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 …

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 …

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 …

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 …

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.

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 …

Final Scholarly Project: Clinical Guidelines For The Perioperative Management Of Patients With Opioid Use Disorder Requiring Anesthesia, Jessica Kayla Joos

Doctor of Nursing Practice Scholarly Projects

Opioids have highly addictive properties that allow for high levels of misuse. Since the early 1990s, the misuse and deaths rates related to narcotics have steadily risen in the United States. Efforts to identify individuals using opioids prior to surgery have proven difficult. The number of patients misusing opioids and reporting for surgery can only be estimated due to under-reporting related to fear and self-stigma. With 50 million surgeries in the U.S. annually and 3.32 million people misusing opioids monthly, the chances of a patient with Opioid Use Disorder (OUD) presenting for anesthesia are exceptionally high. Moreover, patients who rate …

How Soon Is Too Soon? A Quality Improvement Approach To Postoperative Length Of Stay Following Transcatheter Aortic Valve Replacement, David Brian Jones, Robin Harris, Paul N. Fiorilli Md, Allyson Neal

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

BACKGROUND: Heart valve disease prevalence is expected to rapidly increase over the next twenty years. Aortic stenosis, the most common valvular disorder, is a significant cause of heart failure hospital admissions and high mortality if left untreated. Treatment options include surgical aortic valve replacement (SAVR) and the more popular transcatheter aortic valve replacement (TAVR). The rapid increase of TAVR procedures generates hospital bed capacity issues, and there is no recommendation defining the minimum length of stay (LOS) following TAVR.

LOCAL PROBLEM: The setting was a 1,100-bed academic medical center in southeastern Pennsylvania with an average annual TAVR volume …

The Effectiveness Of Dexmedetomidine In The Reduction Of Postoperative Delirium In Patients Over 65: A Scoping Review, Jacqueline Renee Breuer, Michael G. Callonas, Kathleen Chmelicek, Laura Elizabeth Denman, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Postoperative delirium impacts as many as 51% of surgical patients, resulting in increased mortality and morbidity, longer hospital stays, and increased healthcare costs. Adults ≥ 65 have a high risk for developing delirium. This scoping review examines the use of dexmedetomidine in the perioperative period in adults ≥ 65 years old to prevent and treat postoperative delirium.

Methods

Using relevant inclusion criteria, an extensive review of the literature was performed from September through November 2022, utilizing the Cochrane, CINAHL, ClinicalKey, PubMed, and Embase databases. Search phrases included: dexmedetomidine infusion, dexmedetomidine, intraoperative dexmedetomidine, postoperative delirium, older adults, and elderly delirium. …

Evidence Based Practice Change To Incorporate A Standardized Process Checklist For Fecal Microbiota Therapy (Fmt) To Increase Staff Adherence, Alicia Gomez

Student Scholarly Projects

Practice Problem: Staff adherence to new procedures is crucial for ensuring patient safety, maintaining quality care, reducing risks and liabilities, and fostering a positive organizational culture that supports continuous improvement. Having a procedure done safely for patients infected with C.diff provides an overall benefit to the healthcare system.

PICOT: In an endoscopy lab staffed with nurses and surgical technicians (P), does the implementation of a new standardized process of administering FDA approved Fecal Microbiota Transplant Therapy (I) compared to the current process (C), increase staff adherence to the process (O) over 12 weeks(T)?

Evidence: Leadership, supervision, and organizational culture are …

Fire Safety In The Or, Raghda Abo Al Haija, Leah Cullop, Keeli Mckeel

Scholars Week

Fire safety in the operating room (OR) is crucial, and so it is important for the OR team to be aware of practices that help prevent and manage operating room fires. This presentation compiles evidence-based research on practices and interventions that promote OR fire safety.

Local Anesthetic Systemic Toxicity (Last): Provider Education, Alexis Johnson

Scholars Week

Abstract

Background: Local Anesthetic Systemic Toxicity (LAST) is a rare but serious complication due to accumulation of local anesthetics. If not treated quickly, LAST can cause detrimental complications such as seizures and cardiac arrest. Therefore, it is important that anesthesia providers are well versed in preventing, recognizing, and treating this adverse event.

Methods: A LAST flowchart written by The American Society of Regional Anesthesia and Pain Medicine (ASRA) was printed and placed in each operating room in a small suburban hospital. Anesthesia staff were also educated on recognizing signs and symptoms, onset time, high risk patients, and prevention.

Results: Ten …

Nursing Implications For Transgender And Gender Diverse Perioperative Patients: A Discussion Paper, Oona O'Shea, Paula Foran

Journal of Perioperative Nursing

Perioperative nurses must provide culturally competent care to all surgical patients, and understanding gender identity and gender diversity may be the first step to creating an inclusive perioperative practice for transgender and gender diverse patients. In the nurse–patient relationship, limited exposure to and knowledge of diverse populations may negatively affect the health of this important demographic.

