Does Postanesthesia Forced-Air Warming Affect Emergence Delirium in Pediatric Patients Receiving Daily Anesthesia?

PURPOSE: To determine if postanesthesia forced-air warming as a nonpharmacologic intervention for emergence delirium (ED)/emergence agitation (EA) decreased the incidence and severity of ED in children aged 18 months to 6 years old. DESIGN: Prospective nonrandomized controlled trial. METHODS: Participants included children aged 18 months to 6 years old receiving general anesthesia within a radiation oncology setting. Status of ED/EA was based on the participants' Pediatric Anesthesia Emergence Delirium (PAED) scale score (two consecutive scores greater than 10 out of 20) or inconsolable agitation behaviors post computed tomography simulation (day 0). Interrater reliability was conducted among the center's perianesthesia care nurses. Participants who scored positive for ED/EA received a forced-air warming blanket for the remainder of treatment with data collection 1 to 14 days postanesthesia. Non-ED/EA participants were followed for 14 days and provided forced-air warming if ED/EA occurred. Data consisted of daily PAED scores and self- or parent-report on the anxiety scale. If the participants received forced-air warming, nurses' clinical observations and parent satisfaction surveys were collected 3 times during the 14-day study period. FINDINGS: A total of 59 participants completed the study (mean age 3.43 years; 60% male; 63% non-Hispanic White); 16 were identified with ED or EA (mean age 3.56 years; 50% male; 69% non-Hispanic White) with an incidence rate of 28%. For the 16 participants with ED/EA, the primary diagnosis consisted of solid tumors and an American Society of Anesthesia Classification III to IV. Prior to the forced-air warming intervention, all 16 participants exhibited inconsolable ED/EA behaviors, including 8 who had PAED scores greater than 10. ED/EA behaviors expressed included inconsolability, confusion, thrashing, and combativeness. Within the 14-day period, 3 participants received forced-air warming on day 1, while the other 13 received an average of 4.23 days of treatment (range 1 to 11 days; mode 1 day; median 4 days). Comparison of PAED scores pre (mean 4.4) and post (mean 1.8) indicated that the use of forced-air warming was statistically significant (P = .001). ED/EA behaviors and PAED scores after the forced-air warming period decreased in all but one participant. Some agitation behaviors were not captured within the PAED score. CONCLUSIONS: Forced-air warming impacted PAED scores and agitation behaviors for studied participants, offering a safe, nonpharmacological nursing intervention that may be an effective tool for helping to manage this baffling condition.

"A Certainty for you Does Not Mean That it is a Certainty for Science": A Phenomenological Analysis of Experiences of Uncertainty in Clinical Reasoning of Nurses in the Postanesthesia Care Unit.

PURPOSE: To explore the experiences of uncertainty in the clinical reasoning of nurses in the postanesthesia care unit (PACU). DESIGN: A phenomenological descriptive design, following Colaizzi's analysis. METHODS: Semistructured interviews were conducted with 14 nurses from a PACU on their experience of uncertainty in clinical reasoning. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed seven phases: (re)reading the transcripts, extracting significant statements, formulating meanings from significant statements, aggregating formulated meanings into themes, developing a description of the phenomenon's essential structure, generating of the fundamental structure of the phenomenon, validating of the findings through participant feedback. The process employed MAXQDA analytics Pro 2022 software. Consolidated Criteria for Reporting A Qualitative Research checklist was used for reporting. FINDINGS: From uncertainty experiences in nurses' clinical reasoning, 10 themes emerged: ambiguity and decision latitude, communication, work ethic, difficulty interpreting and predicting outcomes, cognitive performance impairment, incivility, core competence vagueness of postanesthesia nurses, high-tech care, (in)security and risk, and occupational stress. CONCLUSIONS: The experiences of uncertainty in clinical reasoning of nurses in postanesthesia care units are highly focused on patient safety. Exploring these experiences has made uncertainty more tangible and explicit, which will enable nurses in postanesthesia care units to prepare for adaptive responses to deal with uncertainty when it occurs in clinical practice.

In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study.

AIM: To evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations. BACKGROUND: The amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence. DESIGN: This was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators. METHODS: A total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment. RESULTS: Nursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group. CONCLUSIONS: In-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.

