Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence.

BACKGROUND: The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses. OBJECTIVES: This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL. METHODS: The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days. RESULTS: From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01). CONCLUSIONS: We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.

Retrospective study of polytrauma patients's medical records that presented abdominal trauma, comperad to abdominal trauma and extra-abdominal injuries

This study sought to retrospectively assess the relationship between intra and extra-abdominal injuries in polytrauma patients undergoing laparotomy at the Regional University Hospital of Maringá between 2017 and 2018.This study was based on 111 electronic medical records from the Brazilian public health system "SUS", admitted to the hospital due to trauma and undergoing laparotomy, comparing two groups: abdominal injury without extra-abdominal injury (WoEI) and abdominal injury with extra-abdominal injury (WiEI).A total of 111 medical records were analyzed, 57 from 2017 and 54 from 2018. Of these 111records, 43 (39%) were trauma victims with only abdominal injuries and 68 (61%) trauma victims with abdominal and extra-abdominalinjuries. Most patients were male (85%), with an average age of 33 years, ranging from 14 to 87 years. In statistical analysis, according to the T-test, there was significance (p > 0.05) between the WoEI and WiEI groups for data collected regarding death rates and hospitalization days. As for the morbidity rate and difference between genders (male and female), there was no statistical significance (p < 0.05).Polytraumapatients are exposed to greater kinetic energy, with more severe conditions and therefore required more in-hospital care.

Management of a patient with autism following ingestion of a foreign body.

Patients with autism often find admission to hospital an anxious time. Awareness of the condition, a speedy diagnosis and flexibility in adapting treatment plans will facilitate early discharge and return to their familiar environment. We describe a patient with severe autism who presented with an acute abdomen secondary to ingestion of a foreign body which required laparotomy. Communication directly to medical staff was greatly limited due to severe autism and close liaison with family members was essential in interpreting scant clinical signs. At the time of surgery a rubber bottle teat was found causing transection of small bowel due to erosion of the foreign body. The postoperative course was fraught with challenges and ensuring side room nursing care with family members present throughout his admission minimised postoperative stress and confusion. We recommend awareness of management strategies for patients with autism to ensure rapid recovery and early discharge home.

Dolor agudo en laparotomía media. Valoración en el postoperatorio de los pacientes / Assessment acute posoperative pain in patients undergoing midline laparotomy

Objetivo. Evaluar la prevalencia e intensidad de dolor agudo postoperatorio (DAP) en pacientes sometidos a laparotomía media en las primeras 24 horas después de la intervención. Método. Estudio transversal de prevalencia. Mediante una visita diaria a la Unidad de Reanimación se procedió a la recogida de datos de los pacientes que cumplían con los criterios de inclusión aportando información previa para la obtención del consentimiento. Se realizaron dos valoraciones mediante la Escala Visual Analógica (EVA): la intensidad de dolor postoperatorio en el momento de la encuesta coincidiendo con las 24 horas postoperatorias, y el máximo de dolor referido en las 24 horas anteriores. Resultados. Se incluyeron 73 pacientes mayores de edad sometidos a laparotomía media. La puntuación de la escala EVA en el momento de la encuesta dentro de las primeras 24 horas tras la intervención fue de 2,01 (DE 2,29) y de 4,43 (DE 3,77) como resultado de la valoración del máximo dolor referido durante su estancia en la unidad. Se observó una correlación negativa con la edad y la puntuación de la EVA, tanto en las 24 horas (p=0,025) como la referida al máximo dolor (p=0,011). La analgesia de base pautada mostró una diferencia significativa en las puntuaciones EVA en los pacientes en tratamiento con dexketoprofeno. Conclusiones. Es necesario mejorar la atención al paciente con dolor agudo postoperatorio, así como revisar los protocolos analgésicos y protocolizar el uso de la EVA de forma sistemática en las Unidades de Reanimación(AU)

