Medicine and Health Sciences Commons^™

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

The Influence Of Depression On Pain In The Postoperative Setting: A Systematic Review, Lewis Lateef Olaoluwa

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Over 5% of Americans over the age of 12 reported depression between 2005–2006, and it remains the second leading cause of death in the adolescent and the early adulthood population. The estimated worldwide impact of depression affects approximately 300 million people (World Health Organization [WHO], 2017). Few research studies analyzed the correlation of depression and postoperative pain. The impact of depression on physiological wellbeing, and evidence from various studies suggest a correlation between psychological illnesses such as depression and the physiological manifestations of pain. This systematic review will consider Randomized Controlled Trials (RCT’s), however in the absence of RCT’s, a …

Improving Operating Room Turnover Cleaning Communication, Alexander Lao Jr.

Master's Projects and Capstones

Operating room (OR) turnover cleaning is an important part of perioperative workflow for surgical teams, particularly to prevent cross-contamination of infectious pathogens from the surgical environment to staff and patients. Incomplete OR turnover cleaning ultimately leaves vulnerable surgical patients at risk for surgical-site infections (SSIs) and other types of hospital acquired infections (HAIs), which leads to delays in overall operations of the OR. A microsystem assessment at a large metropolitan hospital revealed an issue with incomplete OR turnover cleaning evident by the presence of dirty canisters, filters, and unclean anesthesia machines/work-areas after sterile surgical supplies had already been opened in …

Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis

Doctoral Projects

The management of a difficult airway by anesthesia providers is a core component of providing safe care. Simulation provides an opportunity for the student to manage uncommon clinical scenarios without harm to an actual patient. This project aimed to determine if the use of simulation may be useful in training Student Registered Nurse Anesthetist in the management skills of a difficult airway. The proposed intervention of this project was the addition of simulation experience to didactic lecture covering difficult airway management techniques. As supported in the Adult Learning Principles of Medical Learners, by allowing the SRNA to actively participate in …

Elevating The Head Of Bed During Preoxygenation For Obese Patients Undergoing General Anesthesia: A Clinical Policy Proposal, Brian F. Seymour Jr.

Doctoral Projects

Preoxygenation plays a vital role in ensuring patient safety for all patient populations, especially those considered clinically obese. The negative pathophysiological effects obesity has related to body habitus and respiratory mechanics increases the risk of unexpected adverse events. Obese patients encounter a 50% decrease in functional residual capacity (FRC) when undergoing general anesthesia. Dixon et al., (2005) addressed the link between efficient oxygenation and improving oxygen storage by lessening atelectasis and intrapulmonary shunting via preoxygenation in a more upright position. Can standardizing preoxygenation techniques among anesthesia providers improve patient safety and decrease hospital system’s risk by implementing an evidence-based clinical …

The Use Of Preemptive Ketamine For The Prevention Of Postoperative Pain In Surgical Patients, Nicole Blake Brecher

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Post-operative pain is accompanied with strong emotional and physical responses which may often discourage the healing process. Acute pain serves as a physical warning sign to the patient but when left unchecked, the acute pain process can increase nociceptor sensitivity and ultimately lead to chronic pain syndromes. Currently, it is thought that providing pain medication to block pain receptors prior to nociception might decrease the development of, or severity of, pain. Some practitioners have used ketamine as an adjunct pain medication perioperatively to decrease pain. The purpose of this review is to investigate the efficacy of Ketamine administered in a …

The Impact Of Obesity Surgery On Psychosocial Health, Sibel Taze, Oya Gumuskaya, Mustafa Taşkın

Journal of Perioperative Nursing

Background: As obesity affects different dimensions of health, psychosocial wellbeing of patients can be predicted to significantly improve after bariatric surgery.

Method: This qualitative study focused on determining the experience of patients who underwent bariatric surgery and the psychosocial impact of it on their daily lives and provides nurses with detailed information regarding patients’ experience. While some of these outcomes were in line with the literature, they have also revealed new aspects and provided deeper understanding regarding individuals’ experiences.

