Bakgrund: Barn i sjukvården som ska genomgå anestesi och kirurg känner betydande oro och ångest vilket medför ett lidande hos barnet. Detta kan resultera i postoperativa komplikationer och förlängda vårdtider. I sjuksköterskans ansvarsroll ingår det att hjälpa barnet lindra sin oro och ångest. Syfte: Att beskriva och utvärdera de preoperativa metoder sjuksköterskan kan använda sig av för att minska barns oro och ångest inför anestesi och kirurgi. Metod: Design: Litteraturstudie. Artikelsökning genomfördes i databaserna Pubmed och Cinahl. Efter analys och kvalitetsgranskning valdes 20 artiklar ut till resultatet. Inklusionskriterier: Kvantitativa studier genomförda på barn, 0-18 år.  Studierna ska ha publicerats 2005 eller senare samt ha etiskt godkännande alternativt resonemang. Exklusionskriterier: Då interventionen var riktad mot föräldrar eller om barnen inte skulle genomgå anestesi. Resultat: Resultatet visade fyra olika teman med metoder som kan användas för att minska barns preoperativa oro och ångest. Dessa var clowninteraktion, sjukhusmiljö, distraktion och preoperativ information. Clowninteraktion och distraktion visar tydligast evidens för minskad oro och ångest hos barn. Att låta barnet bekanta sig med sjukhusmiljö samt medicinsk utrustning har även en positiv inverkan. Slutsats: I sjuksköterskans profession ingår ansvaret att arbeta mot minskad oro och ångest hos barn. Oro och ångest hos barn ger inte enbart ett ökat lidande utan även förlängda vårdtider med ekonomiska konsekvenser. Sjuksköterskan har olika metoder att använda sig av där distraktionsteknik samt clowninteraktion är de som idag har störst evidensstyrka. / Background: Children within healthcare who are undergoing anesthesia and surgery experience severe anxiety which results in suffering and can also lead to post-operative complications and extended hospitalization. As a registered nurse you are responsible to help the child reduce their anxiety. Aim: To describe and evaluate the pre-operative methods a registered nurse can use to reduce children’s anxiety related to anesthesia and surgery. Method: Literature review. Design: An article search was conducted in Pubmed and Cinahl, 20 articles were chosen for the result. Inclusion criteria: Quantitative studies conducted on children 0-18 years. Exclusion criteria: The aims of the study were directed against the parents or children not undergoing anesthesia. Results: The results showed four different themes that can be used in the reduction of children´s pre-operative anxiety. These were interaction with clowns, hospital environment, distraction, and pre-operative information. Interaction with clowns and distraction are the two methods that show the highest evidence of reducing anxiety. Allowing children to get familiar with the hospital environment and the medical equipment had a positive effect but more studies are needed in this area for greater evidence. Conclusion: The registered nurse is responsible for reducing anxiety in children who are undergoing anesthesia and surgery. A child with anxiety not only suffers more but is also at risk for prolonged hospitalization with economic consequences.  Although the registered nurse has several methods to choose from, distraction techniques and clown interaction produce the greatest results in decreasing anxiety.

