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.

Inevitable problems of older people: presurgery information effect on anxiety levels in patients undergoing cataract surgery.

AIMS AND OBJECTIVES: This study was to determine the effect of preoperative patient training on the concern level of patients who would be undergoing cataract surgery. BACKGROUND: Cataract is one of the main causes of blindness in the world. Cataract surgery is located among the quite frequently performed surgeries today. DESIGN: This study was an experimental study. METHODS: The subject pool for this research consisted of patients admitted to the Eskisehir Osmangazi University Medical Faculty Hospital Ophthalmology Department for cataract surgery. The sampling consisted of volunteers who were able to communicate and were deemed suitable patients within the limitations of this study (a total of 100 patients; control group = 50, experimental group = 50). Patient identification forms and the State Trait Anxiety Inventory I-II scale were used as data collection tools. RESULTS: The mean State Trait Anxiety Inventory pretest score for the experimental group was significantly higher than the mean final test score (53·30 ± 7·02 and 27·54 ± 3·25, respectively, p < 0·05). The mean State Trait Anxiety Inventory pretest score of the control group was 53·82 ± 7·42 and the mean final test score was 49·22 ± 13·17; there was no significant difference between these average scores (p > 0·05). However, the mean final test scores of the experimental and control groups were significantly different (p < 0·05). CONCLUSIONS: In the experimental group in this study, informative, educational and planned nursing care had a significant impact on anxiety levels in patients who had cataract surgery. RELEVANCE TO CLINICAL PRACTICE: Although it is not implemented in most hospitals, and implementation in some hospitals is unplanned, systematically planned preoperative education should take place as part of standard nursing practices.

Síndrome tóxica do segmento anterior após cirurgias de Catarata: implicações para a enfermagem / Toxic anterior segment syndrome after cataract surgery: the implications for nursing

Descrever as características da síndrome tóxica do segmento anterior (TASS) e as implicações para as ações de enfermagem. Método: Trata-se de uma revisão da literatura por meio de pesquisa nas bases de dados Medical Literature Analysis and Retrievel System Online (MEDLINE) e Literatura Latino-Americana em Ciências da Saúde (LILACS). Resultados: A TASS é uma reação inflamatória ocular aguda após cirurgias oftálmicas, principalmente a cirurgia de catarata, cuja apresentação clínica nas primeiras 12 horas após o procedimento inclui sinais como edema da córnea, presença de células na câmara anterior (CA), pressão intraocularaumentada e pupila irregular. As principais causas estão relacionadas com substâncias não infecciosas introduzidas no olho do paciente a partir de produtos usados durante a cirurgia ou devido a falhas no processamento dos instrumentais. Conclusão: As implicações para a enfermagem consistem nas medidas de prevenção, treinamento de pessoal, orientação aos pacientes e vigilância epidemiológica ativa visando à identificação precoce de sinais indicativos da TASS...

Diabetes and cataract surgery: preoperative risk factors and positive nursing interventions.

PURPOSE: In the United States, approximately three million cataract surgeries are performed annually. Although cataract surgery has been demonstrated to improve vision in up to 95% of patients, those with diabetes may be at increased risk of complications and poor visual outcomes. Preoperative risk factors such as age, retinal diseases, hypoglycemic medications, and hemoglobin A1C (Hgb A1C) levels may play a role in patient outcomes following cataract surgery. Furthermore, intraoperative risk factors such as the use of pupillary expanders, trypan blue staining, and additional procedures such as anterior vitrectomy may also be considered as a challenge for diabetic patients. This article will describe preoperative risk factors associated with visual outcomes for diabetic patients undergoing cataract surgery and appropriate nursing interventions for these patients. METHODS: Literature review of risk factors and cataract surgery outcomes in terms of complications, visual acuity, and visual functioning of diabetic patients was undertaken. Preoperative risk factors (i.e., age, retinal diseases, advanced macular disease [AMD], hypoglycemic medications, and Hgb A1C levels) and postoperative complications, including inflammation and cystoid macular edema (CME), were also examined. To emphasize evidence of best practices, the role of the nurse as educator and advocate was further explored in terms of their impact on diabetes management of the patient to improve visual results. RESULTS: Diabetic patients of advanced age, with a history of diabetic retinopathy who are taking insulin and have elevated Hgb A1C levels, may have an increased risk of intraoperative and postoperative complications and decreased postoperative visual acuity and visual functions that may affect their quality of life. CONCLUSIONS: High-risk factors should be identified in diabetic patients when developing a perioperative patient education plan to help reduce their risk of cataract complications and improve their visual outcomes.