Bloqueio neuromuscular residual em pacientes cirúrgicos: conhecimento da equipe de enfermagem da recuperação anestésica / Residual neuromuscular blockade in surgical patients: knowledge of the nursing team at the anesthetic recovery / Bloqueo neuromuscular residual en pacientes quirúrgicos: conocimiento del equipo de enfermería sobre la recuperación anestésica

Objetivo: Identificar o conhecimento da equipe de enfermagem que atua na recuperação anestésica acerca da avaliação do bloqueio neuromuscular residual (BNMR) em pacientes cirúrgicos. Método: Estudo quantitativo, transversal, realizado em um hospital privado de São Paulo. Amostra composta por 50 profissionais, sendo 18 enfermeiros e 32 técnicos de enfermagem, que responderam um questionário validado por um corpo de cinco juízes. Coleta realizada de janeiro a março de 2022, utilizando-se a plataforma REDCap. Realizadas análises descritiva e inferencial, medidas de tendência central e de dispersão, testes de correlação de Pearson e t-Student, considerando-se nível de significância de 5%. Pesquisa conduzida segundo a Resolução 466/2012. Resultados: A média de acertos geral foi de 43%, sendo 44,4% entre enfermeiros e 42,2% entre técnicos. Seis (12%) profissionais já tinham feito algum treinamento sobre bloqueio neuromuscular e 10 (20%) relataram já ter atendido pacientes com BNMR. Não foram observadas diferenças estatisticamente significativas entre a média de acerto das questões e o tempo de formação e atuação profissional, especialização, experiência prévia ou execução de treinamentos. Conclusão: O estudo evidenciou déficits de conhecimento da equipe de enfermagem acerca do BNMR e a assistência durante esta intercorrência. Ressalta-se a importância de ações de educação permanente, com vista à capacitação dos profissionais para o atendimento desta complicação e melhoria dos cuidados de enfermagem prestados na recuperação anestésica para garantia da segurança do paciente

Objective: To identify the knowledge of the nursing team involved in anesthetic recovery regarding the assessment of residual neuromuscular blockage (RNB) in surgical patients. Method: This is a quantitative, cross-sectional study conducted in a private hospital in the state of São Paulo, Brazil. The sample com-prised 50 professionals, 18 nurses and 32 nursing technicians, who answered a questionnaire validated by five judges. The collection was carried out from January to March 2022, using the REDCap platform. Descriptive and inferential analyses, central tendency and dispersion measures, Pearson's correlation and Student's t-test were performed, considering a significance level of 5%. The research was conducted in accordance with Resolution 466/2012. Results: The average num-ber of correct answers was 43%, 44.4% among nurses and 42.2% among technicians. Six (12%) professionals had already took some training on neuromuscular blockade and 10 (20%) reported having treated patients with RNB. We observed no statistically significant differences between the average of correct answers of the questions and the length of training and professional performance, specialization, previous experience, or carrying out training. Conclusions: We identified deficits in the nursing team's knowledge of the RNB and care during this procedure. The importance of continuing education actions is emphasized, with a view to training professionals to treat this complication and improve the nursing care provided during anesthetic recovery to guarantee patient safety

Objetivo: Identificar el conocimiento del equipo de enfermería que trabaja en la recuperación anestésica respecto a la evaluación del bloqueo neuromuscular residual (BNMR) en pacientes quirúrgicos. Método: Estudio cuantitativo, transversal, realizado en un hospital privado de São Paulo. Muestra compuesta por 50 profesionales, 18 enfermeros y 32 técnicos de enfermería, quienes respondieron un cuestionario validado por un panel de cinco jueces. Recolección realizada de enero a marzo de 2022, utilizando la plataforma REDCap. Se realizaron análisis descriptivos e inferenciales, medidas de tendencia central y dispersión, pruebas de correlación de Pearson y t-Student, considerando un nivel de significancia del 5%. Investigación realizada según Resolución 466/2012. Resultados: El promedio global de aciertos fue del 43%, 44,4% entre enfermeros y 42,2% entre técnicos. Seis (12%) profesiona-les ya habían recibido algún entrenamiento en bloqueo neuromuscular y 10 (20%) informaron haber tratado ya pacientes con BNMR. No se observaron diferencias estadísticamente significativas entre el número medio de respuestas a las preguntas y el tiempo de formación y desempeño profesional, espe-cialización, experiencia previa o ejecución de la formación. Conclusión: El estudio destacó déficits de conocimiento entre el equipo de enfermería sobre el BNMR y la asistencia durante este incidente. Se destaca la importancia de acciones de educación continua, con miras a capacitar profesionales para enfrentar esta complicación y mejorar los cuidados de enfermería brindados durante la recuperación anestésica para garantizar la seguridad del paciente

Spanish version of the Pediatric Anesthesia Emergence Delirium scale: translation and cross-cultural adaptation.

BACKGROUND: Emergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile).  METHODS: A five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale.  RESULTS: The PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach's alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3-10 years). CONCLUSIONS: The translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children.

