Zugl.: Giessen, Universiẗat, Diss., 2008.

Zugl.: Giessen, Universiẗat, Diss., 2008.

Thesis (M.Sc. (Nursing)--Mahidol University, 1979.

Univ., Diss., 2006--Giessen

Introdução: A hipotermia inadvertida perioperatória é um evento frequente e atinge cerca de 70% dos pacientes cirúrgicos, levando a complicações importantes, como alterações cardiovasculares, infecção do sitio cirúrgico, desconforto ao paciente, aumento do tempo de hospitalização, entre outros. Por oferecer inúmeros riscos ao paciente cirúrgico, a ocorrência da hipotermia não intencional perioperatória tem ganhado espaço na literatura atual. A manutenção da temperatura perioperatória vem sendo sugerida pela literatura com a implementação de métodos passivos e ativos de aquecimento como o aumento da temperatura da sala cirúrgica, uso de cobertor de algodão, uso de cobertor térmico, uso de dispositivos de ar forçado, infusão de fluidos aquecidos, entre outros. No entanto, não há no Brasil nenhum estudo publicado onde se investigue a atuação das equipes que atuam no bloco cirúrgico realizam a prevenção da hipotermia perioperatória nos hospitais. Objetivos: Verificar como se dá o monitoramento da temperatura e a prevenção de hipotermia inadvertida perioperatória em pacientes cirúrgicos internados em hospitais brasileiros. Material e método: Estudo transversal, realizado na cidade de São Paulo através de questionário preenchido pelos enfermeiros participantes do 12° Congresso Brasileiro de Enfermagem em Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização. Os dados foram analisados descritivamente e demonstrados em foram de tabelas. Resultados: O monitoramento da temperatura no período perioperatório ainda não é realizado sistematicamente por todos os profissionais de centro cirúrgico, porem a realização dessa pratica foi relatada por 92,4% no período pré-operatório, 83,8% no período intraoperatório e 94,9% no período pós-operatório. A prevenção da hipotermia inadvertida no perioperatório é uma pratica exercida pela grande maioria dos participantes (96%), com predomínio nos métodos passivos de manutenção da normotermia nos períodos pré-operatório (51%) e associação de métodos passivos e ativos nos períodos pós (64,6%) e intraoperatório (45,5%) de manutenção da normotermia ao paciente cirúrgico. Os principais profissionais envolvidos para a monitorização da temperatura e a prevenção da hipotermia perioperatória inadvertida são a equipe de enfermagem e os anestesiologistas. Apesar de um número grande de profissionais não informarem a taxa de ocorrência de hipotermia inadvertida perioperatória, nota-se que para a maioria dos respondentes a ocorrência desse evento é baixa. Conclusão: a realização de praticas para a manutenção da normotermia operatória é realidade para a equipe de enfermagem. A monitorização da temperatura ainda não é realizada de maneira constante em todo período perioperatório. A prevenção da hipotermia inadvertida no período perioperatório é pratica bastante frequente entre os procedimentos cirúrgicos. / Introduction: Perioperative inadvertent hypothermia is a frequent event and affects about 70% of surgical patients, leading to important complications, such as cardiovascular alterations, surgical site infection, patient discomfort, hospitalization time, and others. Because it offers innumerable risks to the surgical patient, the occurrence of perioperative unintentional hypothermia has gained space in the current literature. Perioperative temperature maintenance has been suggested in the literature with the implementation of passive and active heating methods such as increased operating room temperature, use of cotton blanket, use of thermal blanket, use of forced air devices, infusion of fluids heated, among others. However, there is no published study in Brazil to investigate the performance of the teams that work in the surgical block, and to prevent perioperative hypothermia in hospitals. Objectives: To verify how temperature monitoring and the prevention of perioperative inadvertent hypothermia occur in surgical patients hospitalized in Brazilian hospitals. Material and method: A cross-sectional study was carried out in the city of São Paulo through a questionnaire filled out by nurses participating in the 12th Brazilian Congress of Nursing in Surgical Center, Anesthetic Recovery and Material and Sterilization Center. The data were analyzed descriptively and demonstrated in the tables. Results: Temperature monitoring in the perioperative period has not been systematically performed by all surgical center professionals, but the practice of this practice was reported by 92.4% in the preoperative period, 83.8% in the intraoperative period and 94, 9% in the postoperative period. The prevention of inadvertent perioperative hypothermia is a practice practiced by the vast majority of participants (96%), with predominance in passive methods of maintaining normothermia in the preoperative periods (51%) and association of passive and active methods in the post- 64.6%) and intraoperative (45.5%) maintenance of normothermia in the surgical patient. The main professionals involved in temperature monitoring and the prevention of inadvertent perioperative hypothermia are the nursing team and anesthesiologists. Although a large number of professionals do not report the occurrence rate of inadvertent perioperative hypothermia, it is noted that for most of the respondents the occurrence of this event is low. Conclusion: the practice of practices for the maintenance of operative normothermia is reality for the nursing team. Temperature monitoring is not yet performed consistently throughout the perioperative period. The prevention of inadvertent hypothermia in the perioperative period is a very frequent practice among surgical procedures.

