The Effect of Modified Early Warning Score (MEWS) and Nursing Guide Application on Postoperative Patient Outcomes: A Randomized Controlled Study.

PURPOSE: The aim of this study is to determine the effect of nursing guide application (NGA) on patient outcomes in patients followed up according to the modified early warning score (MEWS) in the postoperative period. DESIGN: A randomized controlled clinical trial. METHODS: The sample of the study consisted of 252 patients who underwent surgical intervention under general anesthesia in a university hospital between July 29, 2022, and October 31, 2022. FINDINGS: Results showed that the development of complications was less in the study group (SG) compared to the control group (CG) during anesthesia (P = .027), in the postanesthesia care unit (PACU) (P = .017), and in the clinic (P = .001). It was found that the duration of stay in PACU in the CG was significantly shorter than in the study group (P < .001), and as the duration of stay in PACU in CG decreased, the MEWS increased (r = -0.201, P = .024). We found that there were fewer patients transferred to the intensive care unit (ICU) after PACU (P = .007), the MEWS was lower, and the number of nursing interventions applied to patients was higher (P < .05). CONCLUSIONS: In patients followed up according to MEWS, NGA had a positive effect on preventing the development of complications and shortening the intervention time for complications, decreasing ICU admission, decreasing MEWS and increasing the number of nursing interventions. Based on the results, it may be recommended to use MEWS+NGA in the early postoperative period as it positively affects patient outcomes.

Pain Predictors in Patients in the Postanesthesia Care Unit.

PURPOSE: To analyze the effects of pain-predicting factors on patients in the postanesthesia care unit (PACU). DESIGN: This is an observational and prospective study. METHODS: This study was conducted at a University Hospital in the state of Minas Gerais (Brazil). To collect data on demographic, clinical, and surgical factors, a collection instrument was devised. The verbal numerical scale was employed to measure pain levels before and after surgery in the PACU. A path analysis was used to assess a predictive model. FINDINGS: A total of 226 patients were included in this study. The incidence of pain in the PACU was 31.9%. A model with demographic, clinical, and surgical variables was tested. The final model, after including modification indices, obtained results that indicated an acceptable data fit (comparative fit index = 0.996; root mean square error of approximation = 0.08). Age (being young), sex (being a woman), oncological diagnosis as an indication for the surgical procedure, type of surgery (surgery of the digestive system), duration of surgery (longer surgeries), and high intraoperative doses of opioids were predictive variables for pain in the PACU. CONCLUSIONS: This study's findings provide support for pain management in the PACU. Furthermore, the results of this research can be used to anticipate the occurrence of acute postoperative pain and personalized perioperative analgesia needs.

Association Between the Blood Glucose Value at PACU Discharge and Postoperative Hypoglycemia in Nondiabetic Patients With Hyperglycemia After Hysteroscopic Surgery: A Retrospective Cohort Study.

PURPOSE: The target glycemic control for nondiabetic patients in the postanesthesia care unit (PACU) after hysteroscopic surgery remains unclear. Our goal is to determine the optimal level of glycemic control by finding the relationship between blood glucose level (BGL) leaving the PACU and postoperative hypoglycemia in nondiabetic patients. DESIGN: This retrospective cohort study was conducted at a comprehensive tertiary hospital in Chongqing, China between June 2018 and December 2020. METHODS: The target independent and dependent variables were BGL leaving the PACU and postoperative hypoglycemia, respectively. The primary outcome was the incidence of hypoglycemia. Logistic regression was used to explore the association between discharge BGL and hypoglycemia. The optimal glycemic control range was determined by using the receiver operating characteristic (ROC) curve. FINDINGS: Prior to insulin use, BGL in the insulin-using subgroup might be as high as 20 mmol/L. Hypoglycemia was related to the BGL while leaving the PACU (odds ratio (OR) 0.37 [95% confidence interval (CI) 0.22 to 0.65]). The best cut-off value (12.95 mmol/L) was determined by fitting the ROC curve. CONCLUSIONS: If severe hyperglycemia develops during hysteroscopic surgery in individuals with 5% glucose as the mediator of uterine distention, the recommendation is to maintain blood glucose above 12.95 mmol/L when treated with insulin.