Bedside handover with structured and relayed forms in a postanesthesia care unit: A pre- and post-implementation study.

BACKGROUND: Early postoperative patients are vulnerable. Poor communication between health care professionals may seriously damage patients' wellbeing. There is a risk of information loss when bedside handover is performed. OBJECTIVES: To investigate whether the implementation of structured and relayed forms to shift-to-shift bedside handovers improve the frequency of appropriate handover elements and reduces the incidence of adverse events and postoperative length of stay for patients in a postanesthesia care unit. METHODS: This quality improvement project was conducted in a postanesthesia care unit of a tertiary stomatological hospital in China. The study population was patients under surveillance in the postanesthesia care unit for >12 h. A pre- and post-implementation approach was employed. The pre-implementation of unstructured bedside handovers and the post-implementation of bedside handovers with structured and relayed forms were compared. The indicators measured were appropriate handover elements, adverse patient events, and postoperative hospital stay. RESULTS: There were 387 and 395 morning handovers observed pre- and post-implementation of bedside handovers with structured and relayed forms, respectively. Of the 21 elements that should be delivered, 17 elements were noted to be improved. No improvement was found in the incidence of adverse events and postoperative hospital stay. CONCLUSIONS: Bedside handovers with structured and relayed forms increased the incidence of appropriate handover elements. The use of structured and relayed forms did not affect on the incidence of adverse events and postoperative hospital stay. Individualized relayed handover forms may be developed and implemented according to the characteristics in which they are administered.

Instruments to Identify Delirium in Patients Recovering From Anesthesia: A Scoping Review.

PURPOSE: To identify the validated instruments used for screening and detecting postoperative delirium (POD) during Post Anesthesia Recovery (PAR) period, and the incidence and associated risk factors with POD. DESIGN: A scoping review. METHODS: The study search occurred in May 2021 in the PubMed, Embase, Scopus, CINAHL, Web of Science and LILACS databases. Primary studies that used validated instruments for screening and detecting POD in the PAR period were included. FINDINGS: A total of 38 articles were included. The most used instruments were CAM-ICU, Nu-DESC, and RASS. The instruments that screened and detected delirium earliest were the Nu-DESC and CAM-ICU. POD incidence was up to 20% in more than half of the included studies. Cardiovascular comorbidities, chronic kidney disease, low functional reserve, chronic obstructive pulmonary disease and postoperative pain were among the primary risk factors. CONCLUSION: The instrumentsshowing the greatest accuracy for screening and detecting POD in the PAR period were the Nu-DESC and CAM-ICU.

Validação aparente e de conteúdo de escala de avaliação de enfermagem para o paciente na sala de recuperação pós-anestésica / Validación aparente y de contenido de la escala de evaluación de enfermería para pacientes en la sala de recuperación postanestésica / Apparent and content validation of a nursing assessment scale for patients in the post-anesthesia recovery room

RESUMO Objetivo: realizar a construção e a validação de conteúdo e aparente de uma escala de Avaliação de Enfermagem para o paciente na sala de recuperação pós-anestésica. Método: estudo metodológico, com etapas de definição do conceito a ser mensurado, formulação dos itens do instrumento, desenvolvimento de instruções para os respondentes e teste de validade aparente e de conteúdo realizado entre os meses de dezembro de 2020 e março de 2021. Inicialmente, a escala foi dividida em três domínios, com dados sociodemográficos e clínicos, procedimento anestésico-cirúrgico e 10 parâmetros a serem avaliados: temperatura corpórea, frequência cardíaca, respiração, pressão arterial sistólica, saturação periférica de oxigênio, consciência, mobilidade, dor, náusea e vômito e ferida operatória. Cada um dos parâmetros tem o escore mínimo de um (1) e máximo de quatro (4); assim, o escore total pode variar de 10 a 40 pontos. A validação foi realizada com 10 juízes doutores e com experiência na área de Enfermagem Perioperatória. A análise foi realizada por meio dos Índices de Validade de Conteúdo, com questionário contendo cinco possíveis respostas (discordo totalmente; discordo; não discordo e não concordo; concordo; concordo totalmente), além sugestões de forma descritiva. Resultados: após validação dos juízes, a escala permaneceu com o terceiro domínio, com os 10 parâmetros a serem avaliados. A validação obteve a média global de 89%, e nenhum dos parâmetros avaliados apresentou Índice de Validade de Conteúdo inferior a 80%. Conclusão: a escala proposta é um instrumento confiável e válido para avaliação do paciente na Sala de Recuperação Pós-Anestésica.

