RESUMO
INTRODUCTION: The purpose of this article is to explain the role of urology nurse in prehabilitation and same-day discharge programs for robotic radical prostatectomy. METHODS: This article is based on the analysis of the literature and the experience of our center. RESULTS: In order to prepare patients for outpatient surgery, urology nurse plays a key role during prehabilitation journeys. Two weeks before the operation, the healthcare teams (nurses, anesthetists, physiotherapists, etc.) organize workshops to explain to patients the operation course and post-operative care in order to allay any anxieties. Individual and group interviews, in specific workshops (compression stockings, urinary catheter, sexology) are organized in particular with urology nurse to answer all patients' questions. In association with enhanced recovery after surgery pathway, these programs improve the patient experience and satisfaction as well as peri-operative outcomes, and allows the development of an outpatient surgery program which currently represents approximately one third of surgeries. CONCLUSION: The implementation of perioperative protocols including prehabilitation improves the early results of robotic total prostatectomy, but also the patient experience. The urology nurse has a key role to play during these patient education days and in the preparation, information, support and follow-up of the patient, since the prehabilitation journey until the patient leaves the outpatient clinic.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Enfermagem em Nefrologia , Papel do Profissional de Enfermagem , Alta do Paciente , Exercício Pré-Operatório , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Ambulatórios/enfermagem , HumanosRESUMO
PURPOSE: To verify the feasibility of the clinical-based discharge (CBD) criteria and identify the reasons of long postanesthesia care unit length of stay (PACU-LOS) for ophthalmic ambulatory surgical patients under general anesthesia. DESIGN: A prospectively observational study conducted at a tertiary eye center in China. METHODS: Medical records were collected from patients admitted for strabismus ambulatory surgery under general anesthesia from September 2018 to March 2019. The patients were discharged home once met the CBD criteria based on a combination of the modified Aldrete's scoring system and Chung's Post-Anesthetic Discharge Scoring System. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate logistic regression was applied to identify the factors relating to late discharges. FINDINGS: All patients (N = 400) were safely and successfully same-day discharged home as none of the patients informed severe emergency events or unanticipated readmission. Nine displayed discharge delays mainly because of mild postoperative nausea and vomiting (PONV) although met the discharge criteria. About 85.5% of patients were discharged within a PACU-LOS of 150 minutes, 379 (94.8%) were within 180 minutes, and the cutoff time in PACU-LOS was 150 minutes. Multivariable analysis indicated that sevoflurane anesthesia and the presence of PONV were related to late discharges (PACU-LOS of greater than 150 minutes, all P < .05). CONCLUSIONS: The CBD criteria can efficiently and safely guide the ophthalmic ambulatory surgical patients to discharge home on the same-surgery day, whereas sevoflurane anesthesia and the presence of PONV are associated with a relatively long PACU-LOS.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Alta do Paciente , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , China , Humanos , Tempo de InternaçãoRESUMO
INTRODUCTION: Pediatric tracheostomy patients are a medically complex population with increased incidence of emergency room use, hospital readmission, tracheostomy-associated complications, and caregiver anxiety, especially within 30 days after discharge. METHOD: The specific aims of this quality improvement initiative include using a nurse-led, interprofessional care team to improve access to care with creation and implementation of a hospital-based discharge protocol and adoption of telehealth follow-up care for newly placed tracheostomy tubes. RESULTS: Telehealth was accessible for patients living more than 150 miles from the primary clinical site. Caregiver knowledge, satisfaction, self-efficacy, and competence in tracheostomy skills increased after protocol implementation. Outcomes included no tracheostomy-associated complications, emergency room visits, or unnecessary hospitalizations. DISCUSSION: Evaluation of this initiative showed promise telehealth was effective in supporting caregivers and refining proficiency caring for tracheostomy-dependent children. This facility's experience with nurse-led telehealth found it to be an accessible, affordable, and valuable health-care service .