Effects of Nonpharmacologic Distraction Methods on Children's Postoperative Pain-A Nonmatched Case-Control Study.

PURPOSE: To investigate whether nonpharmacologic distraction as a supplement to conventional pain management can reduce children's assessment of pain in the postanesthesia care unit (PACU), and if parental assessment is a reliable proxy in assessing children's postoperative pain. DESIGN: A nonmatched case-control study. METHODS: The sample included 241 children aged 2 to 7 years assigned to one of five intervention groups or a control group. Children's and parents' assessments of pain were registered on arrival to PACU and repeated after 15, 30, and 45 minutes using the Wong-Baker FACES Pain Rating Scale. FINDINGS: Positive effects of interventions were found in both children's and parental assessments. Results indicate a positive correlation between children's and parental assessments in children older than 3 years (P < .001). CONCLUSIONS: Nonpharmacologic distraction is recommended as a supplement to conventional postoperative pain management. Parental assessment is a reliable proxy in assessing postoperative pain in children younger than 5 years.

Preoperative Risk Factors Associated With PACU Pediatric Respiratory Complications: An Integrative Review.

PURPOSE: This article reviews state of the science of preoperative risk factors associated with postanesthesia care unit (PACU) pediatric respiratory complications. DESIGN: An integrative review. METHODS: A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, Cochrane, and Joanna Briggs Institute databases was performed. Thirty-one articles, published between 2006 and 2018, were appraised for quality and the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice Model. FINDINGS: These articles were grouped into the following categories: age, American Society of Anesthesiologists status, gender, airway comorbidities, syndromes, anomalies, pulmonary comorbidities, ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities. CONCLUSIONS: Evidence identified significant preoperative and anesthesia risk factors that are associated with PACU pediatric respiratory complications. This article reveals the importance for the perioperative team to identify, assess for, communicate, and develop a management plan for pediatric respiratory complications.

Perfil diagnóstico de pacientes sometidos a retirada de órgano fundamentado en escalas de evaluación / Perfil diagnóstico de pacientes submetidos à retirada de órgão fundamentado em escalas de avaliação / Profile diagnosis in patients submitted to organ removal based on assessment scales

OBJETIVO: Identificar el perfil de los diagnósticos de enfermería de la NANDA-I de pacientes quirúrgicos sometidos a la retirada de órgano fundamentado por el uso de las escalas de evaluación y trazar el perfil socio clínico demográfico de esa población. MÉTODO: Estudio transversal. Población compuesta por 60 pacientes quirúrgicos hospitalizados en postoperatorio de cirugía de retirada de órgano, después del cálculo muestral. El análisis fue realizado por medio de medidas de tendencia central, media y mediana, y de dispersión, frecuencia absoluta y simple de las variables cuantitativas. Se utilizó el software Excel (R) 2016. Los resultados fueron expresados por medio de tablas. RESULTADOS: Se aplicaron cinco escalas de evaluación. Se obtuvieron 1022 diagnósticos de enfermería basados en la NANDA-I, 93 diagnósticos diferentes, con media de 16,39 por paciente. Siendo 67 co foco en el problema, 23 de riesgo y 3 de promoción de la salud. Los diagnósticos con frecuencia superiores al 50% totalizaron 11, los cuales fueron discutidos. Los dominios sobresalientes fueron: Actividad/Hogar y Seguridad/Protección. CONCLUSIÓN: Se identificó una alta concentración de diagnósticos en esa población. La cantidad de diagnósticos planteados y su diversidad identifican las diferentes áreas del cuidado que el enfermero debe estar apto para prestar sus cuidados, además identificar esas informaciones deposita en el enfermero mayor poder de cuidado sobre el paciente. El estudio demostró la importancia del uso de escalas de evaluación que subsidien los diagnósticos de enfermería. La investigación aún apunta la importancia del uso del diagnóstico de enfermería como forma de cuidado efectivo

OBJETIVO: Realizar o levantamento do perfil dos diagnósticos de enfermagem da NANDA-I de pacientescirúrgicos submetidos à retirada de órgão fundamentado pelo uso das escalas de avaliação e traçar operfil sócio clínico demográfico dessa população. MÉTODO: Estudo transversal. População composta por 60 pacientes cirúrgicos hospitalizados em pósoperatóriode cirurgia de retirada de órgão, após cálculo amostral. A análise foi realizada por meio demedidas de tendência central, média e mediana, e de dispersão, frequência absoluta e simples dasvariáveis quantitativas. Utilizou-se o software Excel (R) 2016. Os resultados foram expressos por meiode tabelas. RESULTADOS: Foram aplicadas cinco escalas de avaliação. Obtiveram-se 1022 diagnósticos deenfermagem baseados na NANDA-I, 93 títulos diagnósticos distintos, com média de 16,39 porpaciente. Sendo 67 com foco no problema, 23 de risco e 3 de promoção da saúde. Os diagnósticoscom frequência superior a 50% totalizaram onze, os quais foram discutidos. Os domínios queconcentraram a maior parte dos diagnósticos de enfermagem foram: Atividade/Repouso eSegurança/Proteção. CONCLUSÃO: Foi identificada uma alta concentração de diagnósticos nessa população. A quantidade dediagnósticos levantadas e sua diversidade identificam as diferentes áreas do cuidado que o enfermeirodeve estar apto para prestar seus cuidados, além de que o levantamento dessas informações depositano enfermeiro maior poder de cuidado sobre o paciente. O estudo demonstrou a importância do uso deescalas de avaliação que subsidiem os diagnósticos de enfermagem. A pesquisa ainda aponta aimportância do uso do diagnóstico de enfermagem como forma de cuidado efetivo

MAIN GOAL: Perform the survey of NANDA-I nursing diagnoses profile of surgical patients submitted toorgan removal based on the use of the evaluation scales and to trace the socio-demographic clinicalprofile of this population. METHODS: Cross-sectional study. The population comprised of 60 surgical patients hospitalized inpostoperative of organ removal surgery, after sample calculation. The analysis was performed bymeans of central, middle and median trend measures, and dispersion, absolute and simple frequency ofquantitative variables. Excel (R) 2016 software was used. The results were expressed by means oftables. RESULTS: Five scales of evaluation were applied. There were 1022 nursing diagnoses based onNANDA-I, with 93 different diagnostic titles, with an average of 16.39 per patient. Being 67 focused onthe problem, 23 risk and 3 health promotion. The diagnoses with frequency greater than 50% totaledeleven, which were discussed. The domains that concentrated the majority of the nursing diagnoseswere: Activity/Rest and Safety/Protection. CONCLUSION: A high concentration of diagnoses in this population was identified. The number ofdiagnoses raised and their diversity identifies the different areas of care that the nurse must be able toprovide care, and the collection of this information places the nurse greater power of care on the patient.The study demonstrated the importance of the use of evaluation scales that subsidize nursingdiagnoses. The research also points out the importance of using nursing diagnosis as a form of effectivecare

Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice.

PURPOSE: This article describes the implementation and maintenance of obstructive sleep apnea (OSA) screening and capnography monitoring. DESIGN: A quality improvement project. METHODS: A multidisciplinary team provided staff education to three perianesthesia care units. Using the STOP-Bang screening tool, five or more positive responses indicated high risk for OSA. A postanesthesia care unit audit tool tracked STOP-Bang scores, capnography use, hypoventilation events, nursing interventions, and respiratory complications. FINDINGS: Among 314 patients with OSA, 36% were identified as high risk. Nurses used capnography on 76% of OSA patients and were able to readily identify hypoventilation and intervene. Respiratory complications occurred in 10.8% (n = 34) requiring a higher level of care. Postimplementation, all six postanesthesia care units employ this best practice. CONCLUSIONS: Perianesthesia nurses found OSA screening and capnography easy to incorporate into nursing practice. This process can reduce respiratory complications in the surgical patient with OSA. An Evidence-Based Practice Fellowship Program facilitated this practice change.

