Nursing Commons^™

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Australian Elective Surgery Patients’ Pre-Operative Preparation, Health Literacy, Learning Preferences And Knowledge Resource Needs: A Cross-Sectional Survey, Cory J. Williams, Jed Duff, Chloe Tannagan

Journal of Perioperative Nursing

Aim: To investigate self-reported health literacy levels, learning preferences and knowledge resource needs of Australian elective surgery patients.

Background: Surgery contributes significantly to global health care, but surgical waitlists, cancellations and delay remain major challenges for health care systems. Pre-operative preparation and patient education about the surgical journey are essential to reducing these disruptions. Unfortunately, preparation and education are limited by short timeframes and one-size-fitsall approaches. Limited information exists about Australian surgical patients’ health literacy levels, learning preferences and knowledge resource needs.

Design and methods: This cross-sectional waiting room survey investigated patient health literacy, preferred education mode and learning styles …

Preoperative Pain Management Education And Narcotic Use: A Quality Improvement Project, Sarah Scheller

DNP Projects

Introduction: Comprehensive preoperative education is an important aspect of pain management and helps empower patients prior to their surgery. Evidence supports the use of a combination of the teach-back method, videos, and pamphlets to educate patients prior to their surgery. A quality improvement project was initiated for patients having total shoulder arthroplasty surgery with an orthopedic surgeon in Connecticut.

Methods: An educational video and handout were created, and preoperative education sessions using the teach-back methods were performed. Postoperative phone calls were placed at 24 and 72 hours to assess the patient’s use of narcotic pain medication, alternative pain management medication …

Measuring Surgical Patient Engagement: A Scoping Review, Rebecca Law, Dawn Wong Lit Wan, Sonja Cleary, Wanda Stelmach, Krinal Mori, Zhen Zheng

Journal of Perioperative Nursing

Background

Patient engagement is a patient’s capacity and willingness to participate and collaborate in their own health care. This scoping review aimed to identify tools used to measure engagement among surgical patients, the levels of engagement and the association between engagement and surgical outcomes. We hypothesise that highly engaged patients are more likely to achieve better surgical outcomes.

Review methods

MEDLINE/PubMed, CINAHL, SCOPUS and Embase were searched for studies that assessed adult perioperative patients for engagement. Analysis from charting the data identified the measurement tools, levels of capacity to engage and relationships between engagement and surgical outcomes.

Results

Twelve studies …

Surgical Site Infections: Reducing Excessive Foot Traffic In The Surgical Room To Minimize The Risk Of Surgical Site Infections, Christopher D. Pobre

Master's Projects and Capstones

Problem: In 2021, a perioperative unit experienced 21 different surgical site infections (SSIs). SSIs are associated with increased medical complications and financial costs. One risk factor for SSIs is the increased or excessive operating room (OR) foot traffic, which increases airborne contaminants within the OR.

Context: A seven-room operating department performing 5,800 surgical procedures annually. The unit specializes in general, elective, and emergent procedures for the adult population predominately in the East Bay Area. A diverse mix of surgical procedures was observed throughout this project.

Assessment: A microsystem assessment was conducted to determine the causes and patterns that lead to …

Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom Dnp, Michael Godbold Md

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

Patient Temperature measurement postoperatively reveals that hypothermia occurs in surgical patients 25-90% of the time. Unintended perioperative hypothermia can be linked to many negative patient outcomes such as increased incidence of surgical site infection (SSI), delayed wound healing and increased length of hospital stay, to mention a few. Any single or combination of the aforementioned issues can eventually lead to an increase in patient morbidity and mortality. The purpose of this proposed quality practice improvement project is to increase the compliance of hypothermia prevention strategies, specifically forced air warming, at the implementation site. The targeted practice improvement is aimed at …

Roles In Preoperative Planning, Joetta Combs

Epsilon Sigma at-Large Research Conference

This project represents the ever-changing methods surrounding Enhanced Recovery after Surgery and the protocols that compose it. The purpose of this study is to expand education of ERAS guidelines and improve patient outcomes through furthering staff education. Enhanced Recovery After Surgery has been a part of perioperative departments worldwide after being introduced in the 1990s by Northern European general surgeons and has been adapted and modified since its introduction (ERAS Society History, 2022). The preoperative and postoperative process is ever-changing and is difficult for staff to keep up with. Many staff members find it difficult to stay on top of …

Examining The Impact Of A Protein Intervention To Improve Outcomes In Frail Perioperative Candidates: A Feasibility Study, Anna M. Rose

DNP Projects

Background: Frailty is a syndrome or grouping of clinical characteristics that collectively increases one’s vulnerability to acute and external health stressors. Higher rates of frailty are present in oncology surgical patients and is a predictor of postoperative complications, as well as increased morbidity and mortality. Long- and short-term survival of surgical oncology patients is worse in frail patients than robust patients. Prehabilitation interventions during the planning phase of surgical intervention may serve to mitigate already known health concerns prior to inflicting the stressor that is surgical intervention.

