Search Results (51)

Background/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interventions offer a promising non-pharmacological approach to perioperative anxiety management. This study evaluated the effectiveness of superimposed binaural beats (SBBs)—classical music layered with frequency differentials—in reducing anxiety during pterygium surgery with conjunctival autografting. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autografting under local anesthesia were allocated to one of three groups: SBBs, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory interventions. The patients’ anxiety was assessed using the State–Trait Anxiety Inventory—State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in their STAI-S scores (p < 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBBs are a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Their integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial. Trial Registration: This study was registered with the Thai Clinical Trials Registry (TCTR) under registration number TCTR20250125002 on 25 January 2025. Full article

Background: Hypotension following epidural labor analgesia (ELA) is its most common complication, affecting approximately 20% of patients and posing risks to both maternal and fetal health. As digital tools and predictive analytics increasingly shape perioperative and obstetric anesthesia practices, real-world implementation data are needed to guide their integration into clinical care. Current monitoring practices rely on intermittent non-invasive blood pressure (NIBP) measurements, which may delay recognition and treatment of hypotension. The Hypotension Prediction Index (HPI) algorithm uses continuous arterial waveform monitoring to predict hypotension for potentially earlier intervention. This clinical trial evaluated the feasibility, acceptability, and efficacy of continuous HPI-guided treatment in reducing time-to-treatment for ELA-associated hypotension and improving maternal hemodynamics. Methods: This was a prospective randomized controlled trial design involving healthy pregnant individuals receiving ELA. Participants were randomized into two groups: Group CM (conventional monitoring with NIBP) and Group HPI (continuous noninvasive blood pressure monitoring). In Group HPI, hypotension treatment was guided by HPI output; in Group CM, treatment was based on NIBP readings. Feasibility, appropriateness, and acceptability outcomes were assessed among subjects and their bedside nurse using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) instruments. The primary efficacy outcome was time-to-treatment of hypotension, defined as the duration between onset of hypotension and administration of a vasopressor or fluid therapy. This outcome was chosen to evaluate the clinical responsiveness enabled by HPI monitoring. Hypotension is defined as a mean arterial pressure (MAP) < 65 mmHg for more than 1 min in Group CM and an HPI threshold < 75 for more than 1 min in Group HPI. Secondary outcomes included total time in hypotension, vasopressor doses, and hemodynamic parameters. Results: There were 30 patients (Group HPI, n = 16; Group CM, n = 14) included in the final analysis. Subjects and clinicians alike rated the acceptability, appropriateness, and feasibility of the continuous monitoring device highly, with median scores ≥ 4 across all domains, indicating favorable perceptions of the intervention. The cumulative probability of time-to-treatment of hypotension was lower by 75 min after ELA initiation in Group HPI (65%) than Group CM (71%), although this difference was not statistically significant (log-rank p = 0.66). Mixed models indicated trends that Group HPI had higher cardiac output (β = 0.58, 95% confidence interval −0.18 to 1.34, p = 0.13) and lower systemic vascular resistance (β = −97.22, 95% confidence interval −200.84 to 6.40, p = 0.07) throughout the monitoring period. No differences were found in total vasopressor use or intravenous fluid administration. Conclusions: Continuous monitoring and precision hypotension treatment is feasible, appropriate, and acceptable to both patients and clinicians in a labor and delivery setting. These hypothesis-generating results support that HPI-guided treatment may be associated with hemodynamic trends that warrant further investigation to determine definitive efficacy in labor analgesia contexts. Full article

Background: Gynaecological oncology (GO) surgery involves a wide range of procedures, from minor diagnostic interventions to highly complex cytoreductive operations. Accurate perioperative diagnostics—particularly in major surgery—are critical to optimise patient care, predict morbidity, and facilitate shared decision-making. This study aimed to evaluate current practices in perioperative risk assessment amongst UK GO specialists, focusing on the use, perception, and applicability of diagnostic risk prediction tools. Methods: A national multicentre survey was distributed via the British Gynaecological Cancer Society (BGCS) to consultants, trainees, and nurse specialists. The questionnaire examined clinician familiarity with and use of existing tools such as POSSUM, P-POSSUM, and ACS NSQIP, as well as perceived reliability and areas for improvement. Results: Fifty-four clinicians responded, two-thirds of whom were consultant gynaecological oncologists. While 51.9% used morbidity prediction tools selectively, only 7.4% used them routinely for all major surgeries. The most common models were P-POSSUM (39.6%) and ACS NSQIP (25%), though over 20% did not use any formal tool. Despite this, 80% of respondents expressed a desire for more accurate, GO-specific models. Conclusions: This study reveals a gap between available perioperative diagnostics and real-world clinical use in GO surgical planning. There is an urgent need for validated, user-friendly, and GO-specific risk prediction tools—particularly for high-risk, complex surgical cases. Further research should focus on prospective validation of tools such as ACS NSQIP and their integration into routine practice to improve outcomes in gynaecological oncology. Full article

