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Resumen Introducción: La situación actual causada por el COVID-19 demanda la implementación de nuevas técnicas en el manejo anestésico y los riesgos preexistentes en los servicios quirúrgicos. Objetivo: Identificar las consideraciones anestésicas para pacientes con COVID-19 con el fin de sugerir intervenciones en el área quirúrgica. Metodología: Revisión integrativa de alcance descriptivo en conjunto con el cumplimiento de los pasos metodológicos de Whittemore-Knafl y los parámetros PRISMA. Se realizó la búsqueda en las bases de datos: PubMed, BVS, Coronavirus Research Database, SCOPUS, Elsevier y SAGE. Se obtuvieron 953 artículos que, junto a un análisis crítico por CASPe, cumplieron los criterios establecidos de inclusión y exclusión. Resultados: Se seleccionaron 27 artículos clasificados en: criterios de selección de técnica anestésica; anestesia general y el uso de medicamentos específicos para el manejo anestésico que disminuyan la tos y prevengan la liberación de aerosoles; manejo de la vía aérea encaminada a evitar intubaciones fallidas; anestesia regional y consideraciones de enfermería sobre la preparación de elementos y dispositivos de manera previa al ingreso del paciente al quirófano; identificación y monitorización de pacientes sintomáticos y asintomáticos durante el proceso perioperatorio. Conclusión: Con respecto a la técnica anestésica, es importante priorizar el uso, en cuanto sea posible, de la anestesia regional guiada con ultrasonido. En caso de requerirse la anestesia general, es recomendable mantener las precauciones para prevenir el contagio con el virus. Para enfermería, es destacable el rol en la preparación de un entorno quirúrgico seguro, del conocimiento sobre la técnica anestésica empleada y los cuidados individualizados según las necesidades requeridas.
Abstract Introduction: The current situation caused by COVID-19 demands the implementation of new techniques in anesthetic management and pre-existing risks in surgical services. Objective: to identify the anesthetic considerations for patients with COVID-19 to suggest interventions in the surgical area. Methodology: Integrative review of descriptive scope in conjunction with compliance with the methodological steps of Whittemore-Knafl and the PRISMA parameters. The search was performed in the following databases: PubMed, VHL, Coronavirus Research Database, SCOPUS, Elsevier, and SAGE. A total of 953 articles were obtained, which together with a critical analysis by CASPe, met the established inclusion and exclusion criteria. Results: Twenty-seven articles classified as: selection criteria for anesthetic techniques; general anesthesia and the use of specific medications for anesthetic management that reduce cough and prevent the release of aerosols; airway management to avoid failed intubations; regional anesthesia and nursing considerations in the preparation of elements and devices prior to the patient's admission to the operating room; identification and follow-up of symptomatic and asymptomatic patients during the perioperative process. Conclusion: Regarding the anesthetic technique, it is important to prioritize the use, as far as possible, of ultrasound-guided regional anesthesia. If general anesthesia is required, it is advisable to maintain precautions to prevent infection with the virus. For nursing, the role in preparing a safe surgical environment, knowledge of the anesthetic technique used and individualized care according to the required needs stand out.
Subject(s)
Humans , Male , Female , General Surgery , Perioperative Nursing , COVID-19 , Anesthesia , Nursing CareABSTRACT
AIM: To understand how the COVID-19 pandemic impacted nurse educators' and novice nurses' experience with the perioperative transition to specialty practice program. DESIGN: A qualitative descriptive study. METHODS: Semi-structured interviews were conducted with five perioperative nurse educators and five perioperative transition to specialty practice program participants from a major metropolitan health service in Melbourne. Data were collected between April and July 2021. Interviews were audio-recorded and transcribed verbatim, and data were analysed using reflexive thematic analysis. RESULTS: Five themes were identified. The value of the perioperative transition to specialty practice program in supporting novice nurses was recognized in the theme 'Nurturing our novices'. Widespread changes to clinical practice were demonstrated in the theme 'Every day is different', including changes to elective surgery, redeployment of staff and the transmission risk of COVID-19. 'The perils and joys of online learning' revealed both challenges and benefits of transitioning theoretical education from face-to-face to online delivery. 'Roller coaster of emotions' represented the heightened emotions participants experienced due to the COVID-19 pandemic. 'Looking back to move forward' encompassed participants' reflections on the year, considering the challenges, adaptive strategies and the future of perioperative nursing education. CONCLUSION: The perioperative transition to specialty practice program was significantly impacted by the COVID-19 pandemic. Participants needed to adapt to rapid and frequent changes, which contributed to feelings of emotional distress, affected consolidation of clinical learning and reduced engagement with theoretical education. IMPACT: Perioperative nurses should acknowledge that opportunities for learning were decreased for transition to specialty practice program participants during the pandemic. Ongoing support and education should be provided, to nurture the future generation of perioperative nurses.
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Background : Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective : To investigate the impact of nurse-surgeons on patient-centred outcomes. Design : Systematic review Method : The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results : Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience;waiting list;perioperative complications;and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies;none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions : Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical specialty. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.
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AIM: This study aims to investigate the problems experienced by perioperative nurses due to the use of personal protective equipment and their attitudes towards caregiving roles. METHODS: This cross-sectional study was conducted with 175 volunteer nurses working in surgical clinics across Turkey between March-June 2021. Data were collected online with a personal information form, an information form regarding the personal protective equipment usage times of nurses and the problems experienced, and the Attitude Scale for Nurses in Caregiving Roles. RESULTS: It was found that 98.3% of nurses had problems with personal protective equipment (excluding gloves); 97.7% of them had problems with sterile or non-sterile gloves, and 65.7% of them stated that pressure injuries developed due to personal protective equipment. It was determined that the rate of nurses considering leaving the profession today is higher than before the outbreak. The Attitude Scale for Nurses in Caregiving Roles obtained a mean score of 65.83 ± 9.41. Those who did not intend to leave the nursing profession had higher scale mean scores than those who thought to leave. CONCLUSION: It was determined that perioperative nurses experienced skin problems due to the use of personal protective equipment and most of them developed pressure injuries, nearly half of them considered leaving the profession during the COVID-19 pandemic, and considering leaving the profession adversely affected their caregiver roles. According to the results of this study, it is recommended that attempts should be made to develop strategies to prevent skin problems and pressure injuries in perioperative nurses.
Subject(s)
COVID-19 , Nurses , Attitude of Health Personnel , COVID-19/prevention & control , Cross-Sectional Studies , Humans , Pandemics/prevention & control , Personal Protective Equipment/adverse effectsABSTRACT
BACKGROUND: Anxiety is common before surgery and known to negatively impact recovery from surgery. The aim of this study was to evaluate the impact of a preoperative nurse dialogue on a patient's anxiety, satisfaction and early postoperative outcomes. METHOD: This 1:1 randomized controlled trial compared patients undergoing major visceral surgery after a semistructured preoperative nurse dialogue (interventional group: IG) to a control group (CG) without nursing intervention prior to surgery. Anxiety was measured with the autoevaluation scale State-Trait Anxiety Inventory (STAI, Y-form) pre and postoperatively. The European Organization for Research and Treatment of Cancer (EORTC) In-Patsat32 questionnaire was used to assess patient satisfaction at discharge. Further outcomes included postoperative pain (visual analogue scale: VAS 0-10), postoperative nausea and vomiting (PONV), opiate consumption and length of stay (LOS). RESULTS: Over a period of 6 months, 35 participants were randomized to either group with no drop-out or loss to follow-up (total n = 70). The median score of preoperative anxiety was 40 (IQR 33-55) in the IG vs. 61 (IQR 52-68) in the CG (p < 0.001). Postoperative anxiety levels were comparable 34 (IQR 25-46) vs. 32 (IQR 25-44) for IG and CG, respectively (p = 0.579). The IG did not present higher overall satisfaction (90 ± 15 vs. 82.9 ± 16, p = 0.057), and pain at Day 2 was similar (1.3 ± 1.7 vs. 2 ± 1.9, p = 0.077), while opiate consumption, PONV levels and LOS were comparable. CONCLUSION: A preoperative dialogue with a patient-centered approach helped to reduce preoperative anxiety in patients undergoing major visceral surgery.
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PURPOSE: This study examined the significance, nature, and structure of the virtual experience of perioperative patients as undergone by nursing students during their practical training through VR and blended learning. METHODS: Data were collected through a focus group interview (FGI) of 21 nursing student participants from November 2019 to December 2019 and analyzed through Colaizzi's phenomenological method. RESULTS: Seven theme clusters were organized that described nursing students' experiences. They are "placed in a passive position," "facing the limits of communication," "thinking of developing and improving competency as a nurse," "recognizing the importance of interacting with their patients", "learning vividly through experience", "engaging in a new type of participatory learning", and "designing nursing knowledge." CONCLUSION: Patient-centered care can be achieved in the nursing school curriculum through "patient experiences." Additionally, the feedback from research participants who have "become keenly aware of the need for patient experiences" shows that empathizing with the "patient experience" is an essential quality to acquire by prospective medical professionals before they are introduced to the nursing field. We suggest future studies that expand on nursing students' patient experience in various teaching methods and curriculums.