Purpose: To measure the feasibility of an educational prehabilitative nutritional intervention aimed at …

Improving First Case Starts For A Neurosurgery Or, Tara L. Goodall

Master's Projects and Capstones

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide …

Standardizing Surgical Skin Antisepsis, Crystal Vackar

MSN Capstone Projects

Skin antisepsis is one of the most critical factors for preventing postoperative surgical site infections, but with the lack of high-quality research, the choice of which preoperative skin antiseptic is best remains a puzzling problem for clinicians (Chen, Chen, Guo, & Xu, 2020). Minimizing the patient’s risk of a surgical site infection by removing skin contaminants at the surgical site is the goal of surgical skin antisepsis. Therefore, the hospital or organization must choose the right product that is cutting costs, is the most effective, saving surgical time, and has the safest results for the patient. Before prepping the skin, …

Environmental Stressors Perceived By Patients In The Surgical Intensive Care Unit And Their Level Of Satisfaction With Nursing Care, Hacer Karaer, Esma Ozsaker

Journal of Perioperative Nursing

Purpose: The purpose of this study was to determine environmental stressors perceived by patients in the surgical intensive care unit and their level of satisfaction with nursing care.

Design: A descriptive cross-sectional study design was used in this study.

Methods: This study was conducted between January 2019 and June 2019 with 120 patients who were hospitalised in the surgical intensive care unit. Data collection was via a patient information form, the Intensive Care Unit Environmental Stressor Scale (ICUESS) and the Experiences of Nursing Care Scale (ENCS) component of the Newcastle Satisfaction with Nursing Scales (NSNS).

Findings: The mean ICUESS score …

Closing Communication Gaps For Unplanned Surgical Patients: One Pre-Op Checklist At A Time, Seda L. Vash

Master's Projects and Capstones

Problem: Unplanned, inpatient surgical patients were experiencing poor outcomes and dissatisfaction with their overall care. This surgical patient population also lacked communication from their healthcare teams with regard to plans of care throughout their hospital stays.

Context: This was a quality improvement project for the unplanned, inpatient surgical patient population in the Central Valley of California. Approximately 13% of this hospital’s surgical patients required post-surgical care in the inpatient units. These patients, according to unfavorable HCAHPS scores, experienced unsatisfying care and insufficient communication from their healthcare teams, including physicians and nurses.

Intervention: This project implemented an Add-On Communication Tool for …

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.

Reflections On Texas Back Institute Internship, Shelby Jones

The Eleanor Mann School of Nursing Undergraduate Honors Theses

For my honors project, I chose to do the experimental option to gain more knowledge on topics that we do not spend much time covering in nursing school. I had the privilege to complete an internship with the Texas Back Institute, their main office is located in Plano, Texas. I worked closely the Scoliosis and Spine Tumor Center that is a branch of their team, and completed my internship from May to the first week of August 2019. I worked 20 hours a week during my internship between the clinic and the hospital. I was able to observe physicians in …

Refining Guidelines For The Care Of Paediatric Perioperative Patients In A Rural Health Care Facility, Michelle Hibberson

Journal of Perioperative Nursing

No abstract provided.

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

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 …

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 …

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 …

Fentanyl Administration On Emergence From Surgery And Post Anesthesia Care Unit Discharge Times And Pain Scores, Andrew Ernst Wetzel

Doctoral Projects

Problem: Pain has been historically mismanaged potentially leading to a host of negative physiological consequences. Today’s dynamic health care reform offers an opportunity to increase satisfaction with care. Utilizing the PICO question, in adults undergoing laparoscopic cholecystectomy over a 12 month period, does medication with fentanyl during emergence versus not medicating during emergence reduce the need for pain medications and discharge times? Evidence/Background: Two national studies surveyed patient perception of pain management following surgery. The first, conducted by Apfelbaum et.al (2003) showed that 80% of patients experienced acute pain after surgery with 86% rating that pain as moderate …

