Perianesthesia Nurses Research Articles

Reducing Opioid Consumption and Length of Stay After Bariatric Surgery: A Nonpharmacologic ERAS Intervention Bundle

PurposeTo reduce opioid consumption and decrease length of stay (LOS) in bariatric surgical patients by implementing an evidence-based, nonpharmacologic enhanced recovery after surgery (ERAS) intervention bundle. DesignEvidence-based practice project. MethodsWe developed and implemented a nonpharmacologic ERAS bundle from existing American Society of PeriAnesthesia Nurses Standards and bariatric and subspecialty surgical ERAS protocols to standardize the postoperative nursing care of bariatric patients. The bundle consisted of early ambulation, immediate initiation and prolonged use of oxygenation, prevention of nausea and vomiting, frequent use of incentive spirometry, and application of ice packs to surgical sites. The two project outcomes were opioid consumption and patient LOS. We used descriptive statistics to summarize opioid consumption and LOS among surgical bariatric patients at baseline and post intervention and independent samples t tests to determine the statistical significance of pre- or post-LOS changes. FindingsAfter implementing the ERAS bundle in 31 bariatric surgical patients, we found that the percentage of patients given an opioid substantially decreased by 13.8%, with both fentanyl and hydromorphone (Dilaudid) consumption meaningfully decreasing by 11.0% and 25.6%, respectively. The average LOS significantly decreased (P = .015) by 23 minutes per patient following the intervention, from 1 hour and 58 minutes to 1 hour and 35 minutes, representing a 19.5% reduction in total patient time in the PACU. ConclusionsUse of a nonpharmacologic ERAS bundle and standardizing postoperative care decreased overall PACU bariatric surgical patient opioid consumption and significantly reduced PACU LOS. Optimizing pain management for bariatric patients in the PACU could lead to improved pain control and reduced reliance on opioids during their entire hospital stay, enhancing health care outcomes and improving patient safety. Perioperative leaders and educators can use our example to develop initiatives that decrease opioid use and LOS to improve care for the high-acuity bariatric patient population.

When Less is More: De-implement Low-Value Practices in Perianesthesia Nursing Care

When Less is More: De-implement Low-Value Practices in Perianesthesia Nursing Care

Perianesthesia Nursing Management & Safety GeoAnesthesia 2024

Perianesthesia Nursing Management & Safety GeoAnesthesia 2024

Strategies in Promoting and Increasing Certification Among Perianesthesia Nurses

Strategies in Promoting and Increasing Certification Among Perianesthesia Nurses

Feasibility of Auricular Acupressure in Post-Surgery Bariatric Patients to Reduce Food Cravings, Anxiety and Increase Autonomy and Implications for Perianesthesia Nurses

Feasibility of Auricular Acupressure in Post-Surgery Bariatric Patients to Reduce Food Cravings, Anxiety and Increase Autonomy and Implications for Perianesthesia Nurses

Bibliometric Analysis on Cholecystectomy Surgery in the Nursing Field

PurposeThis study aimed to bibliometrically examine nursing publications regarding cholecystectomy surgery. DesignThe study is a bibliometric analysis. MethodsThe study was conducted in the Web of Science database. The keywords “cholecystectomy AND nursing” were used during the scanning. The data were evaluated in quantitative aspects. FindingsIn the study, 481 publications were identified, publications were made between 1987 and 2023, the average number of years since the release of the publication was 10.2, and the annual increase rate was 8.19%. The most active country was the United States, and the journal most often published in was the “Journal of Perianesthesia Nursing.” In the last 3 years, the themes of “meta-analysis, complication, pain, anxiety, quality of life” have been trending, the most working and continuing to develop our “laparoscopic cholecystectomy” and “pain” themes, and the leading theme in the field was “anxiety”. ConclusionsThis study is the first bibliometric study examining nursing studies on cholecystectomy and provides a comprehensive overview of cholecystectomy and nursing issues over 36 years. In quantitative data, it was concluded that although studies in this field have a long history, the number of publications is low, and the annual growth rate is low. According to the quantitative evaluation results, it was found that the most studied topic in this field was laparoscopic cholecystectomy and pain, minimally invasive intervention and perioperative period topics remained isolated, and computerized tomography and gallbladder themes were among the newly emerging themes.

Medical Adhesive-related Skin Injuries Caused by Eye Taping: A Case Report

This case report discusses medical adhesive-related skin injuries (MARSIs) caused by eye taping during an emergency open reduction internal fixation surgery under general anesthesia. The presented case involves a 72-year-old woman with a proximal humeral fracture, where 3M Transpore adhesive tape caused blisters on both eyelids. This tape is an acrylic-based medical adhesive and is commonly used to keep eyelids closed during general anesthesia. MARSIs can largely be prevented through evidence-based clinical guidance. Enhancing awareness of MARSIs among anesthesia providers and perianesthesia nurses is crucial to prevent and manage such injuries effectively.

Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study.

To construct a nursing assessment framework for patients in anaesthesia recovery period. A three-round modified Delphi method was employed to capture the consensus of 22 panellists. The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini-clinical evaluation exercise (mini-CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post-anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History-taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. The assessment framework constructed in this study could be used for the process evaluation of post-anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. No patient or public contribution.

Role-Related Value Conflicts: A Qualitative Study of the Experiences of Perianesthesia Nurse Managers

PurposeValue conflicts with the potential to elicit moral distress are among the factors that contribute to burnout and threaten nurse manager retention. Little is known about the value conflicts faced by nurse managers working in the perianesthesia environment. Using the process model of managerial dissonance and responsibility attribution as a framework of inquiry, this study explored the types of value conflicts experienced by perianesthesia nurse managers and how they worked to reduce the accompanying distress. DesignQualitative, descriptive design. MethodsData were collected by means of semi-structured interviews from 14 participants meeting inclusion criteria. Thematic analysis was used to analyze data. FindingsEleven subthemes were identified and mapped onto the four phases of process model of managerial dissonance: Phase 1 Harm Doing Event: (1) Operational management strategies, (2) Patient care management strategies, (3) Standardized organizational practices; Phase 2 Dissonance: (4) Questioning my leadership, (5) Altered well-being, (6) Just do something; Phase 3 Attribution, (7) Consider organizational viewpoint, (8) Consider role and responsibilities, and Phase 4 Outcomes, (9) Commit to act, (10) Value the organization, and (11) Forgotten by leadership. ConclusionsPerianesthesia nurse managers experience similar types of value conflicts as inpatient nurse managers; however, some aspects of their experiences reflect the uniqueness of their practice environment. The process model of managerial dissonance and responsibility attribution serves as a useful framework for understanding the psychological difficulties and processes by which nurse managers seek to resolve the distress associated with mandated actions likely to induce harm in employees. Executive leaders must act to implement strategies to mitigate the associated psychological difficulties and prevent the increased potential in nurse managers for work-role disengagement and potential exit from the organization.

Postgraduate Developments Among Perianesthesia-Trained Nursing Graduates in Japan: A Cross-Sectional Survey

PurposeTo elucidate the postgraduation situation of those who have completed a perianesthesia nurse (PAN) educational course offered in master’s degree programs in Japan. DesignThis cross-sectional study used an anonymous self-administered questionnaire. MethodsOf the 42 individuals who completed a PAN educational course offered in master’s degree programs in Japan by March 2021, 41 were targeted, excluding the author of this study. The questionnaire was distributed by mail between November 20, 2021, and January 14, 2022, and the participants were asked to return the completed questionnaire by mail. Those working as PANs were asked about their work content, work satisfaction, and thoughts on their prospects in the perianesthesia nursing field. Those not working as a PAN were asked about their future intentions to do so. FindingsThe response rate was 95.1% (39/41). PANs are involved in various perianesthesia tasks, and there were no respondents who answered “No” to the question of whether they were glad to have become a PAN. However, of those working as PANs, only 16 (53.3%) indicated that they would like to continue working in that role. Few respondents (n = 3; 10.0%) considered future PAN prospects to be “good,” while eight (26.7%) respondents answered “poor,” and many (n = 19; 63.3%) stated “neither.” ConclusionsUnder the current situation, PANs in Japan do not necessarily have a positive outlook for the future, the causes for which must be analyzed to make the necessary improvements.

Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

Nursing Best Practice: Safe Use, Storage, and Disposal of Opioid Medications & the Critical Contribution of Perianesthesia Nurses

Nursing Best Practice: Safe Use, Storage, and Disposal of Opioid Medications & the Critical Contribution of Perianesthesia Nurses

PeriAnesthesia Staff RN Participation in Formal Incident-Based Nursing Peer Review: Impact on Perianesthesia Nursing Engagement and Occurrence Reporting

PeriAnesthesia Staff RN Participation in Formal Incident-Based Nursing Peer Review: Impact on Perianesthesia Nursing Engagement and Occurrence Reporting

Effectiveness of Pediatric Competency-Based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses

To evaluate the effectiveness of the American Society of Perianesthesia Nurses (ASPAN) pediatric competency-based orientation (PCBO) education program on knowledge, confidence, and early recognition of nursing expertise among perianesthesia nurses in an acute care setting. A quasi-experimental pre/post survey-intervention design. Sixty perianesthesia nurses with experience ranging from less than 5 years to more than 20 years were included. A chapter review survey was completed to assess knowledge before reviewing the chapters and again after reviewing the ASPAN PCBO materials. A presurvey assessing confidence levels, decision making abilities, and early detection of knowledge regarding pediatric patients' expertise were obtained at the beginning of the study. At the end of the study, a post-study survey was completed to evaluate the effectiveness of the intervention. Random codes were assigned to each participant to ensure that the participants' information was blinded. Perianesthesia nurses' knowledge increased from pre to post intervention with one of the three sets of chapters (Set 2) statistically significant. Perianesthesia nurses' confidence and recognition of nursing expertise scores increased statistically significant from pre to post intervention. Both confidence (with 33 items [P value ≤ .001]) and recognition of nursing expertise (with 16 items [P value ≤ 0.001]) were statistically significant. The ASPAN PCBO was shown to be statistically effective at increasing knowledge, building expertise, promoting confidence, and improving decision making skills. The plan is for the ASPAN PCBO to be incorporated into the new-hire perianesthesia orientation didactic and the competency plan.

Documentation of Assessments and Interventions Using a Pediatric Preoperative Risk Assessment Checklist in the Postanesthesia Care Unit: A Quality Improvement Initiative

PurposeDescribe the impact of the implementation of an evidence-based pediatric preoperative risk assessment (PPRA) checklist on the frequency of postanesthesia care unit (PACU) nursing assessments and interventions in children at risk for respiratory complications during emergence from anesthesia. DesignProspective pre-/postdesign. MethodsPediatric perianesthesia nurses assessed 100 children preintervention according to current standard. After nurses received pediatric preoperative risk factor (PPRF) education, another 100 children were assessed postintervention using the PPRA checklist. Pre-/postpatients were unmatched for statistical purposes due to two different groups. Frequency of PACU nursing respiratory assessments/interventions was evaluated. FindingsDemographic variables, risk factors, frequency of nursing assessments/interventions were summarized in pre-/postinterventions. Significant differences (P < .001) were noted between pre-/postintervention groups with increased frequency of postnursing assessments/interventions that correlated with increased risk factors and weighted risk factors. ConclusionsBy identifying total PPRFs, PACU nurses used their plan of care to frequently assess and pre-emptively intervene with children who had increased risk factors to prevent or mitigate respiratory complications on emergence from anesthesia.

Enhancing the Use of Opioid Sparing Protocol in the PACU

IntroductionOpioids serve as the cornerstone for severe acute post-operative pain management in the PACU. Opioids have been used for their quick onset and efficacy without analgesic ceiling yet have significant side effects. Identification of the problemAcute post-operative pain remains a major problem, resulting in the multiple undesirable outcomes if inadequately controlled. In the PACU setting, opioid use is common as the primary treatment for post-operative pain. Purpose of the studyThe purpose of the study is to assess the impact of the Opioid Sparing Protocol on opioid-naive patients in the PACU post knee and hip arthroplasty. MethodsRetrospective analysis by chart review of 200 comparable cases, from each period, for implementation of the Opioid Sparing Protocol pre-intervention (Q2, 2018) and post-intervention (Q2, 2019). Outcomes/ResultsSignificant increase in the use of Tramadol (+242.86%), along with reduction in the use of Percocet (-44.44%) and Oxycodone (-56.52%) have shown to be effective in providing analgesia and improved patient outcomes. DiscussionThere is an ongoing effort to develop strategies for safe and effective alleviation of post-operative pain. This analysis of comparable cases shows that changes in pain management methodologies can lead to positive results for the patient's surgical experience and post-operative clinical outcome. ConclusionUtilizing the multimodal approach outlined in the Opioid Sparing Protocol provides pain relief while reducing opioid requirements and opioid related events. Effective management of acute pain in the PACU results in reduced PACU length of stay and improved patient outcomes. Implications for peri-anesthesia nurses and future researchAs health care professionals, it is our responsibility to provide safe and effective pain management. Considering the heavy societal cost of the opioid crisis, enhanced pain management addresses opioid misuse. The challenge for the healthcare workforce is to develop new, effective and non-addictive approaches to pain management.

