Perioperative, Operating Room and Surgical Nursing Commons^™

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). …

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 …

Development And Implementation Of An Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Program For Student Registered Nurse Anesthetists, Nicholas Colangelo, Zachary Wise

Doctor of Nursing Practice Scholarly Projects

The American Association of Nurse Anesthetists (AANA) has defined the scope of nurse anesthesia practice to include services in acute, chronic, and interventional pain management, as well as the use of ultrasound (U/S) and other diagnostic technologies. However, there are no standard curriculum requirements in place that mandate graduate programs to educate student nurse anesthetists in U/S-related modalities. In addition to the AANA, the use of U/S in nurse anesthesia practice has recently been adopted by The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), which characterizes U/S use by its clinical impact on the reduction in complications, increased …

Breastfeeding After Maternal Anesthesia: A Guideline Development, Megan Berens

Doctor of Nursing Practice Scholarly Projects

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When …

The Practice Environment For Nurse Anesthetists In Tennessee, Taylor Cathey, Jessica Hobbs, Matthew Owen, Alexis Varney, James Alberding, Tausha Alexander

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

Potential consequences of anesthesia provider shortages may include a reduction in health care access, poor patient outcomes, and increased costs to government funded agencies. Current leaders in the anesthesia profession need to establish a work environment that is embracing, supportive, and safe so that certified registered nurse anesthetists (CRNA) can remain healthy and productive. The purpose of this Doctor of Nursing Practice (DNP) scholarly project was to provide an overview of the current CRNA practice environment in Tennessee and advocate for policies to promote CRNA retention and enhance patient access to care. The overarching goal included gathering sufficient evidence regarding …

Implementation Of Purposeful Hourly Rounding To Decrease Fall Rates, Dannette Kizy

Student Scholarly Projects

Practice Problem: Patient falls can lead to an increased length of stay and potentially reduce the quality of life. In addition to serious injury, the patient and the hospital have a significant financial burden. PICOT: On a medical-surgical unit, does incorporating purposeful hourly rounding in the patient care routine compared to no purposeful rounding decrease patient fall rates over eight weeks?

Evidence: Of the 35 articles related to fall prevention and PHR, a final selection of eight articles met the criteria and were of high quality and evidence levels.

Intervention: PHR was implemented to decrease falls over …

Strategies To Optimise Culturally Appropriate Perioperative Care For Aboriginal And Torres Strait Islander Peoples: A Discussion Paper, Maureen Joye, Paula Foran

Journal of Perioperative Nursing

The disparity in health outcomes between Indigenous and non-indigenous Australians continues to increase. Barriers to accessing health care, particularly surgical treatment, contribute to health inequalities among Indigenous Australians. Despite a positive correlation between improved patient experiences and health outcomes, there is little research available on nursing interventions to improve Indigenous patients’ perioperative health care treatment.

This discussion paper investigates culturally appropriate and evidencebased nursing interventions that can be applied in the perioperative setting to improve the surgical experience of Indigenous patients. It was shown that establishing trust among Aboriginal and Torres Strait Islander patients through anaesthetic nurse practices and advocating …

The Impact Of Quality Improvement Interventions On Compliance With Standardised Surgical Count Protocol And Count Discrepancies: A Quality Improvement Study, Sepideh Totonchilar, Akram Aarabi, Aygineh Hairabedian

Journal of Perioperative Nursing

Background: Unintentionally retained surgical items (RSI) are a global problem contributing to adverse events for surgical patients. The Association of periOperative Registered Nurses (AORN) has developed a standardised protocol for the surgical count; however, many hospitals do not follow the protocol for the surgical count. This study was conducted to investigate the effect of implementing quality improvement interventions, for counting surgical sponges, on compliance with the AORN surgical count protocol and occurrence of count discrepancies.

Method: This study was performed as an interventional quality improvement project from 1 February to 20 September 2022 with an intervention and a control group …

Nurses’ Perceptions Of Screening For Delirium In The Post Anaesthesia Care Unit And Orthopaedic Surgical Wards: A Qualitative Study, Rami Kamel Mustafa Aldwikat, Elizabeth Manias, Pat F. Nicholson Dr

Journal of Perioperative Nursing

Purpose: The aims of this study were to explore nurses’ perceptions of the usability and clinical utility of two screening tools for delirium detection in the Post Anaesthesia Care Unit (PACU) and orthopaedic surgical wards settings, and to identify nurses’ decisions about patient care delivery based on delirium assessment outcomes. The tools studied were the 3D-CAM and 4AT – the three-minute diagnostic interview for CAM (Confusion assessment method) delirium and the 4 ‘A’s test, respectively.

Method: A focus group methodology was used. Five semi-structured focus groups were conducted with 24 nurses working in the PACU and orthopaedic surgical wards. Focus …

Nonpharmacological Interventions For The Reduction Of Post-Operative Pain After Ambulatory Surgery: A Systematic Review Of Randomised Controlled Trials, Kevin E. Tololiu, Jed Duff, Krisztina Csokasi

Journal of Perioperative Nursing

Aims: To examine the effectiveness of nonpharmacological interventions for the reduction of post-operative pain in patients undergoing ambulatory surgery (also known as day surgery).

Background: Post-surgical pain remains prevalent, especially in day surgery cases. When poorly managed, this acute pain can lead to chronic pain and delayed recovery. Nowadays, several nonpharmacological regimens are available for reducing pain after ambulatory surgery. Further investigation is required to assess the quality of these alternatives.

