Perioperative, Operating Room and Surgical Nursing Commons^™

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen

Doctor of Nursing Practice Scholarly Projects

Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle

Doctor of Nursing Practice Scholarly Projects

With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) …

The Effects Of Music Therapy On Pediatric Patients With Congenital Heart Defects In The Pre And Postoperative Setting, Janelle Marie Choy

Nursing | Student Research Posters

Congenital heart defects is a prominent medical occurrence especially in pediatrics. These defects often require surgeries and extensive treatment plans. These treatment plans often include invasive surgeries and extensive treatment plans which can require long recovery times along with potential surgical complications. This study aims to evaluate the effectiveness of music therapy on pediatric patients with congenital heart defects in the pre and postoperative setting and how music therapy can be implemented in treatment plans to yield effective recovery results for these patients. This research is significant as elevated vital signs and preoperative anxiety are associated with an increased need …

Improving Local Anesthetic Systemic Toxicity (Last) Recognition And Treatment Through Education Of Advanced Practice Providers On A Code Stroke Team, Benjamin Ty Sweeney, Michael Ellis, Jed Maverick Newport, Julie Bonom

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Local anesthetic systemic toxicity (LAST) presents with neurological and cardiovascular symptoms. LAST typically occurs immediately after administering a local anesthetic, but can occur a few days later. Symptoms can resemble a stroke.

LOCAL PROBLEM: In a large academic medical center in the United States, some code strokes called on post-surgical patients result negative for ischemia or hemorrhage, but documentation is unclear if patients were assessed for LAST. This project aims to educate code stroke team advanced practice providers to identify LAST and include LAST as a differential diagnosis.

METHODS: The Model of Improvement is the framework …

Effectiveness Of Fascia Iliaca Compartment Block In Adult Fractured Neck Of Femur Patients: An Integrative Review, Ramya Kunnath, Paula Foran

Journal of Perioperative Nursing

Introduction: According to the Australian and New Zealand Hip Fracture Registry approximately 19 000 patients in Australia and 4000 patients in New Zealand will fall and fracture their hip every year. This poses a huge burden on health care facilities (both fiscally and functionally) and has an even more dramatic effect on the older patients who fall and their families. The purpose of this review is to give perioperative nurses a deeper understanding of regional blocks that may be considered – in particular, the fascia iliaca compartment block. Traditional pain management strategies, such as opioids, have limitations which leads to …

Triggering Change In Perioperative Pressure Injury Risk Assessment: A Project Report, Jessica Wallent, Paula Foran

Journal of Perioperative Nursing

Introduction: Hospital-acquired pressure injuries (HAPIs) are generally preventable, yet continue to be common adverse events in Australian hospitals, resulting in significant hospital expense and unnecessary harm to patients. Nurses use an appropriate assessment tool to assess patient pressure injury risk, such as the Braden Scale. Despite it being a commonly used tool in ward environments, the Braden Scale is considered by many to be unsuitable to assess patient risk during the intra-operative period. This project trialled using an additional pressure injury risk assessment tool that considers specific intra-operative factors, prior to the patient entering the operating theatre, to determine patient …

Advancing Perioperative Nursing Education And Surgical Skills Acquisition: A Comprehensive Approach, Olivia Sonneborn, Rachel Cardwell

Journal of Perioperative Nursing

Postgraduate nursing education serves as a crucial connection between theoretical knowledge and clinical practice, playing an important role in enhancing the competencies of nurses in specialised fields, such as perioperative nursing. The delivery of higher education has undergone a transformation, focussing on online and blended learning, making higher education more accessible and more flexible to adult learners than traditional face-to-face education programs. However, acquiring hands-on surgical skills poses a potential challenge for online education.

The expanding need for surgical service delivery from Perioperative Nurse Surgical Assistants (PNSAs) is increasing the demand for novice practitioners to acquire surgical skills. Simulation-based learning …

Evaluation Of Pain Levels And Pain Management In Patients After Elective Total Knee Replacement Surgery, Elif Karahan, Mediha Didem Koçoğlu Ağca, Sevim Çelik

Journal of Perioperative Nursing

Objective: The aim of this study was to evaluate early pain management outcomes in patients undergoing total knee arthroplasty.

Materials and methods: This descriptive cross-sectional study was conducted between 1 March and 30 September 2022. The sample consisted of 112 patients who underwent total knee replacement surgery. Data was collected during face-to-face interviews in the first 24 to 48 hours after surgery, using a patient information form and the revised American Pain Society patient outcome questionnaire (APS-POQ-R). One-way analysis of variance (ANOVA), independent-samples t test, Kruskal-Wallis test and Mann-Whitney test were used in statistical analyses. Ethical approval, institutional approval and …

Effectiveness Of Intra-Operative Gentamicin Irrigation In Reducing Post-Operative Surgical Site Infections: A Systematic Review, Kritika J. Kumar, Zaneta Smith

Journal of Perioperative Nursing

Aim: To evaluate and synthesise the effectiveness of intra-operative gentamicin in reducing post-operative surgical site infections compared to other irrigating solutions or no irrigation.

Background: Surgical site infection has posed challenges to health care providers around the globe. It is influenced by many risk factors, only a few of which are under the control of the surgeon and operating team. Wound irrigation is considered an essential part of the intra-operative process. It aims to minimise the risk of surgical site infection by thorough lavage of the operative site.

