Study on physiological and psychological comprehensive nursing of elderly tumor patients after surgery.

The aim of this study is to formulate nursing schemes for elderly tumor patients after surgery according to their clinical characteristics, and give effective guidance for alleviating the patients’ psychological anxiety. One hundred elderly tumor patients admitted to the oncology department of the Affiliated Cancer Hospital of Harbin Medical University were included and divided into an intervention group (50) and a control group (50). Nursing intervention was performed on the intervention group, and routine nursing was performed in the control group. One day before surgery, all the patients were asked to fill in a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS), and their blood pressure and heart rate data were measured. After surgery, the patients were asked to fill in a form which investigated their pain degree, recovery situation and satisfaction degree. The heart rate and blood pressure of the patients in the intervention group recovered faster than those of the control group, with lower SAS and SDS scores and shorter recovery time. In conclusion, effective nursing intervention played a crucial role in the postoperative recovery of elderly tumor patients by reducing pain and anxiety degrees, which improved the patients’ satisfaction with the nursing.

Surgical count process for prevention of retained surgical items: an integrative review.

AIMS AND OBJECTIVES: To analyse the evidence reported in the literature concerning the surgical count process for surgical sponges, surgical instruments and sharps and to identify knowledge gaps for future research on the surgical count process. BACKGROUND: The surgical count process stands out among the practices advocated by the World Health Organization to ensure surgical safety. The literature indicates that this practice should be performed in all surgical processes. However, surgical items are still retained. DESIGN: Integrative review. METHODS: The literature search was conducted in the PubMed, CINAHL and LILACS databases and included studies on the surgical count process published in English, Spanish and Portuguese from January 2003-December 2013. RESULTS: A total of 28 primary studies were included in the sample, allowing the knowledge on the surgical count process to be summarised and grouped into three categories: risk factors for retained surgical items, how the surgical count process should be performed in the intraoperative period and the accompanying technologies that collaborate to improving the manual count process. CONCLUSIONS: The correct implementation of the surgical count process by the perioperative nurse may contribute to preventing retained surgical items, thereby improving surgical patient safety. RELEVANCE TO CLINICAL PRACTICE: Nurses can use this review to assist in decision-making directed towards preparing, updating and implementing a reliable system for the surgical count process based on recent evidence because the perioperative nurse plays a key role in the implementation of this practice in health services.

Registered nurses' personal responses to postoperative pain: a descriptive qualitative study.

This paper explores if nurses' personal responses to postoperative pain contribute to its continuing poor management. A descriptive qualitative design used a purposive sample of 16 registered nurses (RNs), from inpatient surgical areas in the United Kingdom, to participate in one semistructured interview. These were recorded and transcribed verbatim. Analysis used Morse and Field's four stages. A complex picture of collective and individual responses emerged; uncritical adoption of the medical model, with pain as normal and focus on technical aspects of management conforming to a "reference typology." However, individual RNs were also influenced by other personal factors, and findings indicate that scrutinizing individual competency is essential to improve individual and collective practice.

Preparing the skin for surgery.

In 1867, Joseph Lister wrote this account of how to prepare the skin for surgery: "A solution of one part crystallised carbolic acid in four parts of boiled linseed oil having been prepared, a piece of rag from four to six inches square is dipped in the oily mixture, and laid upon the skin where the incision is to be made." Nearly 150 years later, the science of preoperative skin preparation has grown more sophisticated, but continues to be the cornerstone of evidence-based practices to prevent surgical site infections (SSIs) and promote positive surgical outcomes.

Research on nursing handoffs for medical and surgical settings: an integrative review.

AIMS: To synthesize outcomes from research on handoffs to guide future computerization of the process on medical and surgical units. BACKGROUND: Handoffs can create important information gaps, omissions and errors in patient care. Authors call for the computerization of handoffs; however, a synthesis of the literature is not yet available that might guide computerization. DATA SOURCES: PubMed, CINAHL, Cochrane, PsycINFO, Scopus and a handoff database from Cohen and Hilligoss. DESIGN: Integrative literature review. REVIEW METHODS: This integrative review included studies from 1980-March 2011 in peer-reviewed journals. Exclusions were studies outside medical and surgical units, handoff education and nurses' perceptions. RESULTS: The search strategy yielded a total of 247 references; 81 were retrieved, read and rated for relevance and research quality. A set of 30 articles met relevance criteria. CONCLUSION: Studies about handoff functions and rituals are saturated topics. Verbal handoffs serve important functions beyond information transfer and should be retained. Greater consideration is needed on analysing handoffs from a patient-centred perspective. Handoff methods should be highly tailored to nurses and their contextual needs. The current preference for bedside handoffs is not supported by available evidence. The specific handoff structure for all units may be less important than having a structure for contextually based handoffs. Research on pertinent information content for contextually based handoffs is an urgent need. Without it, handoff computerization is not likely to be successful. Researchers need to use more sophisticated experimental research designs, control for individual and unit differences and improve sampling frames.