Background/Objectives: Aortic stenosis is a common heart disease, particularly among elderly patients. Transcatheter aortic valve implantation (TAVI) offers a minimally invasive alternative method to surgical valve replacement for high-risk patients. Although clinical guidelines for TAVI are well established, standardized nursing care pathways are lacking. This systematic review aims to clarify the nursing role in the pre-, peri-, and postoperative phases of TAVI. Methods: This review was conducted in accordance with the PRISMA guidelines. After applying the eligibility criteria, ten studies were selected from five databases: PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library. The work was registered in the PROSPERO database with the ID number CRD420251061863. Results: The analysis revealed the following: (1) a strong emphasis on preoperative patient education, often led by nurse coordinators; (2) perioperative nursing roles in conscious sedation protocols and early mobilization; (3) a lack of standardized rehabilitative protocols, especially in the preoperative phase; and (4) an emerging but insufficiently evaluated role of the TAVI nurse coordinator in multidisciplinary care. Most studies concentrated on postoperative care, outcomes, follow-up, and rehabilitation, but the small sample sizes limited the strength of the conclusions. Conclusions: Nurses play a vital role in multidisciplinary TAVI teams. There is an urgent need for evidence-based nursing guidelines to standardize care, improve clinical outcomes, and address the needs of TAVI patients. This review highlights the pivotal contribution of nursing to the success of TAVI. Full article

Background: Ensuring the safety of patients in the operating room, through the monitoring and prevention of adverse events is a central priority of healthcare delivery. In the professionalization of operating room nurses, the processes of identifying, assessing, developing, monitoring, and certifying transversal competencies are crucial. While national and international frameworks have attempted to define such competencies, they often vary in scope and remain inconsistently integrated into education and clinical practice. There is, therefore, a need for a comprehensive and structured identification of transversal competencies relevant to both perioperative and perianesthesiological nursing roles. Objectives: To formulate a validated and structured repertoire of transversal competencies demonstrated by operating room nurses in both perioperative and perianesthesiological contexts. Methods: A qualitative descriptive design was adopted, combining shadowed observation with Hierarchical Task Analysis (HTA). A convenience sample of 46 participants was recruited from a university and a public hospital in Italy. Data were collected between September 2021 and June 2023 and analyzed using content analysis and data triangulation. Results: Through a qualitative, inductive and iterative approach the study identified 15 transversal competencies, 50 sub-competencies, and 153 specific tasks and activities. Specifically, operating room nurses working in perioperative and perianesthesiological roles presented the following transversal competencies: communication and interpersonal relationships, situation awareness, teamwork, problem solving and decision-making, self-awareness, coping with stressors, resilience and fatigue management, leadership, coping with emotions, task and time management, ethical and sustainable thinking, adaptation to the context, critical thinking, learning through experiences, and data, information and digital content management. Each competency was associated with specific tasks observed. Conclusions: This framework complements the existing repertoire of technical-specialist competencies by integrating essential transversal competencies. It serves as a valuable tool for the assessment, validation, and certification of competencies related to patient and professional safety, emotional well-being, relational dynamics, and social competencies. The findings underscore the need for academic institutions to revise traditional training models and embed transversal competencies in both undergraduate and postgraduate nursing education. Full article

