Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery.

ABSTRACT: Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery.

Cuidados de enfermería al paciente trasplantado renal período pre-operatorio, pos trasplante inmediato y temprano en la Unidad de Trasplante Renal del Hospital de Especialidades Carlos Andrade Marín / Nursing care of the renal transplant patient pre-operative, immediate posttransplant and early post-transplant periods in the Renal Transplant Unit of the Carlos Andrade Marín Specialties Hospital

El trasplante renal es considerado como la mejor alternativa de tratamiento sustitutivo para la enfermedad renal crónica terminal (ERCT)1, es el procedimiento quirúrgico que consiste en reemplazar un riñón sano de un donante vivo o cadavérico a una persona con diagnóstico de ERCT, que ayuda a mejorar su calidad de vida, la reinserción a sus actividades sociales, físicas, emocionales, laborales y sexuales. La Organización Nacional de Trasplantes de España (ONT) en el año 2018, reportó que en la Unión Europea se realizaron 21 102 y en Latinoamérica 12 806 trasplantes renales2, en Ecuador el Ministerio de Salud Pública (MSP) en los años 2007-2020 reportó un total de 1 6153, le correspondió al Hospital de Especialidades Carlos Andrade Marín (HECAM) el 32% del total de trasplantes renales realizados entre el periodo 2007-20184. La evaluación del potencial receptor es realizada por un equipo multidisciplinario con formación académica, experiencia certificada en los diferentes procesos y acreditados por el Instituto Nacional de Donación y Trasplantes (INDOT)5. Los cuidados de enfermería enmarcados en esta ruta, son especializados e integrales, que incluyen los períodos pre operatorio, pos trasplante inmediato y temprano al incorporar además un proceso educativo entre enfermera, paciente y familia/ cuidador, con el fin de preservar la sobrevida del injerto.

Renal transplantation is considered the best alternative replacement treatment for end-stage chronic kidney disease (ESRD)1, it is the surgical procedure that consists of replacing a healthy kidney from a living or cadaveric donor to a person diagnosed with ESRD, which helps to improve their quality of life, reintegration to their social, physical, emotional, work and sexual activities. The National Transplant Organization of Spain (ONT) in 2018, reported that In the European Union 21 102 and in Latin America 12 806 renal transplants were performed2, in Ecuador the Ministry of Public Health (MSP) in the years 2007-2020 reported a total of 1 6153, corresponded to the Carlos Andrade Marín Specialties Hospital (HECAM) 32% of the total number of renal transplants performed between 2007-20184. The evaluation of the potential recipient is performed by a multidisciplinary team with academic training, certified experience in the different processes and accredited by the National Institute of Donation and Transplantation (INDOT)5. The nursing care framed in this route is specialized and comprehensive, including the pre-operative, immediate post-transplant and early post-transplant periods, incorporating an educational process between nurse, patient and family/caregiver, in order to preserve graft survival.

Planning surgery for young people with learning disabilities.

Surgery for spinal deformity is complex and preparation involves a wide multidisciplinary team. For young people with learning disabilities, especially those who have behaviour that challenges, there are further considerations to ensure that their hospital stay is a positive experience and all their additional needs are met. Staff and carers need to be well informed and there must be effective communication. Evaluation of one patient's journey through pre-assessment, surgery and rehabilitation has identified the need for more input from learning disability liaison nurses in acute children's services.

Effect of Preoperative Oral Carbohydrate Administration on Patients Undergoing Cesarean Section with Epidural Anesthesia: A Pilot Study.

