Nursing care complexity as a predictor of adverse events in patients transferred from ICU to hospital ward after general surgery.

OBJECTIVES: Predicting the likelihood of adverse events following discharge from the intensive care unit (ICU) can contribute to improving the quality of surgical care. This study aimed to evaluate the impact of nursing care complexity as a predictor of adverse event development in general surgery patients transferred from the ICU to the hospital ward. METHODS: A prospective observational study was conducted with 100 patients in the ICU and general surgical inpatient unit of a training and research hospital in Istanbul, Turkey. The Nursing Care Complexity tool was used by ICU and hospital ward nurses to measure nursing complexity. RESULTS: A total of 65 adverse events developed in 51 patients during hospital ward hospitalization after discharge from the ICU. Nursing care complexity evaluations by the ICU nurses predicted overall and some specific adverse events, while hospital ward nurses' evaluations predicted ICU readmission and some follow-up abnormalities such as patients' blood pressure, pulse rate, and laboratory results. CONCLUSION: The results of the current study validate that nursing care complexity can serve as a valuable tool for predicting the risk of adverse events and ICU readmission following discharge from the ICU. IMPLICATIONS FOR CLINICAL PRACTICE: The use of the Nursing Care complexity tool by the ICU and even hospital ward nurses after ICU discharge may have a significant impact on patient outcomes and contribute to the recognition of nursing efforts.

Inadvertent Perioperative Hypothermia in Ambulatory Surgery Patients: Incidence, Risk Factors, and Prevention Initiatives.

PURPOSE: Although the number and complexity of ambulatory surgical interventions has grown considerably over the years, it has not been fully established whether hypothermia still poses a risk for these interventions. In this study, we aimed to determine the incidence, risk factors, and methods applied to prevent perioperative hypothermia in ambulatory surgery patients. DESIGN: A descriptive research design was used. METHODS: The study was conducted with 175 patients between May 2021 and March 2022 in the outpatient units of a training and research hospital in Mersin, Turkey. Data were collected using the Patient Information and Follow-up Form. FINDINGS: The incidence of perioperative hypothermia was 20% in ambulatory surgery patients. Hypothermia developed in 13.7% of the patients at the 0th minute at the PACU, and 96.6% of the patients were not warmed intraoperatively. We noted a statistically significant relationship between perioperative hypothermia and advanced age (≥60 years), high American Society of Anesthesiologists' (ASA) class, and low hematocrit values. In addition, we determined that the female gender, presence of chronic diseases, general anesthesia, and a long operation time were other risk factors for hypothermia in the perioperative period. CONCLUSIONS: The incidence of hypothermia during ambulatory surgeries is lower than that in inpatient surgeries. The warming rate of ambulatory surgery patients, which is quite low, can be improved by increasing the awareness of the perioperative team and following the guidelines.

Learning Needs of Patients and Their Caregivers After Ambulatory Surgery.

PURPOSE: The purpose of this study was to determine the learning needs of ambulatory surgery patients and their caregivers. DESIGN: The study was a cross-sectional and descriptive survey. METHODS: The study was conducted between July 2017 and March 2018 in the outpatient units of a training and research hospital in Istanbul, Turkey. The sample consisted of 117 patients and caregivers dyads. The instruments included a Patient Information Form and the Patient Learning Needs Scale (PLNS). FINDINGS: The mean total PLNS scores of ambulatory surgery patients were 193.54 ± 35.46 and that of the patient's caregivers was 199.88 ± 31.84. The highest mean PLNS subscale for patients and caregivers was treatment and complications. As the PLNS scores of the patients increase, the scores of the caregivers also increase. CONCLUSIONS: The learning needs of ambulatory surgery patients and their caregivers are high. Patients and caregivers must be well informed and well prepared to cope with possible problems at home.

Connectors as a risk factor for blood-associated infections (3-way stopcock and needleless connector): A randomized-experimental study.

BACKGROUND: Microorganisms causing catheter-related bloodstream infections colonize to intravenous catheters (IVC)-particularly to connectors mounted to catheters. The aim of this study was to examine the colonization in 3-way stopcock (TWS) connectors and needleless connectors (NCs) that integrated into central, port, and peripheral venous catheters. METHODS: This random, experimental study consisted of 180 connectors that were inserted into the IVCs of patients in general surgery, reanimation intensive care, and daily chemotherapy units. Cultures of the connectors were obtained at least 48 hours after connecting to IVCs. RESULTS: This study showed that gram-negative, gram-positive, and other pathogens reproduced, although their colonization level was not high enough to develop an infection. When the results of colonization for patients using TWS and NC were compared, the peripheral venous catheters (using a TWS) resulted in a significantly higher increase in reproduction than in patients using NC (P ≤ .01) and no significant difference in the level of colonization in other types of connectors or catheters (P ˃ .05). CONCLUSIONS: The study's results indicated no significant difference between NC and TWSs in terms of reproduction. It should also be noted that connectors integrated into IVC pose a risk in the development of catheter-related bloodstream infections.