Assuntos
Procedimentos Cirúrgicos Ambulatórios/enfermagem , Profissionais de Enfermagem Pediátrica , Melhoria de Qualidade , Telemedicina/métodos , Traqueostomia/enfermagem , Procedimentos Cirúrgicos Ambulatórios/métodos , Criança , Acessibilidade aos Serviços de Saúde , Humanos , Equipe de Assistência ao Paciente , Texas , Traqueostomia/métodosRESUMO
O emergente progresso tecnológico associa-se a um aumento substancial dos procedimentos cirúrgicos nas pessoas idosas. Para esta população, o principal benefício da cirurgia em contexto ambulatório (CA) advém da possibilidade em manter ou melhorar a sua independência e evitar o declínio funcional, facilitando a sua recuperação em meio familiar. Esta realidade impôs novos desafios e constrangimentos quer às equipas profissionais quer à pessoa idosa e família. Urge dar respostas atempadas e concertadas ao maior número possível de pessoas no menor espaço de tempo, incentivando os profissionais de enfermagem a assumir um papel cada vez mais ativo e de maior responsabilidade, na componente educativa subjacente aos cuidados prestados em CA. Neste âmbito, surge a implementação de um projeto visando desenvolver competências na área de prestação de cuidados à pessoa idosa e família em diversos contextos e, implementar uma intervenção de enfermagem sistematizada na consulta de enfermagem pré-operatória à pessoa idosa e família submetida a cirurgia em contexto ambulatório. A metodologia escolhida foi o trabalho de projeto, fundamentado no quadro concetual de Collière e teoria das transições de Meleis. Desenvolveu-se uma intervenção estruturada, que se materializou com a elaboração de um instrumento de avaliação multidimensional da pessoa idosa e família submetida a cirurgia de ambulatório e a sua implementação na consulta de enfermagem pré-operatória, bem como um guia orientador para dar suporte à equipa de enfermagem. Como principais etapas, evidenciamos: construção de um questionário para identificação de necessidades formativas; sessões de formação; aplicação do instrumento em consulta de enfermagem; auditorias e análise descritiva simples dos dados obtidos. Esta trajetória possibilitou a implementação do instrumento na consulta de enfermagem e a uniformização dos registos de enfermagem neste âmbito. Por limitação temporal não se obteve a aplicação sistemática do instrumento de avaliação, contudo pretendemos prosseguir com o trabalho realizado, dinamizando e motivando a equipa para a efetivação desta boa prática, dando assim continuidade um processo de mudança rumo à melhoria da qualidade e à obtenção de ganhos em saúde. O percurso realizado permitiu o desenvolvimento de competências especializadas no cuidado à pessoa idosa e família.
Emerging technological progress is associated with a substantial increase in surgical procedures in elderly people. For this population, the main benefit of surgery in an outpatient setting (AC) comes from the possibility of maintaining or improving their independence and avoiding functional decline, facilitating their recovery in a family environment. This reality imposed new challenges and constraints both on professional teams and on elderly people and their families. There is an urgent need to provide timely and concerted responses to the greatest number of people possible in the shortest possible time, encouraging nursing professionals to take on an increasingly active and more responsible role in the educational component underlying the care provided in CA. In this context, the implementation of a project aims to develop skills in the area of ââproviding care to elderly people and families in different contexts and to implement a systematized nursing intervention in the pre-operative nursing consultation for elderly people and families undergoing surgery in outpatient context. The chosen methodology was project work, based on Collière's conceptual framework and Meleis' theory of transitions. A structured intervention was developed, which materialized with the development of a multidimensional assessment instrument for elderly people and families undergoing outpatient surgery and its implementation in the pre-operative nursing consultation, as well as a guidance guide to support the nursing team. The main steps include: construction of a questionnaire to identify training needs; training sessions; application of the instrument in nursing consultations; audits and simple descriptive analysis of the data obtained. This trajectory made it possible to implement the instrument in nursing consultations and standardize nursing records in this area. Due to time limitations, the systematic application of the evaluation instrument was not achieved, however we intend to continue with the work carried out, energizing and motivating the team to implement this good practice, thus continuing a process of change towards improving quality and obtaining health gains. The path taken allowed the development of specialized skills in caring for elderly people and their families.
Assuntos
Idoso , Idoso , Procedimentos Cirúrgicos Ambulatórios , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Enfermagem GeriátricaRESUMO
OBJECTIVE:: To identify the predominant chronotype in nursing workers who work in surgical clinics of university hospitals and to verify the association with work shift. METHOD:: Cross-sectional study, performed in surgical clinics of university hospitals in the Southern region of Brazil. The sample of 270 nursing workers answered questions of socio-occupational characterization, of health and the Morningness-Eveningness Questionnaire of Horne and Östberg. We performed a descriptive and bivariate analysis with the help of the SPSS software and confidence interval of 95%. RESULTS:: The indifferent chronotype predominated (45.2%). There were significant differences between occupational categories and variables "age" (p<0.001), "use of medication" (p=0.035) and "choice of work shift" (p=0.001). There was an association between the chronotype and the variables "work leave due to illness" (p=0.021), "children" (p=0.025), "use of medication" (p=0.018) and "work shift" (p=0.001). CONCLUSION:: The chronotype remained indifferent, and the results confirmed association between chronotype and work shift. OBJETIVO:: Identificar o cronotipo predominante em trabalhadores de enfermagem que atuam em clínicas cirúrgicas de hospitais universitários e verificar associação com o turno de trabalho. MÉTODO:: Estudo transversal, realizado em clínicas cirúrgicas de hospitais universitários da região Sul do Brasil. A amostra de 270 trabalhadores de enfermagem respondeu questões de caracterização sociolaboral, de saúde e o Questionário de Matutinidade-Vespertinidade de Horne e Östberg. Realizou-se análise descritiva e bivariada com auxílio do software SPSS e intervalo de confiança de 95%. RESULTADOS:: Predominou o cronotipo indiferente (45,2%). Houve diferença significativa entre as categorias profissionais e as variáveis "idade" (p<0,001), "uso de medicação" (p=0,035) e "opção pelo turno de trabalho" (p=0,001). Foi identificada associação entre o cronotipo e as variáveis "afastado do trabalho por motivo de doença" (p=0,021), "filho(s)" (p=0,025), "uso de medicação" (p=0,018) e "turno de trabalho" (p=0,001). CONCLUSÃO:: Predominou o cronotipo indiferente, e os resultados confirmaram a associação entre cronotipo e turno de trabalho.
Assuntos
Instituições de Assistência Ambulatorial , Ritmo Circadiano , Pessoal de Saúde/psicologia , Jornada de Trabalho em Turnos/psicologia , Adulto , Idoso , Instituições de Assistência Ambulatorial/tendências , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Procedimentos Cirúrgicos Ambulatórios/psicologia , Procedimentos Cirúrgicos Ambulatórios/normas , Brasil , Estudos Transversais , Feminino , Hospitais Universitários/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Psicometria/instrumentação , Psicometria/métodos , Jornada de Trabalho em Turnos/efeitos adversos , Fatores Socioeconômicos , Inquéritos e Questionários , Recursos HumanosRESUMO
ABSTRACT Objective: To identify the predominant chronotype in nursing workers who work in surgical clinics of university hospitals and to verify the association with work shift. Method: Cross-sectional study, performed in surgical clinics of university hospitals in the Southern region of Brazil. The sample of 270 nursing workers answered questions of socio-occupational characterization, of health and the Morningness-Eveningness Questionnaire of Horne and Östberg. We performed a descriptive and bivariate analysis with the help of the SPSS software and confidence interval of 95%. Results: The indifferent chronotype predominated (45.2%). There were significant differences between occupational categories and variables "age" (p<0.001), "use of medication" (p=0.035) and "choice of work shift" (p=0.001). There was an association between the chronotype and the variables "work leave due to illness" (p=0.021), "children" (p=0.025), "use of medication" (p=0.018) and "work shift" (p=0.001). Conclusion: The chronotype remained indifferent, and the results confirmed association between chronotype and work shift.