Background/Objectives: Bariatric surgery is a crucial intervention for the treatment of morbid obesity, necessitating that nursing staff possess a thorough understanding of expected outcomes to ensure successful patient care and promote healthier lifestyles. Recognizing this need, the present study aimed to develop and implement a reference guide tailored to nursing staff providing bariatric surgery care. Methods: A quasi-experimental design was employed, utilizing a convenience sample of 78 nurses and 156 patients—comprising 78 participants before the administration of the reference guide and another 78 participants after its provision—from the general surgery units at Mansoura University Hospital. Four tools were employed for data collection: a sociodemographic datasheet, a knowledge questionnaire assessing nurses’ understanding of care for bariatric surgery patients, a self-reported practice questionnaire, and a patients’ satisfaction measurement tool. A reference guide for bariatric surgery care was constructed. Descriptive and inferential statistics were conducted with adherence to all ethical considerations. Results: After implementing the reference guide, the percentage of nurses who exhibited good knowledge of bariatric surgery increased from 10.3% to 80.8%. Additionally, the proportion of nurses reporting poor self-reported practices related to necessary procedures decreased from 80.8% to 5.1%. Surprisingly, the improvement in knowledge and self-reported practices was sustained for a long time, though reduced. Furthermore, patient satisfaction levels showed a marked improvement following the intervention. Conclusion: Implementing a reference guide significantly improved nurses’ knowledge, self-reported practices, and patient satisfaction. To sustain these improvements, it is recommended that the reference guide be made available and educational programs be provided to nursing staff. Full article

(1) Background: Prehabilitation programs improve patients’ functional capacity before surgery by enhancing physical activity, nutrition, and psychological well-being, thereby reducing postoperative complications, hospital stays, and readmissions. We propose a centralized model led by an advanced practice nurse and internist to minimize consultations and reduce costs. (2) Methods: We studied 211 patients in a tertiary hospital in Madrid, with 135 enrolled in the centralized prehabilitation program and 76 in standard care (control). We compared complications, hospital stays, blood transfusions, and consultations, estimating costs using public pricing from Madrid’s healthcare authorities. (3) Results: The centralized model significantly reduced blood transfusions (p = 0.014), postoperative complications (p < 0.001), and hospital stays (p = 0.004), leading to annual savings of EUR 593,453.00. (4) Conclusions: A centralized surgical prehabilitation model decreases complications, hospital stays, readmissions, and consultations compared to standard care, significantly reducing healthcare costs. Full article

Background/Objectives: Medication reconciliation is an essential strategy to improve patient safety, especially in polymedicated and chronic patients undergoing surgery. This study describes the implementation of an electronic medication reconciliation tool, ConciliaMed, in a multidisciplinary medication reconciliation programme performed for patients undergoing elective surgery and assesses user satisfaction with the tool since its release. Methods: A prospective observational study was carried out on “high-risk” patients undergoing colorectal surgery. In the medication reconciliation programme, ConciliaMed was mainly used to obtain an optimised and reconciled patient medication list by using the “Perioperative medication reconciliation” and the “Therapeutics equivalents” modules included in the tool. Data were registered about the reconciled medications, medication discrepancies and interventions made to optimise the reconciled medication list. Concerning the users’ satisfaction analysis, data about users’ registration and feedback were collected. Results: Seventy-three patients were enrolled in this study who were mainly polymedicated. A 10.1% of medication discrepancies were identified from the total of 553 reconciled drugs. The pharmacotherapeutic groups most involved in medication discrepancies were psycholeptics or diuretics. Regarding the optimisation of the reconciled drugs, stopping medication before surgery was the most frequent recommendation provided by the tool. According to the results of the satisfaction surveys, high overall satisfaction with the tool (4.45 ± 0.80) was reported by users. Conclusions: Stopping medication before surgery was the most common preoperative medication management recommendation provided by the tool. ConciliaMed was evaluated by pharmacists, nurses and physicians who reported a high level of satisfaction with the tool. A more comprehensive evaluation of this tool in other types of scheduled surgical patients is expected. Full article

