Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme.

The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.

Nurses' evidence-based practice competence and hospital practice environment after specific training under the Best Practice Spotlight Organization® Programme. A cross sectional study.

BACKGROUND: Barriers to implementing training strategies for the improvement of evidence-based practice competence of nurses in hospital practice environments still persist. OBJECTIVE: The aim of the study was to evaluate the impact of a specific training within the framework of the Best Practice Spotlight Organization® programme, on nurses' evidence-based practice competence and the practice environment in two hospitals. DESIGN: This is a observational cross-sectional study assessing evidence-based practice competence and perceptions of Practice Environments. PARTICIPANTS: The study sample were 204 nurses working at medical and surgical inpatient units at two hospitals involved in the Best Practice Spotlight Organization® programme. METHODS: The study was conducted from February 2020 to May 2020. Three questionnaires were used to collect data: a sociodemographic/occupational questionnaire, a questionnaire exploring evidence-based practice skills, and a questionnaire exploring nurses' perceptions of their hospital practice environments. RESULTS: A total of 204 nurses participated. They were classified into two groups: those who had received specific training within the framework of the programme, called trained-champions (n = 66), and those who had not yet received training, control group (n = 138). The trained-champions exhibited better evidence-based practice competence values than the control group in all dimensions (p < 0.001), with a higher difference in means in the "Utilisation" dimension (-0.80; CI:-0.99,-0.60) and the "Knowledge" dimension (-0.63; CI:-0.88,-0.38). Trained-champions also had a more positive perception of the practice environments than the controls in all dimensions (p ≤ 0.001). The largest differences in means were in the "Participation" dimension (-0.48; CI:-0.66,-0.31) and in the "Leadership" dimension (-0.41; CI:-0.59,-0.23). CONCLUSIONS: Specific EBP training within the framework of the Best Practice Spotlight Organization® programme has succeeded in nurses (trained-champions) obtaining better EBP competence than others without this training. This could have contributed to increase nurses' abilities to integrate evidence into decision making in their clinical practice, while positively influencing them to perceive their PEs more favorably.

The influence of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery.

Patients undergoing cardiac surgery represent a challenge in terms of pain management due to multiple factors relating to the patients and to the procedure itself. Our aim was to identify the influence of levels of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery and explore associations between preoperative anxiety, postoperative pain, analgesic requirements, and sex. We present a prospective cohort study of 116 patients undergoing cardiac surgery between January and April 2020. Preoperative anxiety was evaluated using the State-Trait Anxiety Inventory and the amount of morphine needed to keep pain intensity below 4 on the verbal numerical rating scale was recorded for 48 h post-surgery. Given the extracorporeal circulation time, type of surgery and body surface, it was observed that every percentile increase in preoperative state anxiety led to an extra 0.068 mg of morphine being administered. For each extra year of age, the amount of morphine needed decreased by 0.26 mg, no difference was observed between men and women in terms of preoperative anxiety or postoperative analgesics requirements. It may be concluded that in cardiac surgery, postoperative analgesic requirements increased with higher levels of preoperative state anxiety and decreased for every extra year of age.