The nurse's role in day surgery: a literature review

Efficacy of a new day surgery management mode based on WeChat: a study protocol for randomised controlled trials

INTRODUCTION

There is an enormous imbalance between the rapid development of day surgery and the current conventional medical services. Hence, an effective day surgery management mode should be developed that can be used to constantly follow up on patients both preoperatively and postoperatively. In this study, WeChat was chosen as the platform. This study aimed to investigate the feasibility and effectiveness of a new day surgery management mode.

METHODS AND ANALYSIS

This randomised controlled study investigated the efficacy of a new day surgery management mode based on WeChat. The target number of participants was 1000 per group. The application (app) will send personalised information based on the medical history of the patient and the type of surgery at different time points preoperatively and postoperatively. The healthcare worker can follow up the patient and acquire clinical data by simply signing into the app. The patient and the healthcare worker can also engage in video or voice chats using the app when necessary. Multiple departments, including anaesthesiology, internal medicine, surgery, nursing and psychology, will participate in this new mode.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the West China Hospital of Sichuan University Biomedical Research Ethics Committee. Results of this study will be published in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100050793.

Effectiveness of Integrated Education to Reduce Postoperative Nausea, Vomiting, and Dizziness after Abdominal Surgery under General Anesthesia

This study presents an anticipatory integrated education program for nausea, vomiting, and dizziness prevention (anti-NVD education program) for patients undergoing abdominal surgery under general anesthesia. The anti-NVD education program for nephrectomy patients consisted of the following: the causes of postoperative nausea, vomiting, and dizziness; effective deep breathing and how to use an inspirometer; postoperative nausea and vomiting; effective methods of patient-controlled analgesia; and the stepwise standing up method to prevent dizziness. A study was conducted among 79 adults (experimental group: n = 40, control group: n = 39). The degree of nausea and dizziness was measured using a numerical rating scale (NRS), and vomiting and the frequency of antiemetic use were measured in terms of the number of patients. The experimental group, which received the anti-NVD education, showed remarkably lower levels of nausea (p = 0.013) and dizziness (p < 0.001) than the control group. The frequency of antiemetic use 48 hours after surgery was significantly lower in the experimental group (p = 0.03). This study proved the efficacy of the anti-NVD education program for reducing postoperative nausea and dizziness. This program can be used as a noninvasive nursing intervention to prevent nausea, vomiting, and dizziness among patients undergoing abdominal surgery.

Application of situational adaptation training combined with childlike nursing for children undergoing tonsillectomy or adenoidectomy

OBJECTIVE

This study aimed to investigate the clinical effect of situational adaptation training combined with child-friendly nursing in relieving the preoperative anxiety of children undergoing tonsillectomy or adenoidectomy.

METHODS

A total of 160 children undergoing tonsillectomy or adenoidectomy were randomly divided into two groups: a control group and a test group. In addition to the routine operating room nursing in the control group, children in the test group underwent situational adaptation training one day before surgery and child-friendly nursing on the day of surgery. The heart rates and differences in average dynamic pressure were compared between groups, both preoperatively and during anesthesia induction. The cooperativeness with anesthesia was also assessed. The anxiety states of children and their family members after the interventions were scored using the anxiety visual analog scale (VAS). The postoperative satisfaction with nursing was assessed and compared between groups.

RESULTS

The heart rates, differences in average dynamic pressure, cooperativeness with anesthesia, and VAS scores were significantly lower in the test group than in the control group. The VAS scores of family members were significantly lower in the test group than in the control group. The satisfaction degrees with nursing were significantly higher in the test group than in the control group.

CONCLUSION

Situational adaptation training combined with child-friendly nursing can significantly relieve the preoperative anxiety of children undergoing tonsillectomy or adenoidectomy and their family members. This treatment improves child cooperativeness during therapy, significantly reduces the amplitude of physiological stress response during surgery, and increases the satisfaction with nursing. Thus, situational adaptation training combined with child-friendly nursing is worthy of application in clinics.

Outpatient vagus nerve stimulation surgery in patients with drug-resistant epilepsy with severe intellectual disability

PURPOSE

Vagus nerve stimulation (VNS) implantation is increasingly proposed in outpatient procedure. Some epilepsy syndromes are associated with severe neurodevelopmental disabilities (intellectual disability, autism) and often motor or sensory handicaps, making ambulatory surgery more complex.

METHODS

We prospectively assessed the feasibility and safety of outpatient VNS implantation in 26 adult patients with drug-resistant epilepsy with severe intellectual disability between December 2017 and October 2020.

RESULTS

The male-to-female ratio was 0.9 and the mean age on surgery day was 23.1 years. Seventeen patients (65.4%) suffered from epileptic encephalopathy, 7 (26.9%) from cryptogenic or genetic generalized epilepsy, and 2 (7.7%) from severe multifocal epilepsy. Postoperatively, all patients were discharged the day of surgery. No patient was admitted to a hospital or have consulted within one month due to postoperative complications. There was no surgery-related complication during patients' follow-up.

CONCLUSION

Our study highlights the safety and feasibility of VNS surgery in an outpatient setting for patients with severe intellectual disability. We report detailed protocol and preoperative checklist to optimize outpatient VNS surgery in these not able-bodied patients. Severe disabilities or epilepsy-associated handicaps should not be an exclusion criterion when considering ambulatory VNS implantation.

Desenhos de Crianças Submetidas a Cirurgias Eletivas

Resumo O presente artigo tem por objetivo investigar as memórias que as crianças têm sobre a cirurgia a qual foram submetidas. Participaram desta pesquisa 80 crianças com idade entre 6 e 12 anos, internadas num hospital infantil para a realização de cirurgia eletiva de pequeno porte, divididas em quatro grupos de intervenção. Foram utilizados desenhos como forma de instrumento de coleta de dados. A pesquisa ocorreu em duas etapas: na primeira, cada grupo recebeu a sua preparação no hospital, e na segunda, cerca de quinze dias após a cirurgia. Pôde-se constatar, após uma análise dos desenhos, que todos os grupos retrataram a condição de hospitalização e cirurgia, e trouxeram detalhes sobre os aspectos relacionados a esta temática.

A cross-sectional study to assess the difference in perception of day surgery information between patients and medical staff in China

PURPOSE

The development of day surgery in China is still in its infancy. The aim of this study is to examine the difference in perception between patients and medical staff about day surgery and to find out what kind of information should be delivered to patients perioperatively.

METHODS

The study was designed as a cross-sectional study using survey questionnaires. Patients undergoing day surgery and medical staff working in the day surgery center received a preoperative teaching questionnaire (PTQ). The PTQ consisted of preoperative, operative, postoperative and anesthesia information. Participants were asked to rate accurately what day surgery information they perceived as important on a five-point Likert-type scale that ranged from very important to not important. The main outcome was the value patients and staff place on perioperative information.

RESULTS

For patients, details of anesthesia (82.6%) was the most important day surgery information, while for medical staff, preoperative (58.1%), postoperative (60.7%) and anesthesia (60.0%) information were of the same importance. Patients ranked surgery effect (83.3%) and pain management (82.5%) as two of the top five most important details about day surgery, but these were not listed in the top 5 rankings of staff. Student's t-test results of mean rankings also showed that patients placed more importance on surgery effect (4.8±0.6, 4.6±0.6, P=0.036) and pain management (4.8±0.5, 4.5±0.5, P=0.031) than the medical staff did.

CONCLUSION

In China, day surgery is an emerging practice with both patients and medical practitioners still lacking experience, so high-quality perioperative teaching is necessary and important. Our study examining patients and staffs' views on day surgery information should be considered when developing perioperative teaching programs. To increase patient satisfaction of the day surgery experience, delivery of patient-specific information tailored to individual circumstances is necessary.

The Quality of Patient Education in Day Surgery by Adult Patients

PURPOSE

The purpose of the study was to describe the quality of patient education in day surgery as evaluated by adult patients.

DESIGN

Descriptive design using survey methodology.

METHODS

The data were collected by questionnaire and measured the quality and implementation of education resources for day surgery patients (n = 600) in a university hospital. The data were analyzed statistically using basic and multivariate methods.

FINDINGS

The implementation of patient education has been done in a patient-centered and goal-oriented way by half of respondents. Most respondents (81%) were satisfied with the interaction in patient education. The education resources were reported as good by 77% of respondents.

CONCLUSIONS

Health care staff should assess for the presence of anxiety as a barrier to the comprehension of information. In developing patient education, the professional expertise and skills of health care staff in educating patients should be used.

Nurses' Perceptions of Patient Care Continuity in Day Surgery

PURPOSE

The increase in day surgery has brought about a significant change in patient care and care continuity. The purpose of this study was to analyze nurses' perceptions of the realization of continuity of care in day surgery. Continuity of care is examined from the perspectives of time, flow, co-ordination flow, caring relationship flow, and information flow.

DESIGN

Descriptive study.

METHODS

A questionnaire including demographics and questions about continuity of care was completed by 83 of the 120 eligible nurses (response rate, 69%) in one hospital district in Finland.

FINDINGS

According to the nurses, continuity of patient care is mostly well realized. On the day of surgery, information flow was the domain that was best realized. In the opinion of the nurses, continuity of care was least realized at home before surgery and at home during the period after surgery.

CONCLUSIONS

Based on nurses' perceptions, continuity of care was relatively well realized.

A Pain Education Intervention for Patients Undergoing Ambulatory Inguinal Hernia Repair

Background

Inguinal hernia repair is a common ambulatory surgery after which many patients experience moderate to severe post-operative pain. Limited research has examined the effect of education interventions to reduce pain after ambulatory surgery.

Purpose

This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following inguinal hernia repair.

Method

Pre-operatively, participants (N = 82) were randomized to either the intervention (HREI) or the usual care group. The HREI included written and verbal information regarding managing pain and two telephone support calls (before and after surgery). The primary outcome was WORST 24-h pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain-related interference with activities, pain quality, analgesics consumed, and adverse effects at post-operative days 2 and 7.

Results

At day 2, the intervention group reported significantly lower scores across pain intensity outcomes, including WORST 24-h pain on movement and at rest (p < 0.001), and pain NOW on movement and at rest (p = 0.001).

Conclusion

These findings suggest that the HREI may improve patients’ pain and function following ambulatory inguinal hernia repair. Further research should examine the effectiveness of an education intervention over a longer period of time.

[Evaluation of the scales used to measure anxiety and child behaviour during the induction of anaesthesia. Literature review]

The assessment of children's anxiety during anaesthetic induction is useful to determine if pre-operative strategies have been effective in reducing anxiety. The aim of this study is to review the different tools used to evaluate child anxiety or behaviour during the induction of anaesthesia. The electronic databases with no date limits were reviewed in December 2013, with a second review repeated in September 2014. A data extraction template was applied to find the scales used in the articles. Eight observational scales were found. Six of them can only be used during induction of anaesthesia, and two of those could be applied at various perioperative times, before surgery and during induction of anaesthesia.

Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery-A Systematic Review and Meta-Analysis

PURPOSE

To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety.

DESIGN

Systematic review and meta-analysis.

METHODS

The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain.

FINDING

Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit.

CONCLUSIONS

Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.

The impact of hand reflexology on pain, anxiety and satisfaction during minimally invasive surgery under local anaesthetic: a randomised controlled trial

BACKGROUND

Elevated patient anxiety during surgery is linked to a range of suboptimal treatment outcomes. Reflexology has been reported to be effective in reducing pre and post-operative anxiety and post-operative pain.

OBJECTIVES

To explore whether the addition of hand reflexology to treatment as usual during minimally invasive varicose vein surgery under local anaesthetic impacted upon patient reported anxiety and pain during surgery, and patient satisfaction with treatment.

DESIGN

Randomised controlled trial.

SETTING

Private outpatient clinic specialising in venous conditions.

PARTICIPANTS

137 participants were assessed for eligibility. One hundred patients were recruited (mean age 47.8 years, 83% female). Participants received endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins. Inclusion criteria included age (between 18 and 80) and receiving endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins under local anaesthetic. Exclusion criteria included the presence of leg ulcers and receiving microsclerotherapy or foam sclerotherapy treatments, being unwilling to enter into the randomisation process and arriving late at the clinic.