PURPOSE: The aim of this study was to evaluate the effect of preoperative oral carbohydrate administration on patients undergoing Cesarean section with epidural anesthesia. DESIGN: Randomized controlled clinical study. METHODS: A total of 75 patients undergoing Cesarean section (American Society of Anesthesiologists physical status grade I-II) were randomized to preparation with a carbohydrate drink (CHO group), flavored water (placebo group), or to the fasting group. The CHO and placebo groups were double-blinded and given 300 mL of the drink 2 hours before surgery. Visual analog scores of the patient were assessed to evaluate thirst, hunger, and anxiety level, and the gastric antral cross-sectional areas were recorded by ultrasonography during the operative period. Insulin resistance was calculated on the basis of the blood glucose and insulin levels assessed before administration and after surgery. FINDINGS: The CHO and placebo groups did not show an increase in gastric fluid volumes in terms of gastric antral cross-sectional area, and there were no adverse events. The visual analog scale scores at preoperative baseline were not different between groups . During the preoperative waiting period, preparation with CHO reduced not only thirst and anxiety more efficiently than water (placebo) but also hunger (P < .05), whereas water did not. No difference was observed in insulin resistance between groups before intake of the drink. Compared with the preoperative levels, insulin resistance showed a statistically significant increase in all groups (P < .05); however, the increase was significantly higher in the fasting and placebo groups than in the CHO group (P < .05). CONCLUSIONS: Preoperative administration of CHO decreases postoperative insulin resistance and enhances pregnant women's comfort, leading to a reduced sense of thirst, hunger, and anxiety during the preoperative period for Cesarean section.

The efficacy of nursing intervention to reduce preoperative anxiety in patients with total knee arthroplasty: A protocol of prospective randomized trial.

BACKGROUND: Some patients undergoing the total knee arthroplasty (TKA) have suboptimal postoperative results, and preoperative anxiety may be one of the reasons for these unsatisfactory results. We perform this randomized control study protocol to determine the effectiveness of nursing intervention, on the basis of motivational interview, to decrease the preoperative anxiety in patients receiving TKA. METHODS: This is a double-blinded, single-center, placebo-controlled and randomized trial, which will be conducted from December 2020 to June 2021. The protocol of this study was approved by the West China Hospital of Sichuan University (W20200803-28). Sixty patients who will undergo TKA are included in our study. Patients are randomly divided into experiential group (with 30 patients) and the control group (with 30 patients). The control group and experimental group receive an informative and separate session via nursing about the operation preparation and operation process. Both the control group and the experimental group are given habitual treatment, but the experimental group need to receive additional motivational interviews. The primary outcomes are the Hospital Anxiety and Depression Scale and the Amsterdam Preoperative Anxiety and Information Scale. Secondary outcome is postoperative pain, which is assessed by visual analogue scale . RESULTS: Figure 1 will display the comparison of preoperative and postoperative total average anxiety scores in control group and the experimental group. CONCLUSION: Preoperative psychological distress is familiar in our patients. We hypothesized that nursing intervention may be associated with reduced preoperative anxiety in the patients receiving TKA.

Preoperative nursing visit reduces preoperative anxiety and postoperative complications in patients with laparoscopic cholecystectomy: A randomized clinical trial protocol.

BACKGROUND: Anxiety is a kind of emotional disorder caused by acute conditions or trigger. It is manifested in the components of the autonomic nervous system, for instance, stress, anxiety, nervosity, and discomfort. Most patients with anxiety are more active, nervous, and alert to various stimuli. Inappropriate management of early postoperative anxiety will not only prolong recovery but also increase the risk of other complications. We conduct a randomized clinical trial to investigate the influences of nursing visits against the preoperative anxiety and postoperative complications in patients undergoing laparoscopic cholecystectomy (LC). METHODS: This is a single center, placebo-controlled randomized trial, which will be performed from August 2020 to December 2020. The trial is performed in accordance with the SPIRIT Checklist for randomized studies. It is authorized by the Ethics Committee of Taizhou Hospital of Zhejiang Province (D20211-34). Two hundred patients undergoing LC will be included in this study. Patients are randomly divided into 2 groups: experiential group (n = 100) or control group (n = 100). The experimental group is given preoperative nursing visit to each patient 1 day before the operation, whereas the control group did not receive the preoperative nursing intervention. The patients in experience group also received education on the surgery team and the environment of operating room, the process of anesthesia, advantages of laparoscopic surgery, and the postoperative care from recovery room to discharge. The primary outcomes include State-Trait anxiety level and postoperative visual analogue scale. Secondary outcomes include total consumption of analgesics and postoperative complications. RESULTS: Figure (a) will show the comparison of outcomes between 2 groups. CONCLUSION: The preoperative nursing visit may decrease the anxiety and the complications after operation in patients receiving LC. TRIAL REGISTRATION: This study protocol is registered in Research Registry (researchregistry5924).

