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Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses* medication processes, the impact of interruption frequency on nurses* PCA interaction has not been fully measured or described. Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses* (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses* perceptions of the impact of interruption frequency. Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar*s test, and Friedman*s test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs* perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar*s test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses* perception of interruption frequency: the nature of interruptions and nurses* reaction to the interrupted work environment. Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs* described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs* perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs* performance accuracy and cognitive workload.

Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and drug therapy targeted at reducing preoperative anxiety was conducted from various online databases. Peer reviewed articles, published in the English-language between 2006 and 2015 that focused on postoperative outcomes in which preoperative interventions to reduce anxiety in children age two years and older, as well as the parent’s perspective of the outcome, were included for synthesis. Results from 9 randomized controlled trials that used behavioral based interventions implemented on the day of surgery, prior to anesthesia induction were compared for effectiveness at anxiety reduction versus the use of drug therapy prior to surgery. The studies suggest more successful post-surgical outcomes related to shorter length of stay and post-operative delirium for behavioral interventions to reduce anxiety prior to surgery and demonstrated even greater optimal outcomes for combined behavioral interventions. Drug therapy alone to decrease anxiety prior to anesthesia induction showed mixed results in reduction of physiologic and general outcomes following surgery. No significant difference between behavioral based interventions versus drug therapy was shown in any of the reviewed studies to have a significant effect on post-surgical outcomes. However, potentially promising behavioral based interventions such as clowns, electronic devices, parental presence and music over drug therapy prior to surgery, require further evaluation for their use in decreasing pre-operative anxiety in school-age children and having a positive impact on post-operative outcomes.

Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making. The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher administered the Rational Experiential Inventory (REI-40) via electronic survey to enrolled SRNAs and practicing CRNAs. The REI-40 is a validated psychometric tool involving 40 questions. Twenty questions evaluate each decision-making style. Ten questions assess engagement (e.g., enjoyment and reliance), and 10 questions assess the ability (e.g., capability and use) of each style. The demographics (e.g., age, gender, clinical experience, setting, and education) were collected and compared with the cognitive preference. This study revealed that SRNAs’ and CRNAs’ dominant cognitive preference was rational thinking and experiential thinking was greater than mid-scale. There was no statistical difference in how SRNAs and CRNAs scored on the REI-40 Inventory. Furthermore, there were no strong correlations between years of experience and cognitive preferences. However, there was a statistically significant difference in experiential cognitive ability and engagement when compared by gender identity. Ideally how one feels, and thinks should be aligned when making clinical decisions. This is the art and science of the profession. Research has revealed that human factors such as cognitive biases, heuristics, personal experience, and emotions play a role in decision-making. The development and integration of experiential decision-making is essential to aligning clinical judgment and safe patient care. This study describes SRNAs’ and CRNAs’ cognitive preferences and the relationship to the level of skill acquisition. This knowledge contributes to the understanding of CRNAs’ decision-making processes. Furthermore, there are ramifications for developing continuing education and clinical support tools for the profession.

<p>The use of both percutaneous and tunnelled central venous catheters in hospitalized patients has increased markedly over the last decade (Camp-Sorrell, 1990). With this increase, there is a clinical need to have an occlusive central line dressing to maintain a barrier to possible site contamination. This randomized control trial examined the use of the transparent dressing OpSite Wound (Smith and Nephew-Ine.) versus the ransparent dressing LV. 3000 (Smith & Nephew Inc.) in its ability to maintain an occlusive central line dressing. The study took place at Chedoke-McMaster Hospitals McMaster Division from June 1991 to September 1991. Adult medical-surgical patients who had a central line in place for longer than 48 hours were eligible for the study. Twenty five central lines were randomized to either the control group (OpSite Wound) or the experimental group (LV. 3000) An independent assessor saw all study patients daily to document dressing adhesiveness and the number of dressing changes performed. Analysis showed that the LV. 3000 dressing was changed every 5.5 days as opposed to the OpSite Wound dressing that was changed every 2.6 days. This difference was both statistically and clinically significant Analysis also showed that the dressings covering central lines with no intravenous in-line attachment (pigtail) were changed more frequently than the dressings covering central lines with an attached pigtail. This difference was also statistically significant The LV. 3000 dressing therefore, provides an occlusive central line dressing that is changed one-half the number of times that the OpSite Wound dressing is changed, or in other words, the OpSite. Wound dressing is changed twice as often as the I.V. 3000 dressing when used on central lines.</p> / Master of Health Sciences (MSc)

It is widely acknowledged that elevated levels of noise are commonplace in the healthcare environment, particularly in high acuity areas such as the operating room (OR). Excessive ambient noise may pose a threat to patient safety by adversely impacting provider performance and interfering with communication among perioperative care team members. With respect to the certified registered nurse anesthetist (CRNA), increased ambient OR noise may engender distractibility, diminish situation awareness and cause untoward health effects, thereby increasing the possibility for the occurrence of error and patient injury. This research project analytically examines the perceived impact of ambient noise in the operating room by CRNAs. Findings from this study reveal that CRNAs perceive elevated noise to be regularly present in the OR, specifically during the critical emergence phase of the anesthetic. However, CRNAs feel that increased noise only occasionally limits their ability to perform procedures, concentrate and communicate with the perioperative team. OR noise rarely interferes with memory retrieval. CRNAs perceive that noise is sometimes a threat to patient safety but infrequently engenders adverse patient outcomes. CRNAs do not perceive noise in the OR to be detrimental to their health but strongly agree that excessive noise can and should be controlled. Increased ambient OR noise is a veritable reality that may pose a potential threat to patient safety. Further research to identify elevations in noise during critical phases of the anesthetic and delineation of significant contributors to its genesis is warranted.

O processo de recuperação cirúrgica pode ser precoce, esperado ou prejudicado, conforme estado de saúde do individuo e do próprio ato cirúrgico, que determinam a perspectiva de bem-estar e qualidade de vida, tendo neste período como parâmetro o alcance de condições superiores ou equivalentes as que os pacientes apresentavam no período pré-operatório. O objetivo deste estudo foi caracterizar variáveis sociodemográficas, clínicas e psicológicas e identificar os fatores preditivos para o bem-estar e qualidade de vida nos diferentes períodos de observação (0, 30, 90, 180 e 360 dias). Trata-se de um estudo longitudinal, de 120 participantes submetidos à prostatectomia radical, por período de até 12 meses. Foram utilizados questionários para caracterização do participante e para avaliação clínica e os instrumentos: Escala Visual Analógica de Dor, Inventário de Estratégias de Coping, Escala Hospitalar de Ansiedade e Depressão, Escala de Satisfação com o Suporte Social, Escala de Satisfação Conjugal, Escala de Bem-Estar Subjetivo e o Expanded Prostate Cancer Index. Os dados foram descritos por períodos e analisados pelo modelo linear de efeitos mistos. Os principais resultados na descrição dos dados apontaram que as médias dos escores de dor variaram de 0,63 a 2,42. As médias de enfrentamento focado no problema variaram de 1,20 a 1,67, sendo mais evidente em T0, T1, T2 e T3 em relação ao enfrentamento focado na emoção, que teve variação de 1,20 a 1,48. As médias de ansiedade variaram de 4,42 a 6,01 e a depressão de 3,59 a 4,24, sendo as de ansiedade ligeiramente superiores às de depressão na maioria dos períodos, exceto em T4. A satisfação com o suporte social variou com médias de 3,81 a 3,97. A satisfação conjugal variou de 1,73 a 1,99, de modo que, a maioria dos participantes não estava satisfeita com o relacionamento conjugal. Já o bem-estar subjetivo apresentou médias de 2,59 a 2,77, sendo a satisfação com a vida e o afeto positivo os principais domínios. Notou-se que o bem-estar subjetivo se apresentou estável nos períodos quando comparado com T0. Já a qualidade de vida variou com médias de 68,69 a 81,80. No período T0, os participantes apresentaram menores médias quanto à função sexual e incômodo urinário. Entretanto, nos períodos T1, T2, T3 e T4, as menores médias foram em relação à função sexual e incontinência urinária. Quando comparado com T0, a qualidade de vida foi inferior em todos os períodos no pós-operatório. Na análise de métodos mistos, o tempo de cirurgia, enfrentamento focado no problema, ansiedade e satisfação conjugal foram preditores de bem-estar subjetivo, entretanto, as variáveis idade, raça/cor, tempo de anestesia, dor, depressão e satisfação com o suporte social não foram preditoras para o bem-estar subjetivo. Já os preditores de qualidade de vida foram as variáveis dor, depressão, enfrentamento focado na emoção, ansiedade e satisfação conjugal, entretanto, a idade, raça/cor, tempo de anestesia e satisfação com o suporte social não foram preditoras para a qualidade de vida. Os resultados apresentados contribuem para a compreensão do processo de recuperação cirúrgica de participantes submetidos à prostatectomia radical / The surgical recovery process can be early, expected or impaired, according to the individual\"s health condition and the surgery, which determine the perspectives of wellbeing and quality of life. In this period, the achievement of conditions higher or equivalent to what the patients presented in the preoperative period serves as the parameter. The objective in this study was to characterize sociodemographic, clinical and psychological variables and to identify the predictive factors of wellbeing and quality of life in the different observation periods (0, 30, 90, 180 and 360 days). A longitudinal study was undertaken of 120 participants submitted to radical prostatectomy over a 12-month period. Questionnaires were used to characterize and clinically assess the participants, as well as the following instruments: Visual Analogue Pain Scale, Ways of Coping, Hospital Anxiety and Depression Scale, Satisfaction with Social Support Scale, Scale of Marital Satisfaction, Subjective Wellbeing Scale and the Expanded Prostate Cancer Index. The data were described per period and analyzed using the linear mixed effects model. The main results in the description of the data appointed that the mean pain scores ranged between 0.63 and 2.42. The mean problemfocused coping scores varied between 1.20 and 1.67, being clearer in T0, T1, T2 and T3 than emotion-focused coping, which varied between 1.20 and 1.48. The mean anxiety scores ranged between 4.42 and 6.01 and depression between 3.59 and 4.24, the former slightly surpassing the latter in most periods, except in T4. The satisfaction with social support varied with averages between 3.81 and 3.97. Marital satisfaction ranged between 1.73 and 1.99, showing that most participants were not satisfied with the marital relationship. Subjective wellbeing presented mean scores between 2.59 and 2.77, the main domains being satisfaction with life and positive affect. As observed, subjective wellbeing was stable in the periods when compared to T0. Quality of life, then, varied with averages between 68.69 and 81.80. In period T0, the participants presented lower averaged for the sexual function and urinary discomfort. In periods T1, T2, T3 and T4, on the other hand, the lowest averages were related to the sexual function and urinary incontinence. When compared to T0, the quality of life was lower in all postoperative periods. In the mixed methods analysis, the length of surgery, problem-focused coping, anxiety and marital satisfaction were predictors of subjective wellbeing, while age, race/color, length of anesthesia, pain, depression and satisfaction with social support did not serve as predictors of subjective wellbeing. The predictors of quality of life were pain, depression, emotion-focused coping, anxiety and marital situation, while age, race/color, length of anesthesia and satisfaction with social support did not serve as predictors for quality of life. The results presented contribute to understand the surgical recovery process of participants submitted to radical prostatectomy

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Over 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems and fractures. These fractures are increasingly being treated with orthopedic external fixation devices (EFDs). The purpose of this study was to describe the experience of traumatically injured adolescents treated with EFDs. The 4 aims of the study focused on the circumstances leading to the traumatic event, experiences following the traumatic event, the impact of EFD treatment, and adolescents’ role in pin-care self-management, which is crucial to preventing infection. This longitudinal, qualitative descriptive study used purposive sampling to recruit 5 male and 4 female adolescents, 13-20 years old, from a New England level-1 trauma center. Participants were injured in motor vehicle crashes (including an all-terrain vehicle), falls, by gunshot, trampoline and football trauma. Interview questions were framed by two themes from a study of adult recovery from physical injury, i.e., the event and fallout. Participants were interviewed within days of the injury, 2 weeks after returning home, and within one month of EFD removal. Data were coded from verbatim transcripts using NVIVO and organized into themes guided by the principles of qualitative analysis. An overarching theme of “old self no more; forever changed” emerged from 26 interviews. The participants’ experience affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Major themes included “what risk?”, regarding circumstances leading to the traumatic event, mastering the environment, was 2 part first, processing the event, where determining fault and realizing everything has changed, they were ambivalently lucky, and not invincible. Secondly “suck it up and deal with it”, where strategies to deal with traumatic injury emerged (i.e. medication, channeling outlets, and slow caution). EFD experience revealed “Space age robot” and “they’ll do it themselves” as emergent themes. EFDs were described as painless, robotic, no big deal and necessary. One draining pin-site was noted. Findings related to use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions. These findings lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.

Text in English / A descriptive survey was used in order to determine • whether professional nurses are capable of teaching student nurses the application of biophysics and biochemistry related to certain nursing activities/procedures in the surgical unit • student nurses' knowledge of biophysics and biochemistry related to nursing activities/procedures in the surgical unit. The two target groups consisted of student nurses of a Gauteng nursing college and the professional nurses working in the surgical units of the four hospital satellite campuses where these students do their practica. Accidental sampling was used. Two questionnaires were designed: one for each group. Findings revealed that student nurses felt that biophysics and biochemistry were often not applied by professional nurses during clinical teaching. Professional nurses felt they had problems in identifying and applying biophysics and biochemistry principles during clinical teaching. Recommendations were made for nursing practice, nursing education and further research. / Daar heers groot komer oor die toepassing van biofisika en biochemie in die kliniese opset. Voortspruitend uit hierdie probleemstelling is twee vrae gevra in hierdie studie, naamlik: • Is geregistreerde verpleegkundiges daartoe in staat om studentverpleegkundiges te help om die biofisika- en biochemie-konsepte wat hulle leer, toe te pas in die sjirurgiese eenheid? • Kan studentverpleegkundiges die biofisika- en biochemie-konsepte wat hulle leer, toepas in die sjirurgiese eenheid? Doelwitte van die studie was om • 'n oorsig te gee oor verbandhoudende literatuur • te bepaal oor watter biofisika- en biochemie-kennis studentverpleegkundiges beskik wat verband hou met verpleegaksies in sjirurgiese eenhede • te bepaal of geregistreerde verpleegkundiges studentverpleegkundiges kan onderrig in die toepassing van biofisika en biochemie wat verband hou met sekere verpleegaksies in sjirurgiese eenhede. Die navorsingsbenadering wat gebruik is, is die beskrywende opname. Teikengroepe vir die studie was fase II studentverpleegkundiges van 'n Gauteng Verpleegkollege en geregistreerde verpleegkundiges wat in die sjirurgiese eenhede werk van vier Gautengse hospitale wat dien as satelietkampusse vir hierdie verpleegkollege. Twee vraelyste, respektiewelik gerig aan die studentverpleegkundiges en die geregistreerde verpleegkundiges is gebruik as instrumente. Toevallige steekproeftrekking is gebruik. Analise van die data het getoon dat studentverpleegkundiges gevoel het hulle is nie betrek in die beplanning van kliniese onderrig nie en ook dat biofisika en biochernie dikwels nie toegepas is tydens kliniese onderrig deur geregistreerde verpleegkundiges nie. Geregistreerde verpleegkundiges het gevoel hulle het probleme in die identifisering en toepassing van biofisika- en biochemie-beginsels tydens kliniese onderrig. Bevindings kan nie veralgemeen word nie. Aanbevelings vir verpleegpraktyk, -ondenvys en verdere navorsing is gemaak. / Health Studies / M.A. (Nursing Science)--University of South Africa, 1999