[The role of the urology nurse in prehabilitation and same-day discharge robot-assited radical prostatectomy programs]. / Le rôle de l'IDE dans l'éducation thérapeutique avant opération et la mise en place d'un programme de prostatectomie totale robotique en ambulatoire.

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.

Using Clinical-Based Discharge Criteria to Discharge Patients After Ophthalmic Ambulatory Surgery Under General Anesthesia: An Observational Study.

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.

Nurse Practitioner-Led Telehealth to Improve Outpatient Pediatric Tracheostomy Management in South Texas.

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 .

Chronotype and work shift in nursing workers of university hospitals.

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.

Chronotype and work shift in nursing workers of university hospitals / Cronotipo y turno de trabajo en trabajadores de enfermería de hospitales universitarios / Cronotipo e turno de trabalho em trabalhadores de enfermagem de hospitais universitários

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.

Quality of counselling for knee and shoulder arthroscopy patients during day surgery.

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.

Picture book support for preparing children ahead of and during day surgery.

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.

Children's postoperative symptoms at home through nurse-led telephone counseling and its effects on parents' anxiety: A randomized controlled trial.

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.

Patients' experience of mood while waiting for day surgery.

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.

Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review.

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.

Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes.

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.

[Organization of nurses' work in day surgery]. / Organisation du travail des infirmières en chirurgie ambulatoire.

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.

Home recovery following day surgery: a patient perspective.

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.

The pediatric sedation unit: a prospective analysis of parental satisfaction.

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.

An alternative outpatient care model: postoperative guest suite-based care.

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.

Small interventions in outpatient surgery: Project of Advanced Nursing Skills.

The research analyzes data on the impact of the introduction of the figure nursing with advanced skills, "Advanced Skills" , in diagnostic and therapeutic surgical clinics within the Hospital of Piacenza. This is the application of the testing on the Project of Nursing "Skills"on advanced minor surgery "Minor Surgery", an outpatient procedure. They were given the satisfaction questionnaires to users and to the medical and nursing staff of the USL in Piacenza. The aim of the study was to verify the contention of the literature about the usefulness of an increased use of nursing skills within an ambulatory surgery to improve the quality of care and consequently to a higher user satisfaction. In light of the findings of the research, the ' impact of the implementation of the Project Advanced Nursing Skills has been positive, both among users is that health care providers. For a functional and effective management of the surgery may be useful to train a new nursing characterized by the possession of "Advanced Skills" whose "mission" is to develop more knowledge, share knowledge, as well as to foster innovation organizational and management to meet the demands of public health.