Care of the surgical patient: part 1.

This article provides clinical guidance on the care of a patient undergoing an elective surgical procedure. It discusses preoperative care and the preparation of the patient. It aims to provide an awareness of the complications associated with perioperative care. Through the use of a patient case study, the authors demonstrate the care required across the full perioperative journey from diagnosis to discharge.

Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant: Considerations for Critical Care Nursing Practice.

TOPIC: Candidates waiting for lung transplant are sicker now than ever before. Extracorporeal membrane oxygenation has become useful as a bridge to lung transplant for these critically ill patients. CLINICAL RELEVANCE: Critical care nurses must be prepared to care for the increasing number of lung transplant patients who require this advanced support method. PURPOSE OF PAPER: To provide critical care nurses with the foundational knowledge essential for delivering quality care to this high-acuity transplant patient population. CONTENT COVERED: This review describes the types of extracorporeal membrane oxygenation (venovenous and venoarterial), provides an overview of the indications and contraindications for extracorporeal membrane oxygenation, and discusses the role of clinical bedside nurses in the treatment of patients requiring extracorporeal membrane oxygenation as a bridge to lung transplant.

Using intervention mapping to develop an outpatient nursing nutritional intervention to improve nutritional status in undernourished patients planned for surgery.

BACKGROUND: Undernutrition in surgical patients leads to a higher risk of postoperative complications like infections and delayed recovery of gastrointestinal functions, often resulting in a longer hospital stay and lower quality of life. Nurses at outpatient clinics can deliver nutritional care during outpatient preoperative evaluation of health status to ensure that patients are properly fed in preparation for hospital admission for surgery. However, nutritional nursing care was not determined in research yet. This paper describes the structural development of an Outpatient Nursing Nutritional Intervention (ONNI). METHODS: A project group followed the steps of the Intervention Mapping. The needs assessment included assessment of delivery of nutritional care and nutritional care needs at two anaesthesia outpatient clinics of an academic and a teaching hospital. Also, outpatient clinic nurses and patients at risk for undernutrition were interviewed. Determinants resulted from these methods were matched with theories on behaviour change and nutritional support. RESULTS: Both patients and nurses were unaware of the consequences of undernutrition, and nurses were also unaware of their roles with regard to nutritional support. The intervention goals were: 1) enabling surgical patients to improve or maintain their nutritional status before hospital admission for surgery, and 2) enabling nurses to deliver nutritional support. The ONNI was developed for outpatients at risk for or with undernutrition. A training was developed for nurses. The ONNI included the five following components: 1) identification of the causes of undernutrition; 2) provision of a nutritional care plan including general and individually tailored advice; 3) self-monitoring of nutrient intake; 4) counselling and encouragement; and 5) support during a telephone follow-up meeting. The intervention and training were tested. A multifaceted implementation strategy was used to deliver the intervention in daily practice. CONCLUSIONS: Despite the unique position of the nurses at outpatient clinics, nurses were unaware of their role with regard to nutritional care. The ONNI was developed and implemented along with a training program for nurses. The test confirmed that the training can improve nurses' knowledge, skills, and sense of responsibility for nutritional support. The intervention may empower patients to actively improve their nutritional status.

An outpatient nursing nutritional intervention to prehabilitate undernourished patients planned for surgery: A multicentre, cluster-randomised pilot study.

