pump, and prevention and treatment of postoperative complications, as well as a successful job in postoperative health guidance and discharge guidance, were all implemented, and the extubation was performed, during the perioperative period in which advanced fast track surgery was used.&#x0D; Results: All 89 patients who underwent holmium laser enucleation of the prostate made a full recovery, with only one experiencing post-operative recurrent hyphema, five experiencing post-operative urinary tract infection, and ten experiencing transient and urge urinary incontinence; all were discharged after conservative treatment.&#x0D; Conclusion: Using fast track surgery as a guide for perioperative care of HoLEP surgeries might lessen the number of issues that arise after surgery and help patients get back to normal quicker.

Application value of 6S management model in perioperative nursing of dental implants.

Application value of 6S management model in perioperative nursing of dental implants.

Interprofessional Collaboration in the OR: AQualitative Study of Nurses' Perspectives.

Interprofessional collaboration (IPC) in the OR enhances safe and effective patient care. The aim of this qualitative study was to explore perioperative nurses' perspectives on their contributions to IPC. We conducted a secondary analysis of 19 semistructured interviews with perioperative RNs and completed inductive thematic analysis with subsequent categorization of the themes into the Interprofessional Education for Collaborative Patient-Centred Practice Framework. Nurses expressed the importance of being heard through effective communication, feeling confident in their role, being aware of interdependent roles, and sharing a common understanding. From nurses' perspectives, use of structured processes enabled organization of interdisciplinary patient care. Nurses showed leadership skills when they anticipated the needs of the team and recognized they needed support to develop these skills. They contributed to IPC through their shared understanding of common goals, leadership skills in the OR, and active involvement in delivering structured processes.

Using Simulation to Teach the Scrub Person Role to Perioperative Nurses.

Using Simulation to Teach the Scrub Person Role to Perioperative Nurses.

Intraoperative pressure injury and risk factors in long-term surgical interventions

Background: If the operation time is 60 minutes or longer, the patient's risk of pressure injury increases.&#x0D; Aim: This study aims to determine the prevalence and risk factors for intraoperatively acquired pressure injury (IAPI) in patients who underwent surgery for 60 ≥ minutes in a hospital in Turkey.&#x0D; Methods: The research is a cross-sectional, descriptive, prospective design. Data were collected in the perioperative period (N=200). Sociodemographic and Clinical Characteristics Form and 3S intraoperative pressure injury risk assessment scale were used for data collection.&#x0D; Findings: IAPI occurred in 18.0% of participants. In this study, there was a statistically significant correlation with women ([RR: relative risk]:1.242, 95%, CI [confidence interval]: 0.484-3.190) at risk of pressure injury, those with chronic diseases and those who had major surgery (RR: 11.569, 95%, CI: 2.029-65.954). In addition, the patient's position during surgery posed a 2.6 times (95% CI: 0.552-12.674) risk for pressure injury.&#x0D; Based on IRAS score, there was a significant relationship between the time of the operation (RR:2.051, 95% CI: 1.113-3.780), and the intraoperative stress (RR:4.338, 95% CI: 1.815-10.369) for the risk of pressure injury.&#x0D; Conclusion: IAPI remains a significant problem in the operating room. In this study, according to sociodemographic characteristics, being female, having a history of chronic disease and being a candidate for major surgery may cause the intraoperative pressure injury. According to 3S- IRAS, long operative time and high skin stress score may create a significant risk of intraoperative pressure injury. Perioperative nurses should assess the risk of each surgical patient and provide position support for the patient during the surgical procedure.&#x0D; Keywords: Surgery; pressure injury; intraoperative; risk factors; prevalence

Implementation of continuous temperature monitoring during perioperative care: a feasibility study

BackgroundContinuous body temperature monitoring during perioperative care is enabled by using a non-invasive “zero-heat-flux” (ZHF) device. However, rigorous evaluation of whether continuous monitoring capability improves process of care and patient outcomes is lacking. This study assessed the feasibility of a large-scale trial on the impact of continuous ZHF monitoring on perioperative temperature management practices and hypothermia prevention.MethodsA feasibility study was conducted at a tertiary hospital. Participants included patients undergoing elective surgery under neuraxial or general anesthesia, and perioperative nurses and anesthetists caring for patient participants. Eighty-two patients pre and post introduction of the ZHF device were enrolled. Feasibility outcomes included recruitment and retention, protocol adherence, missing data or device failure, and staff evaluation of intervention feasibility and acceptability. Process of care outcomes included temperature monitoring practices, warming interventions and perioperative hypothermia.ResultsThere were no adverse events related to the device and feasibility of recruitment was high (60%). Treatment adherence varied across the perioperative pathway (43 to 93%) and missing data due to electronic transfer issues were identified. Provision of ZHF monitoring had most impact on monitoring practices in the Post Anesthetic Care Unit; the impact on intraoperative monitoring practices was minimal.ConclusionsEnhancements to the design of the ZHF device, particularly for improved data retention and transfer, would be beneficial prior to a large-scale evaluation of whether continuous temperature monitoring will improve patient outcomes. Implementation research designs are needed for future work to improve the complex area of temperature monitoring during surgery. Trial registrationProspective registration prior to patient enrolment was obtained from the Australian and New Zealand Clinical Trials Registry (ANZCTR) on 16th April 2021 (Registration number: ACTRN12621000438853).

