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Lin X, Zhang J, Du H, Yang Z, Deng S, Li B, Zhou Y, Wang J, Guo X, Zheng H, Li Z. The Scheduling Mode of Anesthesia Nurses Affects Postanesthesia Care Unit Efficiency: A Single-Center Retrospective Study From China. J Perianesth Nurs 2024; 39:736-740. [PMID: 38727654 DOI: 10.1016/j.jopan.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 10/04/2024]
Abstract
PURPOSE Anesthesia nurses play an important postsurgical role during the anesthesia recovery period, which is characterized by a high incidence of complications related to anesthesia and surgery. Strengthening staff allocation and skill management in the postanesthesia care unit (PACU) is therefore particularly important in managing length of stay. We aimed to investigate the effect of two schedule modes for anesthesia nurses on PACU efficiency. DESIGN A retrospective observational cohort study. METHODS We conducted a retrospective study in a large tertiary academic medical center. In 2018, the PACU operated with traditional scheduling and the nurse-to-patient ratio was 1.2:1. The PACU implemented intensive scheduling and this ratio was adjusted to 1:1 in 2019 by adjusting the anesthesia nurse allocation scheme. We compared the number of admitted patients, length of PACU stay, the incidence of anesthesia-related complications, and nurse satisfaction with the two modes. FINDINGS The total number of admitted patients was 10,531 in 2018 and 10,914 in 2019. PACU admitted 401 more patients in 2019 than in 2018, even with two fewer nurses per day. Nevertheless, the median length of PACU stay in 2019 was statistically significantly shorter than in 2018 (29 [22-40] vs 28 [21-39], P < .001], while the incidence of anesthesia-related complications including postoperative pain, nausea and vomiting, hypertension, and shivering were comparable in the 2 years (P > .091). The intensive scheduling implemented in 2019 received more satisfaction from nurses than the traditional scheduling applied in 2018 (P < .01). CONCLUSIONS The scheduling of anesthesia nurses affects PACU efficiency. The intensive scheduling mode implemented in 2019 resulted in a comparable number of admitted patients, a better quality of care, and higher nurse satisfaction than those under the traditional scheduling mode.
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Affiliation(s)
- Xiaona Lin
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jing Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Haiming Du
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China; Program Executive Office, Beijing Center of Quality Control and Improvement on Clinical Anesthesia, China
| | - Zihan Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China; Peking University School of Basic Medical Sciences, Beijing, China
| | - Shuhua Deng
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Baohua Li
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China; Program Executive Office, Beijing Center of Quality Control and Improvement on Clinical Anesthesia, China
| | - Jun Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China; Program Executive Office, Beijing Center of Quality Control and Improvement on Clinical Anesthesia, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China; Program Executive Office, Beijing Center of Quality Control and Improvement on Clinical Anesthesia, China
| | - Hongcai Zheng
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China; Program Executive Office, Beijing Center of Quality Control and Improvement on Clinical Anesthesia, China.
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Cunha LDM, Pestana-Santos M, Lomba L, Santos MR. "A Certainty for you Does Not Mean That it is a Certainty for Science": A Phenomenological Analysis of Experiences of Uncertainty in Clinical Reasoning of Nurses in the Postanesthesia Care Unit. J Perianesth Nurs 2024; 39:409-416.e3. [PMID: 37978973 DOI: 10.1016/j.jopan.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To explore the experiences of uncertainty in the clinical reasoning of nurses in the postanesthesia care unit (PACU). DESIGN A phenomenological descriptive design, following Colaizzi's analysis. METHODS Semistructured interviews were conducted with 14 nurses from a PACU on their experience of uncertainty in clinical reasoning. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed seven phases: (re)reading the transcripts, extracting significant statements, formulating meanings from significant statements, aggregating formulated meanings into themes, developing a description of the phenomenon's essential structure, generating of the fundamental structure of the phenomenon, validating of the findings through participant feedback. The process employed MAXQDA analytics Pro 2022 software. Consolidated Criteria for Reporting A Qualitative Research checklist was used for reporting. FINDINGS From uncertainty experiences in nurses' clinical reasoning, 10 themes emerged: ambiguity and decision latitude, communication, work ethic, difficulty interpreting and predicting outcomes, cognitive performance impairment, incivility, core competence vagueness of postanesthesia nurses, high-tech care, (in)security and risk, and occupational stress. CONCLUSIONS The experiences of uncertainty in clinical reasoning of nurses in postanesthesia care units are highly focused on patient safety. Exploring these experiences has made uncertainty more tangible and explicit, which will enable nurses in postanesthesia care units to prepare for adaptive responses to deal with uncertainty when it occurs in clinical practice.