BACKGROUND & AIMS: To improve the nutritional status of surgical patients before hospital admission, an Outpatient Nursing Nutritional Intervention (ONNI) was developed. The ONNI comprehends five components: determining causes of undernutrition, performing a nutritional care plan including tailored and general advice, self-monitoring of nutritional intake and eating patterns, counselling and encouragement, and conducting a follow-up telephone call to discuss improvements in nutritional behaviour. Here, we evaluate the feasibility and effectiveness of the ONNI. METHODS: In a multi-centred, cluster-randomised pilot study, nurses from outpatient clinics were randomly allocated to usual care (UC) or the ONNI. Patients planned for elective surgery were included if they were at increased risk for undernutrition based on the Malnutrition Universal Screening Tool (MUST) and hospital admission was not planned within seven days. Feasibility outcomes included participation rate, extent of intervention delivery, and patient satisfaction. Nutritional intake was monitored for two days before admission. Body weight, BMI and MUST scores at hospital admission were compared to measurements from the outpatient clinic visit. Data were analysed on an intention-to-treat basis by researchers who were blinded for patients and caregivers. RESULTS: Forty-eight patients enrolled the feasibility phase. Participation rate was 72%. Nurses delivered all intervention components adequately in the end of the implementation period. Finally, 152 patients (IG: n = 66, 43%) participated in the study. A significant difference in mean energy intake (870 kcal/d, 95%CI:630-1109 p < 0.000) and mean protein intake (34.1 g/d, 95%CI: 25.0-43.2; p < 0.000) was observed in favour of the IG. Nutritional energy requirements were achieved in 74% (n = 46) of the IG and in 17% (n = 13) of the UC group (p < 0.000), and protein requirements were achieved in 52% (n = 32) of the IG, compared to 8% (n = 6) of the UC group (p < 0.000). Body weight, BMI and MUST scores did not change in either group. CONCLUSIONS: The ONNI is a feasible and effective intervention tool for nurses at outpatient clinics. Patients in the IG had more nutritional intake and fulfilled nutritional requirements significantly more often than patients receiving UC. Further research is required to determine the optimal pre-operative timing of nutritional support and to measure its effect on other patients groups. CLINICAL TRIAL REGISTRATION: The study protocol was registered at the ClinicalTrial.gov website with the following identifier: NCT02440165.

The use of mentholated popsicle to reduce thirst during preoperative fasting: A randomised controlled trial.

AIMS AND OBJECTIVES: To compare mentholated popsicle with usual care (absolute fasting) in the change of thirst intensity and discomfort of patients in the preoperative fasting. BACKGROUND: Thirst is defined as the desire to drink water, and it is considered to be a multifactorial symptom. In the preoperative fasting, the patient may experience intense thirst, often for a long time, that can lead to feelings of suffocation, desperation, fear and anxiety. DESIGN: A randomised controlled trial. METHODS: Forty patients, aged between 18-60 years, were randomised to mentholated popsicle group or absolute fasting group (twenty in each). The primary outcomes were thirst intensity, evaluated by a numeric scale ranging from 0 (no thirst)-10 (the worst possible thirst), and discomfort from thirst (evaluated by the Perioperative Thirst Discomfort Scale), both measured twice (baseline and after 20 min of intervention). The CONSORT checklist was used to report this study. RESULTS: Mean age was similar in both groups (38 years in the mentholated popsicle group and 39 in the absolute fasting group). At baseline, the mentholated popsicle group had higher median for the scales of intensity (6.5) and discomfort (7.5) from thirst than the absolute fasting group (5.0 and 5.0, respectively). At the end of 20 min, the popsicle group had a statistically significant decrease in intensity and discomfort from thirst (median decreases of 5.0 and 7.0 points, respectively) when compared to the absolute fasting group (median increases of 0.5 and 1.0 points, respectively). CONCLUSIONS: The use of mentholated popsicle decreased the intensity and discomfort from thirst, and it is a viable strategy for the management of thirst in the preoperative fasting. RELEVANCE TO CLINICAL PRACTICE: In the preoperative fasting, making mentholated popsicles available to patients is an easy strategy to manage thirst, which might lead to better care.

Risk factors for intraoperative pressure injuries in patients undergoing digestive surgery: A retrospective study.

AIM AND OBJECTIVE: To investigate the incidence of intraoperative blanchable erythema and pressure injuries in patients undergoing digestive surgery and to explore potential risk factors. BACKGROUND: Pressure injuries pose significant economic and healthcare burden to patients and are used as one of the key indicators of nursing in the operation room with high incidence. DESIGN: A retrospective observational study. METHODS: Basic information and the results of 3S intraoperative risk assessment scale of pressure injury were obtained from the information system. And the patients with intraoperative blanchable erythema or pressure injuries were followed up for 72 hr by the information system. The clinical data were collected to analyse risk factors for intraoperative blanchable erythema and pressure injuries by univariate analysis and logistic regression analysis. STROBE checklist for cohort studies was applied in the preparation of the paper. RESULTS: Of 5,136 surgical cases, 134 (2.61%) had blanchable erythema, 37 (0.72%) had intraoperative pressure injuries, and 8 (0.16%) had pressure injuries at 72-hr follow-up. Preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure were considered independent risk factors for intraoperative pressure injuries. CONCLUSION: The incidence of pressure injuries in our study was lower than those reported in the previous studies. Accessing preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure was considered to be significant for preventing pressure injuries. RELEVANCE TO CLINICAL PRACTICE: The findings suggest that preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure are associated with intraoperative pressure injuries in patients undergoing digestive surgery.