Analysis of Perioperative Nursing Intervention Effect of Cerebrovascular Intervention Patients Based on Intelligent Internet of Things.

The postoperative results of cerebrovascular surgery patients have been successfully used in medical practice using the Internet. The results obtained through data analysis were used in the study. So far, 120 patients who underwent cerebrovascular surgery from February 2018 to December 2018 have been enrolled. The selected class was divided into two groups: 60 psychiatric patients, a control group and an observation group. The former is medical treatment and the latter is postoperative treatment. Results: The results showed that the blood pressure of control group was lower than that of control group, and the incidence of adverse events was lower than that of control group (P < 0.05). Meanwhile, the average hospitalization rate of cerebrovascular disease patients in control group was lower than that in control group (P < 0.05). Conclusion: For patients with cerebrovascular disease, postoperative nursing can reduce the incidence of postoperative complications, reduce the risk of surgery, and improve the effect of surgery. Acute ischemic stroke refers to a kind of clinical syndrome caused by abnormal blood supply in the brain, resulting in ischemia, hypoxic brain tissue necrosis, and focal or comprehensive neurological deficiency. Among them, progressive cerebral infarction accounted for about 20~35%, and most occurred in the early stage of the disease (48~72)h.

Evaluation of Perioperative Nursing for Patients with Hepatobiliary Pancreatic Diseases Combined with Diabetes Mellitus Based on Multilayer Perceptron Neural Network

Objective. To analyze the perioperative nursing methods for patients with hepatobiliary pancreatic diseases combined with diabetes mellitus and to evaluate the differences in nursing methods based on a multilayer perceptron (MLP) neural network. Methods. 80 patients with hepatobiliary and pancreatic diseases complicated with diabetes admitted to our hospital from January 2021 to January 2022 were selected as subjects. According to different nursing methods, two groups of hepatobiliary and pancreatic diseases with diabetes were randomly divided into the control group and the experimental group, 40 patients in each group, two groups were given routine nursing care, and the experimental group was given perioperative nursing intervention on the basis of routine nursing. The fasting blood glucose (FBG), postprandial two-hour blood glucose (2hPG), and glycosylated hemoglobin (HbA1c) index of two groups of patients with hepatobiliary pancreatic diseases and diabetes mellitus were observed and compared. The incidence of postoperative complications, the average hospitalization time of patients, and the clinical nursing satisfaction rate of patients were observed and compared. Results. The blood glucose level including FBG, 2hPG, and HbA1c in the experimental group were better than those in the control group, and the data comparison difference was statistically significant ( P &lt; 0.01 ). The incidence of postoperative complications in the experimental group was lower than that in the control group, and the data comparison difference was statistically significant ( P &lt; 0.05 ). The discharge time of patients in the experimental group was significantly shorter than that in the control group, and the satisfaction rate was significantly higher than that in the control group ( P &lt; 0.05 ). The comprehensive analysis based on MLP neural network model confirmed that perioperative surgical nursing can improve the treatment effect of patients. Conclusion. In the perioperative period of patients with hepatobiliary and pancreatic diseases combined with diabetes, the implementation of comprehensive and comprehensive nursing intervention will help to improve the effect of surgical treatment and postoperative recovery.

Doctors’ and Nurses’ Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey

Acupuncture and acupressure are not being systematically used in the management of postoperative nausea and vomiting and pain, despite being included in the guidelines. To examine the beliefs, attitudes, and knowledge of Australian nurses/midwives and doctors toward the perioperative use of AA for the management of postoperative nausea and vomiting and pain; to explore the barriers and enablers influencing acupuncture and acupressure integration into hospital setting. A mixed-mode approach was undertaken for data collection. An online approach was used to recruit respondents from Australian College of Perioperative Nurses. Three hospitals from three different Australian states were selected via convenience sampling. A total of 421 usable surveys were included in data analysis. The respondents comprised 14.3% doctors and 72.9% nurses/midwives. Overall, 69.4% were female, 85% were trained in Australia with 35% and 51.4% having knowledge or personal exposure to AA in general respectively. Over 60% of the respondents agreed AA should be routinely integrated into perioperative care, and over 80% would recommend AA to their patients if it was provided at their hospital, and, 75% would be willing to receive further education. The three main reported barriers included: perceived lack of scientific evidence (80.9%), unavailability of credentialed provider (77.2%) and lack of reimbursement (60.4%). Positive attitudes are reported by Australian doctors and nurses toward AA. This is despite of low levels of knowledge or personal exposure to AA. Further studies are required to explore the implementation of barriers and address respondent calls for further education.

Application Effect of Targeted Complication Nursing in Perioperative Nursing of Pancreaticoduodenectomy

Application Effect of Targeted Complication Nursing in Perioperative Nursing of Pancreaticoduodenectomy

Development and validation of the perioperative care and user participation (POUP) questionnaire.

To validate a Perioperative User Participation questionnaire (POUP) that measures elective adult surgical patient experiences and evaluation of the significance of selected perioperative care items. A generic perioperative user involvement questionnaire (POUP) was developed in the form of four psychometric scales based on the Fundamentals of Care (FoC) framework. The POUP is designed to capture patients' perceived and subjective importance of selected items of perioperative care. It was developed in Danish and comprehensive Danish-Norwegian translations were conducted. Face and content validation were conducted involving patients and expert nurses. The relevance of items was assessed by 68 patients, and the internal consistency of the scales was calculated. Danish and Norwegian patients assessed the POUP's face validity, and perioperative expert nurses reported no problems in clarity or ambiguity. However, a few reformulations of the questionnaire texts were suggested. None of the questions were reported as irrelevant or difficult to answer nor was any topic reported missing. Patients assessed all items as relevant, and the internal consistency for the three scales was between 0.8 and 0.9, and no differences between countries were found. The POUP questionnaire has four scales; the items are valid, but the scales need further statistical validation and refinement. At present, the POUP might provide insight into how elective adult surgical patients value the significance of perioperative care.

Chinese expert consensus on the nursing management of the totally implantable venous access device.

The totally implantable venous access device (TIVAD) has been widely used in clinical nursing work in China. The use of TIVAD has significantly improved the safety of venous access and reduced the pain caused by a repeated puncture; however, it may also bring with it varying degrees of complications associated with the long-term insertion of TIVAD and the maintenance quality of the venous access. Standard maintenance of the venous access for TIVAD is very important for reducing complications and improving the efficacy and patient's quality of life. This consensus briefly describes the fundamental knowledge and operating procedures of TIVAD while focusing on the evaluation and management of perioperative nursing, the observation and treatment of complications, the operation methods, and precautions for maintenance of venous access, as well as health education. This agreement seeks to standardize the nursing care of TIVAD patients in China.

Using Continuous Intraoperative Pressure Mapping to Describe Patterns of Tissue Interface Pressure.

The purpose of this study was to describe patterns of intraoperative tissue interface pressure, identify the amount of time during which the pressure at four anatomical locations exceeded 32mm Hg, and examine associations between patient- and surgery-related variables and peak tissue interface pressure. We used a pressure mapping system to measure the intraoperative tissue interface pressure of 150 patients. We implemented linear mixed-effects models to assess trends in the mean and peak tissue interface pressure. The percentage of time during which the interface pressure exceeded 32mm Hg at the scapulae, interscapular area, and sacral area was 70%, 70%, and 90%, respectively. Body mass index, length of surgery, and intraoperative position were major predictors of increased pressure. Understanding patterns of tissue interface pressure of patients during surgery may help perioperative nurses develop strategies to attenuate pressure and protect skin integrity.

Development of a "Scissor-Tip-Separator" for adjustment of scissor blade separation and prevention of scissor blade damage during steam sterilization

BackgroundReprocess reusable surgical instruments during steam sterilization; damage occurs to sharp scissor blades in close position, so steam cannot reach the blades. Surgical instruments' management requires standards to ensure patient safety and prevent harmful pathogens, especially in the COVID-19 pandemic. Although various devices can separate scissor blades, they do not prevent damage to cutting edges. To address the above problem, we developed a new scissor protector, the "Scissor-Tip-Separator," and evaluated its efficacy.MethodsThe "Scissor-Tip-Separator" design follows the steam sterilization guideline that instrument tips must be separated. The locking handles and V groove mechanism keep the scissor blades separated while preventing damage to the cutting edges. For efficacy assessment, purposive sampling was performed to select 44 Thai perioperative nurses at Ramathibodi Hospital, Bangkok, Thailand, to evaluate the "Scissor-Tip-Separators" in 450 sterile instrument containers. All participants evaluated surgical scissors placed in the "Scissor-Tip-Separators" during instrument setup, following a problem record checklist. At the end of the fifth use, participants were asked to complete the "Scissor-Tip-Separator" Effectiveness Scale, which was used to test the structural design of the "Scissor-Tip-Separator" in terms of function, usability, and safety. The Adenosine Triphosphate surface test was also used to validate the "Scissor-Tip-Separator" cleanliness. Data were collected from August 2020 to November 2020, then analyzed via descriptive statistics.ResultsThe "Scissor-Tip-Separator" met the cleaning validation criteria, and in 44 uses, the physical property remained the same. The scissor shank was discovered loose from the handle before it had been unlocked (0.2–0.4%) at the 45th use. Based on participants' opinions, the overall instrument effectiveness was high in terms of function, usability, and safety.ConclusionThe "Scissor-Tip-Separator" regulates scissor blade separation under sterilization guidelines; it prevents damage to cutting edges, thus ensuring patient safety. It protects against losses in a sterile field and can prevent hand injuries.

Analysis of the Perioperative Nursing Strategy for Single-hole Thoracoscopic Lung Surgery

Analysis of the Perioperative Nursing Strategy for Single-hole Thoracoscopic Lung Surgery