Results: Five themes were identified: limitations in physical activity, social isolation due to negative body image, increased self-esteem, change in romantic …

Using The Acorn Standards: An Exploration Of Claims, Concerns And Issues, Carollyn Williams, Jed Duff Dr, Pat Nicholson, Lois Hamlin Rn, Brigid M. Gillespie Phd

Journal of Perioperative Nursing

An interactive action research workshop was offered during the ACORN & ASIORNA Conference which was held in Adelaide in 2018. The purpose of the workshop was to explore the research evidence supporting ACORN’s Standards for Perioperative Nursing in Australia, to identify gaps in the evidence related to standards and to explore challenges associated with the implementation of standards in clinical practice. The workshop also provided perioperative nurses with the opportunity to discuss their research interests and ask questions about undertaking research-focused degrees. Workshop participants provided an eclectic and credible range of issues related to the development and implementation of standards, …

Perioperative Handover Using Isbar At Two Sites: A Quality Improvement Project, Patricia Kitney

Journal of Perioperative Nursing

Background:The use of ISBAR handover principles assists in enabling the provision of best care to perioperative patients1. Reviews of post-operative handover research studies confirm the positive association between the quality of handovers and the decrease in adverse patient events2,3. Other reviews identify that globally handovers can be highly unpredictable and unreliable3–6. Therefore, the argument for standardised handovers to reduce the probability of adverse patient events in comparison to unstructured handovers, which have been shown to increase the chances of adverse patient events, is worth investigating.

Method:The method used was a multisite quasi-experimental design involving audits of perioperative handovers …

Developing Cultural Competency In Anesthesia Through Student Registered Nurse Anesthetists, Emma To

Doctoral Projects

Certified Registered Nurse Anesthetists (CRNAs) are the main anesthesia providers in over 70% of rural hospitals providing anesthesia. Each year, over 2,000 student registered nurse anesthetists (SRNAs) graduate and continue as licensed CRNAs. This Doctor of Nurse Practice (DNP) project emphasizes the importance of developing culturally competent providers in anesthesia by promoting early outreach in cultural competence education of SRNAs. Cultural competence is described as possessing characteristics of congruent attitudes, awareness, and conduct that provides and enables effective skills in cross-cultural encounters. Encompassing cultural competency education early in the SRNAs profession may provide valuable lifelong cultural skills that will benefit …

Current Opinion About Surgery-Related Fear And Anxiety, Nicholas Ralph

Journal of Perioperative Nursing

No abstract provided.

Pressure Injury Prevention In The Perioperative Setting: An Integrative Review, Isabel Wang, Rachel Walker, Brigid M. Gillespie Phd

Journal of Perioperative Nursing

Background: Pressure injury (PI) has a significant impact on patients and their families, and is costly to health care institutions. Perioperative PI remains problematic, although little is reported about current perioperative pressure injury prevention (PIP) strategies.

Aim: To identify the key perioperative PIP strategies, following a systematic review of published research, to describe existing gaps in the literature, and to inform the development of subsequent observational study.

Design:An integrative literature review method developed by Whittemore and Knafl was used.

Method: Research inclusion and exclusion criteria were identified a priori. Six data bases were searched and search terms included pressure …

Haloperidol And Postoperative Nausea And Vomiting: A Systematic Review, Megan Collins

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Postoperative nausea and vomiting (PONV) is a complication that affects up to 30% of the patients undergoing general surgery. This complication can be dangerous for patients, increase recovery time and decrease patient satisfaction scores. There are many different medications that have been used to prophylactically treat PONV including haloperidol. A systematic review was conducted to determine the efficacy of haloperidol as an antiemetic. Databases were searched and inclusion and exclusion criteria were applied to finalize the articles included. The PRISMA framework was used to guide the review and a total of five studies were critically analyzed. Two data collection tables …

Scarring And The Psychosocial Impact On Surgical Patients: A Review Of Questionnaires, Shandra Melick

Grace Peterson Nursing Research Colloquium

Scarring and the Psychosocial Impact on Surgical Patients:

Integrative Literature Review

Abstract

Background: Skin scars have the potential to impact patients in a variety of ways which can include impaired psychological, physical, social, and emotional well-being. Beginning in the 1990s, guidelines were created for patient-reported outcomes (PRO) to measure these patient specific concepts of scarring. but guidelines require refinement.

Objectives: The primary objective was to examine validated instruments to measure the psychosocial impact of surgical patients in relation to their acquired scar.