RESUMEN Objetivo: Identificar el cronotipo predominante en trabajadores de enfermería que actúan en clínicas quirúrgicas de hospitales universitarios y verificar asociación con el turno de trabajo. Método: Estudio transversal realizado en clínicas quirúrgicas de hospitales universitarios de la región sur de Brasil. La muestra de 270 trabajadores de enfermería respondió cuestiones de caracterización sociolaboral, de salud y el Cuestionario de Matutinidad-Vespertinidad de Horne y Östberg. Se realizó un análisis descriptivo y bivariado con ayuda del software SPSS y un intervalo de confianza del 95%. Resultados: Predominó el cronotipo intermedio (45,2%). Se observó una diferencia significativa entre las categorías profesionales y las variables "edad" (p <0,001), "uso de medicación" (p = 0,035) y "opción por el turno de trabajo" (p = 0,001). Se identificó asociación entre el cronotipo y las variables "alejado del trabajo por motivo de enfermedad" (p = 0,021), "hijo (s)" (p = 0,025), "uso de medicación" (p = 0,018) y "turno de trabajo" (p = 0,001). Conclusión: Predominó el cronotipo intermedio, y los resultados confirmaron la asociación entre cronotipo y turno de trabajo.
RESUMO Objetivo: Identificar o cronotipo predominante em trabalhadores de enfermagem que atuam em clínicas cirúrgicas de hospitais universitários e verificar associação com o turno de trabalho. Método: Estudo transversal, realizado em clínicas cirúrgicas de hospitais universitários da região Sul do Brasil. A amostra de 270 trabalhadores de enfermagem respondeu questões de caracterização sociolaboral, de saúde e o Questionário de Matutinidade-Vespertinidade de Horne e Östberg. Realizou-se análise descritiva e bivariada com auxílio do software SPSS e intervalo de confiança de 95%. Resultados: Predominou o cronotipo indiferente (45,2%). Houve diferença significativa entre as categorias profissionais e as variáveis "idade" (p<0,001), "uso de medicação" (p=0,035) e "opção pelo turno de trabalho" (p=0,001). Foi identificada associação entre o cronotipo e as variáveis "afastado do trabalho por motivo de doença" (p=0,021), "filho(s)" (p=0,025), "uso de medicação" (p=0,018) e "turno de trabalho" (p=0,001). Conclusão: Predominou o cronotipo indiferente, e os resultados confirmaram a associação entre cronotipo e turno de trabalho.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Ritmo Circadiano , Pessoal de Saúde/psicologia , Instituições de Assistência Ambulatorial/tendências , Jornada de Trabalho em Turnos/psicologia , Psicometria/instrumentação , Psicometria/métodos , Fatores Socioeconômicos , Brasil , Estudos Transversais , Inquéritos e Questionários , Recursos Humanos , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/psicologia , Jornada de Trabalho em Turnos/efeitos adversos , Hospitais Universitários/organização & administração , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologiaAssuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente , Cuidados Pré-Operatórios/enfermagem , Cuidados Pré-Operatórios/psicologia , Liberação de Cirurgia/enfermagemRESUMO
BACKGROUND: Counselling for day surgery patients is one of the core components for a knee or shoulder arthroscopy patient to succeed in self-care. AIM: This cross-sectional study examined the quality of counselling given to patients (n = 86) during their day surgery, using the Counselling Quality Instrument (CQI). METHODS: The data were analysed using basic and multivariate statistical methods. RESULTS: Most respondents were male and aged over 50 years. Almost all knee and shoulder arthroscopy patients were satisfied with the counselling given on follow-up and rehabilitation as well as the counselling given relating to wound and pain treatment. There was a lack of patient-centred and goal-oriented counselling, although interaction during counselling was good. Counselling was perceived as providing benefit in regard to a patient's self-care, emotions and knowledge. Respondents aged below 40 years were more dissatisfied with counselling for day surgery than those aged 40 years and over. CONCLUSION: This study identified a need to train healthcare staff in patient-centred and goal-oriented counselling. Counselling with people who are aged below 40 years should take account of patients' specific concerns.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/enfermagem , Artroscopia/enfermagem , Aconselhamento/normas , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Artropatias/enfermagem , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Assistência Centrada no Paciente , Qualidade da Assistência à Saúde , Autocuidado , Adulto JovemRESUMO
Aim To develop and evaluate the use of a specific picture book aiming to prepare children for anaesthesia and surgery. Methods An intervention comparing two different information methods before ear, nose and throat day surgery was performed. The intervention involved using a specific information sheet and a specific picture book. Parents (n=104) of children aged 2-12 years completed open-ended questions that were analysed with qualitative content analysis. They were divided into two groups: one group received routine information and one received routine information and the intervention. Findings The picture sheet and picture book were valuable aids to prepare small children for anaesthesia and surgery by explaining the procedures that would take place. The parents expressed that knowledge of the procedures made them and the child feel secure. Conclusion Peri-operative information through pictures supports children and their parents during day surgery and may be helpful in future healthcare visits.