The Effects Of Implementing Best Practices On 30-Day Readmission Rates In Adults Following Cabg Surgery, Linda Elaine Kline

Evidence-Based Practice Project Reports

Coronary artery bypass graft (CABG) surgery is one of the most frequent and expensive cardiac surgical procedures in the U.S. today. Complications from CABG surgery are one of the top causes of 30-day hospital readmissions. Readmissions after CABG surgery are often preventable and add to health care costs. Recent government legislation mandates penalties for hospitals with excess readmission rates. The purpose of this evidence-based practice project was to determine if implementation of best practice recommendations effected 30-day readmission rates following CABG surgery. A critical appraisal of the literature was conducted to identify best practice recommendations. The Iowa model and Lewin’s …

The Effect Of Telephone Follow-Up On Pain Experienced By Patients After Knee Replacement Surgery, Laurie J. Jones

Evidence-Based Practice Project Reports

Hospital length of stays are decreasing throughout the U.S. in an effort to contain healthcare costs, but these measures can be detrimental to patients. Those who get knee replacement surgery are finding their length of stay reduced from an average of 3 to 4 days to 24 to 48 hours, which can affect pain control and interfere with rehabilitation and recovery. This affects many people, as more than 632,000 knee replacements occur each year (American Academy of Orthopedic Surgeons, 2008). The purpose of this evidence-based project was to evaluate the effect of telephone follow-up on pain experienced by knee replacement …

Patient Comfort And Multimodal Analgesia: Effects Of Preoperative Ibuprofen, Rodney Nash

Nursing Theses and Capstone Projects

Multimodal therapy for surgical patients is explified by use of a combination of a non-steroidal anti-inflammatory and an opioid to control visceral pain by decreasing both inflammation and pain transmission. Perioperative or postoperative use of multimodal therapy has been shown to provide adequate surgical pain relief while decreasing the total dose of opioids required. This project demonstrated that preoperative use of ibuprofen for women undergoing total laparoscopic hysterectomy decreased the total dose of opioids consumed in a 24-hour period, and increased the likelihood of the patient reaching her pain goal target at discharge. This finding adds to the literature support …

Surgical Delay For Hip Fracture Clients And The Use Of Clopidogrel: An Integrative Review, Phoebe Genevieve Waller

Senior Honors Theses

Abstract

Hip fractures in elderly patients have very high postoperative mortality rates and the number of hip fractures in the United States is expected to increase exponentially before 2030. Early surgery is essential to improve outcomes, but patients on clopidogrel (Plavix) have a high risk for increased bleeding if surgery is performed within the usual 72 hour window. This paper presents literature and research addressing the dangers of delaying surgery versus undergoing surgery before the effects of the clopidogrel are gone. Based on articles published after 2006, most researchers advocated earlier surgical intervention than previously recommended and emphasized an individualized …

What Is The Impact Of Tram Flap Breast Reconstruction On Self-Esteem And Perceived Body Image For Women With Breast Cancer?, Olivia Hill

Theses : Honours

Breast cancer is the most common of all cancers in women (26%) in Australia (Australian Institute Health Welfare AIHW, 1996; National Breast Cancer Centre NBCC, 1999). It is estimated that the lifetime incidence of one in eleven women in Australia will be diagnosed with breast cancer by the age of seventy-four (National Health and Medical Research Council NHMRC, 2000). Surgical resection continues to be the mainstay of treatment for early breast cancer, with approximately 50% of women diagnosed with breast cancer undergoing mastectomy (NBCC, 1999). Both the diagnosis of breast cancer and subsequent mastectomy raises a number of psychosocial issues …

An Investigation Into The Effects Of Preoperative Teaching On The Self Reported Levels Of Anxiety Of Patients Undergoing Elective Surgery, Megan Inglis

Theses : Honours

Over the last twenty years there has been a considerable amount of research conducted into the effects of preoperative teaching on postoperative recovery. While it is well known that preoperative instruction assists patients to recover from their operation, the mechanisms by which this occurs are not clear. One mechanism which may improve postoperative recovery is preoperatively. This research the reduction of anxiety examined the effects of preoperative teaching on preoperative levels of anxiety in patients undergoing elective cholecystectomy or herniorrhaphy. Twenty eight patients had their preoperative anxiety levels measured by a widely used questionnaire known as the State Trait Anxiety …