Objective: To asses the prevalence and intensity of acute postoperative pain (APP) in patients undergoing midline laparotomy in the first 24 hours after surgery. Method: Cross-sectional study of prevalence. By a daily visit to the unit of resuscitation we proceeded to the collection of data from patients who met the inclusion criteria, providing prior information to obtain the consent. Two valuations were realized by visual analog scale (VAS), the intensity of postoperative pain at the time of the survey, coinciding with 24 postoperatory hours, and the maximum of pain referred in the previous 24 hours. Results: We included seventy-three adult patients undergoing midline laporotomy. The VAS score at the time of the survey within 24 hours post-surgery was 2.01 (DE 2.29) and 4.43 (DE 3.77) as a result of the assessment of the maximum referred pain during their stay in the unit. It was observed a negative correlation with age and the VAS score in both the 24 hours (P=0.025) and the one referred to the maximum pain (P=0.011). Scheduled based analgesia showed an important difference in VAS scores in patients treated with dexketoprofen. Conclusions: It is concluded the need for improvement in the care of patients with accute postoperative pain and the need for revision of analgesic protocols. It is also necessary to protocolize the use of VAS in units of resuscitation in a systematic way (AU)

The impact of listening to music on analgesic use and length of hospital stay while recovering from laparotomy.

Postoperative pain management is based on the use of analgesics; however, music may alleviate pain either by direct analgesic effects or by relaxing and distracting the mind from pain and unpleasant feelings. Conflicting results have been presented about how listening to music affects analgesic use and length of hospital stay after surgery. We assessed the effect of music listening on analgesic use, length of hospital stay, and adverse effects in adult patients having laparotomy, using a prospective design with two parallel groups. Patients undergoing elective abdominal surgery (n = 168) were assigned to either a music group (n = 83) operated on odd weeks or a control group (n = 85) operated on even weeks. The music group listened to music 7 times for 30 minutes at a time during the first 3 postoperative days. The control group did not listen to the music. The hypotheses that patients in the music group will need less analgesic, have a shorter length of hospital stay, and experience less adverse effects than those in the control group were not supported by the data, although patients recovering from surgery enjoyed listening to music. Music listening may enhance quality of hospital stay and recovery in patients undergoing major abdominal surgery and could be a useful tool to relieve the patient's pain experience.

Emergency laparotomy in high risk general surgical patients: a review of perioperative care.

High risk general surgical patients account for the largest proportion of surgical deaths. There is concern from the Royal College of Surgeons of England (RCSEng) and National Confidential Enquiry into Patient Outcome and Death (NCEPOD) that these patients may receive suboptimal care. Patients undergoing an emergency laparotomy were identified and the notes reviewed; patients had high observed and predicted mortalities. Consultant involvement, patient consent and nutritional planning were all assessed. An agreed method of patient identification and quantification of risk was recommended. The use of an emergency laparotomy proforma was suggested.

[The use of topical negative pressure in an open abdomen]. / Brug af topical negative pressure ved åbent abdomen.

The article is a review of the literature concerning the use of topical negative pressure (TNP) in open abdomen. TNP appears to be superior to other methods in that the frequency of ventral hernia seems to be less after TNP than after other methods. TNP reduces both the cost of nursing and the damage to the abdominal wall. Vacuum-assisted closure (VAC) appears to be superior to the vacuum pack technique, but there is a lack of studies comparing the two methods of TNP in open abdomen.

Perioperative assessment of the obstetric patient undergoing abdominal surgery.

Care of the obstetric patient undergoing nonobstetric surgery can be challenging. Approximately 1 in 500 pregnancies is complicated by a nonobstetric surgical condition. To adequately care for the mother and fetus, the nurse must know the physiological changes that occur during pregnancy, and make an aggressive attempt to maintain those changes. This article reviews common reasons for abdominal surgery during pregnancy, the physiological changes that occur during pregnancy, techniques to maintain those responses, and discusses issues related to fetal monitoring and postoperative care.

Vacuum-assisted closure in the management of the open abdomen: a report of a case and initial experiences.

In certain surgical patients undergoing laparotomy it may be best to leave the abdomen open as a laparostomy. Care of the resulting wound represents a considerable medical and nursing challenge. This article presents such a case and the authors' initial experience of managing laparostomy wounds with vacuum-assisted closure.

Managing the open abdomen.