Design: Systematic review of effectiveness.

Review methods: The databases CINAHL, Scopus, Embase, …

Local Anesthetic Systemic Toxicity: Last Protocol Development, Implementation, And Evaluation For Healthcare Providers, Rachel Vaughn

Doctor of Nursing Practice Projects

LAST is an uncommon but deadly complication of local anesthetic administration. Healthcare facilities benefit from protocol implementation to help streamline best evidence-based practice. The American Society of Regional Anesthesia and Pain Medicine warrants a LAST emergency protocol for any healthcare facility practicing regional anesthesia. Healthcare personnel encountering patients at risk for LAST must understand the symptoms and treatment of LAST to improve response time and patient outcomes. The project implemented a LAST protocol at a rural hospital in Southern Illinois in July 2023. The investigator held an educational service to discuss the new LAST protocol and implementation. The educational service …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Procedural Oxygen Mask Use For Inpatient Bariatric Endoscopy: A Scoping Review, Makinlee Meadows, Marion Millette, Brittany Morgan, Lauren Pegrim, William Collier Phillips, Dwayne Accardo Dnp, Crna, Faana, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Hypoxia is a severe adverse event that is often associated with sedated endoscopy procedures, and bariatric patients have a significantly higher risk for complications related to oxygenation during sedation due to pathophysiological changes to the respiratory system. This scoping review compares the rate of hypoxemic events with the use of a binasal cannula versus a procedural oxygen mask during inpatient endoscopic procedures in patients aged 19-64 with a BMI greater than 40.

Methods

The scoping review includes control trials with and without randomization, case-control/cohort studies, systematic reviews, and qualitative/descriptive studies. With limited research regarding the PICOT, extending the age …

Comparing The Effects Of The Induction Of Anesthesia With Etomidate To The Induction Of Anesthesia With Midazolam On The Incidence Of In-Hospital Mortality: A Scoping Review, Madison Hayes Bsn, Rn, Ashley Lynch Bsn, Rn, Scott Jamison Bsn, Rn, Mary Joiner Bsn, Rn, Gray Seymour Bsn, Rn, Dwayne Accardo Dnp, Aprn, Crna, Tracy Mcclinton, Dnp, Aprn, Agacnp-Bc, Epb-C

Doctor of Nursing Practice Projects

Purpose/Background

The induction of anesthesia using hypnotic sedatives, such as etomidate and midazolam, is common practice. Etomidate and midazolam are commonly employed in the induction of anesthesia in the septic patient population, each with its unique advantages and drawbacks. This scoping review aims to synthesize evidence on the effects of anesthetic induction with etomidate versus midazolam in adult septic patients, focusing on the incidence of mortality and associated adverse effects during hospitalization. The purpose is to establish a standard of care for anesthetic induction in this population.

Methods

A literature review was conducted from September 2022 to March 2023 utilizing …

The Effectiveness Of Dexmedetomidine As An Adjunct In Spinal Anesthesia For Pain Relief In Cesarean Patients: A Scoping Review, Tyler Polanco Bsn, Rn, William Riley Bsn, Rn, Michelle Russell Bsn, Rn, Christina Samson Bsn, Rn, Bria Sharp Bsn, Rn, Dwayne Accardo Dnp, Ccrna, Faana

Doctor of Nursing Practice Projects

No abstract provided.

Antibiotic Prophylaxis In Surgical Patients, Rebekah Muselin

ONU Student Research Colloquium

Problem: Post operative surgical site infections continue to be an issue that hospitals face. Although there is not one specific root cause of postoperative surgical site infections, there are steps that can be taken that potentially decrease the risk of acquiring an infection. By initiating prophylactic antibiotics prior to surgery, the incidence of postoperative infections may be decreased. Purpose:The purpose of this project is to compare the occurrence of postoperative surgical site infection rates when using prophylactic preoperative antibiotics to postoperative antibiotics. Methods: This project will be a retrospective chart review. There will be a review of the rate of …

Cultural Education Interventions Impact On Cultural Competence, Kaylie V. Griffin Ms

ONU Student Research Colloquium

Problem: In the United States, there is a substantial increase in diversity. This increase in diversity poses multiple challenges for healthcare workers and healthcare systems. Because nurses care for patients with various cultural backgrounds, health beliefs and practices, and languages, cultural competency plays a pivotal role in providing patient-centered care. There is a need to enhance cultural education for healthcare workers to ensure that healthcare workers have the skills and knowledge to effectively engage with all patient populations. Implementing cultural education interventions seeks to increase healthcare workers' competency, communication, and patient outcomes. Purpose: The purpose of this research question is …

The Future Of Artificial Intelligence In Perioperative Nursing, Nick Nijkamp, Erin Wakefield

Journal of Perioperative Nursing

Artificial Intelligence (AI) stands poised at the forefront of health care innovation, promising transformative advances across multiple domains. In the field of perioperative nursing, where precision, efficiency and patient safety are paramount, the integration of AI holds immense potential to revolutionise clinical practice.

Defined as the imitation of human acumen, AI enables computers to perform tasks ‘that typically require human intelligence, such as decision-making, problem-solving and learning’. This editorial explores the current landscape of AI, future prospects for AI in perioperative nursing and the ethical imperatives that accompany this transformative paradigm shift.

As technology continues to evolve rapidly, perioperative nursing …