RESUMO
AIMS AND OBJECTIVES: Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety? BACKGROUND: Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery. INTRODUCTION: According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety. DESIGN: Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety. METHODS: A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO. RESULTS: A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results. CONCLUSION: Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs. RELEVANCE TO CLINICAL PRACTICE: This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results. NO PATIENT OR PUBLIC CONTRIBUTION: Not applied to our study, as it is a systematic review of systematic reviews.
Assuntos
Musicoterapia , Música , Adulto , Criança , Humanos , Ansiedade/prevenção & controle , Transtornos de Ansiedade , Musicoterapia/métodos , Revisões Sistemáticas como AssuntoRESUMO
Care process re-engineering combining patient in situ simulation with a systems-based approach has proven useful for improving the quality of care of patients with postpartum hemorrhage. However, new processes are not always transferred to clinical practice. We studied the degree of implementation of a new process and the reasons for introducing it. Professionals managing postpartum hemorrhages between January 15 and April 4, 2018 were interviewed and completed anonymous questionnaires. An ethnographic analysis of the workplace was also carried out. There was bleeding in 1.26% of deliveries, and the massive hemorrhage protocol was activated in 0.47%. The data collected were categorized according to a sociotechnical health system-based approach, including human, social and organizational factors, as well as clinical, technical, and architectural aspects. All participants interviewed found the new process and the flowchart useful for the management of hemorrhage. Only 12.5% of the incidents detected were clinical, and the rest were related to the system. Modifications introduced after the analysis included placing all drugs and instructions for the hemorrhage kit in a single location and signaling this in the flowchart, moving the flowchart to a more accessible location, and removing the old process protocol and disseminating the current one among new staff. The redesign of the postpartum hemorrhage care process combining in situ simulation with a sociotechnical health system-based approach is viable and well accepted by clinicians
La reingeniería de procesos asistenciales combinando la simulación clínica con un enfoque al sistema de trabajo se ha mostrado como un método útil para mejorar la calidad de la atención a la hemorragia posparto. Sin embargo, en ocasiones los nuevos procesos diseñados no se llevan a la práctica clínica. Se estudió el grado de implantación de un nuevo proceso y las causas que lo condicionaron. Se realizaron entrevistas individuales y cuestionarios anónimos a quienes asistieron las hemorragias postparto ocurridas entre el 15 enero y el 4 abril, 2018, y un análisis etnográfico del lugar de trabajo. Hubo sangrado en 1,26% de los partos y se activó el protocolo de hemorragia masiva en 0,47% de ellos. Los datos recogidos se categorizaron según el enfoque del diseño de sistemas socio-técnicos, incluyendo factores humanos, sociales y organizacionales, así como aspectos clínicos, técnicos y arquitectónicos. Todos los entrevistados encontraron útil el nuevo proceso, así como el flujograma para guiar el manejo de la hemorragia. El 12,5% de las incidencias detectadas fueron clínicas y el resto del sistema. Tras el análisis se introdujeron modificaciones incluyendo la colocación de todos los fármacos e instrucciones del kit de hemorragia en una única localización indicándolo en el flujograma, cambiar de ubicación el mapa del proceso, retirar el antiguo proceso y difundir el actual entre el nuevo personal. El rediseño del proceso de atención a la hemorragia masiva postparto combinando la simulación con un enfoque al sistema sanitario socio-técnico es viable y aceptado por los profesionales