Nästan alla patienter blev hypoterma före, under och efter operation. För att undvika detta vidtog sjuksköterskan olika omvårdnadsåtgärder för att minska risken för oönskad hypotermi. Det var viktigt för vårdpersonal att få kunskap om vilka omvårdnadsåtgärder som är optimala för att minska komplikationer, samt få förståelse för hur hypotermi påverkar patienten under hela vårdförloppet. Kunskapen behövs för att lindra lidandet och öka tryggheten i samband med operation. Syftet var att söka evidens för bästa beprövade omvårdnadsåtgärd för att förebygga hypotermi hos patienter samt beskriva hypotermins påverkan på patienter under dagoperativt vårdförlopp. En litteraturstudie genomfördes där kvantitativa och kvalitativa artiklar analyserades med hjälp av innehållsanalys enligt Fribergs modell (Friberg 2012). Resultatet visade att det var viktigt att börja värma patienten före operation och att starta med en högre begynnelsetemperatur. Vid steriltvättning rekommenderades varm desinfektion. Även vid artroskopier var det en fördel att använda uppvärmd vätska. Vid korta ingrepp fungerade både värmekällan Hot dog (elektriskt täcke/madrass) och Bair Hugger (varmluftstäcke). Bair Hugger var i dagsläget den enskilt mest effektiva metoden för att snabbt höja temperaturen, mest miljömässiga samt ekonomiskt hållbara metoden vid längre operationer, givet att den var inställd på hög värme (43°C). Dock räckte det inte med en metod för att få en normaltempererad patient, utan flera olika metoder behövde kombineras samtidigt. En riktlinje för sjuksköterskor var att fortsätta med hög temperatur på värmekällan även då patientens kroppstemperatur hade uppnått normal temperatur. Först när patienten började svettas var det lämpligt att sänka temperaturen. Det var viktigt att mäta temperaturen för att fånga upp alla som var hypoterma, då inte alla patienter uppvisade symtom såsom shivering. Öka vårdpersonalens medvetenhet om vikten av att värma patienter på operation och använda alla metoder som finns tillgängliga för att minska hypotermi och öka välbefinnandet.

Submitted by (edna.saturno@ufrpe.br) on 2016-08-12T12:05:48Z No. of bitstreams: 1 Cecilia de Carvalho Ferreira.pdf: 351028 bytes, checksum: ea340635e1ce19cdbd1c6940085b6d29 (MD5) / Made available in DSpace on 2016-08-12T12:05:48Z (GMT). No. of bitstreams: 1 Cecilia de Carvalho Ferreira.pdf: 351028 bytes, checksum: ea340635e1ce19cdbd1c6940085b6d29 (MD5) Previous issue date: 2007-02-26 / As important as the surgery itself is the preoperative evaluation pointing to assure the success of anaesthesia and minimize risks of complications in the postoperative period. In this context, the preoperative electrocardiogram is very important since certain arrhythmias increases anaesthesical risk. The aim of this research was to evaluate the prevalence and types of electrocardiographic that should be submitted to some surgery and its relation with the surgery recommendation, historical of heart disease, clinical signs of cardiopathy, obesity, age, sex and body size,by clinical and electrocardiographic exams. It was evaluated 474 dogs of different breeds, age and size, and male and female, recommended to different types of surgeries. The electrocardiogram was made using the traditional or computerized methods, were 46% of them presented changes, showing that it is high the changes in preoperative electrocardiogram. Where males were statically more attacked than females (p<0,05), and left ventricular enlargement was the most common feature (24,31%), it was not observed inclination to specifics arrhythmias in the recommended surgeries evaluated. “Mixed breed dogs” (MBD) represented 42,52% of the analyzed sample, and it was significantly (p<0,05) the proportion of obese MBD that presented changes compared to the non-obeses, what lead to conclude the association of high frequency of electrocardiographic changes to the body condition. There was no statistical significant difference to the presence of change in healthy patients led to castration and in ills send to varied surgeries, what make lead us to believe that it is necessary the evaluation independent of surgery indication. MBD that presented historical of heart disease, were the ones that presented more changes(p<0,01) and the same wasn’t observed in the population in general and in Poodles, stressing that this exam must be done even without the historic of heart disease. The same affirmative is truth to the presence of clinical signs of heart disease, according to what checked in the analyzed population (p>0,05). Concerning to the weight it was checked that there is no statistical significant difference between the groups: until 9,9kg (45,1%), 10kg to 20kg (47,8%) and over 20kg (45,3%). The same occur in the analysis of age in accordance