Assuntos
Adenoidectomia/enfermagem , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Ansiedade/enfermagem , Livros , Educação de Pacientes como Assunto/métodos , Enfermagem Pediátrica , Cuidados Pré-Operatórios/enfermagem , Tonsilectomia/enfermagem , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pais , Pesquisa QualitativaRESUMO
PURPOSE: The objective of this study was to evaluate children's postoperative symptoms at home after outpatient surgery through nurse-led telephone counseling and the effects of the nurse-led telephone counseling on parents' state-trait anxiety scores. DESIGN AND METHODS: In this prospective randomized controlled study, nurse-led telephone counseling was provided every day to parents in the intervention group until they came for the follow-up visit. Parents of children (n = 54) ages 3-17 years who had undergone outpatient surgery for appendicitis, cholecystectomy, or ovarian cysts were eligible to participate in the study. On the first postoperative day and at the follow-up visit, the Spielberger State-Trait-Anxiety Inventory (STAI) was administered to parents who were randomly allocated to the intervention (n = 24) and control groups (n = 30). RESULTS: The parents reported on postoperative symptoms such as pain, activity levels, excretion, sleep, nutrition, and wound infection. While there was no difference in STAI scores for parents between the groups at the first postoperative day, there was a significant decrease in STAI scores in the intervention group versus the control group, with parents in the intervention group reporting lower anxiety scores. PRACTICE IMPLICATIONS: Our results suggest that nurse-led telephone counseling is effective at reducing anxiety in parents of children after outpatient surgery.
Assuntos
Ansiedade/etiologia , Cuidadores/psicologia , Serviços de Assistência Domiciliar , Pais/psicologia , Cuidados Pós-Operatórios/psicologia , Complicações Pós-Operatórias/enfermagem , Telemedicina/métodos , Adolescente , Adulto , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Criança , Pré-Escolar , Aconselhamento , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , TelefoneRESUMO
AIMS AND OBJECTIVES: The aim was to describe the moods experienced by people waiting for day surgery. BACKGROUND: Except for anxiety, there is a lack of knowledge about the moods experienced by patients while waiting for day surgery, as well as the impact of mood during the perioperative period. Preoperative anxiety is common and has multiple negative effects. A deeper knowledge of preoperative moods and how they are experienced is needed and may be useful for improving perioperative care. DESIGN: Qualitative descriptive design. METHODS: Qualitative semi-structured interviews (n = 20) with adults waiting for day surgery in a Swedish university hospital. Data were analysed with inductive content analysis. RESULTS: The informants described a variety of moods and mood-influencing reasons. The main category that emerged was, 'feeling hope about regaining health as a help to balance mood' regardless of mood. This category was abstracted from the generic categories 'experiencing a harmonious mood' and 'experiencing a shifting mood'. The subcategories were 'feeling calm and at ease despite concerns and fear,' 'experiencing expectation,' 'feeling trust and confidence,' 'shifting between expectancy and anxiety,' 'feeling vulnerable and exposed, and 'feeling uncertainty'. CONCLUSIONS: The findings contribute to the knowledge about that regardless of mood, feeling hope about regaining health may help patients to balance their mood during the waiting period. RELEVANCE TO CLINICAL PRACTICE: The results can have implications with respect to developing and improving preoperative care, such as having clinicians extend offers of individual assistance and information during the waiting period to patients experiencing shifting mood. Instilling hopefulness in patients who are waiting for day surgery by means of clinical staff attitudes and interactions may help patients to develop healthy coping strategies and thereby improve their physical and emotional well-being.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/psicologia , Ansiedade/psicologia , Pacientes/psicologia , Listas de Espera , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Feminino , Hospitais Universitários , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Suécia , IncertezaRESUMO
BACKGROUND: Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION: Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS: An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS: Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION: The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Alta do Paciente/tendências , Intervenção Coronária Percutânea/enfermagem , Fatores de Tempo , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Procedimentos Cirúrgicos Ambulatórios/normas , HumanosRESUMO
OBJECTIVE: This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients. METHODS: A sample of 104 patients undergoing general ambulatory surgery was randomly assigned to the intervention (IG) and the control (CG) groups. Before surgery, the IG received personalized information through an empathic patient-centered interview. The CG received standardized information on surgical procedures. Anxiety was assessed before and after the preoperative interview and after the surgery. Wound healing, post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery. RESULTS: The two groups were identical at baseline regarding anxiety, socio-demographic and clinical characteristics. After the patient-centered intervention, the IG showed lower levels of preoperative anxiety (p<0.001) and pain (p<0.001), better surgery recovery (p<0.01) and higher levels of daily activity (p<0.001) and of satisfaction with the information received (p<0.01) than the CG. The IG also showed better wound healing (tissue type, p<0.01; local pain, p<0.01). CONCLUSION: An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery, wound healing and patient satisfaction. PRACTICE IMPLICATIONS: This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical contexts.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/psicologia , Ansiedade/prevenção & controle , Empatia , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Assistência Centrada no Paciente , Cuidados Pré-Operatórios/métodos , Adulto , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Fatores Socioeconômicos , Estresse Psicológico/prevenção & controle , Resultado do TratamentoRESUMO
Day surgery articulates strongly the dimensions of time, space and work organisation. This modifies the nursing practice itself, the visibility and the recognition of the tasks: maintaining the flow of the pathways, monitoring, informing the patient and seeing to their comfort.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/enfermagem , Enfermagem Perioperatória/organização & administração , França , HumanosRESUMO
AIMS AND OBJECTIVES: To investigate aspects of care potentially most influencing home recovery following day surgery. BACKGROUND: Elective surgery undertaken on a day-case basis is expanding. Many medical aspects of recovery have been investigated although less is known about the psychosocial view of postdischarge recovery. Greater insight into such issues is required for the development of a more coordinated nurse-led approach. DESIGN: Cross-sectional questionnaire. METHOD: As part of a larger study, questionnaires were distributed to 2401 adult patients on the day of operation (September 2010-October 2011) to examine patients' experiences of psychosocial recovery. Participants were requested to complete and return the questionnaire by mail one week after surgery with 684 returned. RESULTS: Eighty-five per cent were fully prepared for all events during home recovery. Satisfaction with pre- and postoperative surgical information was high although less so anaesthetic information. Using factor analysis, preoperative information, pain management, postdischarge information, anxiety management, postoperative nausea and vomiting, help and rest once home were central features. Multiple regression analysis demonstrated pre- and postoperative information provision to have a statistically significant positive association with patients' being 'fully prepared for all events during home recover'. Unsatisfactory pain management, increased anxiety and reduced help once home had a statistically significant negative association with patients' being 'fully prepared for all events during home recovery'. CONCLUSION: Focusing on the delivery of surgical and anaesthetic information, managing pain and anxiety and ensuring support once home may help to enhance recovery. A more comprehensive plan embracing such aspects could help enhance the day surgery patients' experience. RELEVANCE TO CLINICAL PRACTICE: Increased satisfaction and surgical/anaesthetic information are central to the continued success of minimal-stay surgery. A broader hospital/home strategy is required as too frequently nursing care can become fragmented between the preoperative outpatient visit, preassessment, day of surgery and postoperative outpatient visit.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/reabilitação , Educação de Pacientes como Assunto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/enfermagem , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Recuperação de Função Fisiológica , Inquéritos e Questionários , Adulto JovemRESUMO