Methods: An integrative literature review was conducted to analyze results and findings of different validated …

An Evaluation Of Implementing Enhanced Recovery After Surgery Protocol Throughout The Perioperative Phase: A Quality Improvement Initiative To Enhance Patient Outcomes After Colorectal Surgery, Jerica Hill Dnp

Doctoral Projects

Abstract: The Enhanced Recovery After Surgery protocol (ERAS) is a multimodal collaborative approach implemented throughout the perioperative phase to enhance patient outcomes. The key mechanism for effectiveness in the ERAS protocol is the attenuation of the surgical stress response combined with treatments that support the return of functions that delay recovery in traditional methods. The purpose of this scholarly project was to evaluate the results of the ERAS Pilot program currently initiated at Baptist Memorial Hospital to improve patient outcomes undergoing major abdominal surgery. Prior to the implementation of the ERAS protocol there was no standardized method in place at …

Documentation Of Vital Signs During The Post-Operative Phase, Jennifer Susan Thran

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Post-Anesthesia Care Units (PACUs) were introduced in the 1930s to address excessive post-operative morbidity and mortality rates. The PACU provides an area where patients recovering from anesthesia can be observed intensely and treated appropriately until they return to a stable physiological state. Measurement of vital signs has always been a central task of the nurses providing care in the PACU; abnormal vital signs indicate an unstable patient and the possibility of an adverse event. Over time, both hospital policies on conduct of care in the PACU, including documentation of vital signs, and the technology for measuring vital signs have evolved. …

The Perioperative Patient Experience Of Hand And Wrist Surgical Patients: An Exploratory Study Using Patient Journey Mapping, Else F. De Ridder, Tessa Dekkers, Jarry T. Porsius, Gerald Kraan, Marijke Melles

Patient Experience Journal

Patient-centred care is becoming more important in healthcare. The success of patient-centred care can be assessed by exploring the patient experience through a patient journey map. As the number of outpatient surgeries is increasing, it is important to reveal the specific characteristics of this type of surgery. The perioperative patient experience is considered very important for outpatient surgery, because all perioperative activities are condensed in one day. To investigate this experience, we performed a case study of hand and wrist surgery. Six teams of two industrial design engineering students interviewed 40 patients in total in two private and two public …

Dexmedetomidine And Postoperative Delirium In The Adult Cardiac Surgical Population: A Systematic Review, Joanne Custodio

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Postoperative delirium (POD) is a major complication following surgery and is considered the most common complication among older adults following cardiac surgery; with up to 87% of patients being affected (Whitlock, Vannucci, & Avidan, 2011). Dexmedetomidine, a highly selective α2 agonist, inhibits the release of norepinephrine presynaptically causing analgesia and inhibits central nervous system stimulation in the postsynaptic neurons causing decreased blood pressure and heart rate; together, contributing to the effects of analgesia, anesthesia, and sedation (Naaz & Ozair, 2014). The purpose of this systematic review was to analyze the current literature and examine the effects of dexmedetomidine on POD …

Intraoperative Ketamine Administration: An Adjunctive Therapy That Reduces Postoperative Pain For Patients Undergoing Spinal Surgery, Brittany Pierce

Doctoral Projects

In 2017, the United States Department of Health and Human Services declared that the country was experiencing an opioid crisis (U.S. Department of Health and Human Services, 2018). As a result of this phenomenon, healthcare providers are examining how they are managing pain and researching new avenues for the treatment of pain. Anesthesia providers are in a unique position to help reduce postoperative pain and ultimately the development of chronic pain. This doctoral project was conducted in order to write an evidence-based policy that directs and educates anesthesia providers in the administration of intraoperative ketamine to reduce postoperative pain in …

Intraoperative Ketamine Administration: An Adjunctive Therapy That Reduces Postoperative Pain For Patients Undergoing Spinal Surgery, Brittany Pierce

Brittany Pierce

No abstract provided.

Pressure Injury Prevention For Surgery: Results From A Prospective, Observational Study In A Tertiary Hospital, Isabel Wang, Rachel Walker, Brigid M. Gillespie

Journal of Perioperative Nursing

No abstract provided.

Editorial: Fundamentals Of Missed Care – Implications For The Perioperative Environment, Nicholas Ralph

Journal of Perioperative Nursing

No abstract provided.

