La transición posquirúrgica en adolescentes que padecen escoliosis idiopática. Un estudio cualitativo / The post-surgical transition in adolescents who have idiopathic scoliosis. A qualitative study

Objetivo: Conocer el proceso que viven las y los adolescentes que padecen escoliosis idiopática al intervenirse quirúrgicamente para corregir la deformidad física. Método: Estudio cualitativo con enfoque interaccionismo simbólico. Se realizaron 22 entrevistas semiestructuradas a adolescentes intervenidos de fusión espinal posterior en un hospital de tercer nivel de Madrid entre mayo de 2019 y enero de 2021. Se llevó a cabo análisis en progreso de Taylor y Bogdan. Resultados: Los pacientes con escoliosis idiopática del adolescente presentan una transición compleja simultánea de tipo salud/enfermedad y de desarrollo. Las principales condiciones inhibidoras de la transición son los significados sobre: su identidad, sociales, creencias sobre la cirugía, el desconocimiento sobre la patología, el proceso quirúrgico y su recuperación. Como condiciones facilitadoras encontramos: la actitud positiva hacia el cambio físico, estético, social, el nivel socioeconómico y el apoyo familiar. Conclusiones: Los informantes de este estudio refieren que la afectación estética y las limitaciones físicas son los principales elementos que les causan disconfort. La intervención quirúrgica se presenta como la solución a esta situación. La recuperación es un punto crítico en el proceso de transición debido principalmente al dolor. Aceptan el malestar sufrido durante la recuperación porque esperan obtener una mejora en la imagen y las limitaciones físicas. Los cambios y diferencias que experimentan durante la transición les hace pensar que van a poder llevar una «vida normal» a la que se refieren constantemente en los discursos.(AU)

Objective: To know the process experienced by adolescents suffering from idiopathic scoliosis when undergoing surgery to correct the physical deformity. Method: Qualitative study with a symbolic interactionism approach. 22 semi-structured interviews were conducted with adolescents who underwent posterior spinal fusion in a third-level hospital in Madrid between May 2019 and January 2021. Taylor and Bogdan's analysis in progress was carried out. Results: Patients with adolescent idiopathic scoliosis present with a complex simultaneous health/illness and developmental transition. The main inhibitory conditions of the transition are the meanings about: their identity, social, beliefs about surgery, ignorance about the pathology, the surgical process, and their recovery. As facilitating conditions, we find: a positive attitude towards physical, aesthetic, and social change, socioeconomic level, and family support. Conclusions: The informants of this study refer that aesthetic affectation and physical limitations are the main elements that cause them discomfort. Surgical intervention is presented as the solution to this situation. Recovery is a critical point in the transition process mainly due to pain. They accept the discomfort suffered during the recovery because they hope to obtain an improvement in the image and physical limitations. The changes and differences they experience during the transition make them think that they will be able to lead a «normal life» to which they constantly refer in their speeches.(AU)

Time from Pain Assessment to Pain Intervention.

OBJECTIVE: The purpose of this study was to describe factors that influence nurses' time from pain assessment to intervention for acute postsurgical pain. BACKGROUND: Nurses' time is a limited resource that must be optimized to manage patients' pain within budget constraints. Little is known about processes and activities nurses negotiate to manage pain. METHODS: Human factors engineering and ethnography were used to quantify factors influencing time from pain assessment to intervention. RESULTS: On the basis of 175.5 observation hours, nurses spent 11% of shifts (mean, 83 minutes) on pain care activities. Time from alert to intervention with PRN analgesics or biobehavioral strategies for 58 cases ranged from 0 to 48 minutes (mean, <11 minutes). Five factors influenced timeliness. CONCLUSIONS: Nurses most efficiently managed postsurgical pain by giving analgesics ordered PRN on a scheduled basis. Nurse leaders can empower prompt responses to patients' pain through delegation, process improvements, real-time monitoring, and prescriber engagement.

Pain Quality Among Hospitalized Postcraniotomy Brain Tumor Patients.

PURPOSE/AIMS: The aim of this study was to describe how persons given a diagnosis of a brain tumor who have had a craniotomy describe the quality of their pain after surgery. DESIGN: A qualitative descriptive design was used. METHODS: Qualitative descriptive methods as described by Sandelowski guided this study. Semistructured interviews were conducted with patients hospitalized on a neurological step-down unit in an urban teaching hospital in the Midwestern United States. Interviews focused on the quality of participants' pain after surgery. Narratives were analyzed using standard content analysis. RESULTS: Twenty-seven participants were interviewed. Most were White and female. Most underwent a craniotomy using an anterior approach with sedation. Participants described the quality of their pain with 6 different types of descriptors: pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. CONCLUSIONS: Participants' descriptions of their pain quality after surgery provide a different understanding than do numerical pain ratings. Clinicians should use questions to explore patients' individual pain experiences, seeking to understand the quality of patients' pain and their perceptions.