First in Japan: Training Curriculum for Perianesthesia Nurses and Their Clinical Practice

Problem DefinitionJapan is dealing with a superageing society found nowhere else in the world. This problem is provoking other complex issues such as aggravation of patients’ condition, and a shortage of anesthesiologists leading to overwork. Strategies to Address the ProblemAs a solution, our hospital established the PeriAnesthesia Nurse (PAN) for the first time in Japan. Unlike the United States and other developed countries in Europe, Japan did not have a license for nurses specialized in anesthesia. Thus, in collaboration with a graduate school of nursing, our hospital started a perianesthesia nursing course within the advanced practice nurse's training curriculum in 2010. At the graduate school, students take specialized lectures on anesthesia with a curriculum that focuses on risk management. On graduation, they work together with anesthesiologists in the department of anesthesiology and perform anesthesia-related tasks under the medical specialist's supervision. Their main duties include preoperative anesthesiology outpatient, surgical anesthesia, acute pain service (APS) for postoperative periods, and labor analgesia, and they collaborate with various specialists inside and outside of the operating room. Evaluation and ResultsOutcomes of patient care after the introduction of PAN have been observed. PAN provides persuasive explanations and guidance seamlessly to the patients by taking advantage of their experience in anesthesia and the scientific thinking they've acquired in graduate school. This paper reports on the training and clinical practice of perianesthesia nurses in Japan as a measure to improve the quality of perioperative medical care as well as the safety of patients.

Perianesthesia Nursing.

These nurses care for patients before and after surgery.

Military Veterans’ Perspectives on Postoperative Opioid Use: A Secondary Analysis of Qualitative Data

PurposeThis qualitative analysis of interviews with surgical patients who received a brief perioperative psychological intervention, in conjunction with standard medical perioperative care, elucidates patient perspectives on the use of pain self-management skills in relation to postoperative analgesics. DesignThis study is a secondary analysis of qualitative data from a randomized controlled trial. MethodsParticipants (N = 21) were rural-dwelling United States Military Veterans from a mixed surgical sample who were randomized to receive a manual-based, telephone-based Perioperative Pain Self-management intervention consisting of a total of four pre- and postoperative contacts. Semi-structured qualitative interviews elicited participant feedback on the cognitive-behavioral intervention. Data was analyzed by two qualitative experts using MAXQDA software. Key word analyses focused on mention of analgesics in interviews. FindingsInterviews revealed a dominant theme of ambivalence towards postoperative use of opioids. An additional theme concerned the varied ways acquiring pain self-management skills impacted postoperative opioid (and non-opioid analgesic) consumption. Participants reported that employment of pain self-management strategies reduced reliance on pharmacology for pain relief, prolonged the time between doses, took the “edge off” pain, and increased pain management self-efficacy. ConclusionsPerioperative patient education may benefit from inclusion of teaching non-pharmacologic pain self-management skills and collaborative planning with patients regarding how to use these skills in conjunction with opioid and non-opioid analgesics. Perianesthesia nurses may be in a critical position to provide interdisciplinary postoperative patient education that may optimize postoperative pain management while minimizing risks associated with prolonged opioid use.

Association Between Patient Satisfaction and Preoperative Task-Shifting From Anesthesiologists to Perianesthesia Nurses: A Questionnaire Survey Study

PurposeWe examined whether patients’ satisfaction improved when patients’ preoperative consultations were conducted with perianesthesia nurses (PANs) in collaboration with anesthesiologists, as compared with preoperative consultations conducted by anesthesiologists only. DesignWe conducted a study using questionnaires regarding outpatient satisfaction among patients who visited the perioperative management department of Yokohama City University Medical Center between July and December 2018. MethodsThere were 1,595 outpatients during the survey period. After exclusion criteria were applied, we analyzed 590 valid responses. FindingsRegarding the level of understanding, 96.9% of the patients in the nurse-and-anesthesiologist group and 95.6% of the patients in the anesthesiologist-only group answered, “easy to understand,” indicating no significant difference. A reduction in concerns, worries, and anxiety was reported by 86.3% of the patients in the nurse-and-anesthesiologist group and 70.4% in the anesthesiologist-only group, indicating a significant difference. Furthermore, 94.1% of the patients in the nurse-and-anesthesiologist group and 87.9% in the anesthesiologist-only group indicated patients’ satisfaction with the overall evaluation, indicating another significant difference. A multiple logistic regression analysis was conducted to analyze the anxiety reduction and overall evaluation. We uncovered significant differences in PANs’ examinations regarding anxiety reduction and overall evaluation. ConclusionsCollaboration between anesthesiologists and PANs might be associated with satisfaction and reduced anxiety in preoperative patients without adversely affecting patients’ comprehension of anesthesia. Further research is necessary to verify the impacts of PANs’ involvement in anesthesia patient care on intra and postoperative patient outcomes and on the cost and efficiency of anesthetic care.