Patient safety education: an exploration of student-driven contextual learning.

Medical and nursing students organized a contextual interprofessional learning experience involving observation of surgical safety practices according to the parameters of the World Health Organization (WHO) surgical safety checklist. Students were oriented to patient safety principles, operating room (OR) protocol, and the WHO surgical safety checklist. One hundred thirty students participated in interprofessional OR visitations. Selected students participated in focus groups, during which feedback regarding educational value and OR observations was obtained: Students thought that patient safety education was more meaningful in a clinical setting, and the degree of interprofessional collaboration appeared related to individual factors. Focus group data collected provides a foundation on which future research can build. Areas of inquiry may include development of teamwork within the context of interprofessional education, examination of the role of students in developing their own curricula, and randomized comparisons of clinical-based and classroom-based approaches to surgical safety education.

Diabetes mellitus as a risk factor for surgery-related pressure ulcers: a meta-analysis.

PURPOSE: The purpose of this study was to determine whether diabetes mellitus is associated with increased likelihood of surgery-related (perioperative) pressure ulcers. METHODS: The MEDLINE and Thomson Reuters Web of Knowledge electronic databases were searched for studies of diabetes as a risk factor for surgery-related pressure ulcers in case-control or cohort design; studies were limited to those published in English. Data from studies meeting inclusion criteria were pooled, and a meta-analysis was completed using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Odds ratios for surgery-related pressure ulcers were calculated for patients with and without diabetes mellitus. RESULTS: Six observational studies were identified involving a total of 2453 patients. When compared to patients with normal glucose tolerance, persons with diabetes mellitus were more likely to experience surgery-related pressure ulcers (odds ratio = 2.15; 95% confidence interval: 1.62-2.84). CONCLUSION: Our meta-analysis indicates that patients with diabetes mellitus are slightly more than twice as likely to develop surgery-related pressure ulcers as compared to patients with normal glucose tolerance.

[Descriptive study of the results of nursing interventions applied to surgical patients]. / Pacientes quirúrgicos e intervenciones enfermeras estandarizadas. Estudio descriptivo sobre resultados.

OBJECTIVES: Knowing the evolution of health outcomes of surgical patients during their hospital stay, evaluating NOC outcome criteria at admission and discharge. MATERIAL AND METHODS: Prospective observational study conducted in the surgical hospital wards of the Hospital General de Vic, with patients who required surgical intervention of any specialty, of 18 or more years old and anesthetic risk levels I, II or III. The main outcome variables were indicators associates with each NOC of a standard of care based on the "patient type" concept. RESULTS: Four hundred and six patients participated. Of these, 69 (15%) were operated of the musculoskeletal system and 391 (85%) were operated on the digestive or urinary systems, male/ female genitalia, skin, integuments, and endocrine system. NOC scores high of all patients were maintained or improved, never worse and in all patients the number of falls and recurrent infections was constant, virtually no patient fell or became infected. CONCLUSIONS: The majority of surgical patients at the time of hospital discharge improves or maintain their conditions of admission and patients who never worse substantially.

Medical mission volunteering: Ecuador.

This article discusses a volunteer medical mission of 50 people traveling to Ecuador. Included were surgeons, an anesthesiologist, a gastroenterologist, and an ear, nose, and throat surgeon as well as certified registered nurse anesthetists, registered nurses for pre-, intra-, and postrecovery, a certified registered gastroenterology nurse, and helpers. The focus is on the people involved, starting as strangers, working together, crossing bridges, and helping others in a third world country.

The future of surgical nursing and enhanced recovery programmes.