Implementation of a Multimodal Analgesia Protocol Among Outpatient Neurosurgical Patients Undergoing Spine Surgery to Improve Patient Outcomes.

PURPOSE: This quality improvement project implemented an evidence-based multimodal analgesia protocol among patients undergoing outpatient spine surgery in an attempt to decrease postoperative opioid requirements, postoperative pain scores, and facility and postanesthesia care unit length of stay (LOS). DESIGN: Two independent samples were compared with a preimplementation and postimplementation design. There were 37 patients in the preimplementation group and 36 patients in the postimplementation group. METHODS: Data were collected by a retrospective chart review of neurosurgical patients undergoing spine surgery and included postoperative opioid requirements, postoperative pain scores, facility and postanesthesia care unit LOS, and the number of protocol components implemented on each patient. FINDINGS: Intraoperative and postoperative by mouth opioid requirements were significantly decreased postimplementation. Postoperative opioid requirements decreased, and postimplementation pain scores were reduced across all time points. LOS did not significantly change. CONCLUSIONS: This multimodal analgesia protocol significantly decreased opioid consumption among neurosurgical patients at this surgery center.

Efecto de una intervención educativa de enfermería para reducir el dolor en el paciente con revascularización miocárdica durante el posoperatorio ambulatorio / Effect of an educational nursing intervention to reduce pain in patients with myocardial revascularization during the outpatient postoperative period

Introducción: Las necesidades que experimentan los pacientes en el postoperatorio de cirugía cardiaca van desde lo fisiológico hasta la esfera emocional. A nivel fisiológico el dolor es una necesidad insatisfecha, que repercute en otras necesidades como el sueño y la actividad física, el estado de ánimo, la adherencia terapéutica y la calidad de vida. Objetivo: Determinar el efecto de una intervención educativa de Enfermería comparada con el cuidado de enfermería convencional, para reducir el dolor del paciente de cirugía cardiaca en el posoperatorio ambulatorio en una Institución de alta complejidad en Cúcuta durante el II semestre del año 2020 y el I semestre del año 2021. Metodología: Estudio cuantitativo, cuasi experimental, con medición preprueba en el control posoperatorio realizado al tercer día y posprueba, con grupo de comparación, en pacientes con revascularización miocárdica de una institución de alta complejidad en Cúcuta, con muestreo probabilístico, aleatorio simple, con una muestra estimada de 40 pacientes para cada grupo. Para la recolección de la información se utilizó el cuestionario del dolor McGill (índice de valoración del dolor) (Cibersam, 1994) y el Inventario de la Ansiedad Rasgo, IDARE, previo diligenciamiento del consentimiento informado, se realizaron mediciones del dolor al tercer día de posoperatorio ambulatorio, a los 15 y 30 días de entrega de la intervención educativa, para determinar el efecto de la intervención entre grupos e intragrupo frente al cuidado convencional. Resultados: El grupo experimental exhibió una reducción estadísticamente significativa de los niveles del dolor para cada una de las dimensiones y a nivel general luego de la intervención educativa (p< 0.05) mientras que en el grupo de comparación no hubo cambios importantes en los niveles de dolor entre ambas mediciones (p > 0.05). También se pudo establecer que el grupo experimental exhibió una reducción estadísticamente significativa de los niveles de ansiedad para cada una de las dimensiones y a nivel general luego de la intervención educativa (p< 0.05) contrario al grupo de comparación, donde se evidenció un aumento en el nivel de ansiedad, aunque sin diferencias importantes respecto de la medición inicial (p > 0.05). (AU)

Pós-operatório de paciente oncológico em jejum prolongado: diagnósticos e intervenções de enfermagem / Post-operative oncological patients in prolonged fast: nursing diagnosis and interventions / Postoperatorio del paciente oncológico bajo ayuno prolongado: diagnósticos e intervenciones de enfermería

Objetivo: identificar os principais diagnósticos de enfermagem e suas respectivas intervenções em uma população de pacientes oncológicos submetidos a jejum prolongado no pós-operatório. Método: estudo descritivo, documental e transversal. O cenário do estudo foi um hospital federal de ensino no Rio de Janeiro, caracterizado como UNACON. Os dados foram coletados durante 60 dias em prontuários referentes aos anos de 2016 a 2018. Foram analisados 61 prontuários que atendiam aos critérios de inclusão e 208 complicações foram apresentadas pelos pacientes oncológicos. Resultados: Foram definidos oito diagnósticos de enfermagem, entre os quais os mais evidentes foram: Nutrição desequilibrada: menor que as necessidades corporais e Risco de glicemia instável. Onze intervenções de enfermagem foram definidas em consonância com a Taxonomia de NANDA-I e buscaram ser de fácil aplicação na prática assistencial de enfermagem. Conclusão: foi evidenciada uma ampla gama de diagnósticos e intervenções de enfermagem a qual se recomenda sua adoção no processo de enfermagem.

Objective: to identify the main nursing diagnoses and respective interventions in a population of cancer patients undergoing prolonged postoperative fasting. Method: descriptive, cross-sectional, documentary study. The study scenario was a federal teaching hospital in Rio de Janeiro, characterized as a high-complexity oncological facility. Data were collected for 60 days from medical records for the years 2016 to 2018. In the 61 medical records that met the inclusion criteria and were analyzed, cancer patients presented 208 complications. Results: eight diagnoses were established, the most in evidence being: nutrition imbalance: less than body requirements; and risk of unstable blood glucose level. Eleven nursing interventions, designed to be easily applied in nursing care practice, were specified in line with the NANDA-I Taxonomy. Conclusion: the wide range of nursing diagnoses and interventions evidenced are recommended for adoption in the nursing process.

Objetivo: identificar los principales diagnósticos de enfermería y sus respectivas intervenciones en una población de pacientes oncológicos sometidos a ayuno postoperatorio prolongado. Método: estudio descriptivo, transversal, documental. El escenario de estudio fue un hospital universitario federal en Río de Janeiro, caracterizado como una instalación oncológica de alta complejidad. Se recolectaron datos durante 60 días de las historias clínicas de los años 2016 a 2018. En las 61 historias clínicas que cumplieron con los criterios de inclusión y fueron analizadas, los pacientes con cáncer presentaron 208 complicaciones. Resultados: se establecieron ocho diagnósticos, siendo los más evidentes: desequilibrio nutricional: menor que los requerimientos corporales; y riesgo de niveles inestables de glucosa en sangre. Once intervenciones de enfermería, diseñadas para ser fácilmente aplicadas en la práctica del cuidado de enfermería, fueron especificadas de acuerdo con la Taxonomía NANDA-I. Conclusión: la amplia gama de diagnósticos e intervenciones de enfermería evidenciados se recomiendan para su adopción en el proceso de enfermería.

The effects of immediate programmed cryotherapy and continuous passive motion in patients after computer-assisted total knee arthroplasty: a prospective, randomized controlled trial.

BACKGROUND: The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA). METHODS: A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n = 30) and control group (n = 30). The intervention group applied programed cryotherapy and CPM within 1 h while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare the numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4. RESULTS: There was no significant difference in the NRS score between the groups (p = 0.168). The intervention group had significantly higher ROM than the control group (98° vs. 91°, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups (p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm). CONCLUSIONS: Immediate programmed cryotherapy and continuous passive motion could help to improve ROM quickly after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04136431 . Registered 23 October 2019-retrospectively registered.

Nurses' Knowledge and Attitude towards Postoperative Pain Management in Ghana.

Background: Pain management is a very important aspect of nursing care among postoperative patients. Deficit in the knowledge and bad attitude towards pain management among nurses remain a problem in Ghana. In order to manage pain better in the surgical wards, nurses should be well equipped with knowledge of pain assessment and management. Purpose: The purpose of the study was to determine nurse's knowledge and attitude towards pain management among postoperative patients in surgical units in Ghana. Methodology. This study used the quantitative study approach with a descriptive cross-sectional study design. A sample of 211 nurses was recruited using the convenience sampling method. Data were collected using a questionnaire regarding postoperative pain management. Descriptive statistics, Pearson's correlation coefficient, and the chi-squared test were used to analyze the data using SPSS version 16.0. Results: The mean age of the nurses was 29.77, with the youngest nurse being 23 years and oldest being 39 years. Majority (72.5%) of nurses had moderate knowledge, and 89.6% of the nurses had negative attitude towards pain management. There was no significant relationship between nurse's knowledge and years of experience as a nurse (r = -0.03, p=0.64), as well as no significant relationship between knowledge and number of years working in the surgical ward (r = 0.06, p=0.36). Also, there was no significant relationship between nurses' knowledge and nurses' attitude (r = 0.06, p=0.36). Conclusion and recommendation. The level of knowledge and attitude towards postoperative management were generally inadequate among nurses. Therefore, there is the need to implement in-service training on pain management for nurses working in the surgical units frequently.

Nursing aromatherapy using lavender with rose essence oil for post-surgery pain management

OBJECTIVE: Pain management is one of the methods used in the health sector. Nursing care focuses on non-pharmacological measures, including the provision of aromatherapy using lavender and rose aromatherapy, which aims to understand the effectiveness of lavender and rose aromatherapy on pain intensity of postoperative patients in Laparatomi Hospital in Aisyiyah General Hospital in the surgical inpatient room, Padang in 2019. METHOD: The design of this study is a Quasi Experiment with pre-test and post-test designs with two groups. The sample of this study was Post Laparatomi in RSU with the technique of Accidental Sampling. The sample of this study consisted of 30 people for lavender and rose aromatherapy. Statistical tests used the Independent Test T-test. RESULT: Based on the results of the study it was found that lavender and rose aromatherapy can reduce pain scale in postoperative patients. But compared to the two intervention groups, the aroma group of lavender therapy is more effective with mean pain scale before lavender aromatherapy being 5.20 and pre-test is 3.40 with p-value 0.000. CONCLUSION: The nurses could provide nursing care in dealing with pain management in postoperative patients in addition to deep breathing techniques. It is recommended to apply aroma lavender therapy, which reduces pain and makes patients more relaxed

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The role of acute pain service in postoperative pain relief / [Az akutfájdalom-kezelo szolgálat szerepe a mutét utáni fájdalomcsillapításban]

Perioperative analgesia is a major challenge for healthcare providers. Not well-controlled pain after surgery can lead to complications. The worldwide spread of acute pain service (APS) teams has proven to increase the effectiveness of postoperative pain management. This publication aims to describe the concept, structure, quality criteria, and implementation models of acute pain management services based on relevant publications. A systematic literature review was conducted in the relevant databases by the PICO technique, and 263 abstracts were evaluated. The service is available in many countries around the world, basically in three functional structures. The team consists of anesthesiologists and nursing staff specialized in pain therapy. There are 5 quality criteria for describing how the teams work, but service plays an important role in educating patients and staff and developing pain-therapy protocols. We recommend a survey-based evaluation of the current status of APS and the fulfilment of quality criteria in the field of postoperative pain management in Hungary. Orv Hetil. 2020; 161(15): 575­581.

El enfermero operado / The Operated Patient

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Role of the nurse in the assessment and management of post-operative pain.

While post-operative pain is a common and unavoidable consequence of surgery, evidence suggests that the levels of pain experienced by patients are unnecessarily high. In the past two decades, evidence has also indicated that nurses' knowledge of the assessment and effective management of pain is suboptimal. This article considers the elements required for an effective post-operative pain assessment, as well as examining the barriers that result in many patients' post-operative pain not being assessed. The article also provides an overview of the main pain management interventions available to nurses.

Congruence between nurses' and patients' assessment of postoperative pain: a literature review.

Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.

Association of Prescription Opioid Exposure and Patient Factors With Prolonged Postoperative Opioid Use in Opioid-Naïve Patients.

The purpose of this research study was to identify factors associated with prolonged postoperative opioid use in opioid-naïve patients in 2 domains: specific patient characteristics and exposure through postoperative opioid prescriptions. A retrospective analysis was conducted of electronic medical records of opioid-naïve adult orthopedic surgical patients at a large academic medical center from January 1, 2012, through December 31, 2017. In this cohort, 4% continued to refill opioid prescriptions more than 90 days after their surgical procedure. Prolonged use was associated with an initial prescription that had an oral morphine milligram equivalent above 675. Receipt of opioid prescription refills was a significant predictor for receiving additional opioid prescriptions over time. Multivariate logistic regression indicated that the independent predictors of prolonged postoperative opioid use were alcohol abuse, black race, Medicaid insurance, and the following comorbidities: diabetes, mood disorder, hypertension, and chronic kidney disease. To decrease the rate of prolonged postoperative opioid use, clinical changes can be investigated, including collaborative perioperative pain management strategies using nonopioid pain control methods; perioperative patient screening; education of patients and clinicians; and close postoperative follow-up, especially in the most vulnerable populations.

Effect of Eye Masks on Pain and Sleep Quality in Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial.

BACKGROUND: Impaired sleep is a common complaint among patients undergoing major surgery and may be a contributing factor in postoperative pain. The provision of eye masks to patients after cardiac surgery may reduce postoperative pain through improvements in sleep quality. OBJECTIVE: To examine the effect of nocturnal eye masks on postoperative pain and sleep quality in cardiac surgical patients. METHODS: In this randomized controlled trial, 70 adult patients who had undergone cardiac surgery requiring immediate postoperative care in the intensive care unit were randomly assigned to sleep with or without nocturnal eye masks for the first 3 nights in the unit. A visual analog scale was used to assess pain intensity, and the Arabic version of the Richards-Campbell Sleep Questionnaire was used to assess subjective sleep quality. RESULTS: A total of 66 patients completed the trial. A statistically significant difference was found between groups in mean total Richards-Campbell Sleep Questionnaire score over the 3-day study period (P = .001), with the intervention group reporting better sleep quality. A statistically significant difference was also found between groups in mean pain score on days 1, 2, and 3 (P < .001), with the intervention group having less pain. CONCLUSION: Nocturnal eye masks are a simple, low-risk, low-cost intervention that may contribute to reductions in perceived pain in cardiac surgery patients.

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery.

AIMS AND OBJECTIVES: To explore the consistency of pain intensity and pain location assessed by nurses and patients in gynaecology undergoing enhanced recovery after surgery pathway. BACKGROUND: Several studies have shown that clinical nurses' assessment of patients' pain is not always accurate. Little is known about the accuracy of nurses' pain assessments for gynaecological patients. Postoperative pain assessment and management is an essential part of enhanced recovery after surgery. DESIGN: Comparative cross-sectional study. METHODS: A total of 160 patients were recruited and only 85 patients and 17 nurses participated. Patients and nurses recorded pain scores (using an 11-point Numeric Rating Scale) and pain location (incision pain, surgical area pain in the abdominal cavity, other pain or no pain) on Pain Assessment Forms at 4 hr after surgery and on the first and second postoperative days. We used the STROBE guidelines to report our study. RESULTS: The patients' pain score was higher than that of nurses from 4 hr to second day after laparoscopic surgery at rest. The pain scores of both nurses and patients decreased over this period of time. All the intraclass correlation coefficients were between 0.214-0.296. At the three time points, surgical area pain in the abdominal cavity and abdominal incision pain were the main pain areas. All the kappa coefficients were between 0.164-0.255. CONCLUSIONS: The consistency of postoperative pain assessment about pain score and pain location between nurses and patients was not high. We should attach importance to systematic pain assessment, and more detailed enhanced recovery after surgery pathways should be developed about pain assessment. RELEVANCE TO CLINICAL PRACTICE: Continuing education for nurses regarding pain assessment is necessary. Nurses should accept the patient's self-reported pain. There should be a step that gives more time for pain assessment in enhanced recovery after surgery pathways.

Clinical supervision: analysis of postoperative pain evaluation in the ambulatory surgery setting / Supervisão clínica: análise da avaliação da dor pós-operatória em cirurgia de ambulatório

Clinical supervision, as a formal process of monitoring professional practice, aims to improve decision-making to contribute to safety and quality of care through reflection processes and analysis of clinical practice. This study aimed to compare the postoperative pain evaluation and clinical recording procedures performed by nursing staff and clinical supervisors in ambulatory surgery patients.The study was integrated into the research project "SAFECARE". It was developed a descriptive cross-sectional quantitative study in an ambulatory surgery unit of a University Hospital in Oporto, Portugal. The study population was the nursing staff with an intentional non-probabilistic sampling method. A questionnaire was constructed and evaluation of postoperative pain, patient clinical and demographic variables was included. This instrument was applied in 116 patients matched by 12 surgical specialties. Results were compared between nursing staff, clinical supervisors and electronic nursing records. Patients had an average age of 48.6 years, being mostly female. Regarding pain evaluation, the scale most used by nurses (62.1%) and clinical supervisors (67.2%) was the "Numerical Scale". Postoperative pain evaluation scores ranged from 0 to 7, with score 0 (no pain) presenting more frequently by nurses, electronic nursing records and clinical supervisors. 34.5% of results were not documented in electronic nursing records. These findings support the importance of an intervention of clinical supervision in the indicator "pain" for the outpatient surgery setting. Local protocols of clinical supervision practice would contribute to improve postoperative pain evaluation, as well as standardization and optimization of nursing records, thus ensuring quality care

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