When nurses are unaware of how care can be affected by explicit (conscious) or implicit (unconscious) bias, they may use transphobic stereotyping behaviours or act with microaggressions, like using excessive protective attire. Such care may invalidate gender identity and impede trust. In contrast, nurses …

Preoperative Warming To Improve Patient Outcomes: Implementation Of A Warming Protocol, Tiara Switzer-Houston

Student Scholarly Projects

Practice Problem: Inadvertent perioperative hypothermia (IPH) is noted to be the most common surgical complication. IPH is associated with a variety of complications which are known to impact the well-being of the patient, family, and healthcare system.

PICOT: The PICOT question that guided this scholarly project was scheduled for total hip and knee arthroplasty surgical procedures under general or neuraxial anesthesia greater than 60 minutes (P), how effective is the implementation of an evidence-based pre-surgical warming protocol including forced-air warming (FAW) (I) compared to current practices (C) in improving normothermia readings within 15 minutes of arriving to the PACU, …

Barriers To And Facilitators Of Using Cognitive Aids In Perioperative Emergencies: An Integrative Review, Simon Almoite, Paula Foran

Journal of Perioperative Nursing

Problem identification: Perioperative emergencies, although infrequent, may lead to significant morbidity and mortality associated with anaesthesia and/or surgery. Human factor errors account for between 43 to 65 per cent of sentinel events in the perioperative environment. Cognitive aids were introduced to reduce a user’s cognitive workload and assist in adherence to key interventions during emergencies. Despite the availability of these aids, implementation of their use remains low. This integrative literature review will identify the barriers to and facilitators of the implementation of cognitive aids during perioperative emergencies.

Literature search: An electronic database search of EBSCO databases (CINAHL Complete, Health Source: …

Effect Of Using Virtual Reality To Manage Needle Phobia In Adults Undergoing Medical Procedures: A Rapid Review, Craig J. Gilbertson, Tshepo Rasekaba, Irene Blackberry

Journal of Perioperative Nursing

Background: Needle phobia, also known as blood–injection–injury (BII)phobia, is a severe form of needle fear that affects from 20 to 50 per cent of adolescents, 20 to 30 per cent of young adults and less than 5 per cent of the older adult population. When faced with venepuncture, approximately 75 per cent of patients with needle phobia will undergo an extreme physiological response which can lead to a vasovagal or fainting episode. An emerging therapy for medical phobias is the use of virtual reality, a three-dimensional environment generated by a computer that creates a sense of immersion.

Aim: To evaluate …

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 …

‘I Want To Be A Member Of My Heart Team’: Insights From Patients’ Experiences Of Minimalist Transcatheter Aortic Valve Implantation, Celeste G. Percy, A. Fuchsia Howard Dr., Bobby Lee Dr., Janarthanan Sathananthan Dr., David A. Wood Dr., John G. Webb, Sandra B. Lauck Dr.

Journal of Perioperative Nursing

Background: Internationally, transcatheter aortic valve implantation (TAVI) is the most common approach for treating aortic stenosis. There is growing evidence to support the implementation of a streamlined clinical pathway to optimise outcomes, improve capacity and facilitate safe early discharge home. Best practices that are emerging include adopting a minimalist approach and transition from general anaesthesia to conscious sedation or local anesthesia only. We aimed to explore what could be learned from patients’ experiences of their care in this rapidly evolving context

Methods: We conducted a qualitative study of patients in the first week after TAVI to explore their perspectives of …

Effects Of Compassion Fatigue On Surgical Staff Productivity, Marcy I. Harris

Electronic Theses and Dissertations

Compassion fatigue is a psychological phenomenon affecting many healthcare professionals; however, many professionals are unaware of compassion fatigue or its signs and symptoms. Individuals suffering from compassion fatigue may experience mental and physical side effects and a decline in their work productivity. This quality improvement project was aimed at determining if implementing Vintapatr’s compassion fatigue education and management program would improve perceived levels of compassion fatigue and reduce operating room turnover time. The researcher utilized a descriptive correlational design to identify the relationship between compassion fatigue levels and operating room turnover times. This quality improvement project was implemented at a …

Thermoregulation In Colorectal Patients: Heating Co2 Insufflation Gas, Alejandro Conde, Alieu Jawara, Laura Savage, James Alberding Dnp, Michael Godbold

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

BACKGROUND: 600,000 colorectal surgeries are performed annually in the United States, with 26-90% experiencing some form of unintended hypothermia. Consequences of hypothermia include surgical site infections (SSIs), delayed wound healing, cardiac dysrhythmias, and increased hospital length of stay. Utilization of the laparoscopic approach to intra-abdominal colorectal surgery uses un-warmed CO₂ gas. Multiple studies demonstrate the addition of heated CO₂, for insufflation, reduces intraoperative hypothermia.