Orientador: Gloria Maria Braga Poterio, Ilka de Fatima S. Ferreira Boin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T04:48:43Z (GMT). No. of bitstreams: 1 Santos_ReginaMariadaSilvaFeu_M.pdf: 2522967 bytes, checksum: 7189a57f4af010fc0ae8d017adcf0e5d (MD5) Previous issue date: 2008 / Resumo: A elaboração da Sistematização da Assistência de Enfermagem é um dos meios de que o enfermeiro dispõe para aplicar seus conhecimentos técnico-científicos e humanos na assistência ao paciente e caracterizar sua prática profissional, colaborando na definição do seu papel. O objetivo do presente estudo, foi contribuir para diminuir o risco de acidentes alérgicos, durante o período perioperatório, quando do atendimento a pacientes alérgicos ao látex, identificando antecedentes de risco e transmitindo-lhes informações sobre a alergia ao látex. Trata-se de um estudo prospectivo, de caráter descritivo e exploratório realizado com pacientes cirúrgicos eletivos, com história pregressa de reação comprovada a produtos que continham látex. Como resultados, foram identificados produtos que continham látex e produtos isentos de látex, para atendimento perioperatório. Por meio da visita pré-operatória, foram identificados fatores que pudessem expor o paciente a riscos. A proposta da confecção de um protocolo perioperatório para atendimento de pacientes alérgicos ao látex foi particularmente importante e encontra-se em fase de pré-teste. É importante destacar que é função do enfermeiro do centro cirúrgico proporcionar estrutura física, recursos humanos e materiais para que o ato anestésico-cirúrgico seja realizado em condições ideais, visando à assistência integral ao paciente, principalmente utilizando dados previamente coletados por meio da Vpré-OE. Dos resultados obtidos nas condições adotadas neste estudo nos permitiram concluir que os fatores de risco detectados, alimentares ou não, coincidem com os citados na literatura, mas diferem quanto à freqüência. Dentre as alergias às frutas, as mais freqüentes, em ordem decrescente, foram maracujá, banana e nozes; e em menor e igual percentual, tomate, abacate, kiwi, abacaxi e laranja. / Abstract: The elaboration of the Systematization of Nursing Assistance is one of the means that the nurse applies his/her technical-scientific and human knowledge on the assistance to the patient and characterizes his professional practice, collaborating on the definition of his/her role. The main objective is to reduce the risk of allergic accidents during the Peroperative period, of attending allergic patients to latex by identifying previous risk patients and providing knowledge concerning latex allergy. It is a prospective descriptive and exploratory study accomplished with surgical chosen patients with former proven history of reaction to products that contained latex. As results, products that contained latex were identified and products exempt from latex for preoperative assistance, as well as by means of a pre-surgical visit, factors that could put the patient at risk were identified. The proposal of making a Peroperative protocol for assisting patients allergic to latex was particularly important and is in phase of pre-testing. It is worth pointing out that due to the CC nurse providing physical structure, human resources and materials for the anesthetic/surgical procedure to be performed in ideal conditions, in view of the complete assistance to the patient, specially using data previously collected by the (Vpré-OE). The results obtained with the conditions adopted in this study allow us to conclude: The risk factors detected, related to nourishment or not, correspond to the ones mentioned in literature, but differ with regards to its frequency. Amongst the allergies to fruits, the most frequent ones in decreasing order were: passion fruit, banana and nuts and in less or similar percentage, tomato, avocado, kiwi, pineapple and orange. / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Bakgrund: Bristande kommunikation är en av de vanligaste orsakerna till vårdskador. Bristande kommunikation orsakar lidande för den enskilde patienten och en ökad belastning på vården med exempelvis extra vårddygn. Kommunikation och informationsöverföring är av Socialstyrelsen identifierat som ett riskområde i vården. Flera studier samt nationella och internationella myndigheter rekommenderar standardiserade verktyg vid överrapportering. Den kirurgiska patienten är särskilt utsatt och råkar oftare ut för vårdskador. Syfte: Syftet med studien var att beskriva vad anestesi-, operations-, och postoperativa sjuksköterskor upplever och fokuserar på vid överrapportering från operationsavdelning till postoperativ avdelning. Metod: Fokusgruppsintervjustudie, materialet har analyserats med kvalitativ innehållsanalys. Studien bestod av tre fokusgruppsintervjuer med tre deltagare i varje grupp. Resultat: Studiens resultat består av tre teman, innehåll, struktur och miljö. Innehåll består av den information som respektive fokusgrupp anser är viktig vid en överrapportering. Struktur beskriver på vilket sätt överrapporteringen sker. Överrapporteringen följer en informell struktur ibland med stöd av olika journalhandlingar. Miljö beskriver den kontext där överrapporteringen sker. Överrapporteringsmiljön upplevdes i många fall som stökig med flera distraherande moment. Slutsats: Samtliga sjuksköterskor upplevde överrapporteringssituationen på liknande sätt. Vad beträffade den innehållsmässiga och strukturella delen av rapporten upplevdes den av samtliga fokusgrupper som adekvat. Den miljömässiga aspekten av överrapporteringen upplevdes av samtliga som ett område med förbättringsmöjligheter. / Background: Communication failure is one of the most common causes for medical injuries. Every year lack in communication causes suffering for the patient and an increased burden on healthcare, for example trough extra care days. Communication and information transfer are identified by the National Board of Health and Welfare (Socialstyrelsen) as a risk area in healthcare. The surgical patient is particularly vulnerable and prone to medical injuries. Purpose: The purpose of this study was to describe what anesthesia-, operating room- and postoperative care unit nurses experience and focus on in a handoff from the surgical unit to the postoperative care unit. Method: A focusgroup interview study was conducted; the data was analyzed using qualitative content analysis. The study consisted of three focusgroups, with three participants in each group. Result: The results of the study consists of three themes, content, structure and environment. Content entails the information that the focusgroups believes is important in an handoff. Structure describes how the handoff is done. The handoff follows an informal structure, sometimes with the support of various medical records. Environment describes the context in which the handoff is done. The handoff environment was perceived in many cases as messy with multiple distractions. Conclusion: All of the nurses described the handoff situation similarly. The content and structural part of the handoff was perceived by all of the focusgroups as adequate. The environmental aspect of the handoff was perceived by all as the area with most improvement possibilities.

Patients undergoing surgery with unrecognized obstructive sleep apnea (OSA) are at greater risk of complications. Ninety percent of those affected in the United States remain undiagnosed. To improve identification, screening tools such as the STOP-Bang questionnaire (Chung et al. 2008), provide anesthesia providers a method of detecting undiagnosed OSA. The purpose of this study is to assess anesthesia providers' practice of preoperative screening for OSA. An email survey was conducted at a Level-III trauma center in Phoenix, Arizona. The survey consisted of a 13 question, 5-point Likert scale questionnaire. It was sent to 29 Certified Registered Nurse Anesthetists (CRNA). A total of 8 CRNA's responded. Respondents were either neutral or disagreed that current methods of OSA screening works well and generally agree that the STOP-Bang tool would provide an advantage over the current methods, accurately detect OSA, and inform their anesthetic plan over current methods. Respondents leaned towards strong agreement that improving the recognition of undiagnosed OSA is needed. However, they were generally neutral on agreement that the STOP-Bang is necessary at their facility. Respondents agreed that the STOP-Bang tool is easy to use and interpret. However, most agreed that integrating the tool would add complexity to the preanesthesia evaluation but they remained neutral on whether it would add significant time to this process. Respondents were neutral on their observations that the STOP-Bang tool would improve early detection of OSA or reduce perianesthesia complications. Just 25% of respondents reported being aware of the existence of the STOP-Bang tool and none reported having used it. In conclusion, this project demonstrates that some providers have not used the STOP-Bang screening tool to detect undiagnosed OSA, but agree this tool is preferred over their current method. Results from the survey brought insight to a potential quality improvement strategy related to improving the perianesthesia care of patients with undiagnosed OSA. Improving knowledge through dissemination of evidence illustrates the value of the STOP-Bang prior to piloting the tool. The rates of perioperative complications justify the implementation of perioperative strategies such as the STOP-Bang as a tool for anesthesia providers.

This experimental study was designed to determine the effectiveness of a structured preoperative teaching programme for the adult surgical patient as measured by several indicators. The major questions asked in this study were: What are the effects of a structured preoperative teaching programme upon the adult surgical patient's length of hospital stay, postoperative complications, number of analgesics administered postoperatively, recall of knowledge explained preoperatively, and satisfaction with his preoperative teaching. This study was conducted over a four month period, on one surgical ward of a large general hospital. A total of forty subjects met the criteria of the study, and their informed consent was obtained. The first twenty subjects were assigned to the control group, and received the unstructured, pre-existing preoperative instruction from the staff nurses. The second twenty subjects made up the experimental group and received structured preoperative teaching in small groups conducted by the investigator, with the aid of a slide-taped programme developed specifically for the study. Prior to discharge, each subject was given two questionnaires to complete, and data were collected by means of a patient profile sheet. The two groups of subjects were found to be similar when compared on selected characteristics. The alternative hypotheses of the study were analyzed by means of a t-test, and chi square test at the .05 level of significance. The results revealed no significant effect of the structured preoperative teaching programme upon the adult surgical patient's length of hospital stay, postoperative complications, number of analgesics administered postoperatively, or the degree of satisfaction attained from the preoperative teaching he received. However, statistical significance was found for the patient's ability to recall knowledge explained preoperatively. Implications of this study and recommendations for future research were also suggested. / Applied Science, Faculty of / Nursing, School of / Graduate

Anestesisjuksköterskan ansvarar för den perioperativa dialogen med patienten. En av anestesisjuksköterskans kärnkompetenser är att arbeta personcentrerat, det innebär att inte bara se till patientens fysiska behov utan även de psykiska samt att se patienten som en unik person. Forskning visar att de flesta patienter som ska genomgå en operation under generell anestesi upplever oro och att perioperativ oro kan leda till både postoperativa komplikationer och långvariga konsekvenser för patienten. Syftet med studien var att undersöka vilka strategier anestesisjuksköterskan använder vid det perioperativa mötet för att lindra oro hos patienter som ska genomgå kirurgi och generell anestesi. Den metod som användes för att svara på forskningsfrågan var en systematisk litteraturstudie med kvalitativ ansats. Studien resulterade i fyra huvudkategorier: verbal kommunikation, icke-verbal kommunikation, personcentrerad vård och patientsäkerhet. Genom verbal kommunikation kunde anestesisjuksköterskan se till att patienten kände sig välinformerad och bekräftad. Med den icke-verbala kommunikationen kunde anestesisjuksköterskan få patienten att känna sig trygg och sedd genom omvårdnadshandlingar och samtidigt visa att hen fanns vid patientens sida. Genom att arbeta personcentrerat kunde anestesisjuksköterskan bevara autonomi, främja delaktighet och individanpassa vården. Genom att säkerställa patientsäkerheten genom kontroll av operationssal och högteknologisk utrustning samt avsätta tid för samtal så möjliggjorde det för anestesisjuksköterskan att känna sig trygg och därmed fokusera på att förmedla trygghet till patienten. Svårigheter i det perioperativa mötet kan uppstå vid tidsbrist, avsaknad av erfarenhet hos anestesisjuksköterskan, vid språkförbistringar samt om patienten har en kognitiv sjukdom. Vidare forskning behövs gällande patienternas upplevelser av de strategier som framkommit i studiens resultat.