Nursing care of the laryngeal mask airway in pediatric cataract surgery.

PURPOSE: To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children undergoing cataract surgery. METHODS: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and received perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. RESULTS: Through perioperative nursing care and psychological counseling for children with LMA, all patients were anesthetized without complications and underwent successful surgeries. No severe postoperative complications were observed. CONCLUSION: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

Improved pupil dilation with medication-soaked pledget sponges.

Use of multiple preoperative drops for pupil dilation has been shown to be inexact, to delay surgery, and to cause dissatisfaction among perioperative personnel. This article reports on an evidence-based, quality improvement project to locate and appraise research on improved effectiveness and efficiency of mydriasis (ie, pupillary dilation), and the subsequent implementation of a pledget-sponge procedure for pupil dilation at one ambulatory surgery center. Project leaders used an evidence-based practice model to assess the problem, research options for improvement, define goals, and implement a pilot project to test the new dilation technique. Outcomes from the pilot project showed a reduced number of delays caused by poor pupil dilation and a decrease in procedure turnover time. The project team solicited informal feedback from preoperative nurses, which reflected increased satisfaction in preparing patients for cataract procedures. After facility administrators and surgeons accepted the procedure change, it was adopted for preoperative use for all patients undergoing cataract surgery at the ambulatory surgery center.

Care of culturally diverse patients undergoing ophthalmic surgery.

We live and work in a multicultural world and need to be knowledgeable about culture and how it affects the quality of care given to patients. Although people of the non-dominant culture may have knowledge of the English language, many have limited English proficiency (LEP), a topic of great importance for the ophthalmic patient in the healthcare setting where populations grow increasingly diverse. Knowing how to communicate effectively with patients includes an understanding oflanguage. Because of the need for accuracy in ophthalmic surgical treatment, it is critical for ophthalmic caregivers to learn the skills necessary to communicate proficiently with their patients in order to assure a positive outcome in patient care. To achieve this goal, ophthalmic healthcare providers need to realize that accessing medical interpreter services is a necessary component of providing culturally sensitive patient care.

The provision of information for patients prior to cataract surgery.

This clinical audit evaluates the provision of patient information. It also establishes patients' views on satisfaction regarding the information provided at nurse-led preoperative assessment prior to giving informed consent for cataract surgery. A quantitative descriptive audit was conducted using a questionnaire, by which the questions reflected the baseline standards. A convenience sample of 75 postcataract patients took part in this retrospective audit. All 75 patients stated that they were either 'very satisfied' or 'satisfied' with both the verbal explanation and written information received, and identified the preoperative assessment nurse as the main source of information.

Registered nurse-led Group Medical Appointments for preoperative cataract patients.

In summary, our findings have found the Registered Nurse Led Group Medical Appointments for preoperative cataract patients to be very beneficial for both our patients and providers. This type of preoperative education fully utilizes the expertise of the CRNO in a way that is professionally rewarding to the nurse and adds value to the entire ophthalmic team. Due to the success of this program, we are now considering building a nurse led group educational program that would meet the needs of our patients with macular degeneration and glaucoma. Additionally, as a result of this study a new position (0.75 FTE) was created in the Ophthalmology Department at Palo Alto Medical Foundation for an Ophthalmic Nurse Educator.

Holistic approach to pre-operative assessment for cataract patients.

When patients agree to have cataract surgery it is important that they are fully assessed to determine their fitness for surgery. This article discusses the benefits of a nurse-led holistic approach to patient assessment, which, in practice, should be more than simply a 'tick-box exercise'. Essential components of the assessment include obtaining valid informed consent and performing biometry - the process by which the required dioptric power of an intraocular lens (IOL) implant is calculated prior to cataract surgery. It is a highly skilled procedure, which involves the measurement of corneal curvature and the axial length of the eye using either ultrasound or optical methods of biometry. This article examines the vital nursing roles aimed at improving the quality and efficiency of the patient's 'journey'.

Supporting patients undergoing cataract extraction surgery.