Private Pain – Identifying Gaps In The Management Of Chronic Pain Patients In Private Hospitals: A Case Study, Johanna Gale

Journal of Perioperative Nursing

This is a case study of a patient who experiences chronic pain and was admitted for an acute surgical procedure in a private hospital. It illustrates how communication and teamwork can be overlooked within the multidisciplinary focus when jointly caring for this group of patients within the public and private sectors. This case study offers a nurse-led approach to improving individualised health care for chronic pain patients while preventing gaps in health care.

Establishing A New Cardiac Surgery Service In An Australian University Hospital: Pitfalls And Lessons Learned, Claudia Ciobanu, Sharon Latimer, Brigid M. Gillespie

Journal of Perioperative Nursing

Cardiovascular disease is the leading cause of death among Australians. Creating and delivering a world-class cardiac surgery service in a cost-effective way is the principle goal of health care organisations and managers. Establishing a new health care service is a unique opportunity and requires detailed planning and implementation. Managing change is pivotal to establishing a new patient-focused health care service, and should be coupled with effective communication and teamwork among all stakeholders. There are foreseen and unforeseen challenges associated with any project so sharing the lessons learned is an important way for others in a similar situation to avoid potential …

Intestinal Bacterial Contamination Of Surgical Instruments Used For Wound Closure During Intestinal Surgery, Norihiro Kameda, Junko Nishio, Toshiko Ogawa, Shinobu Okada

Journal of Perioperative Nursing

No abstract provided.

Prevalence And Risk Factors Of Low Back Pain And Disability Index Among Operating Room Nurses, Anita Kiruba Jeyakumar, Florence Segaran

Journal of Perioperative Nursing

Introduction

Work related low back pain (LBP) has a clear impact on productivity at work. The aim of the study was to assess the prevalence and risk factors of LBP among operating room (OR) nurses. It also aimed to identify the disability index among those OR nurses diagnosed with LBP.

Method

This cross-sectional survey was conducted among the OR nurses working at a 2500-bed tertiary care centre with 37 operating rooms. OR nurses with a minimum of one year experience were included. A validated self- structured questionnaire was administered to them. Statistical analysis was done using Chi square test, and …

Attitudes And Beliefs Among Anesthesia Provides Regarding Smartphone Use For Intraoperative Anesthetic Management, Jasprit Dulat, Marjorie Reeves

Grace Peterson Nursing Research Colloquium

Background: Smartphone technology has evolved at the same accelerated pace as healthcare technological innovation. The literature shows that healthcare providers already utilize Smartphone technology to bridge gaps in knowledge and provide quality care to patients. Critics of these advancements are leery about Smartphone use in the operating room (OR) because it may be a source of distraction for anesthesia providers; however, supporters argue that their use is also recognized as a potential aid in learning. Objectives: This study was conducted to assess workplace attitudes and beliefs regarding the use of Smartphones in the operating room in order to establish policies …

Improving Surgical Patient Outcomes Through A Cross-Training Program For The Hybrid Operating Room, Ana Chozet-Griggs

Master's Projects and Capstones

Abstract

Innovations in the treatment of abdominal aortic aneurysms have resulted in the reduction of open surgical procedures and the increased use of minimally invasive procedures known as endovascular aortic artery repairs (EVAR) and thoracic endovascular artery repairs (EVAR). These hybrid procedures integrate the technical skills and resources used in surgical procedures with the technology used for radiological interventions. (Odle, 2011). These procedures are performed in a Hybrid Operating Room (HOR) within the Catheterization Laboratory (Cath Lab) microsystem. A HOR is a surgical operating room that is equipped with interventional radiology imaging and equipment (Taylor, 2017). These high-risk procedures demand …

The Association Of Prescription Opioid Exposure And Patient Factors With Prolonged Postoperative Opioid Use In Opioid Naive Patients, Jennifer Lanzillotta

Electronic Theses and Dissertations

Background

Research suggests prolonged postoperative opioid use occurs in 4-13% of opioid naïve patients and is related to factors other than surgical pain. However, it is unclear which patient factors and prescribing practices are associated with prolonged use after surgery among opioid naïve patients.

Objectives

To identify factors associated with prolonged postoperative opioid use (refills 90-180 days after surgery) in opioid naïve patients in two domains: specific patient characteristics (demographics, smoking status, comorbidities, etc.) and exposure through postoperative opioid prescriptions (in oral morphine milligram equivalents [OME]).

Methods

An electronic medical record dataset analysis of inpatient and outpatient opioid naïve adult …