Control of intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure is a major challenge in the management of patients with an open abdomen. Studies comparing different protocols of care have not been conducted and frequency of exploration, surgical procedures, and indications for definitive closure are generally based on clinical judgment. Morbidity and mortality rates are high. Vacuum-assisted therapy has been reported to help meet the challenges of managing the open abdomen and is particularly useful in patients with abdominal compartment syndromes, traumatic injuries, and severe intra-abdominal sepsis. Over the years, clinicians have developed various approaches to achieve vacuum-assisted closure using wall suction. Some disadvantages of the wall-suction methods are eliminated when using more recently developed vacuum therapy devices. These devices apply subatmospheric pressure, reducing bowel edema, bacterial counts, and inflammatory substances found in open abdominal wounds while eliminating the need for frequent dressing changes, maintaining intact skin, and improving fluid management. The results of six case studies presented are encouraging, suggesting that this treatment approach is safe and effective. Controlled clinical studies to establish the safety and effectiveness of this treatment approach and to facilitate the development of treatment guidelines are needed to help manage an increasingly common group of patients who might benefit from this treatment approach.

Abdominal aortic aneurysm repair.

Rupture of an abdominal aortic aneurysm (AAA) is often a catastrophic event, while elective traditional repair involves major surgery. This article explains AAA development and traditional repair, and introduces a new, less invasive method of repair: endovascular stenting.

Lost gallstones--a small but real complication.

Retained gallstones are considered a complication of cholecystectomies. If stones can be removed using minimally invasive procedures (i.e., laparoscopically), patients' recovery time may decrease and satisfaction may increase. Correct and immediate diagnosis of this complication at the time of the procedure often is the determining factor between patients' full recovery and their potential chronic illness. This article describes diagnostic tests and techniques used to surgically correct this complication and presents two case studies depicting patients' experiences from a few months to nine years postoperatively.

Covering the "open abdomen": a better technique.

"Damage control" in severe abdominal trauma, abdominal compartment syndrome, necrotizing fasciitis of the abdominal wall, and necrotizing pancreatitis often preclude closure of the fascia after laparotomy. Many techniques have been reported for temporary coverage of the exposed viscera, but most have had documented problems. We report the successful use, since 1989, of a temporary sutureless coverage. The viscera are covered with omentum when possible, then with a clear plastic sheet. Sump drains are placed over this layer. The entire abdomen is then covered with two layers of iodophor-impregnated adhesive plastic drape. The last 50 patients managed with this technique are reported. The most common indication (27 patients) was for treatment of severe abdominal trauma. There were no wound infections, fasciitis, or bowel obstruction. Eighteen patients died; no deaths were related to abdominal closure. Temporary abdominal covering with adhesive plastic sheeting is a rapid, safe, and readily available method for managing the open abdomen. This technique provides a physiologic milieu for the abdominal viscera, simplifies nursing care, and promotes safe closure of the abdomen at a later time.

Removal of fascial staples from the midline incision in patients undergoing a second laparotomy procedure.

A technique for removal of midline fascial staples is described. The staples are removed quickly and without significant anatomical distortion of the linea alba. In the majority of the patients a second row of fascial staples can be placed safely and in the same location as found in the original operation.

Comparison of three rewarming methods in a postanesthesia care unit.

Postoperative hypothermia is problematic because patients in postanesthesia care units (PACUs) often feel very cold, and unrecognized or prolonged postoperative hypothermia can aggravate patients' underlying cardiovascular disorders. The researchers compared three methods of rewarming PACU patients who had undergone laparotomy procedures. Patients were assigned randomly to three groups. Each patient in group one received the standard PACU rewarming intervention (ie, two warmed thermal blankets and a hospital bedspread). Each patient in group two received the standard PACU rewarming intervention plus a reflective blanket. Each patient in group three received the standard PACU rewarming intervention plus a reflective blanket and a reflective head covering. Nurses measured patients' vital signs on admission to the PACU and every 15 minutes thereafter until patients' sublingual temperatures reached 36 degrees C (96.8 degrees F). No significant temperature differences occurred among patients in the three groups, but an inverse relationship existed between patients' PACU admission temperatures and the time they required to reach normothermia.