Incidence and Severity of Catheter-Related Bladder Discomfort Among Nonurological Adult Patients in a Postanesthesia Care Unit.

PURPOSE: The purpose of this study was to identify the incidence and severity of catheter-related bladder discomfort (CRBD) among nonurological adult patients in a postanesthesia care unit with catheter sizes of 10 to 18 Fr. DESIGN: Descriptive, prospective, and quantitative study. METHODS: In all, 401 patients were included. Incidence and severity of CRBD were assessed upon arrival and 1 hour after arrival. FINDINGS: CRBD incidence was 17.2% (n = 69) on arrival versus 19.1 (n = 74) 1 hour after arrival. Male gender showed a significantly higher risk of developing CRBD upon arrival (odds ratio, 3.15; P = .000; 95% confidence interval, 1.78 to 5.59), and 1 hour after arrival (odds ratio, 2.34; P = .002; 95% confidence interval, 1.38 to 3.99). CONCLUSIONS: The findings suggest using a catheter as small as possible and confirm that men experience significantly more discomfort, whatever sized catheter is used.

Perceived Discomfort, Pain and Nonpain Symptoms in a Postanesthesia Care Unit: An Observational Study.

PURPOSE: To assess patient-perceived discomfort in a postanesthesia care unit (PACU) and to explore the contributing symptoms and related characteristics. DESIGN: Cross-sectional observation was used in this study. METHODS: Postgeneral anesthesia patients in a PACU were asked to report their overall discomfort level on a 0 to 10 scale and to report and rank the symptoms they were suffering. All data were analyzed with SPSS software. FINDINGS: The average level of perceived discomfort was 4.90 ± 2.669. A hierarchical regression model showed that pain and nonpain symptoms contributed 0.084 and 0.074 to the overall discomfort level, respectively. Dry mouth, sore throat, and urethral catheter discomfort were the most common nonpain symptoms. Sex, department, anesthesia duration, American Society of Anesthesiologists physical status classification and other symptoms were all related to symptom reports. CONCLUSIONS: PACU patients suffer medium levels of discomfort, with pain and nonpain symptoms contributing nearly equally to it. In addition, multiple related characteristics were identified.

Complicaciones postoperatorias relacionadas con la hipotermia intraoperatoria / Complicações pós-operatórias relacionadas à hipotermia intraoperatória / Postoperative complications related to intraoperative hypothermia

Introducción: la hipotermia es un evento común en el período intraoperatorio, acarrea consecuencias en la recuperación del paciente, con complicaciones en diversos sistemas del organismo, como el cardíaco, respiratorio, tegumentario, digestivo, inmunológico y también el sistema de coagulación. Objetivo: analizar las complicaciones presentadas por el paciente en el período postoperatorio relacionadas con la hipotermia intraoperatoria. Métodos: estudio de cohorte retrospectivo, muestra compuesta por 54 registros clínicos de pacientes, participantes de un estudio anterior, de diseño experimental, en que fueron sometidos o no a infusión de solución intravenosa caliente, en el período intraoperatorio y de recuperación anestésica. Las variables fueron analizadas en 4 tiempos diferentes, a la llegada a la Unidad de Internación, después de 17, 32 y 108 horas de período postoperatorio. El modelo utilizado fue el logístico marginal. Resultados: la mayoría de los pacientes 40 (74,07%) eran del sexo femenino, edad media de 47,06 años, y 42 (77,78%) salieron normotérmicos de la Sala de Recuperación Post-Anestésica, con temperatura media de 36,2ºC. En cuanto a la comparación de las variables entre los grupos de pacientes normotérmicos e hipotérmicos, a lo largo del tiempo, las variables que presentaron significancia estadística fueron el tiempo de internación, dolor, náusea y herida operatoria con presencia de secreción, con p-valor menor que 0.05. Conclusión: ante las complicaciones encontradas en este estudio, se hace necesario el desarrollo de acciones de prevención y control de la hipotermia intraoperatoria buscando una mejor recuperación del paciente en el período de postoperatorio