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Affiliation(s)
- Lara D M Cunha
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - Márcia Pestana-Santos
- Scientific-Pedagogical Child and Adolescent Health Nursing Department, Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Lurdes Lomba
- Scientific-Pedagogical Child and Adolescent Health Nursing Department, Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Margarida R Santos
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal; Scientific-Pedagogical Child and Adolescent Health Nursing Department, Nursing School of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS@RISE), Porto, Portugal
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Dahlberg K, Jaensson M, Nilsson U, Hugelius K. The Transition Between Surgery and Ward: Patients' Experiences of Care in a Postoperative Care Unit. J Perianesth Nurs 2024; 39:288-293. [PMID: 37877910 DOI: 10.1016/j.jopan.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 10/26/2023]
Abstract
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.
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Affiliation(s)
- Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Hugelius
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Hedlund J, Blomberg K, Hjelmqvist H, Jaensson M. Student Nurse Anesthetists' and Supervisors' Perspectives of Learning in the Operating Room: An Integrative Review. J Perianesth Nurs 2024; 39:303-310.e8. [PMID: 37906248 DOI: 10.1016/j.jopan.2023.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives. DESIGN An integrative review. METHODS Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method. FINDINGS Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment. CONCLUSIONS SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.
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Affiliation(s)
- Jakob Hedlund
- Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Li H, Wang H, Pan Y, Huang Q, Li X, Zeng X, Zhou L. Efficacy of High-Quality Nursing Service for the Patients during the Anesthesia Recovery Period: A Meta-Analysis. Appl Bionics Biomech 2022; 2022:3528915. [PMID: 35979241 PMCID: PMC9377987 DOI: 10.1155/2022/3528915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background To investigate the efficacy of high-quality nursing service for the patients during the anesthesia recovery period. Methods We used the National Library of Medicine (PubMed), Cochrane Library of Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Wanfang, and very important person (VIP) databases for conducting a systematic literature study. We employed the fixed-effects model for evaluating the standardized mean differences (SMDs) with 95% confidence intervals (CIs). The sensitivity and publication bias were estimated for determining the efficacy of high-quality nursing services during the recovery period of anesthesia. Results In our study, the result showed that the efficiency of recovery time of spontaneous respiration was significantly improved in the experimental group (SMD = -1.48, 95%CI = [-1.62, -1.34]). In this analysis, the extubation time of the experimental group was lower than that of the control group. In control group [WMD = -15.54, 95% CI (-21.24, -9.83), P < 0.00001], the improvement of extubation time was more obvious on high-quality nursing. Moreover, the incidence of agitation in the experimental group was lower than that of the control group, and the score of nursing satisfaction was higher than that in the control group (P = 0.01). The funnel plots identified no publication bias during the identification of efficacy. Conclusions The high-quality nursing care for patients during the resuscitation period can shorten the recovery time of their self-consciousness and self-breathing, reduce the occurrence rate of restlessness, improve patients' anxiety and depression, reduce complications, and play a certain clinical application effect.
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Affiliation(s)
- Hui Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Heng Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yan Pan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qian Huang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xueping Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoqi Zeng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Li Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
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