RESUMEN Objetivo: construir y validar el contenido y la validez aparente de una escala de evaluación de enfermería para pacientes en la Sala de Recuperación Postanestésica. Método: estudio metodológico, con etapas de definición del concepto a medir, formulación de los ítems del instrumento, desarrollo de instrucciones para los encuestados y la prueba de validez aparente y de contenido, realizado entre los meses de diciembre de 2020 y marzo de 2021. Inicialmente, la escala se dividió en tres ámbitos con datos sociodemográficos y clínicos, procedimiento anestésico-quirúrgico y diez parámetros a evaluar: temperatura corporal, frecuencia cardiaca, respiración, presión arterial sistólica, saturación periférica de oxígeno, consciencia, movilidad, dolor, náuseas y vómitos y herida quirúrgica. Cada uno de los parámetros tiene una puntuación mínima de uno (1) y máxima de cuatro, por lo que la puntuación total puede variar de 10 a 40 puntos. La validación se realizó con diez jueces con doctorado y experiencia en el área de Enfermería Perioperatoria. El análisis se realizó utilizando el Índice de Validez de Contenido, con un cuestionario que contenía cinco posibles respuestas: totalmente en desacuerdo; en desacuerdo; no en desacuerdo y no de acuerdo; de acuerdo; totalmente de acuerdo; y sugerencias de forma descriptiva. Resultados: tras la validación de los jueces, la escala quedó con el tercer dominio, con los diez parámetros a evaluar. La validación obtuvo una media global del 89% y ninguno de los parámetros evaluados tuvo un Índice de Validez del Contenido inferior al 80%. Conclusión: la escala propuesta es un instrumento fiable y válido para la evaluación de pacientes en la sala de recuperación Postanestésica.

ABSTRACT Objective: to build and validate the content and apparent validity of a Nursing Assessment Scale for patients in the post-anesthesia recovery room. Method: methodological study, with stages of defining the concept to be measured, formulation of the instrument items, development of instructions for respondents, and apparent and content validity test carried out between December 2020 and March 2021. Initially, the scale was divided into three domains, with sociodemographic and clinical data, anesthetic-surgical procedure, and ten parameters to be assessed: body temperature, heart rate, respiration, systolic blood pressure, peripheral oxygen saturation, consciousness, mobility, pain, nausea and vomiting, and surgical wound. Each parameter has a minimum score of one (1) and a maximum score of four (4); thus, the total score can range from 10 to 40 points. The validation was performed with ten doctoral judges with experience in Perioperative Nursing. The analysis was performed using the content validity indices, with a questionnaire containing five possible answers (totally disagrees, disagrees, does not disagree and does not agree, agrees, and totally agrees), in addition to suggestions in descriptive form. Results: after the judges' validation, the scale remained with the third domain, with the ten parameters to be evaluated. The validation obtained an overall average of 89%, and none of the parameters evaluated had a content validity index below 80%. Conclusion: the proposed scale is a reliable and valid instrument for assessing the patient in the Post-Anesthesia Recovery Room.

Investigating the Effects of Protective Face Masks on the Respiratory Parameters of Children in the Postanesthesia Care Unit During the COVID-19 Pandemic.

PURPOSE: The purpose of this study was to investigate the effect of protective face mask usage during the postoperative period on carbon dioxide retention in children during the COVID-19 pandemic. DESIGN: This study was designed as a prospective, randomized trial including 40 ASA I-II patients aged 3 to 10 years who were scheduled for elective surgery. METHODS: Patients were randomly allocated to two groups. The first group (group 1) received O2 treatment over the protective face mask. In the second group (group 2), the protective face mask was worn over the O2 delivery system. Heart rate, oxygen saturation (SPO2) level, end-tidal carbon dioxide (EtCO2) level, and respiratory rate were measured using a patient monitor at 0, 5, 10, 15, 30, and 45 minutes and recorded. The primary outcome of the study was the determination of the EtCO2 levels, which were used to assess the safety of the mask in terms of potential carbon dioxide retention. FINDINGS: None of the participants' SPO2 levels fell below 92% while wearing masks. There was no statistically significant difference between the groups in terms of EtCO2, heart rate, SPO2, and respiratory rate (P > .05). CONCLUSIONS: During the COVID-19 pandemic, protective surgical face masks can be used safely in the postoperative period for pediatric patients aged 3 to 10 years.

Nurses' experience of incident reporting culture before and after implementing the Green Cross method: A quality improvement project.

BACKGROUND: Adverse events are a leading cause of death worldwide, although many are considered preventable. Incident reporting is a prerequisite for preventing adverse events; however, underreporting is common. The Green Cross method is an alternative incident reporting process that includes a daily team meeting to discuss incidents and work on improvements. OBJECTIVES: The aim of this quality improvement project was to improve the culture of incident reporting by implementing the Green Cross method and to evaluate the improvement by describing nurses' experience with the culture of incident reporting. METHODS: The project included a three-month implementation of the method in a postanesthesia care unit, which was evaluated by focus group interviews (n = 22 nurses) and analysed by qualitative content analysis. FINDINGS: Four focus group interviews were conducted before implementation (n = 19 nurses) and four after implementation (n = 16 nurses). Before implementation, Theme 1, "Incident reporting with potential for improvement", was constructed, describing a culture wherein nurses expressed motivation to report incidents but barriers, such as finding the system complicated and experiencing emotional obstacles towards reporting, prevented them. After implementation, Theme 2, "Increased focus on transparency", was constructed, describing a culture wherein nurses perceived an increased rate of incident reporting but still encountered barriers, such as finding reporting uncomfortable and demanding, experiencing a threatened working environment, and still wanting visible improvement. CONCLUSION: The nurses in the postanesthesia care unit experienced the Green Cross method as a useful patient safety initiative for improving the rate of incident reporting, but barriers to reporting still existed.

The observation on the effect of prospective intervention on emergence agitation and postoperative recovery in patients with chronic sinusitis during preoperative visits / 中国医师进修杂志

Objective:To investigate the effect of prospective intervention on emergence agitation and postoperative recovery in patients with chronic sinusitis during preoperative visits.Methods:A total of 80 patients with chronic sinusitis who underwent general anesthesia in Dayi County People′s Hospital of Chengdu City from December 2019 to October 2020 were selected and randomly divided into group D and group G, with 40 patients in each group. Group D received preoperative visit with conventional methods and group G received preoperative visit with prospective intervention methods. The hemodynamic changes of patients in the two groups at 30 min before the operation (T 1) and 1 (T 2), 5 (T 3), 10 (T 4) and 30 min (T 5) after tracheal tube extraction were recorded. The anxiety and depression scores of patients before the intervention and 1 d after the operation were compared between the two groups. The incidence of emergence agitation after the operation and complications during anesthesia awakening period were observed in the two groups, sino-nasal outcome test-20 (SNOT-20) was used to assess the postoperative recovery. Results:The incidence of emergence agitation in group G was lower than that in group D: 7.5%(3/40) vs. 25.0%(10/40), the difference was statistically significant ( χ2 = 4.50, P<0.05). There was no significant difference in systolic blood pressure, diastolic blood pressure and heart rate between the two groups at T 1 and T 5 ( P>0.05), but the level of above indicators in group G at T 2, T 3 and T 4 were significantly higher than those in group D ( P<0.05). The scores of State-Trait Anxiety Inventory(S-AI) and Self-Rating Depression Scale (SDS) in group G at the first day after the operation were significantly lower than those in group D: (35.45 ± 5.32) scores vs. (39.35 ± 4.91) scores, (35.42 ± 7.82) scores vs. (38.76 ± 5.21) scores, the differences were statistically significant ( P<0.05). The incidence of complications during anesthesia awakening period in group G was slightly lower than that in group D ( P>0.05). After the operation, the scores of sinusitis symptoms and nasal symptoms in the two groups were significantly decreased compared with those before the operation, and the scores of group G were significantly lower than those in group D ( P<0.05). Conclusions:Prospective intervention before anesthesia in patients with chronic sinusitis surgery can reduce stress response, improve bad mood, reduce the incidence of emergence agitation, and promote the postoperative recovery.

Development and reliability and validity testing of the assessment scale for patients with persistent vegetative state or minimally conscious state discharge from the anesthesia recovery room / 中国实用护理杂志

Objective:To develop and test the reliability and validity of the assessment scale for patients with persistent vegetative state (PVS) or minimally conscious state (MCS) discharge from the anesthesia recovery room after operation.Methods:From September 2018 to October 2020, three dimensions and 17 item pools were determined through literature review and discussion among the project members. Two rounds of expert consultation were conducted to determine the respiratory (R), circulatory (C), oxygenation (O), bispectral index (B) and neuromuscular monitoring (N) scale (RCOBN scale), the reliability and validity were tested. 87 patients with PVS or MCS after operation Affiliated Sichuan Bayi Rehabilitation Center of Chengdu University of Traditional Chinese Medicine were selected to verify the effectiveness.Results:In the first round, 23 questionnaires were distributed. The total score of experts was 50 ± 3, F=9.24, CV were 0.00-0.43. The Cronbach α coefficient of each dimension was 0.782-0.846, and the Cronbach α coefficient of the total scale was 0.813. In the second round, 10 questionnaires were distributed. The item-level content validity index was 0.7-1.0, the probability of random consistency ( Pc) was 0.001-0.117, the adjusted kappa value ( k*) was 0.567-1.000, and the sum of the index scores corresponding to k* > 0.74 was 8. The scale-level content validity index of the overall consistency was 0.87. The ratio of patients transferred out of PACU by two rounds of evaluation method was 100 : 96.55, and the difference was not statistically significant ( χ2=3.05, P>0.05). The time of the first round of assessment was significantly longer than that of the second round, which were (197 ± 52) s and (58 ± 14) s respectively. The difference was statistically significant ( t=26.52, P < 0.01). Conclusions:The RCOBN scale has high reliability and validity. It can be used as an assessment scale for patients with PVS or MCS to transfer out of PACU after surgery, and those with a total score of 8 can be transferred out of PACU.

Diagnósticos de enfermagem em recuperação pós-anestésica: intervenções e resultados segundo linguagens padronizadas / Nursing diagnoses in post-anesthetic recovery: outcomes and interventions according to standardized languages

Introdução: os sistemas de classificação com linguagens padronizadas se estabelecem em um conjunto de conhecimentos estruturados, conceitos fundados de forma lógica e coerente, com base em suas similaridades. Nesse sentido, identificar um perfil junto a populações pode cooperar para uma melhor definição e compreensão situacional para aquela unidade e/ou pacientes. Objetivos: realizar mapeamento cruzado entre os diagnósticos de enfermagem da NANDA-I com os registros manuais de enfermagem em sala de recuperação pós-anestésica; e propor intervenções e resultados, segundo linguagens padronizadas. Método: estudo exploratório, retrospectivo com análise estatística descritiva de registros de enfermagem de 187 pacientes que estiveram hospitalizados no período de junho a julho de 2018, em sala de recuperação pós-anestésica de um hospital oncológico. O mapeamento cruzado foi realizado em três etapas: identificação dos indicadores dos diagnósticos; proposição de intervenções e atividades; e indicadores de resultados. Os dados foram analisados e descritos em frequências absoluta e relativa. Resultados: dos 13 domínios da NANDA-I, cinco foram representados; identificaram-se cinco diagnósticos de risco e 11 com foco no problema; observou-se 100% de frequência para os diagnósticos de: Risco de aspiração; Risco de infecção; Risco de queda; Capacidade de transferência prejudicada; Mobilidade no leito prejudicada; Integridade da pele/tissular prejudicada e Conforto prejudicado. Conclusões: para os 16 diagnósticos de enfermagem mapeados, foram selecionadas 22 intervenções e 58 atividades; 23 resultados e 48 indicadores de resultados.

Introduction: the classification systems with standardized languages are established in a set of structured knowledge, concepts founded in a logical and coherent way, based on their similarities. In this sense, identifying a profile with the populations can cooperate for a better definition and situational understanding for that unit and/or patients. Objectives: to perform cross-mapping between the nursing diagnoses of NANDA-I with the manual nursing records in the post-anesthetic recovery room; and, to propose interventions and outcomes, according to standardized language. Method: exploratory, descriptive and retrospective analysis of the nursing records of 187 patients hospitalized from June to July 2018, in the post-anesthetic recovery room of an oncology hospital. Cross-mapping was carried out in three stages: identification of diagnostic indicators; proposition of interventions and activities; and outcomes indicators. The data were analyzed and described in absolute and relative frequencies. Results: of the 13 NANDA-I domains, five were highlighted; were identified five risk diagnoses and 11 focused on the problem; 100% frequency was observed for the diagnoses of: Aspiration, infection and falling risk; Impaired transfer capacity; Impaired bed mobility; Impaired skin/tissue integrity and impaired comfort. Conclusions: from the 16 nursing diagnoses mapped, were selected 22 interventions and 58 activities; 23 results and 48 outcomes indicators.

Developing a Model of Care for a 4- to 6-Bedded Postanesthetic Recovery Unit: A Delphi Study.

PURPOSE: Recovery units are typically open-plan rooms where all patients can be seen at all times; however, a new hospital has been built with 4- to 6-bed perioperative bays. The purpose of the study was to establish expert consensus regarding problems, benefits, and suggested solutions for the new design across four domains: patient safety, staff satisfaction, organizational efficiency, and maintenance of professional standards. DESIGN: We conducted a Delphi study to inform the development of a model of care for this new design. METHODS: A two-round Delphi study involved 71 recovery unit nurses from 13 countries. Problems, solutions, and any potential benefits of the new design were collected in round 1 and ranked in round 2. FINDINGS: The highest ranked problems were mixing conscious and unconscious patients and need for safe skilled staffing levels. The highest ranked solutions were division of patients, increased safe skilled staffing, and staff education. CONCLUSIONS: Participants identified clear risks and mitigation strategies. Implementing these strategies should allow for a safer environment for both patients and staff. A model of care to ensure safety and quality in 4- to 6-bedded bay postanesthetic recovery units should address mixing of patients, staffing levels and staff education.

Use of Mentholated Popsicle in the Management of the Elderly Patient's Thirst in the Immediate Postoperative Period: A Randomized Controlled Trial.

PURPOSE: This study aimed to compare a mentholated popsicle with usual care (absolute fasting) in the change in thirst intensity and discomfort in elderly patients in the immediate postoperative period (IPP). DESIGN: A randomized controlled trial. METHODS: The sample consisted of 50 elderly patients (60 years or older) in the IPP who were randomly assigned to two groups: experimental group (20 mL mentholated popsicle) and control group (usual care). The outcomes, thirst intensity and discomfort, were assessed at baseline and 20 minutes after the intervention. FINDINGS: The mentholated popsicle presented a statistically significant (P < .001) decrease in thirst intensity and discomfort by 5.0 in the median and a Cohen's r large effect size for both outcomes. There were no adverse events or side effects. CONCLUSIONS: The use of a mentholated popsicle decreased the intensity and discomfort of the elderly patient's thirst in the IPP.

The effects of a psycho-educational intervention to improve pain management after day surgery: A randomised clinical trial.

AIMS AND OBJECTIVES: To evaluate the effectiveness of a psycho-educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function. BACKGROUND: Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed. DESIGN: Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used. METHODS: Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi-squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures. RESULTS: After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence. CONCLUSIONS: No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed. RELEVANCE TO CLINICAL PRACTICE: Day surgery patients' postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT01595035).

Instrument content validation for teaching the nursing process in a post-anesthetic recovery room / Validação de conteúdo de instrumento para o ensino do processo de enfermagem em sala de recuperação pós-anestésica

Objective: To build and validate the content of an instrument to support the teaching and learning of the nursing process in the Post-Anesthetic Recovery Room, intended for nursing students. Method: This is a methodological study with a quantitative approach. In the content validation, seven judges, nurse doctors and postdoctors participated in teaching and research in the area of ​​perioperative nursing. In the semantic analysis, 30 nursing students participated. The construction of the instrument was based on a literature review, Horta's theoretical framework and a nursing classification system. In data analysis, the Content Validity Index and the Agreement Index were calculated. Results: In the content validation, the instrument obtained Content Validity Index high in the psychometric criteria: relevance (CVI = 0.99), clarity (CVI = 1) and objectivity (CVI = 1). In the semantic analysis, the concordance index of the items was also high (CI> 0.80). Conclusion: The instrument was considered valid and understandable, with the potential to be a pedagogical tool that facilitates the process of caring for patients in the Post-Anesthetic Recovery Room.

Objetivo: Construir e validar o conteúdo de um instrumento para subsidiar o ensino e aprendizagem do processo de enfermagem em Sala de Recuperação Pós-Anestésica, destinado aos acadêmicos de enfermagem. Método: Trata-se de um estudo metodológico com abordagem quantitativa. Na validação de conteúdo participaram sete juízes, enfermeiros doutores e pós-doutores atuantes no ensino e pesquisa na área da enfermagem perioperatória. Na análise semântica, participaram 30 acadêmicos de enfermagem. A construção do instrumento foi pautada em revisão de literatura, referencial teórico de Horta e sistema de classificação de enfermagem. Na análise dos dados, o Índice de Validade de Conteúdo e o Índice de Concordância foram calculados. Resultados: Na validação de conteúdo, o instrumento obteve Índice de Validade de Conteúdo elevados nos critérios psicométricos relevância (IVC =0,99), clareza (IVC=1) e objetividade (IVC=1). Na análise semântica, o Índice de Concordância dos itens também foi elevado (IC>0,80). Conclusão: O instrumento foi considerado válido e compreensível, com potencial para ser uma ferramenta pedagógica facilitadora do processo de cuidar dos pacientes em Sala de Recuperação Pós-Anestésica.

A brief intervention to standardize postanesthetic clinical handoff.

This naturalistic, pre- and post-design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anesthetists and postanesthesia nurses in the postanesthetic care unit. Observation and interview data were collected pre- and post-intervention from a convenience sample of 27 nurses and 23 anesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses' performance of several patient safety behaviors, but trends in nurses' interdisciplinary communication behaviors such as asking questions and escalation of care were nonsignificant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during interprofessional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education, and further research.

Perfil e tempo de permanência de pacientes intensivos assistidos na recuperação pós-anestésica / Profile and length of stay of intensive care patients admitted to the post-anesthesia care unit / Perfil y estancia de pacientes intensivos asistidos en la recuperación postanestésica

Objetivo: Identificar a frequência, o perfil e o tempo de permanência de pacientes intensivos admitidos na sala de recuperação pós-anestésica (SRPA). Método: Estudo transversal e retrospectivo, realizado com base em registros de admissões na SRPA de um hospital público no Rio Grande do Sul, entre julho de 2012 e julho de 2017. Resultados: No período estudado, admitiram-se no setor 22.333 pacientes, sendo 717 (3,2%) pacientes intensivos por indisponibilidade de leito na unidade de terapia intensiva. Destes, 67,6% eram do sexo feminino, 61,2% em idade adulta, submetidos à neurocirurgia (61,5%). O tempo de permanência médio no setor foi de 10,7 horas, e 4,1% dos pacientes foram a óbito. Conclusão: A permanência de pacientes intensivos na SRPA requer adequação do setor em sua estrutura física e operacional, especialmente no que diz respeito à equipe assistencial tanto em quantidade de pessoal quanto em capacitação técnica necessária para assegurar uma assistência de qualidade.

Objective: To identify the frequency, profile, and length of stay of intensive care patients admitted to the post-anesthesia care unit (PACU). Method: This is a retrospective cross-sectional study based on PACU admission records of a public hospital in Rio Grande do Sul, Southern Brazil, between July 2012 and June 2017. Results: In the study period, 22,333 patients were admitted to the PACU; 717 (3.2%) of them were intensive care patients due to the unavailability of beds in the intensive care unit. Among them, 67.6% were women, 61.2% were adults, and 61.5% were individuals submitted to neurosurgery. The mean length of stay in the unit was 10.7 hours, and 4.1% of patients died. Conclusion: The stay of intensive care patients in the PACU requires adapting the physical and operational structure of the unit, particularly in aspects related to the care team, including the number of personnel and the technical training necessary to ensure the quality of care.

Objetivo: Identificar la frecuencia, perfil y tiempo de estancia de los pacientes de cuidados intensivos ingresados en la Sala de Recuperación Posanestésica (SRPA). Método: Estudio transversal y retrospectivo, realizado a partir de los registros de ingreso en la UCPA de un hospital público de Rio Grande do Sul, entre julio de 2012 y julio de 2017. Resultados: En el período estudiado ingresaron al sector 22.333 pacientes, 717 (3,2%) pacientes de cuidados intensivos por indisponibilidad de camas en la Unidad de Cuidados Intensivos. De estos, el 67,6% eran mujeres, el 61,2% adultos, sometidos a neurocirugía (61,5%). La estancia media en el sector fue de 10,7 horas y falleció el 4,1% de los pacientes. Conclusión: La permanencia de los pacientes de cuidados intensivos en la SRPA requiere la adecuación del sector en su estructura física y operativa, especialmente en lo que se refiere al equipo asistencial, tanto en el número de personal como en la formación técnica necesaria para asegurar una atención de calidad.

Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery. / Asociación entre diagnósticos e intervenciones de enfermeras en pacientes sometidos a cirugía torácica o abdominal superior.

OBJECTIVE: To determine associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery. METHOD: Cross sectional quantitative study. Participants were 312 adult patients within the first 48 hours after thoracic or upper abdominal surgery. Patients were examined by the research team using an instrument with variables related to the respiratory function. The research team established the presence/absence of three nursing diagnoses and proposed interventions using the NANDA-I classification and the Nursing Interventions Classification. Correlations were tested using the chi-square or Fisher's test. RESULTS: From the total 312 examinations, ineffective airway clearance was present in 185 (59.3%) assessments, ineffective breathing pattern in 123 (39.4%), and impaired gas exchange in 141 (45.4%). Significant correlations showed that patients with ineffective airway clearance were more likely to require pain management (or: 2.27), chest physiotherapy (or: 2.96), and positioning (or:1.8), while patients with impaired gas exchange were less likely to require airway management (or: 0.13) and chest physiotherapy (or: 0.28). CONCLUSIONS: Patients with ineffective airway clearance had more chances of requiring pain management, chest physiotherapy, and positioning, while the nursing diagnosis impaired gas exchange was related with airway management and chest physiotherapy. The findings provide basis for nurses to develop effective care plans and to minimize postoperative respiratory complications.