Intervención de enfermería para modular el nivel de incertidumbre de pacientes pre-quirúrgicos / Nursing intervention to modulate the level of uncertainty of pre-surgical patients

Objetivo: Determinar el efecto de una intervención de enfermería comparada con la intervención informativa habitual sobre el nivel de incertidumbre de un grupo de pacientes pre-quirúrgicos, controlando el nivel de ansiedad, en una institución privada de III nivel de atención de la ciudad de Girardot en el periodo noviembre del 2017 a mayo del 2018 Metodología: Abordaje cuantitativo, cuasi experimental, con pre y pos prueba, en un grupo experimental y control. Midiendo la ansiedad rasgo y estado con la escala de Idare y valorando el nivel de incertidumbre mediante la aplicación de la escala de incertidumbre del adulto (MIUS), elaborada por Merle Mishel, la muestra incluye pacientes que acuden a la valoración pre anestésico de una institución de salud, privada, de III nivel de la ciudad de Girardot Resultados: se encontraron niveles de ansiedad moderados y altos tanto para el grupo experimental como para el grupo comparación. Al igual que niveles de incertidumbre, medios y altos, en los dos grupos. El nivel de incertidumbre se modificó en el grupo experimental, lo cual se evidencio en los 4 factores de incertidumbre, teniendo marcada influencia en el factor ambigüedad, la cual aumento en 7 puntos después de la intervención, los demás factores, aunque se modificaron, no fueron tan significativos. Al estimar la correlación entre ansiedad e incertidumbre, el coeficiente de correlación fue de 0.035 p (<0.05), con un coeficiente de determinación de 0.238 lo que nos indica que a mayor ansiedad mayor incertidumbre; en los pacientes del estudio, la correlación es débil, pero significativamente diferente de 0. Conclusión: estos hallazgos, indican la necesidad de valorar la incertidumbre, e identificar factores que pueden estar relacionados, al ser altos predictores de la misma, como el dolor, la información y el apoyo social, que inciden positiva o negativamente en la aparición de la misma, las estrategias de enfermería utilizadas en este estudio, pueden considerarse, una herramienta, que permite el afrontamiento y la modulación del nivel de incertidumbre del paciente que va a ser intervenido quirúrgicamente. Discusión: aunque hay poca literatura al respecto, la existente señala, que la falta de información y el uso de estrategias de afrontamiento, facilitan la adaptación del proceso de vivir la cirugía, del paciente que será intervenido quirúrgicamente. Recomendaciones: el estudio de estos fenómenos, permite a la disciplina de enfermería, utilizarlos como sustento teórico-práctico en el desarrollo de programas que se ajusten a las necesidades de cuidado del paciente que será intervenido quirúrgicamente. (AU)

