Levels of education and technical skills in registered nurses working in post-anaesthesia care units in Sweden

The Transition Between Surgery and Ward: Patients' Experiences of Care in a Postoperative Care Unit

PURPOSE

The aim of this study was to describe adult patients' experiences of postoperative care in the postanesthesia care unit (PACU) after undergoing surgery in Sweden.

DESIGN

Qualitative inductive study.

METHODS

Individual interviews with 14 adults who had experience of being cared for in the PACU were conducted on day 14 to day 26 after surgery. The interviews were analyzed using thematic analysis.

FINDINGS

Early recovery in the PACU was described as a small step in the recovery process and as a time of transition from surgery to the ward. When patients perceived the PACU staff as competent, and as having a positive attitude, providing individualized care, and addressing symptoms or discomfort without being specifically alerted, patients felt safe and cared for. When they were not personally acknowledged, the patients felt abandoned in the highly technological environment.

CONCLUSIONS

To enhance the transition from surgery to the ward, patients need to be personally acknowledged. Their symptoms need to be properly treated by competent staff with a positive and proactive attitude. This creates safe care that supports the transition from the PACU to the ward, as well as the overall recovery process.

Analysis of Adverse Events in the Postanesthesia Unit at a Tertiary Pediatric Hospital

PURPOSE

The postanesthesia care unit (PACU) is an indispensable part of modern medicine which provides critical care to patients to ensure safe and smooth emergence from anesthesia. The adverse events in the PACU have been widely investigated in adults. However, little is known about the adverse events in pediatric populations. This study was designed to investigate adverse events, including the incidence, disease spectrum, and possible risk factors, in pediatric patients in the PACU at a tertiary pediatric hospital.

DESIGN

This is a retrospective observational study.

METHODS

Children admitted to the PACU at the Children's Hospital of Fudan University from September 2021 to August 2022 were included in the study. The following adverse events were recorded: hypothermia, fever, adverse airway events, hypotension, hypertension, prolonged length of stay in PACU, pain, reintubation, neurological events, unplanned admission to the intensive care unit, arrhythmia, water-electrolyte imbalance, and bleeding requiring medical intervention. Descriptive analyses, t tests, and χ2 tests were performed.

FINDINGS

A total of 16,012 children were included in the study, and 305 adverse events occurred in 237 (1.48%) children. The three most frequently occurring adverse events were prolonged stay in the PACU (8.4%), adverse airway events (5.6%), and abnormal temperature (2.7%). Age, American Society of Anesthesiologists' grade, and general surgery were independent risk factors of both overall adverse events and prolonged stay in the PACU in multivariate logistic regression analysis. Children with adverse events stayed in the PACU significantly longer than those without adverse events (60.04 ± 1.01 vs 95.8 ± 47.25 minutes, P < .05). Compared with the other surgeries, a significantly higher proportion of severe pain (37.5% vs 0%) after thoracic surgery, prolonged stay in the PACU (52.9% vs 36.4%) after general surgery, and neurological events (14.7% vs 0%) after neurological surgery was detected, while a significantly lower proportion of adverse airway events after general surgery (21.1% vs 43%) and neurological surgery (8.8% vs 43%) was detected, respectively.

CONCLUSIONS

Our study reports the current incidence and spectrum of adverse events in the PACU at a tertiary pediatric hospital. Patients with young age, high American Society of Anesthesiologists' grade, and those from the general surgery department are at a significantly increased risk of adverse events in the PACU. Significant differences were detected in the proportion of specific adverse events after specific surgeries.

Co-teaching in medicine and nursing in training nurse anesthetists: a before-and-after controlled study

BACKGROUND

Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training.

METHOD

The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed.

RESULTS

Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved.

CONCLUSION

In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.

Nurse competence in the post-anaesthesia care unit in Sweden: a qualitative study of the nurse's perspective

Background

To enable safe and successful recovery for surgery patients, nurses working in post-anaesthesia care units need competence in postoperative care. No consensus defines what this specific competence includes, and it has not been studied from the perspective of nurses working in post-anaesthesia care units. The aim of this study is twofold: 1) To explore and describe nurses’ perception of the competence needed to work in post-anaesthesia care units. 2) To explore and describe nurses’ perception of what characterizes an expert nurse in post-anaesthesia care units.

Methods

This qualitative inductive study uses individual interviews. Sixteen nurses were recruited from two post-anaesthesia care units located in different parts of Sweden. Inclusion criteria were nurses employed in the post-anaesthesia care units for ≥1 years.

Semi-structured individual interviews were conducted; data were analysed using thematic analysis.

Results

The interview analysis identified six subthemes and three themes. The themes being adaptable in an ever-changing environment and creating safe care represent the overarching meaning of competence required when working as a nurse in a Swedish post-anaesthesia care unit. Nurses must possess various technical and nontechnical skills, which are core competences that are described in the sub-themes. The theme seeing the bigger picture describes the nurse’s perception of an expert nurse in the post-anaesthesia care unit.

Conclusions

Nurse competence in post-anaesthesia care units entails specific knowledge, acknowledging the patient, and working proactively at a fast pace with the patient and team to provide safe, high-quality care. An expert nurse in post-anaesthesia care units can see the bigger picture, helping share knowledge and develop post-anaesthesia care. The expert competence to see a bigger picture can be used in supervising novices and creating a knowledge base for postgraduate education in order to promote safe, high-quality post-anaesthesia care.