The Effect of Preoperative Nursing Visit on Anxiety and Pain Level of Patients After Surgery

The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials

BACKGROUND

As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative.

OBJECTIVE

This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature.

METHODS

In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery.

RESULTS

Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies.

CONCLUSIONS

Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes.

TRIAL REGISTRATION

PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.

[Effects of nursing visits on primary nursing : An evaluation study in an intensive care unit]

BACKGROUND

After a pilot phase in 2017, nursing visits (PV) were implemented in an intensive care unit (ICU) at a university hospital. So far, published findings on the impact of PV on the primary nursing organisation system (process-responsible nursing [PP]) could not be identified.

AIM

Primary aim was to investigate the effects of PV on PP from the nurses perspective. Secondary aims included comparison with the results of the pilot phase (t0) to determine further effects, general conditions of the PP and the overall evaluation.

METHODS

A quantitative evaluation study using a standardised questionnaire was used.

RESULTS

The survey was conducted in September to October 2023 (t1) with a response rate of 74.6% (n = 47). On a scale of 1-6 (strongly agree; strongly disagree), 100.0% of the process-responsible nurses (PP; n = 8) and 77.0% of the nurses without process responsibility (P; n = 30) rated the PV at levels 1-3 (p = 0.328) as contributing to the evaluation of care planning for patients with process responsibility. PV provided support for the implementation of PP (PP: 100.0%, n = 8; P: 79.5%, n = 31; p = 0.318) and had a statistically significant effect (r = 0.97, p = 0.035) on improving the quality of care and care planning for patients with procedural responsibility. The nurses indicated with levels 1-3 that the patients were more consciously brought into the focus of nursing care through the PV (t1: 74.4%, n = 35; t0: 86.4%, n = 38; p = 0.953). The PV should take place weekly and was rated with a median of 2 (IQR t1: 1-3; t0:1-2).

CONCLUSION

PV support the implementation of PP and patient-centred care in the ICU.

Influence of certified perioperative nurses on the establishment of preoperative outpatient clinic and rate of preoperative assessment in Japan

This study aimed to investigate the influence of certified perioperative nurses on preoperative outpatient clinic and preoperative assessments. The study was conducted from February 2021 to September 2022; data were collected and analyzed using a questionnaire at 247 hospitals in Japan. To analyze the factors affecting the rate of preoperative assessment with the primary endpoint of preoperative outpatient care and preoperative nursing visits, we performed multiple linear regression analysis of facility characteristics, perioperative nurse background, and the presence or absence of certified perioperative nurses. Regarding the presence or absence of a preoperative outpatient clinic, patients from 68 (52.3%) and 41 (35.0%) institutions in the enrolled and nonenrolled groups. Respectively, underwent a preoperative assessment; the rate of preoperative assessments in the enrolled group was significantly higher than that in the nonenrolled group. Multivariate analysis of factors influencing the preoperative assessment rate revealed a significant association with certified perioperative nurse attendance. Facilities with certified perioperative nurses have a significantly higher prevalence of preoperative outpatient clinic and significantly higher rates of preoperative assessments than facilities without certified perioperative nurses. Enrollment of certified perioperative nurses may lead to the improvement of the quality of preoperative nursing interventions.

The impact of preoperative interview and prospective nursing on perioperative psychological stress and postoperative complications in patients undergoing TACE intervention for hepatocellular carcinoma

TACE has become one of the main methods for the treatment of liver cancer. The study aimed to investigate the effects of preoperative interview and prospective nursing in patients with hepatic carcinoma undergoing transcatheter chemoembolization (TACE). Eighty-six patients with hepatocellular carcinoma who underwent TACE intervention treatment at our hospital between 2020 and 2023 were selected and randomly assigned to 2 groups using computerized randomization. The control group (n = 43) received routine nursing care, while the study group (n = 43) received preoperative interviews in combination with prospective nursing during the procedure. The patients' heart rate, mean arterial pressure, and blood pressure variations were recorded, along with their mood changes after intervention. The postoperative pain and satisfaction levels were compared between the 2 groups of patients, and the incidence of postoperative complications was observed. The heart rate, systolic blood pressure, and diastolic blood pressure of the 2 groups of patients were compared 1 day before the operation (P > .05). Compared to 1 day before the operation, there was no significant change for the study group at 10 minutes after entering the room. However, the control group showed an increase. Both groups showed an increase in heart rate, systolic blood pressure, and diastolic blood pressure after the operation, with the study group having lower values than the control group (P < .05). The levels of tension, fatigue, anxiety, energy, anger, depression, self-esteem, and POMS index were compared between the 2 groups before intervention (P > .05). After intervention, there were significant differences between the 2 groups(P < .05). Immediately after the operation, the NRS scores of the 2 groups of patients were compared (P > .05). Compared to the control group, the study group showed a decrease in NRS scores at 12, 24, and 48 hours after the operation (P < .05). The nursing satisfaction rate of the study group patients was 97.67% (42/43), which was higher than the nursing satisfaction rate of the control group of 76.74% (33/43) (P < .05). Compared to routine nursing, preoperative visits and prospective nursing interventions can effectively alleviate patients' psychological stress reactions, relieve pain, reduce the incidence of complications, and improve patients' satisfaction with nursing care.

Comparison of postoperative pain, anxiety, and sleep quality in robotic-assisted and manual total knee replacement surgery

This study aimed to comparatively evaluate postoperative pain, anxiety, and sleep quality in patients after robotic-assisted and manual total knee replacement surgery. Patients who underwent either robotic or manual total knee replacement (TKR) surgery were analyzed in this cross-sectional observational study. Volunteers who were conscious, mentally healthy, without primary sleep disorders, without chronic uncontrolled diseases, 18 years of age or older, able to understand verbal warnings, and who agreed to participate in the study after being informed about the purpose of the study were included in the study. A total of 80 patients who underwent robotic-assisted TKR and 87 patients who underwent manual TKR were participated in the study. Data were collected using the "Patient Description Form" Visual Analog Scale, Richards-Campbell Sleep Scale, and State Anxiety Scale. All patients were operated on by the same physicians and received standard perioperative care. In the study, a statistically significant difference was found between the education level of the patients and the type of surgery (p = 0.007). According to the average scores, it was observed that the patients in the robotic group had higher pain levels, better sleep quality, and higher anxiety levels compared to the manual group. There was a significant correlation between the level of pain felt on the 1st and 2nd day (p =  < 0.001) and state anxiety levels with gender (p = 0.010) in the robotic group. For the robotic group, pain on day 2 was mostly affected by pain on day 1 and state anxiety. For the manual group, pain on day 2 was mostly affected by pain on day 1. According to our results, patients who underwent robotic-assisted TKR had higher pain levels, better sleep quality, and higher anxiety levels than patients who underwent manual TKR.