Background/Objectives: Total knee Arthroplasty (TKA) is a prevalent treatment modality for degenerative knee diseases. Nevertheless, the success of the intervention is contingent on effective rehabilitation. The +PERTO^® program (a Technological Rehabilitation Nursing Program) was developed as a mobile application comprising three phases to support patients during the perioperative period by providing exercises, information, and direct communication with healthcare professionals. The present study aims to evaluate the effects and usability of the +PERTO^® program in patients undergoing total knee arthroplasty. Methods: In 2024, a hospital in northern Portugal conducted a pilot trial with eleven patients undergoing elective total knee arthroplasty. Researchers collected data both before surgery and six weeks after discharge. To evaluate effectiveness, software satisfaction, and usability, they used several assessment tools, including the Oxford Knee Score (OKS), SF-36v2, Visual Analog Scale (VAS), Short Physical Performance Battery (SPPB), QSEnf-10, and System Usability Scale (SUS). Researchers analyzed the data using both descriptive and inferential statistics. The hospital’s ethics committee and board of directors approved the study. Results: There was a significant reduction in pain (p = 0.041) and improvement in knee functionality (p = 0.010), physical performance (p = 0.038), and quality of life (p < 0.05). Patient satisfaction was high (QSEnf-10: 3.8/4), and the usability of +PERTO^® was considered excellent (SUS: 96.6/100). Conclusions: The +PERTO^® program proved to be an effective and innovative solution to support rehabilitation after TKA, promoting improvements in pain, functionality, and quality of life. This digital program stands out for its high rate of usability and its ability to modernize healthcare by providing a patient-centered approach. Full article

Background: During the COVID-19 pandemic, perioperative nurses faced extraordinary demands in frontline roles, leading many to leave their positions. This study investigates the factors influencing their decisions to resign or change roles during or after the pandemic, providing insights into systemic, ethical, and emotional contributors to professional attrition. Methods: A qualitative study was conducted at a university hospital in Spain between December 2021 and March 2022. A hermeneutic phenomenological approach was used to analyze the lived experiences of perioperative nurses who worked during the pandemic and subsequently resigned or changed role. Data were collected through in-depth individual interviews and analyzed using Atlas.ti (version 22). Ethical issues such as informed consent and participants confidentiality were upheld. Results: Eighteen perioperative nurses participated. Four themes emerged: (1) balancing professional duty and personal limits, (2) the role of workplace culture (emphasizing peer support and managerial neglect), (3) resilience and moral conflict, and (4) the emotional cost of caring. Conclusions: Attrition among perioperative nurses during the COVID-19 pandemic was driven by physical and emotional exhaustion, lack of managerial support, ethical dilemmas, and emotional trauma. Healthcare organizations should implement strategies such as strengthening leadership, providing mental health resources, and creating a supportive work culture to improve staff retention and ensure workforce sustainability in future crises. The clinical implications highlight the need for specific interventions to support the emotional and professional well-being of perioperative nurses, ensuring high quality care and continuity of health services. Full article

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams’ use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively. Full article

Background: Pediatric orthopedic nursing requires specialized competencies to optimize patient outcomes, particularly in the complex realm of pediatric surgery. This study explores the effectiveness of the Pediatric Nursing Excellence (PNE) Model in enhancing nurses’ knowledge and clinical practice in providing perioperative care for pediatric orthopedic patients in tertiary care inpatient settings. Methods: A double-blind, randomized controlled trial was conducted from February to July 2024, involving 100 nurses from two tertiary care hospitals in Tanta, Egypt. Participants were randomly assigned to receive PNE Model training (n = 50) or routine care (n = 50). Nurses’ knowledge, practical skills, and adherence to PNE principles were assessed at baseline, immediately post-intervention, and after one, three, and six months using validated tools. Results: The intervention group showed significantly greater improvements in knowledge (20.62 ± 6.7 vs. 8.16 ± 5.5, p < 0.001) and practice scores (62.28 ± 4.1 vs. 40.06 ± 14.7, p < 0.001) post-intervention, sustained over six months. Path analysis revealed that the PNE Model enhanced nursing practice directly (β = 0.25, p < 0.001) through improvements in engagement and adherence to excellence principles and indirectly (β = 0.53, p < 0.001) by significantly enhancing nurses’ knowledge (β = 0.70, p < 0.001), which in turn positively influenced their clinical practice (β = 0.75, p < 0.001). Post-intervention, 82% of nurses in the intervention group achieved high levels of professional excellence, compared to 8% at baseline (p < 0.001). Conclusions: The PNE Model demonstrates robust effectiveness in enhancing nurses’ knowledge, clinical practice, and professional excellence in pediatric orthopedic surgery care, with sustained long-term benefits. This evidence supports implementing specialized nursing education models to improve pediatric care quality in orthopedic settings. Full article