LOCAL PROBLEM: This project was implemented at a facility in Tennessee. On average, 250 laparoscopic colorectal cases are performed at this facility annually. Participants were adult colorectal surgical patients, 18 years …

The Effects Of An Educational Intervention On Nursing Knowledge Of Post-Operative Care Of Patients After Minimally Invasive Esophagectomy Surgery, Kelli Curry

DNP Projects

Abstract

Background: Minimally invasive esophagectomy surgery is commonly performed by thoracic surgeons on patients with esophageal cancer. The post-operative care of these patients is meticulous and follows a protocol developed by the thoracic surgeons at the University of Kentucky. At UK Chandler Medical Center, concerns have been raised regarding nurses’ lack of education of the protocol, and therefore decreased implementation. Increasing nursing knowledge pertaining to this protocol by performing educational in-services periodically and standardizing and implementing formal education as part of nursing orientation will decrease the knowledge gap and improve patient outcomes and increase utilization of the post-operative protocol.

Purpose: …

Why We Should Be Counting In The Cardiac Catheter Lab: A Discussion Paper, Stephanie Biggs, Paula Foran

Journal of Perioperative Nursing

The cardiac catheter laboratory, which in many health care facilities falls under the umbrella of perioperative services, generally sits geographically outside the traditional operating suite. Perhaps due in part to this geographical distance, standards that are routinely applied in the operating suite may not be applied in the cardiac catheter laboratory. One such standard is the management of accountable items such as swabs, surgical instruments, sharps and sheaths. Well-known standards and guidelines for managing accountable items recommend mandatory counting and documentation of all accountable items in environments where a surgical item may be left behind; yet, despite this, counting is …

Multidisciplinary Simulation Training For Australian Perioperative Teams: A Qualitative Descriptive Exploratory Study, Michelle Hibberson, Jessica Lawton, Dean Whitehead

Journal of Perioperative Nursing

Background: Perioperative units are complex and high-risk environments in which teams of multidisciplinary health care professionals work collaboratively. Multidisciplinary simulation training is a form of education that allows perioperative teams to practise the non-technical and technical skills essential for managing emergency events within the perioperative environment. Despite the benefits of multidisciplinary simulation training, there is a paucity of literature about it; therefore, this study examined the experiences of Australian multidisciplinary perioperative team members who had undertaken simulation training.

Objectives: This study examined the experiences of Australian multidisciplinary perioperative team members who had undertaken multidisciplinary simulation training with the aim of: …

Depression Screening Tool For Hysterectomy Patients, Dede C. Mihedji

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The prevalence of hysterectomies in the United States ranges from

5.1 to 5.8 per 1000 women (Harnod et al., 2018). A standardized screening tool for assessing

depression preoperatively could mitigate the worsening of postoperative depressive symptoms in patients scheduled for a hysterectomy.

Local Problem: Currently, there is no standard of practice to routinely screen for depression in preoperative patients scheduled for hysterectomy surgeries. However, as with any surgical intervention, there are risks of long-term complications. Studies have identified that a hysterectomy may increase the risk of cardiovascular events, menopause, depression, and other outcomes (Madueke-Laveaux et al., 2022). …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Evaluation Of Registered Nurses’ Knowledge And Confidence In Encouraging Cardiac Surgery Patients To Participate In Digital Education, Katelin A. Welch, Jewyl Gibson

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

Abstract

Background: Cardiac surgery remains a necessary means of medical management for cardiac disease. Patient anxiety is a common mental health challenge experienced by cardiac surgical candidates. Preoperative educational videos can reduce anxiety and improve the surgical experience.

Local Problem: This project was conducted for hospital nurses caring for cardiac surgery patients. Cardiac patients are assigned digital education to educate them about their procedures. Regardless of availability, nurse and patient engagement of the material is low. Competing nursing priorities prevent nurses from disseminating education to cardiac surgery patients, thus increasing patient anxiety. Educating nurses on utilizing digital surgery …

Evidence-Based Pain Management With Inclusion Of Music Therapy For Post-Surgical Patients: A Benchmark Study, Ashleigh Rowan

MSN Capstone Projects

Improper pain management in the postsurgical patient can delay proper healing, increase frustration for the patient, and prolong hospital stays (Córcoles-Jiménez et al., 2021). Moderate to severe pain can pose a greater risk for complications such as deep vein thrombosis, pneumonia, and delayed recovery (Kolaczko et al., 2019). Music therapy is an underutilized pain intervention in the PACU environment. Music therapy has been shown to lower pain and anxiety scores in many different clinical settings (Lee et al., 2017). Pain management can radically improve a patient’s outlook and recovery (Luo & Min, 2017). Patients who return to wakefulness and receive …

Perceptions And Awareness Of Operating Room Staff Regarding Surgical Smoke: Implications For Safety And Health, Karla Flores

MSN Capstone Projects

In the ever-evolving landscape of modern medicine, surgical procedures have become increasingly complex and reliant on energy-based devices, leading to the ubiquitous presence of surgical smoke in ORs. This phenomenon, while a byproduct of technological advancement, poses significant concerns regarding the health and safety of OR personnel, including surgeons, nurses, anesthesiologists, surgical technicians, and ancillary staff. This paper presents a meticulous examination of the multifaceted impacts of surgical smoke, emphasizing the urgency for comprehensive intervention and systemic change.

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …