Thesis (M Nursing (Advanced Practice))--University of South Australia, 1995

Thesis (M Nursing (Advanced Practice))--University of South Australia, 1996

Thesis (M Nursing (Advanced Practice))--University of South Australia, 1995

Copy of author's previously published work inserted. Includes bibliographical references (leaves 273-283). Aims to identify if the current practice of post-operative vital sign collection detects complications in the first 24 hours after the patient has returned to the general ward setting using a combination of methods within a triangulated approach to data collection.

Includes bibliographical references. Electronic publication: Fulltext available in PDF format; abstract in HTML format. The nursing practice of monitoring patients in the post-operative (PO) phase upon returning to the general ward setting has traditionally consisted of the systematic collection of vital signs and observation of other aspects of the patient's recovery. For the most part the primary focus of this monitoring has been the detection of post-operative complications. There is a need for more substantive evidence to support an appropriate frequency of post-operative observation. The aim of this research was to identify if the current practice of PO vital sign collection detects PO complications in the first 24 hours after the patient has returned to the general ward setting. Due to the complex world in which nurses practice the research was undertaken using a combination of methods within a triangulated approach to collect data. Electronic reproduction.[Australia] :Australian Digital Theses Program,2001.

Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003. / Copy of author's previously published work inserted. Includes bibliographical references (leaves 273-283). Also available electronically.

Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003. / Includes bibliographical references. Also available in a print form.

The purpose of this descriptive study was to evaluate, through clinical testing, the interrater reliability and concurrent validity of the Interchange of Gases Assessment Tool (IGAST) for monitoring the respiratory status of patients in the Postanesthesia Care Unit. The IGAST was used to assess the respiratory status of 20 patients over three time periods (60 data samples). Findings indicated that interrater reliability of the IGAST was acceptable for clinical use in the PACU. The IGAST received a mean interrater reliability rating of 98% in the PACU setting. Results of the mean dimension scores supported the patients' readiness for discharge. Chart audit revealed that the IGAST had concurrent validity since charted information and rated IGAST items were congruent. Further findings suggested that nurses using the IGAST document the respiratory status of patients more completely and more consistently than nurses using narrative documentation.

Background: There are a number of different anesthetic techniques used in same-day surgery. The aim of the present study was to try to describe the postoperative clinical course and to identify factors that may be associated with the delay time from the surgical procedure was completed until discharge from hospital when intravenous anesthesia was used. Methods: A Quantitative Cross- sectional designed was used by using a self-designed questionnaire. Results: Total of 289 patients were enrolled in the study. The mean age was 40 years and 63% were women and 37% men. Of the 289 patients’ only one required unanticipated admission over night at the hospital. The median delay from completed surgery until discharge from hospital was 2 hours and 5 minutes and the maximum delay was 5 hours and 55 minutes. All patients received general anesthesia with an intravenous as maintenance anesthesia. Important risk factors for increasing postoperative delay were the severity of the postoperative pain and thereby the requirement of opioids in the postoperative phase Conclusion: Then undergoing daytime surgery the median delay from completed surgery until hospital discharge was about two hours. Problems with postoperative pain was associated with a prolonged delay. Thus, in order to shorten the delay to hospital discharge even further the pain-relieving treatment needs to be enhanced.

Esse estudo teve como objetivos identificar os diagnósticos de enfermagem presentes em pacientes em pós-operatório imediato de colecistectomia, submetidos à anestesia geral com base na Taxonomia II da North American Nursing Diagnoses Association (NANDA) e no Modelo Conceitual de Horta; analisar os diagnósticos de enfermagem presentes nesses pacientes em relação aos fatores relacionados, características definidoras e fatores de risco e em relação ao seu estabelecimento e resolução no pós-operatório imediato; dentre os pacientes estudados que apresentaram o Diagnóstico de Enfermagem de Dor aguda, identificar as manifestações de dor apresentadas no pós-operatório imediato e compará-las com as características definidoras apresentadas pela NANDA e por outras literaturas. Para a etapa de coleta de dados, foi elaborado e validado um instrumento de coleta de dados com base no Modelo Conceitual de Wanda Horta. Foram avaliados 15 pacientes adultos no período pós-operatório imediato de colecistectomia laparoscópica, durante o período de setembro de 2004 a janeiro de 2005, no Centro de Recuperação Pós-anestésica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Para o estabelecimento dos diagnósticos de enfermagem, utilizou-se um modelo de processo raciocínio diagnóstico, sendo esses nomeados de acordo com a Taxonomia II da NANDA. Foram identificados nove diferentes diagnósticos de enfermagem: Integridade tissular prejudicada (100%), Risco para infecção (100%), Percepção sensorial perturbada (100%), Risco para aspiração (100%), Risco para função respiratória alterada (80%), Hipotermia (60%), Risco para temperatura corporal desequilibrada (40%), Nutrição desequilibrada: mais do que as necessidades corporais (33,3%) e Dor aguda (26,7%). Para cada diagnóstico foram identificados e discutidos os fatores relacionados e características definidoras. Os pacientes que manifestaram o diagnóstico de enfermagem de Dor aguda apresentaram as seguintes características definidoras: relato verbal, evidência observada, expressão facial e comportamento de defesa. Observamos que todas essas manifestações são características definidoras apresentadas pela NANDA (2002) para esse diagnóstico. Em relação ao seu estabelecimento e resolução no pós-operatório imediato, os diagnósticos de enfermagem Risco para aspiração, Percepção sensorial perturbada e Hipotermia foram resolvidos em 50 minutos após a sua identificação. Para os diagnósticos de Risco para função respiratória alterada, Risco para temperatura corporal desequilibrada e Dor aguda, o tempo médio de resolução foi de 63,7, 77,5 e 36 minutos, respectivamente. Destacamos que os diagnósticos de Integridade tissular prejudicada, Risco para infecção e Nutrição desequilibrada: mais do que as necessidades corporais estiveram presentes desde a admissão do paciente no Centro de recuperação pós-anestésica até o momento da alta do paciente. / This study aimed to identify what nursing diagnoses are present in patients who had been submitted to general anesthesia during the immediate post-operative period after cholecystectomy, based on North American Nursing Diagnoses Association (NANDA) Taxonomy II and on Horta?s Conceptual Model; to analyze the nursing diagnoses that were present in these patients in terms of related factors, defining characteristics and risk factors, as well as with respect to their development and solution in the immediate post-operative period; to identify, among those study participants who presented the Nursing Diagnosis of Acute pain, the pain manifestations they presented during the immediate post-operative period and to compare them with the defining characteristics presented by NANDA and other literature sources. With a view to data collection, we elaborated and validated a data collection instrument on the basis of Wanda Horta?s Conceptual Model. 15 adult patients were evaluated in the immediate post-operative period after laparoscopic cholecystectomy, between September 2004 and January 2005, at the Post-Anesthesia Recovery Center of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The nursing diagnoses were established by means of a diagnostic reasoning process model, and were named in accordance with NANDA Taxonomy II. We identified nine different nursing diagnoses: Impaired tissue integrity (100%), Risk for infection (100%), Sensory perception alterations (100%), Risk for aspiration (100%), Risk for altered respiratory function (80%), Hypothermia (60%), Risk for imbalanced body temperature (40%), Altered nutrition: more than body needs (33,3%) and Acute pain (26,7%). For each diagnosis, we identified and discussed the related factors and defining characteristics. Patients with the nursing diagnosis of Acute pain presented the following defining characteristics: verbal report, observed evidence, facial expression and defense behavior. We observe that all of these manifestations are defining characteristics NANDA (2002) presented for this diagnosis. With respect to their development and solution during the immediate post-operative period, the nursing diagnoses Risk for aspiration, Sensorial perception alterations and Hypothermia were solved within 50 minutes after their identification. For the diagnoses Risk for altered respiratory function, Risk for imbalanced body temperature and Acute pain, average solution time was 63.7, 77.5 and 36 minutes, respectively. We highlight that diagnoses of Impaired skin integrity, Risk for infection and Unbalanced nutrition: more than body requirements were present from the patient admission on Post anesthesia Care Unit until the patient?s discharge.