A cataract is an opacification, or clouding, of the lens of the eye, causing a deterioration in the clarity and brightness of vision, which may reduce quality of life. Surgical removal and artificial replacement of the opacified lens is the only treatment option available. This article discusses the patient's experience of treatment and highlights the role of the nurse in pre and post-operative care. A review of the anatomy of the eye is included and, as nurses have a vital role in supporting patients undergoing surgery, the cataract extraction operation and its potential risks and complications are described briefly.

Concordancia oftalmólogo-enfermera en la primera exploración postquirúrgica de la cirugía de cataratas / Agreement between ophthalmologist and nurse in the first postoperative exploration following cataract extraction

Introducción: La actividad de enfermería en el proceso quirúrgico de la catarata engloba, desde la realización de la biometría en el preoperatorio y la colaboración en la cirugía, hasta la administración de los primeros cuidados en el postoperatorio y la información al paciente y a la familia durante todo el proceso. El objetivo del presente trabajo es analizar la concordancia entre oftalmólogo y enfermera en los hallazgos de la primera exploración postquirúrgica de los pacientes intervenidos de cataratas mediante facoemulsificación y sin complicaciones en la cirugía. Metodología: El estudio se realizó entre mayo y junio de 2005 en 129 pacientes intervenidos de cataratas, 78 mujeres y 51 hombres con edad media de 73,1 años. Se definieron las variables a valorar en la primera exploración postquirúrgica y se estudió la concordancia entre oftalmólogos y enfermeras en la identificación de las complicaciones más frecuentes de la cirugía de cataratas. Resultados: La concordancia fue del 100% de los casos en la presión intraocular >22 mm de Hg, la irregularidad pupilar, la reacción inflamatoria de cámara anterior y el prolapso de iris; del 65,9% en la presencia de Seidel, y del 60,5% en el edema corneal severo. Conclusiones: El alto índice de concordancia médico-enfermera encontrado en 4 de las variables, puede ofrecer la posibilidad de que la enfermera realice esta primera exploración postquirúrgica. Sin embargo, una concordancia moderada en el resto hace necesario un mayor periodo de formación del personal de enfermería, para conseguir aumentar estos valores (AU)

Introduction: Nursing activity in the cataract extraction process extends from carrying out biometry in the preoperative stage and collaboration in surgery, to providing the initial care in the postoperative stage and keeping the patient and family informed throughout the whole process. This article analyses agreement between ophthalmologists and nurses in the findings of the first post-surgical exploration of patients of cataract extraction using facoemulsification and without complications in surgery. Methods: The study was carried out between May and June of 2005 on 129 patients who had been operated on for cataracts, 78 women and 51 men with an average age of 73.1 years. The variables to be evaluated in the first post-surgical exploration were defined, and a study was made of the agreement between ophthalmologists and nurses in identification of the most frequent complications in cataract surgery. Results: Agreement was 100% in the cases of intraocular pressure >22 mm Hg, pupil irregularity, inflammatory reaction of the anterior chamber and iris prolapse; it was 65.9% on the presence of Seidel; and 60.5% on severe corneal edema. Conclusions: The high rate of agreement between ophthalmologists and nurses in 4 of the variables might offer the possibility of the nurse carrying out this post-surgical exploration. However, a moderate rate of agreement in the other variables makes a longer training period for nursing personnel necessary in order to obtain higher values (AU)

Ocular complications associated with diabetes mellitus.

Diabetes is a progressive disease that may adversely affect healthy functioning of the body. The eyes are often indicators of systemic disease and are particularly vulnerable to the pathophysiological changes that occur as a result of diabetes. This article provides an overview of five main ocular complications associated with diabetes, cataract, diabetic retinopathy, central retinal vein occlusion, central retinal artery occlusion and neovascular glaucoma. The assessment and treatment of such complications and the role of the nurse in the care and management of patients are discussed.

Local anaesthetic cataract surgery: factors influencing perception of pain, anxiety and overall satisfaction.

To assess factors influencing perception of pain, anxiety and overall satisfaction during local anaesthetic cataract surgery an audit was carried out at the West of England Eye Unit. Patients receiving sub-Tenons after previous peribulbar anaesthesia had significantly higher pain scores. Patient satisfaction was significantly higher when a handholder was present in theatre. Finally, no difference was found in the three variables whether anaesthesia was administered by an anaesthetic practitioner or an anaesthetist.