METHODS

Participants were randomly allocated to either treatment as usual (control group) or intra-operative hand reflexology during minimally invasive varicose vein surgery under local anaesthetic. Participants in the reflexology group received a session of intra-operative hand reflexology which began in the operating theatre, prior to analgesic injections and continued until surgery was complete. It was not possible to blind the participants, researchers or theatre staff to group allocation due to the modifications required to the operating theatre for participants in the reflexology group. The researcher could not be blinded due to the role they played in the trial organisation.

RESULTS

Of the 137 participants screened for eligibility, 7 participants declined to participate and a further 30 did not meet the inclusion criteria, giving a recruitment rate of 93%. Fifty participants were randomised to the reflexology group and fifty participants were randomised to the control group. Intra-operative anxiety was significantly lower in the reflexology group (mean score of 3.24 on an 11-point rating scale) than the control group (mean score of 5.0, p<.001).

CONCLUSIONS

Intra-operative hand reflexology is a useful adjunct to local anaesthetic varicose vein surgery, with participants in the reflexology group reporting significantly lower intra-operative anxiety and shorter pain duration than participants receiving treatment as usual.

Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment

Background

Available evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay.

Objectives

This study sought to (i) describe the nature of interventions that have been used to reduce length of stay in acute care hospitals; (ii) identify the factors that are known to influence length of stay; and (iii) assess the impact of interventions on patient outcomes, service outcomes and costs.

Data sources

We searched MEDLINE (Ovid), EMBASE, the Health Management Information Consortium and System for Information on Grey Literature in Europe for the period January 1995 to January 2013 with no limitation of publication type.

Methods

We conducted a rapid evidence synthesis of the peer-reviewed literature on organisational interventions set in or initiated from acute hospitals. We considered evidence published between 2003 and 2013. Data were analysed drawing on the principles of narrative synthesis. We also carried out interviews with eight NHS managers and clinical leads in four sites in England.

Results

A total of 53 studies met our inclusion criteria, including 19 systematic reviews and 34 primary studies. Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways. Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.

Limitations

We only considered assessments of interventions which provided a quantitative estimate of the impact of the given organisational intervention on length of hospital stay. There was a general lack of robust evidence and poor reporting, weakening the conclusions that can be drawn from the review.

Conclusions

The design and implementation of an intervention seeking to reduce (directly or indirectly) the length of stay in hospital should be informed by local context and needs. This involves understanding how the intervention is seeking to change processes and behaviours that are anticipated, based on the available evidence, to achieve desired outcomes (‘theory of change’). It will also involve assessing the organisational structures and processes that will need to be put in place to ensure that staff who are expected to deliver the intervention are appropriately prepared and supported. With regard to future research, greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes. There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings. Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation. Full economic costing should be undertaken where possible, including considering the cost implications for the wider local health economy.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

A study of clinical and information management processes in the surgical pre-assessment clinic

Background

Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients.

Methods

As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team.

Results

The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team.

Conclusion

Successful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial – yet unfulfilled – potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes.

Continuity of care in day surgical care - perspective of patients

BACKGROUND

The realisation of continuity in day surgical care is analysed in this study. The term 'continuity of care' is used to refer to healthcare processes that take place in time (time flow) and require coordination (coordination flow), rapport (caring relationship flow) and information (information flow). Patients undergoing laparoscopic cholecystectomy or inguinal hernia day surgery are ideal candidates for studying the continuity of care, as the diseases are very common and the treatment protocol is mainly the same in different institutions, in addition to which the procedure is elective and most patients have a predictable clinical course.

AIM

The aim of the study was to describe, from the day surgery patients' own perspective, how continuity of care was realised at different phases of the treatment, prior to the day of surgery, on the day of surgery and after it.

METHOD

The study population consisted of 203 day surgical patients 10/2009-12/2010 (N = 350, response rate 58%). A questionnaire was developed for this study.

RESULTS

Based on the results, the continuity of care was well realised as a rule. Continuity is improved by the fact that patients know the nurse who will look after them in the hospital before the day of surgery and have a chance to meet the nurse even after the operation. Meeting the surgeon who performed the operation afterwards also improves patients' perception of continuation of care.

CONCLUSIONS

Continuity of care may be improved by ensuring that the patient meets caring staff prior to the day of operation and after the procedure. An important topic for further research would be how continuation of care is realised in the case of other patient groups (e.g. in internal medicine). On the other hand, realisation of continuation of care should also be studied from the viewpoint of those taking part in patient care in order to find similarities/differences between patients' perceptions and professionals' views. Studying interventions aimed to promote continuity of care, for example in patient guidance, would also be of great importance.

Effectiveness of audiovisual interventions on stress responses in adolescents with ENT surgery in hospital: randomized controlled trial protocol

AIM

To investigate the circadian pattern of cortisol secretion and other stress indictors in association with audiovisual stimuli in adolescents having otorhinolaryngological surgery in hospital.

BACKGROUND

Hospitalization for surgery is a major stressful life event for adolescents causing negative consequences, including anxiety. Recent studies suggest that entertaining and educational interventions might be effective at reducing such adversities, but little is known about the pattern of these responses and effects.

DESIGN

Randomized controlled trial.

METHODS

Adolescents with otorhinolaryngological surgery in hospital without any contraindictions for salivary cortisol enzyme immunoassays will be recruited and randomly allocated to experimental, placebo and control. Stress indicators will be collected regularly for 5 days. Standard audiovisual interventions will be displayed for experimental and placebo groups including a simultaneous video-recording of facial and behavioural changes on the second afternoon postadmission and stress indicators will be collected pre- and three times with 20-minute interval postintervention. Follow-up will be conducted to evaluate the longer term effects at 2 weeks, 1-month and 3 months postadmission, respectively. Descriptive and comparative analyses of stress indicators will be performed to examine group differences. Competitive funding was obtained from the Independent Innovation Foundation of Shandong University for interdisciplinary research in 2012.

DISCUSSION

This study will help identify timeslots for interventions for integrating strength-building into stress response reduction in adolescents hospitalized for surgery.

A qualitative study of regional anaesthesia for vitreo-retinal surgery

AIM

The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery.

BACKGROUND

Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times; this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited.

DESIGN

An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics.

METHODS

Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts.

FINDINGS

Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block; 'experiencing': the experience of regional ocular anaesthesia; 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored; and 'knowing': when further surgery was required and past experiences were recalled.

CONCLUSIONS

The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function.

Living with age-related macular degeneration treatment: Patient experiences of being treated with ranibizumab (Lucentis)(R) intravitreal injections

This study reports the results of a qualitative study of patient experiences of receiving treatment for wet age-related macular degeneration with ranibizumab (Lucentis)(R). Treatment involved monthly hospital visits for assessment and, where required, an intravitreal Lucentis injection. Qualitative narrative interviews were conducted with 22 patients, 18 of whom received treatment and were interviewed at two points during their treatment journey. Interviews allowed participants to reflect on their experiences of being assessed for and receiving this treatment. Overall, treated participants reported that while they had been apprehensive about treatment, the actual experience of it was far less unpleasant than they had expected. However, the data also revealed a number of issues surrounding the provision of information about treatment, as well as service delivery issues, which had considerable impact upon their experience.

Postoperative recovery and its association with health-related quality of life among day surgery patients

Background

Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge.

Methods

A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.

Results

Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

Conclusion

Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

Preparação psicológica de pacientes submetidos a procedimentos cirúrgicos

Este trabalho tem por objetivo identificar, entre artigos publicados em periódicos indexados pelo PubMed/MedLine, informações sobre as principais modalidades e efeitos de intervenção psicossocial em procedimentos pré e pós-operatórios com pacientes adultos, bem como, apontar algumas lacunas na produção científica acerca do tema. Foram selecionados 32 artigos, sendo oito teórico-conceituais e 24 empíricos, dos quais um era estudo de caso, nove se referiam à avaliação específica de efeitos de preparação psicológica e 14 tratavam de temas associados ao contexto de preparação psicológica e cuidados cirúrgicos. As intervenções psicológicas foram divididas em oito categorias, baseadas em características funcionais das respectivas intervenções. Verificou-se uma deficiência de estudos na área de atuação específica da Psicologia, sendo os profissionais de enfermagem e medicina os que mais produziram estudos sobre o tema. Constatou-se, também, a ausência de protocolos sistematizados de intervenção psicológica relacionados a procedimentos cirúrgicos.

Benefits of preoperative education for adult elective surgery patients

Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience. Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. (c) AORN, Inc, 2009.

Introduction of a day-case laparoscopic cholecystectomy service in the UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers

INTRODUCTION

The objective of this study was to determine the safety and acceptability of the implementation of a day-case laparoscopic cholecystectomy (LC) service in a large UK teaching hospital, and analyse factors influencing contact with primary care providers. Wide-spread introduction of day-case LC in the UK is a major target of healthcare providers. However, few centres have reported their experience. In the US, out-patient surgery for LC has been reported, though many groups have utilised 24-h observation units to facilitate discharge. Concerns remain amongst surgeons regarding the feasibility and acceptability of the introduction of day-case LC in the UK.

PATIENTS AND METHODS

Comprehensive care and operative data were prospectively collected on the first 106 consecutive day-case procedures in our hospital. Postoperative recovery was monitored by telephone questionnaire on days 2, 5 and 14, including complications, satisfaction and general practitioner consultation.

RESULTS

A total of 106 patients were admitted for day-case LC, of whom 84% were discharged on the day of surgery. Patient satisfaction rate was 94% in both the successful day-case and the admitted patients. Mean operation time was 62 min, with an average total stay on the day-care unit of 426 min. Training-grade surgeons performed 31% of operations. Both the readmission rate after surgery and rate of conversion to open surgery were 2%. Advice from primary healthcare providers was sought by 33% of patients within the first 14 postoperative days.

CONCLUSIONS

Introduction of day-case LC in the UK is feasible and acceptable to patients. The potential burden to primary care providers needs further study.

Patient anxiety and conscious surgery

The amount of surgery undertaken on the conscious patient is increasing. However, many patients are anxious and resistant to such surgery. Patients (n = 214) were surveyed to determine their related apprehensions. Being awake, feeling or seeing the body cut open and experiencing pain all increased anxiety. The potential for insufficient information provision was also a source of concern. Formal management of intraoperative apprehension may help limit anxiety and expel apparent misapprehensions.

Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study

BACKGROUND

Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice.

AIM

To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain.

METHODS

This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method.

FINDINGS

Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse-patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills.

CONCLUSION

Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.

Conscious surgery: influence of the environment on patient anxiety

AIMS

This paper is a report of a study: (i) to investigate anxiety arising from the experience of the clinical environment during surgery under local/regional anaesthesia and (ii) to uncover the specific aspects patients find anxiety provoking and possibly dissuade them from opting for such anaesthesia.

BACKGROUND

Operating theatre staff have focused historically on conducting safe, efficient surgery with unconscious patients and not primarily on the care of 'awake' patients. However, with the rise in day surgery, the volume of surgery performed under local or regional anaesthesia is increasing.

METHOD

As part of a larger study investigating anxiety in elective day surgery, a questionnaire was given to 523 patients on the day of surgery to adult patients undergoing surgery with local or regional anaesthesia between 2005 and 2007. They were asked to return this by mail 24-48 hours following surgery and 214 completed questionnaires were returned (response rate 41%).

FINDINGS

The experience of being awake, possibly feeling the surgeon's touch, seeing their body cut open or surgery being more painful than expected were anxiety-provoking aspects. Using factor analysis, 'intra-operative apprehension', 'anaesthetic information provision' and 'health control' were identified as central features. Multiple regression showed that apprehension associated with the intra-operative experience and anaesthetic information provision were statistically significantly associated with an increase in overall level of anxiety.

CONCLUSION

Focusing care on managing the intra-operative experience and providing anaesthetic information in advance might help limit anxiety and expel the apparent misapprehensions associated with conscious surgery.