Objective: To determine the effect of a nursing intervention compared with the usual informative intervention on the level of uncertainty of a group of pre-surgical patients, controlling the level of anxiety, in a private institution of III level of care of the city of Girardot in the period November 2017 to May 2018 Methodology: Quantitative, quasi-experimental approach, with pre- and post-test, in an experimental and control group. Measuring the trait and state anxiety with the Idare scale and assessing the level of uncertainty through the application of the adult uncertainty scale (MIUS), developed by Merle Mishel, the sample includes patients who come to the pre-anesthetic assessment of an institution of health, private, of III level of the city of Girardot Results: moderate and high levels of anxiety were found for both the experimental group and the comparison group. As Levels of uncertainty, medium and high, in the two groups. The level of uncertainty was modified in the experimental group, which was evidenced in the 4 uncertainty factors, having a marked influence on the ambiguity factor, which increased by 7 points after the intervention, the other factors, although modified, were not so significant When estimating the correlation between anxiety and uncertainty, the correlation coefficient was 0.035 p (<0.05), with a coefficient of determination of 0.238, which indicates that the greater the anxiety, the greater the uncertainty; in the Study patients, the correlation is weak, but significantly different from 0. Conclusion: these findings indicate the need to assess uncertainty, and identify factors that may be related to being high predictors of it, such as pain, information and social support, which have a positive or negative impact on the appearance of it, The nursing strategies used in this study can be considered a strategy that allows coping and modulation of the level of uncertainty of the patient who is going to be operated on. Discussion: although there is little literature on the subject, the existing one points out that the lack of information and the use of coping strategies, facilitate the adaptation of the process of living the surgery, of the patient that will be operated surgically. Recommendations: the study of these phenomena allows the nursing discipline to be used as a theoretical and practical support in the development of programs that adjust to the needs of the patient who will be operated onAbstract. (AU)

The effect of nursing intervention on preoperative cataract.

This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.

A prospective observational study of the impact of an electronic questionnaire (ePAQ-PO) on the duration of nurse-led pre-operative assessment and patient satisfaction.

OBJECTIVE: Standard pre-operative assessment at our institution involves a comprehensive history and examination by a nurse practitioner. An electronic pre-operative assessment questionnaire, ePAQ-PO® (ePAQ, Sheffield, UK) has previously been developed and validated. This study aimed to determine the impact of ePAQ-PO on nurse consultation times and patient satisfaction in low-risk patients. METHODS: The duration of pre-operative assessment consultation was recorded for American Society of Anesthesiology physical classification 1 and 2 patients undergoing pre-operative assessment by an electronic questionnaire (ePAQ-PO group) and standard face-to-face assessment by a nurse practitioner (standard group). Patients were also asked to complete an eight-item satisfaction questionnaire. Eighty-six patients were included (43 in each group). RESULTS: After adjusting for the duration of physical examination, median (IQR [min-max]) consultation time was longer in the standard compared to the ePAQ-PO group (25 (18-33 [10-49]) min vs. 12 (8-17 [4-45]) min, respectively; p <0.001). Response rate for the satisfaction questionnaire was 93%. There was no significant difference in patient satisfaction scores (38/39 in standard group vs. 39/41 in ePAQ-PO group were fully satisfied with their pre-operative assessment; p = 0.494). CONCLUSION: Pre-operative assessment using ePAQ-PO is associated with a significant reduction of over 50% in the duration of the assessment without impacting on patient satisfaction.

A comunicação como ferramenta educativa no préoperatório mediato de transplante renal / The communication as an educational tool during kidney transplantation preoperative period / La comunicación como herramienta educativa en el período pre-operatorio mediato de trasplante renal

Objetivo: O objetivo do estudo é reconhecer a importância da comunicação como ferramenta utilizada pelo enfermeiro no pré-operatório mediato do paciente em terapia hemodialítica indicada para transplante renal. Métodos: Trata-se de um estudo descritivo, convergente, com abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada com 9 enfermeiras, utilizando um roteiro pré-estabelecido com questões subjetivas das quais emergiram 2 categorias: Responsabilidade do enfermeiro na comunicação com o paciente; e Importância da comunicação enfermeiro/ paciente. Resultados: Os resultados apontam a relevância de estudar o processo da comunicação, pois, ao praticá-lo, há aperfeiçoamento do modo que o enfermeiro se comunica, evitando interferências que possam comprometer as informações prestadas. Conclusão: Ressalta-se a importância da relação enfermeiro/paciente, que possibilita o entendimento das informações educativas e o modo como são prestadas, constituindo poderosa ferramenta no pré-operatório mediato de transplante renal