Patients undergoing surgery in the UK are seeing a rise in the development of enhanced recovery programmes as a result of increasing medical advances. Enhanced recovery is concerned with helping patients get better sooner after an operation by following a meticulous regime of care. The practical application of these programmes is undertaken largely by nurses, despite encompassing explicit, medically-driven protocols. However, beyond the professional knowledge and skills required to aid the programmes, nursing knowledge has contributed little to this rapidly developing aspect of surgery to date. Nursing has much to offer through future creation of centrally coordinated, surgical nursing units focusing on patients' holistic experience. This article will briefly describe enhanced recovery, identify aspects of nursing knowledge that can have a positive influence, and outline practical changes to assist the development of such programmes, thereby benefiting all patients undergoing elective surgery.

[Italian validation of the Patient Satisfaction Scale]. / Misurare la soddisfazione del paziente: validazione della versione italiana della Patient Satisfaction Scale.

Patient's satisfaction is a major outcome of the health care services and it is mainly determined by patients' perception of the nursing care received. Many instruments measuring patients' satisfaction are described in the literature. In this study the validation of the Patient Satisfaction Scale in the Italian context is documented. Content validity of the scale has been reached with forward-backward translation, achieving semantic equivalence with the original scale. The scale has been completed by 220 (response rate 91%) surgical patients during their hospitalization and has showed a good response variability and a high reliability (Cronbach alpha = 0.93). The Italian version of the PSS is considered valid and reliable; moreover the high response rate obtained indicates a good level of acceptability of the scale in clinical settings.

[Surgical emergencies in elderly patients]. / Urgences chirurgicales chez le patient âgé.

Surgical emergencies represent a diverse combination of common and particularly severe pathologies in elderly patients. This severity is due in part to concurrent comorbidities and sometimes atypical clinical presentations, causing delay in diagnosis and treatment.

Best practices for preventing hospital-acquired pressure injuries in surgical patients.

Hospital-acquired pressure ulcers (HAPUs) and deep tissue injuries (DTIs), while considered to be preventable in most cases continue to affect many patients in acute care facilities. Surgical patients have an especially high risk of developing HAPUs for several reasons, including immobility during the intraoperative and immediate postoperative periods. HAPUs are responsible for significant patient harm in the form of pain, increased susceptibility to infection, and delayed recovery. Perioperative nurses must take a proactive and comprehensive approach to protecting their patients from pressure injuries, including HAPUS and DTIs.

Patients with cochlear implants in the OR--issues and concerns.

Safety standards for patients with cochlear implants are difficult to find. Safety standards are, in fact, constantly evolving as more information becomes available. This article provides an overview of current philosophies and guidelines for most medical/surgical interventions, with emphasis on the operating room environment, as indicated by the three manufacturers authorized to market cochlear implants in Canada.

A descriptive study exploring the principles of asepsis techniques among perioperative personnel during surgery.

BACKGROUND: Perioperative nurses are expected to demonstrate strict adherence with asepsis principles to prevent surgical site infections (SSIs) as breaching of these principles poses a serious risk of infection to surgical patients. METHODS: A descriptive survey was conducted with a convenience sample of 87 perioperative personnel to describe self-reported compliance with the principles of asepsis during surgery. PURPOSE: The purpose of this study was to examine the practices of perioperative scrub personnel with surgical asepsis. RESULTS: A sizable percentage of participants indicated that they never or rarely observe breaches in the sterile field during surgery with regards to open suction drain systems (46.6%; n = 41), closed suction drain systems (46.6%; n = 41), suture material (39.7%; n = 35), use of surgical instruments (37.5%; n = 33), and prosthetic implants (56.8%; n = 50). Perioperative scrub RNs were less likely to wear shoe covers during surgical procedures than ORTs (M = 3.42 and 4.17; mdn = 3.00 and 5.00 respectively; p = .026). CONCLUSIONS: The findings showed areas of compliance and noncompliance with the principles of asepsis. Given that the role of the perioperative nurse is paramount in maintaining surgical integrity, and enhancing positive patient outcomes, strict adherence to surgical asepsis is vital to prevent SSIs and other complications.

Understanding the issues experienced by older people undergoing emergency surgery.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration.

Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial.

OBJECTIVE: To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. DESIGN: Multicentre randomised controlled trial. SETTING: 8 acute care hospitals in Canada. PARTICIPANTS: 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. INTERVENTION: Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre's usual care. Patients, healthcare providers, and data collectors were aware of patients' group allocations. Outcome adjudicators were blinded to group allocation. MAIN OUTCOME MEASURES: The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. RESULTS: All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval -0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (-0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. CONCLUSION: Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344665.