UNLABELLED: As financial pressures drive health care to be more cost-effective and efficient, performing procedures outside the main operating room (MOR) is becoming more common. Pediatric sedation units (PSU) have proven both effective and safe at providing anesthesia for children. However, there is limited data available regarding the PSU and its potential application in pediatric otolaryngology. OBJECTIVE: To evaluate the experience of performing pediatric outpatient procedures in a PSU through a parental satisfaction survey. METHODS: Pediatric otolaryngology procedures performed in the PSU were prospectively recorded in a database. A prospective survey analysis was performed that measured parental satisfaction with scheduling/registration for surgery, nursing care, surgeon care, facility environment, timing/duration, and overall satisfaction. Parents completed this survey for outpatient procedures performed in either the PSU or in the MOR. The same attending surgeon was involved in all cases, with the only independent variable being the location of the surgery. Fifty surveys were collected for each group, and the surveys scores were statistically compared using nonparametric statistical analysis. RESULTS: Parental satisfaction was high in both the PSU and OR, with mean overall satisfaction scores of 4.8 and 4.9 (respectively) on an ordinal scale from 1 to 5. Parents reported greater clarity in preoperative information in the MOR (mean 4.8) compared to the PSU (mean 4.6) (p<0.006). Also, parents reported that MOR procedures started on time more often than those in the PSU (90-64%, p<0.002). There were no significant differences between locations in any other survey metrics, with mean satisfaction scores ranging from 4.5 to 5.0. CONCLUSIONS: The PSU is a satisfactory patient experience for outpatient procedures in pediatric otolaryngology at our institution. However, this parent survey has identified education prior to surgery and timeliness of surgery as two areas to improve to meet the satisfaction standard provided by the OR.
Assuntos
Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/normas , Otolaringologia , Pais , Satisfação do Paciente , Pediatria , Instituições de Assistência Ambulatorial/organização & administração , Procedimentos Cirúrgicos Ambulatórios/enfermagem , Anestesia , Agendamento de Consultas , Criança , Ambiente de Instituições de Saúde , Humanos , Salas Cirúrgicas/organização & administração , Educação de Pacientes como Assunto/normas , Estudos Prospectivos , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: Patients recovering from outpatient surgery are responsible for managing their pain, managing ambulation, and even implementing thromboembolism prophylaxis after discharge. Because of the importance of postoperative care to prevent complications, a model of care that helps a patient transition to independent self-care could provide optimal results. OBJECTIVES: The authors investigated the safety and morbidity rate for patients who underwent body contouring procedures and overnight care at an attached, nurse-staffed guest suite facility. METHODS: A retrospective review was conducted of 246 patients who underwent major body contouring and who stayed at least 1 night in the guest suite facility. Major complications included a return to the operating room within 48 hours, major wound infection, and unplanned hospitalization within 48 hours. Minor complications included any postsurgical effect necessitating unplanned physician intervention within the first 30 days. Univariate analyses correlating patient characteristics and complication rates were conducted, as well as comparison of complication rates among same procedures reported in the literature. RESULTS: The complication rate (major and minor complications) was 25.20%. Surgical site infection occurred in 8.13% of patients. The most common wound complication was erythema around the incision site (12.20%). Death, deep vein thrombosis, or pulmonary embolism did not occur. Comparison with relevant results reported in the literature indicated a significant reduction in the occurrence of postoperative venous thromboembolism. CONCLUSIONS: Patient education after surgery is essential to healing and adequate care. The guest suite model provides improved care and education for the patient and family postsurgery by addressing some of the known risk factors of plastic surgery. LEVEL OF EVIDENCE: 4.