Objetivo: El objetivo es reconocer la importancia de la comunicación como herramienta utilizada por los enfermeros en el paciente preoperatorio mediato en hemodiálisis indicado para el trasplante de riñón. Método: Se trata de un estudio descriptivo, convergente, con un enfoque cualitativo. Los datos fueron recogidos a través de entrevista semi-estructurada con 9 enfermeras, utilizando un guión pre-establecido con preguntas subjetivas de las que emergieron 2 categorías: Responsabilidad del enfermero en la comunicación con el paciente; e Importancia de la comunicación enfermero/ paciente. Resultados: Los resultados señalan la relevancia de estudiar el proceso de la comunicación, pues, practicándola, hay una mejora en la forma en que el enfermero se comunica, evitando interferencias que puedan poner en peligro las informaciones ofrecidas. Conclusión: Se destaca la importancia de la relación enfermero/paciente, que permite la comprensión de las informaciones educativas y la forma en que se prestan, constituyendo poderosa herramienta en el período pre-operatorio mediato de trasplante renal

Objective: The study's aim has been to recognize the importance of the communication as a tool used by the nurse over the preoperative period of patients undergoing hemodialysis therapy and indicated for having renal transplantation. Methods: It is a descriptive and convergent study with a qualitative approach. Data were collected through a semi-structured interview with 9 female nurses and using a pre-established script with subjective questions. By using this approach, the following 2 categories emerged: the nurse's responsibility in communicating to the patient; and the significance of nurse/patient communication. Results: The results point out the relevance of studying the communication process, because, by putting it into practice, there is an improvement regarding the nurse's communication skills, and then avoiding any interference that may affect the information provided. Conclusion: The significance of the nurse/patient relationship stands out, which enables understanding the educational information and the way in which they are provided, then constituting a powerful tool during the preoperative period of a renal transplantation

Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep Before Coronary Artery Bypass Grafting.

The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.

Prepared for surgery - Communication in nurses' preoperative consultations with patients undergoing surgery for colorectal cancer after a person-centred intervention.

AIMS AND OBJECTIVES: To describe preoperative communication after a person-centred intervention in nurses' consultations with patients undergoing surgery for colorectal cancer. BACKGROUND: Patients all over the world scheduled for surgery are referred to preoperative consultations with healthcare professionals. The goal is to assess the risk of perioperative complications, improving quality of care and enabling patients to be prepared for surgery and recovery. A person-centred intervention was developed, which consisted of an interactive written patient education material and person-centred communication. DESIGN: An explorative quantitative and qualitative study based on 18 audio-taped transcriptions. METHODS: Eighteen patients preoperative nursing consultations at three Swedish hospitals were analysed quantitatively regarding structure: words, time, phases, questions, discursive space, and qualitatively: topics and how the person-centred communication appeared in the consultations. RESULTS: The median time for consultations was 27 min (range 13-64 min). The nurses used two-thirds of the discursive space in the consultations with the patients. The patient education material was used as a support to structure the consultation and discuss sensitive and difficult issues. Seven topics were discussed during the consultation. Two different approaches to communication were identified: Talking with the patient versus Talking to the patient. Talking with the patient (seen as person-centred communication) was defined as: listening to the narrative and confirming each other, raising difficult topics, seeing each other as persons, building on strengths and resources, preparing for surgery and asking open questions. CONCLUSION: Ways of communicating influence how the preoperative consultation develops. Talking with the patient could be seen as person-centred communication in the preoperative care, and when using this approach, the intervention purpose of person-centred communication was met. RELEVANCE TO CLINICAL PRACTICE: Education in person-centred communication is important for nurses to improve their skills in performing preoperative consultations.

The Fontan Procedure for Single-Ventricle Physiology.

The Fontan procedure is the final procedure in staged palliation for patients with functional single-ventricle physiology. The goal of the procedure is to separate systemic and pulmonary blood flow by directing systemic venous return through the Fontan connection to the pulmonary arteries and the lungs without ventricular contribution. Following the procedure, pulmonary blood flow is completely passive and dependent on pressure gradients, resulting in complex postoperative cardiopulmonary interactions. Understanding the physiology is essential to effectively manage these patients. Critical care nurses caring for patients after a Fontan procedure must understand preoperative data, risk factors, and unique postoperative physiology so they can anticipate specific postoperative problems, recognize trends in clinical status, and develop an appropriate plan of care. This paper reviews the first 2 stages of single-ventricle palliation, relevant modifications to the Fontan procedure, important preoperative cardiac catheterization data, common postoperative problems, and outcomes after the Fontan procedure.