Design: Systematic review

Methods: An electronic search of PubMed, CINAHL (via EBSCOhost), Embase, and Cochrane library was undertaken to screen and assess the studies of nonpharmacological intervention in reducing …

Health Librarians As Part Of The Perioperative Care Team, Gemma Siemensma

Journal of Perioperative Nursing

Chances are you may never find a librarian in the operating suite, unless as a patient, but they do play a vital role in enabling the work of perioperative nurses. A perioperative nurse’s role can encompass a variety of tasks at the pre-operative, operative and post-operative stage and includes the daily use of information resources to ensure evidence-based practice (EBP) occurs. This article explores the role of health librarians in the perioperative environment and highlights resources and services that are offered to assist perioperative nurses.

Optimising Post-Operative Recovery Of Elective Abdominal Surgery Patients: A Multimodal Approach, Jasmine Joseph, Meinam Deepa Devi

Journal of Perioperative Nursing

Aim: This study aimed to identify and validate a multimodal approach for optimising post-operative recovery of patients admitted for elective abdominal surgery.

Background: Identifying the risk of post-operative complications after abdominal surgery enables modification of the risk through targeted interventions and enhanced monitoring. Evidence shows that patients suffer needlessly due to inadequate pre-operative preparation and lack of information regarding the post-operative journey.

Methods and materials: The study was conducted using a quasiexperimental, post-test-only, control group design. The sample comprised 60 participants, 30 each in the experimental and control groups. Four aspects of participant recovery were measured – pain (using a …

Instituting An Educational Module To Improve Knowledge Of Local Anesthetic Systemic Toxicity Among Anesthesia Providers, Alisha Marie Linehan, Chad Andrew Mcclure, Steven Taylor Moon, Shukhratilla Ibragimov Shamshitdinov, Julie Newton Bonom, Jason Michael Buehler

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

Local anesthetic use in the perioperative period is increasing in the United States as healthcare providers seek alternatives to opioid-based pain management. While increased use of local anesthetics has many benefits, their use also increases the risk of Local Anesthetic Systemic Toxicity (LAST), which is a serious and potentially life-threatening complication. A search of the literature indicates there is a considerable gap in knowledge of LAST among healthcare providers, including Certified Registered Nurse Anesthetists (CRNAs) and anesthesia residents. This knowledge gap is combined with a lack of standardized approaches to identifying and treating this complication. Identifying and treating LAST is …

Development And Implementation Of An Evidence-Based Practice Guideline Regarding Cricoid Pressure, William Carson Ii

Doctor of Nursing Practice Scholarly Projects

Cricoid pressure (CP) has been a standard of practice since the 1960s. The purpose is to reduce aspiration of gastric content into the lungs in high-risk patients undergoing induction of general anesthesia. Aspiration has been identified as the most common cause of airway-related mortality for patients undergoing general anesthesia. The cause of airway-related mortality can be correlated to the application of CP. Incorrect application of CP may lead to adverse clinical events and outcomes. It has been demonstrated that when administering CP in a simulation-based environment, providers are applying pressure to the incorrect anatomical location and/or applying the incorrect amount …

Addressing The Inpatient Penicillin Allergy And Antibiotic Stewardship: The Effect Of Education On Compliance Rates Of The Nurse Driven Penicillin Allergy Assessment Tool, Alexandria Bassler

DNP Projects

Background: Penicillin allergies are the most frequently reported drug allergy but less than 1% of the total population has a true immune-mediated allergy. Patients who are labeled as having a penicillin allergy may receive drugs that are less effective, more costly, and more toxic. The nurse driven penicillin allergy assessment tool strives to increase penicillin allergy de-labeling rates by pharmacists and providers.

Objective: The purposes of this study were to (1) perform a retrospective and prospective chart review to determine compliance rates with the nurse driven penicillin allergy assessment tool, (2) provide an education module on antibiotic stewardship …

Intraoperative Dexmedetomidine Administration Effects On Postoperative Pain Scores And Opioid Medication Requirements: Pain Management Expectations Among Crnas, Dorilynn Nicol, Melissa Gheen, Matthew Bodine

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

Abstract

Opioid pain medications are currently viewed as a standard part of pain control in the vast majority of surgical procedures. However, opioid pain medications can have harmful effects on patients leading to increased length of hospital stay, unplanned readmission, and contribution to relapse or development of opioid use disorder. An opportunity for improved practice of pain management lies within opioid alternative pain medications such as dexmedetomidine. Evidence-based literature reviews have shown that dexmedetomidine has promise as an analgesic medication within the perioperative period with fewer harmful side effects. Barriers to more widespread use of this medication include staff unfamiliarity …

Retention Of New Nurses In The Cardiovascular Operating Room, Hannah Shufeldt

Doctor of Nursing Practice Projects

Background

In January of 2020, a hospital in Springfield, Illinois started the year with seven full-time circulating nurses in the cardiovascular operating room (CVOR). Three of those nurses left before the end of the year and an additional four nurses were hired. In January of 2021, the CVOR began the year with eight nurses. Five of these nurses left by the end of the year and seven more were hired, one of which left before the end of 2021. This department has struggled to retain nurses, with a turnover rate of 42.9% in 2020 and 62.5% in 2021.

Purpose

The …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Lateral Decubitus And Prone Positioning: An Objective Structured Clinical Evaluation, David Hesley-Hernandez, James Bailey

Doctoral Projects

Improper positioning of patients in the lateral decubitus or prone positions can lead to significant complications, including but not limited to: airway and invasive line loss, physiologic derangements, soft tissue injury, and peripheral nerve injuries (PNI) (Barash et al., 2017; Butterworth et al., 2018). Chui et al.’s (2018) analysis found that PNIs accounted for 12% of anesthesia malpractice since 1990, making PNIs costly. PNIs effects are not limited to cost and result in increased lengths of stay, increased pain levels, and decreased quality of life (Wojtkiewicz et al., 2015). The massive effect poor positioning can have requires that the anesthesia …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …