An integrative review of a preoperative nursing care structure

Experiences and Fundamental Care Needs in Patients With Small Intestinal Neuroendocrine Tumours-An Interview Study in a Surgical Context

AIMS

The study aimed to describe patients' fundamental care needs and their experiences of nursing care, throughout surgical treatment of small intestinal neuroendocrine tumours.

DESIGN

A qualitative descriptive study was performed.

METHODS

Patients' interviews (n = 19) were conducted in Sweden from May 2021 to January 2022 and analysed using directed qualitative content analysis guided by the Fundamentals of Care framework.

RESULTS

The results are presented in three descriptive categories chronologically throughout the care chain. In the preoperative phase of care, the category was 'Feeling safe but lonely and frightened, and struggling with existential thoughts'; experiences in the postoperative phase of care resulted in the category 'Feeling cared for but suffering from physical symptoms and feelings of loneliness'; and the category in the discharge phase was 'Lacking self-care information and feeling worried about the future'.

CONCLUSION

There were deficiencies in the delivery of fundamental care for patients with a rare tumour diagnosis throughout surgical treatment. Nursing care is mostly task focused and fragmented, and there is a lack of psychosocial and relational care across the care chain. Registered nurses and nursing managers need to take responsibility for their leadership in nursing care to fulfil patients' fundamental care needs. The Fundamentals of Care framework could be used for work improvements to include all aspects of nursing care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

High-quality nursing care is needed throughout the care chain, including self-care after discharge, for patients with this rare tumour diagnosis. A higher awareness of patients' experiences and the importance of psychosocial support is warranted. Registered nurses and nursing managers must revise and improve routines to support patients' psychosocial needs. Registered nurses need to take responsibility for their leadership in nursing care to fulfil patients' fundamental care needs.

IMPACT

What problem did the study address? This study highlights patients' fundamental care needs and experiences of nursing care throughout surgical treatment of small intestinal neuroendocrine tumours. What were the main findings? There are deficiencies in fulfilling patients' fundamental care needs across the care chain and in all dimensions of the Fundamental of Care framework throughout surgical treatment of small intestinal neuroendocrine tumours. Patients struggled with loneliness and existential thoughts, as well as worries about the future. Patients experienced a lack of information about plans for the day, self-care, and follow-ups. Where and on whom will the research have an impact? For clinicians to develop an understanding of, and improve, fundamental care needs for patients with small intestinal neuroendocrine tumours in a surgical context. For registered nurses to understand the importance of their leadership and nursing responsibility to fulfil fundamental care needs.

REPORTING METHOD

The consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

PATIENT CONTRIBUTION

The patients shared their experiences during the interviews, which has contributed to a deeper knowledge and understanding of the phenomena under study.

Patient satisfaction with preoperative nursing care and its associated factors in surgical procedures, 2023: a cross-sectional study

BACKGROUND

To enhance patient satisfaction, nurses engaged in preoperative care must possess a comprehensive understanding of the most up-to-date evidence. However, there is a notable dearth of relevant information regarding the current status of preoperative care satisfaction and its impact, despite a significant rise in the number of patients seeking surgical intervention with complex medical requirements.

OBJECTIVE

To assess patient satisfaction with preoperative nursing care and its associated factors in surgical procedures of, 2023.

METHODS

A cross-sectional study was conducted, and the data was collected from the randomly selected 468 patients who had undergone surgery during the study period. The collected data was entered into Epidata version 3.1 and analyzed using SPSS version 25 software.

RESULTS

The complete participation and response of 468 participants resulted in a response rate of 100%. Overall patient satisfaction with preoperative nursing care was 79.5%. Sex (Adjusted odds ratio (AOR): 1.14 (95% confidence interval (CI): 0.21-2.91)), payment status for treatment (AOR: 1.45 (95% CI: 0.66-2.97)), preoperative fear and anxiety (AOR: 1.01, 95% CI: 0.49-2.13)), patient expectations (AOR: 3.39, 95% CI: 2.17-7.11)), and preoperative education (AOR: 1.148, 95% CI: 0.54-2.86)) exhibited significant associations with patient satisfaction with preoperative nursing care.

CONCLUSION

It is important to exercise caution when interpreting the level of preoperative nursing care satisfaction in this study. The significance of preoperative nursing care satisfaction lies in its reflection of healthcare quality, as even minor deficiencies in preoperative care can potentially lead to life-threatening complications, including mortality. Therefore, prioritizing the improvement of healthcare quality is essential to enhance patient satisfaction.

Introduction of a Multidisciplinary Preoperative Clinic at Juntendo University Hospital - A Retrospective Observational Study Focusing on Effects of Preoperative Interventions on Clinical Outcomes

Objectives

To investigate the effects of interventions provided by a multidisciplinary team consisting of anesthesiologists, dentists, pharmacists, and nurses at a Preoperative Clinic (POC) on postoperative outcomes.

Methods

We retrospectively investigated patients who underwent preoperative evaluation at the POC at Juntendo University Hospital between May and July, 2019. Patients were divided into intervention and non-intervention groups according to whether they received intervention(s) at the POC or not. Postoperative outcomes were compared between the groups, before and after propensity score (PS) matching.

Results

We investigated 909 patients who completed POC evaluation and underwent surgery. Patients in the intervention group (n = 455 [50.1%]) received at least one intervention delivered, in the order of higher delivery frequencies, by dentists, pharmacists, nurses, and anesthesiologists. Before PS matching, the intervention group was associated with older age, more frequent cardiovascular comorbidities, and higher ASA-PS grades than the non-intervention group, while neither frequencies nor severities of postoperative complications differed between the groups. These outcomes did not differ between 382 PS-matched pairs with comparable risk factors either.

Conclusions

Before PS matching, postoperative outcomes did not differ between the groups, although the intervention group was associated with higher risks. These suggested that POC interventions could have improved postoperative outcomes in the higher-risk intervention group to the same level as in the non-intervention group. However, such potential beneficial effects of interventions could not be proven after PS matching. Further studies are required to elucidate effects of POC interventions on postoperative outcomes.

Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews

AIMS AND OBJECTIVES

Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety?

BACKGROUND

Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery.

INTRODUCTION

According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety.

DESIGN

Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety.

METHODS

A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO.

RESULTS

A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results.

CONCLUSION

Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs.

RELEVANCE TO CLINICAL PRACTICE

This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results.

NO PATIENT OR PUBLIC CONTRIBUTION

Not applied to our study, as it is a systematic review of systematic reviews.

Preoperative Surgical Fear and Related Factors of Patients Undergoing Brain Tumor Surgery

PURPOSE

Patients with brain tumors may experience preoperative fear due to various reasons such as obscurity, pain, and loss of function. This study was carried out to reveal the pre-operative fear levels of patients undergoing brain tumor surgery.

DESIGN

This descriptive and cross-sectional study was completed with 144 patients.

METHODS

Data were obtained using patient identification forms and the Surgical Fear Questionnaire (SFQ). Descriptive statistics, independent t test, one-way Anova, Pearson correlation, and multiple regression analysis were used.

FINDINGS

The results revealed that the duration of preoperative hospital stay was 3.05 ± 2.26 days, the mean age of the patients was 51.44 ± 13.76 years, and more than half (54.1%) were male. The SFQ total and subscale mean scores of patients who are not working were higher (P < .05). The mean SFQ total and subscale mean scores of those aged 53 and over were lower. (P < .05). Duration of preoperative hospital stay, age, and female gender were statistically significant predictors of SFQ. Duration of preoperative hospital stay was responsible for 62.3% of the change in the SFQ, female gender was responsible for 17.6%, and age was responsible for 20.4%.

CONCLUSION

Understanding the risk factors for preoperative fear can help identify patients at risk. Factors that cause fear should be investigated and information deficiencies that increase the level of fear should be eliminated. It is recommended to use pharmacological and nonpharmacological methods in managing the fear of risk groups.

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

AIM AND OBJECTIVES

The aim of this study is to identify preoperative indicators and/or predictors of complications or inefficiencies in the surgical process that can be modified within nursing practice.

BACKGROUND

Due to rapid sociodemographic and technological change, the global demand for surgical attention is rising exponentially, requiring new strategies for optimisation and sustainability in perioperative care.

DESIGN

We conduced the scoping review using the methodology recommended by the Joanna Briggs Institute supported with The PAGER framework and guided by the PRISMA-ScR Checklist.

METHODS

Four databases (CINAHL, MEDLINE, SCOPUS and PUBMED) were examined to extract relevant published results for elective surgery on adult patients during the period 2011-2021. This process identified 609 records. Exclusion criteria were applied, and the sample was then evaluated with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD), after which 15 studies remained.

RESULTS

The following preoperative indicators and/or predictors were considered: (1) Anxiety; (2) Pain; (3) Health education, knowledge and training; (4) Satisfaction; (5) Management/organisation (including costs, resources used/available, organisational issues, hospital stay (preoperative), standardisation and protocolisation.

CONCLUSION

The identification of five indicators and/or predictors of complications or inefficiencies in the surgical process, which can be modified by nursing, allows the effective application of interventions in the preoperative phase, optimising care and improving health outcomes.

RELEVANCE TO CLINICAL PRACTICE

The development and implementation of specific nursing skills in the preoperative phase are essential to optimise the surgical process.

The Effect of an Operating Room Nurse Visit on Surgical Patient Anxiety

PURPOSE

The purpose of this study was to evaluate the effect of an operating room nurse visit on the anxiety levels of surgical patients.

DESIGN

A prospective, interventional, quasi-experimental design.

METHODS

80 patients were divided into the control group (n = 40) and the intervention group (n = 40). The control group was given routine care, and the intervention group was visited preoperatively by the operating room nurse in addition to routine care.

FINDINGS

The State-Trait Anxiety Inventory (STAI TX-1) mean score of the control patients who had information about anesthesia was low, while the STAI TX-1 mean score of the patients who had concerns about surgery was high. The STAI-TX-1 mean score of the control group patients who had information about anesthesia was significantly lower. There was no statistically significant difference in the STAI TX-1 scores between the two groups before and after surgery (P > .05). However, the STAI TX-1 mean score of the control patients was high in the post-operative period.

CONCLUSIONS

In an effort to reduce anxiety, the psychological preparation of the patient undergoing urological surgery should involve an anesthesia team member and the operating room nurse together.

How Hospital Tours Affect Preoperative Anxiety in Mothers with Children Undergoing Open-Heart Surgery in Iran: A Quasi-Experimental Study

Background:

Parents tend to experience considerable amounts of anxiety before their children undergo open heart surgery. This study was conducted to assess the effects of taking a hospital tour on preoperative anxiety in the mothers of children undergoing open heart surgery.

Methods:

In this quasi-experimental study, 96 mothers from Shahid Modarres Hospital in Tehran, Iran, during April to December 2018, were selected through convenience sampling and were assigned to three groups using simple randomization. The oral instruction group (N=32) attended two oral instruction sessions; the hospital tour group (N=32) participated in tours of the operation room and intensive care unit; the control group (N=32) was prepared according to the ward’s routine. Preoperative anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale and the State Trait Anxiety Inventory. Data were analyzed in SPSS-20. The ANOVA, paired t-test and Tukey’s test were used for the data analysis. The level of statistical significance was set at P<0.05.

Results:

The mothers’ anxiety about surgery (F=30.99, P≤0.001) and their scores of state anxiety (F=6.02, P<0.001) differed significantly among the three groups after the intervention. A significant difference was observed between the oral instruction and control groups (P<0.001) and the hospital tour and control groups (P<0.001) regarding the surgery-related anxiety scores. A significant difference was also observed between the oral instruction and control groups (P=0.002) regarding the mothers’ state anxiety scores.

Conclusions:

The results suggest the greater efficiency of oral instructions versus hospital tours. Nurses can use oral instructions for reducing surgery-related anxiety and state anxiety of mothers before their toddlers’ open heart surgery.

Trial Registration Number: IRCT20180904040944N1.

Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland

OBJECTIVES

This study aims to analyse the relationship between patient education and the quality of surgical nursing care as perceived by patients. The background of the study lies in the importance of a patient-centred approach for both patient education and quality evaluation.

DESIGN

This was a cross-sectional descriptive correlational study with surgical patients.

SETTING

Data were collected in 2013 in one hospital district in Finland.

PARTICIPANTS

480 hospitalised surgical patients.

METHODS

The data were collected using two structured instruments: one measuring the perceived quality of nursing care experienced by patients (Good Nursing Care Scale) and one measuring the received knowledge of hospital patients (RKhp). Data were analysed statistically using descriptive and inferential statistics to describe the sample and study variables. Pearson's correlation coefficients were used to analyse the association between the scales.

RESULTS

Surgical hospital patients evaluated the level of the quality of nursing care as high; this was especially true with reference to the environment and staff characteristics, but not to collaboration with family members. Most (85%) of the patients had received sufficient knowledge preoperatively and they were familiar with the proceeding of their care and treatment after discharge; in particular, they had received bio-physiological knowledge, consisting of knowledge of the disease, symptoms and the physiological elements of care. The positive correlation between the perceived quality of surgical nursing care and received knowledge was strong, suggesting a positive relationship between patient education and improvement of the quality of nursing care.

CONCLUSIONS

Based on the results, the quality of nursing care and patient education are interconnected. Thus, by improving patient education, the quality of nursing care can also be improved. It is particularly important to improve collaboration with family members and patients' own management strategies as well as the multidimensionality of educational knowledge.