Introdução: a hipotermia é um evento comum no período intraoperatório, acarreta consequências na recuperação do paciente, com complicações em diversos sistemas do organismo, como o cardíaco, respiratório, tegumentar, digestório, imunológico e também o sistema de coagulação. Objetivo: analisar as complicações apresentadas pelo paciente no período de pós-operatório relacionadas com a hipotermia intraoperatória. Métodos: estudo de coorte retrospectivo, amostra composta por 54 prontuários de pacientes, participantes de um estudo anterior, de delineamento experimental, em que foram submetidos ou não à infusão venosa aquecida no período intraoperatório e de recuperação anestésica. As variáveis foram analisadas em 4 tempos diferentes, na chegada a Unidade de Internação, após 17, 32 e 108 horas de período pós-operatório. O modelo utilizado foi o logístico marginal. Resultados: a maioria dos pacientes 40 (74,07%) eram do sexo feminino, com média de idade de 47,06 anos, e 42 (77,78%) saíram normotérmicos da Sala de Recuperação Pós-Anestésica, com temperatura média de 36,2ºC. Em relação à comparação entre as variáveis e os grupos de pacientes normotérmicos e hipotérmicos, ao longo do tempo, as variáveis que apresentaram significância estatística foram o tempo de internação, dor, náusea, evacuação e aspecto da ferida operatória com presença de secreção, com p-valor menor que 0,05. Conclusão: diante das complicações encontradas neste estudo, faz-se necessário o desenvolvimento de ações de prevenção e controle da hipotermia intraoperatória visando uma melhor recuperação do paciente no período de pós-operatório

Introduction: hypothermia is a common event in the intraoperative period, it triggers consequences in the recovery of the patient, with complications in several systems of the organism, such as cardiac, respiratory, integumentary, digestive, immunological and also the coagulation system. Objective: to analyze the complications presented by the patient in the postoperative period related to intraoperative hypothermia. Methods: a retrospective cohort study was carried out in a sample composed of 54 patients' files, from a previous experimental study, in which they were submitted or not to warmed intraoperative intravenous infusion and anesthetic recovery. The variables were analyzed at 4 different times, upon arrival at the hospitalization unit, after 17, 32 and 108 hours postoperative. The model used was the marginal logistics. Results: the majority of patients 40 (74.07%) were female, mean age of 47.06 years, 42 (77.78%) were normothermic patients from the Post Anesthesia Recovery Room, with a mean temperature of 36.2ºC. Regarding the comparison between variables and groups of normothermic and hypothermic patients, over time, the variables that presented statistical significance were the time of hospitalization, pain, nausea, evacuation and surgical wound with presence of secretion, with a p-value less than 0.05. Conclusion: in view of the complications found in this study, it is necessary to develop preventive and control actions for intraoperative hypothermia aiming at a better recovery of the patient in the postoperative period

Decreasing the Incidence of Postoperative Urinary Retention and Incontinence With Total Joint Replacement Patients After Spinal Anesthesia in the Postanesthesia Care Unit: A Quality Improvement Project.

PURPOSE: Patients with postoperative urinary retention (POUR) can develop bladder atrophy, urinary incontinence, and hypertension. The purpose of this quality improvement project was to implement standardized guidelines for bladder scanning for patients who have total knee or hip replacement to decrease POUR and incontinent episodes. DESIGN: A retrospective descriptive study was implemented in a 425-bed Magnet community hospital. METHODS: Patients were bladder scanned within the first hour of postanesthesia care unit admission. Straight catheterization was performed for those who had more than 400 mL of retained urine. The protocol included both total knee and total hip replacement surgeries with spinal anesthesia. Compliance with scanning, percentages with POUR, and incontinent episodes were reviewed. FINDINGS: POUR was detected in 46% of total knee replacement patients and 36% of total hip replacement patients. Incontinence rates for knee replacement patients decreased by 14% and by 2% for patients with total hip replacements. CONCLUSIONS: A bladder scanning protocol decreases postoperative incontinence. Bladder scanning also helps to decrease POUR by decreasing the potential risk of complications.