Background/Objectives: Surgical procedures carry inherent risks, including injuries from surgical positioning, which impact patient safety and healthcare quality. An instrument to assess and prevent these injuries is essential. This study aimed to validate and culturally adapt the ELPO-PT for the Portuguese population to ensure its applicability and effectiveness in assessing the risk of injury from surgical positioning. Methods: A validation study was conducted with 126 adult patients undergoing surgical procedures at a central hospital in northern Portugal. Statistical analyses, including the calculation of Cronbach’s alpha coefficient, assessed the internal reliability of the scale. Additionally, sensitivity and specificity analyses evaluated the ELPO-PT’s diagnostic accuracy in identifying patients at risk of developing positioning-related injuries. Results: The validation showed a Cronbach’s alpha coefficient of 0.782, indicating reasonable internal reliability. Sensitivity analysis revealed an 85% accuracy rate in identifying patients at risk of positioning injuries, while specificity analysis demonstrated a 90% accuracy rate for patients not at risk. Conclusions: The ELPO-PT is a valid and reliable instrument for aiding nurses in clinical decision-making, with significant sensitivity and specificity in identifying the risk of positioning-related injuries, including pressure ulcers, in adult patients during the intraoperative period. Its implementation is expected to be beneficial in healthcare settings, contributing to the prevention of complications associated with surgical positioning. Full article

Background/Objectives: Individualized nursing care allows for systematic assessment and intervention; considers a patient’s preferences, values, and context; and contributes to a positive care trajectory. However, its operationalization has proven to be challenging. This research aimed to evaluate nurses’ perceptions of individualized care and analyze their relationship with sociodemographic variables. Methods: A cross-sectional study was conducted on 122 eligible and registered nurses at a Hospital Center, in the Ophthalmology (operating room and inpatient ward) service, the Cardiology service, the Internal Medicine service, and the Medical Emergency Unit, for adults/older adults in Portugal. The nursing version of the Individualized Care Scale (ICS-Nurse) was used for the assessment, including three sub-dimensions: clinical situation, personal life situation, and decisional control over care-related decisions. Cronbach’s alpha and principal component analysis were used for the data analysis. The STROBE checklist was used to report this study. Results: No statistically significant differences were found based on the age, gender, level of education, or years of professional experience of the nurses within the sub-dimensions of individualization. The nurses overall had a good perception of the importance of individualized care (4.06 ± 0.46 ICS-A-NURSE) but faced difficulties in its implementation during the last shift they worked (3.97 ± 0.49 ICS-B-NURSE). Conclusions: The items considered to be of greatest importance were the response to the physical and emotional needs arising from illness and assistance in decision-making through educational instructions. Aspects related to the personal lives of patients, such as family inclusion in an individual’s care plan, everyday habits, and previous experiences of hospitalization, received the lowest scores. Recognizing priority areas for improvement in the individualization of nursing care can contribute to developing training programs and policies that promote a holistic approach. Future studies should consider patient outcomes related to their needs for individualization. Full article

Introduction: The recovery room (RR) is a hospital area where patients are monitored in the early postoperative period before being transferred to the surgical ward or other specialized units. The utilization of scores in the RR context facilitates the assignment of patients to the appropriate ward and directs necessary monitoring. Some scoring systems allow nurses to select patients who can be discharged directly to their homes. Aim and methods: The aim of this narrative review was to describe and compare the scoring systems employed to discharge postoperative patients from RR, with a focus on item characteristics. Results: Nine scoring systems were identified and discussed: the “Aldrete Score System” and its modified version, the “Respiration, Energy, Alertness, Circulation, Temperature Score”, the “Post Anesthetic Discharge Scoring System”, the “White and Song Score”, the “Readiness for Discharge Assessment Tool”, the “Anesthesia and Perioperative Medicine Service Checklist”, the “Post-Anesthetic Care Tool”, the “Post-operative Quality Recovery Scale”, and the “Discerning Post Anesthesia Readiness for Transition” instrument. Discussion and conclusions: To obtain a comprehensive overview, the items included in the scoring systems were compared. Despite the availability of guidelines for patients’ discharge readiness from the RR, there is no universally recommended scoring system. Next-generation scores must be improved to ease their use, minimize errors, and increase safety. The main goals of the scores included in this narrative review were to be simple to use, feasible, intuitive, comprehensive, and flexible. However, these goals frequently conflict because patient assessment takes time, and a smart and comprehensive score may not consider some clinical parameters that may be crucial for the discharge decision. Therefore, further research should be conducted on this topic. Full article