Identification and Management of Ischemic Stroke in the Postanesthesia Care Unit.

A thromboembolic stroke is a debilitating event that can occur with little or no warning. This report details the case of a 63-year-old male experiencing a stroke in the immediate postoperative period after total knee arthroplasty. Risk for perioperative stroke is influenced by age, sex, ethnicity, comorbidities, and some medications. The depressed neurocognitive state of patients recovering from anesthesia warrants special consideration for the identification and management of perioperative stroke.

Nursing Perceptions and Workload Impact of a Standardized Emergence Delirium Assessment Scale in a Postanesthesia Care Unit.

PURPOSE: Emergence delirium (EDL) is a psychomotor behavioral phenomenon that occurs immediately after emergence from general anesthesia. EDL is nearly 1.5 times more common among military than nonmilitary patients. Indirect delirium scales have precluded understanding of EDL in military patients. This quality improvement project assesses the feasibility of adopting a population-specific scale, the Emergence Delirium in the Wounded Warrior (ED-WW) Tool. DESIGN: Pre-post implementation design. METHODS: Postanesthesia care unit (PACU) nurses were surveyed on the clinical utility of the ED-WW Tool and its impact on their workload. The incidence of EDL behaviors in a Veterans Administration PACU was also recorded using the ED-WW Tool. FINDINGS: PACU nurses agreed the ED-WW Tool was of clinical value to military patients and had a very low workload impact. Twenty-one percent of patients demonstrated at least one behavior associated with EDL. CONCLUSIONS: ED-WW Tool adoption is clinically feasible and recommended for practice.

Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery.

PURPOSE: The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery. DESIGN: The structure of this project was a preimplementation and postimplementation design. METHODS: A convenience sample of 63 patients admitted to the PACU after spinal fusion surgery, with diagnosed or high-risk OSA, was included in protocol implementation. FINDINGS: The prevalence of diagnosed and high-risk OSA at the project implementation site totaled 74% in the spinal fusion population. The incidence of oxygen desaturations was 41% in the preimplementation group and 35% in the postimplementation group. The PACU to intensive care unit transfers were 10% in the preimplementation group and 3% in the postimplementation group. CONCLUSIONS: Protocols for surgical patients with OSA require further examination but may function as a guide for postoperative nursing care.

Nurse-led extubation in the post-anaesthesia care unit.

Weaning of mechanical ventilation occurs in intensive care units by nurses, which stimulates the prospect of nurse-led extubation extending into the PACU environment for improved patient outcomes and reduced demand of hospital resources. Nurse-led patient extubation in the PACU, would involve specially trained nurses weaning mechanical ventilation via an established protocol for a specific patient group, prior to the patient being extubated by an anaesthetist or intensivist.

Estimating Respiratory Rate in Post-Anesthesia Care Unit Patients Using Infrared Thermography: An Observational Study.

The post-anesthesia care unit (PACU) is the central hub for recovery after surgery, especially when the surgery is performed under general anesthesia. Aside from clinical aspects, respiratory impairment is one of the major causes of morbidity and affected recovery in the PACU and should therefore be monitored. In previous studies, infrared thermography was applied to assess the breathing rate (BR) of healthy volunteers. Here, the transferability of published methods for postoperative patients in the PACU was examined. Video recordings of 28 patients were acquired using a long-wave infrared camera, and analyzed offline. For validation purposes, BRs derived from body surface electrocardiography were measured simultaneously. In general, a close agreement between the two techniques (r = 0.607, p = 0.002 upon arrival, and r = 0.849, p < 0.001 upon discharge from the PACU) was obtained. In conclusion, the algorithm was demonstrated to be feasible and reliable under these challenging conditions.

Nicotine addiction management following surgery: a quality improvement approach in the post anesthesia care unit.

QUALITY PROBLEM: For smokers, hospital admission is accompanied by forced involuntary nicotine abstinence due to smoke-free site/grounds policies. An audit of patients admitted to our surgical wards revealed that identification of smoking status was inadequate and that nicotine addiction management (NAM) was infrequently offered. The project aimed to enhance both these metrics by initiating NAM in the post anesthesia care unit (PACU). INITIAL ASSESSMENT: Out of 744 patients admitted to our PACU in August 2015, 54% had their smoking status documented. The 200 patients (27%) out of the 744 were smokers and only 50% were offered NAM before discharge. CHOICE OF SOLUTION: PACU unit staff to determine the smoking status of every patient before discharge from the PACU (later changed to OR nursing staff) and, if a patient was identified as a smoker, to offer NRT (patch and mouth spray only) and initiate therapy prior to transfer of the patient to the ward. IMPLEMENTATION: Data about number of patients admitted, presence of documented smoking status, number of identified smokers, and number offered/accepted nicotine replacement therapy (NRT) were collected at baseline and thereafter quarterly. Engaging video education sessions addressed the education gaps highlighted in a needs assessment. Identification of smoking status was made part of preoperative checklist and NRT was made available in post-operative recovery room. RESULTS: These interventions resulted in an increase in screening for tobacco use from 54% at baseline to 95% and the offer of NRT to smokers from 50 to 89%.

Efficacy of an Ice Popsicle on Thirst Management in the Immediate Postoperative Period: A Randomized Clinical Trial.

PURPOSE: Perioperative thirst is an intense discomfort with high incidence in the immediate postoperative period, but nonetheless, it is highly neglected in clinical practice. The purpose of this study was to evaluate the efficacy of an ice popsicle compared with water at room temperature for thirst relief in the immediate postoperative period in terms of variation in the intensity of the initial compared with the final thirst and the satiety reached after an hour of evaluation and intervention. DESIGN: A parallel randomized clinical trial was used. METHODS: A total of 208 patients in the immediate postoperative period were assessed for 1 hour, every 15 minutes. Thirst intensity was assessed initially and subsequently; interventions were performed according to the group: (1) control group, 10 mL of water at room temperature; and (2) experimental group, 10-mL ice popsicle. FINDINGS: The ice popsicle was 37.8% (P < .01) more effective than water regarding the intensity variation between the initial and final thirst. The thirst intensity and number of interventions were different for the two groups as from the second moment (P < .01). Regarding not reaching satiety after an hour of evaluation and intervention, the relative risk was 41%, the relative risk reduction was 59%, the absolute risk reduction was 31%, and the number needed to treat was 3.2. CONCLUSIONS: Ice popsicle has greater efficacy than water at room temperature for thirst management in the immediate postoperative period.

Perceived Needs, Preparedness, and Emotional Distress of Male Caregivers of Postsurgical Women With Gynecologic Cancer

OBJECTIVES: To describe the perceived needs, preparedness, and emotional distress of male caregivers of postsurgical patients with gynecologic cancer during the transition from hospital to home. 
. SAMPLE & SETTING: 50 male caregivers of patients with gynecologic cancer on an inpatient unit at University Hospitals Seidman Cancer Center in Cleveland, OH.
. METHODS & VARIABLES: Caregiver needs, perceived preparedness, and emotional distress were measured at admission and at one week postdischarge. Instruments included the Comprehensive Needs Assessment Tool for Cancer Caregivers, Preparedness for Caregiving Scale, and National Comprehensive Cancer Network Distress Thermometer. The analysis consisted of descriptive statistics, Spearman's correlations, and univariate linear regressions.
. RESULTS: At both time points, male caregivers' greatest needs were interaction with the healthcare staff and information. Perceived preparedness was not associated with emotional distress. Male caregivers who were young, were employed, were unmarried, and had a lower income had greater needs.
. IMPLICATIONS FOR NURSING: A relational nursing care approach that maintains effective communication with male caregivers is essential. Nurses should broaden the caregiver assessment beyond the practical care of the patient.