with size, highlighting the importance of exam independent of weight and age. In conclusion it is often the electrographical changes in preoperative period, mainly in males, were the left ventricular enlargement is the most common feature and the electrocardiogram must be done as a preoperative exam, independent of age, body size, surgery recommendation, or clinical sign of heart disease, and specially in male dogs, obese MBD and in MBD with historical of cardiopathy aims to minimize the anesthetic risks and cardiovascular complications. / Tão importante quanto o procedimento cirúrgico em si é a avaliação pré-operatória dos pacientes, com a finalidade de assegurar o sucesso da anestesia e minimizar os riscos de complicações potenciais no pós-cirúrgico. Neste contexto, a avaliação eletrocardiográfica préoperatória é de suma importância uma vez que certas arritmias conferem riscos anestésicos aumentados. Objetivou-se com este trabalho avaliar a freqüência de alterações no eletrocardiograma de caninos atendidos no setor de cirurgia do HV/UFRPE e o tipo dessas anormalidades, bem como sua relação com a enfermidade cirúrgica, histórico de doença cardíaca, sinais clínicos de cardiopatia, obesidade, idade, sexo e porte, utilizando para isto, avaliação clínica e eletrocardiográfica. Foram avaliados 474 cães de raça, idade e porte variados, machos e fêmeas, encaminhados para procedimentos cirúrgicos diversos. O eletrocardiograma foi realizado por meio do método convencional ou computadorizado.Verificou-se que 46% dos cães apresentaram alterações,demonstrando ser alta a freqüência pré-operatória de alterações eletrocardiográficas, onde os machos foram estatisticamente mais acometidos que as fêmeas (p<0,05), e o aumento na duração do complexo QRS foi a alteração mais freqüentemente observada (24,31%), não tendo sido observada predisposição para o aparecimento de arritmias específicas em relação às enfermidades cirúrgicas avaliadas. Os cães sem raça definida (SRD) representaram 42,52% da amostra analisada, sendo significativo (p<0,05) a proporção de obesos SRD que apresentaram alterações comparadas aos não obesos, associando assim a elevada freqüência de alterações eletrocardiográficas à condição corpórea. Não houve diferença estatisticamente significativa para a presença de alterações em pacientes hígidos encaminhados para gonadectomias e em enfermos encaminhados para cirurgias diversas, levando a crer que é necessária essa avaliação independente da enfermidade cirúrgica. Nos cães SRD, aqueles com histórico de doença cardíaca foram os que mais apresentaram alterações (p<0,01), não sendo o mesmo observado para a população geral e de Poodles, ressaltando a importância da realização desse exame também nos que não apresentam histórico de cardiopatia, da mesma maneira, os cães que apresentaram sinais clínicos de doença cardíaca não necessariamente são os que mais apresentam alterações eletrocardiográficas (p>0,05). Com relação ao peso foi verificado que não há diferença estatisticamente significativa entre os grupos: até 9,9kg (45,1%), 10 a 20,0kg (47,8%) e com mais de 20,0kg (45,3%), ocorrendo o mesmo na análise da idade de acordo com o porte. Conclui-se que são freqüentes as alterações eletrocardiográficas no pré-operatório, onde o aumento na duração do QRS é a alteração mais observada, devendo o eletrocardiograma ser realizado como exame pré-operatório independente da idade, peso, enfermidade cirúrgica, ou sinais de cardiopatia ao exame clínico e, em especial nos cães machos, e nos sem raça definida que apresentem histórico de doença cardíaca ou sejam obesos, a fim de se obter maior segurança anestésica e menor risco de complicações cardiovasculares.

Magister Curationis - MCur / Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols.Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: A systematic review using the guide by the Centre for Reviews and Dissemination was done, and studies were identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery

Background: Pre-operative anxiety remains a serious problem affecting surgical patients. The prevalence rate ranges between 60% to 80% percent among western surgical patients. Nothing is known about the prevalence of pre-operative anxiety among Nigerian Hausa speaking elective surgical patients. It is also not known what non-pharmaceutical pre-operative anxiety reduction interventions are preferable in reducing their anxiety before they undergo elective surgery. Participants: Thirty adult patients scheduled to undergo elective surgery in a tertiary health facility in north eastern Nigeria. Design/procedure: The study consists of three phases: Phase 1- translating and cross-cultural validation of Amsterdam Pre-operative Anxiety and Information Scale (APAIS) into Nigerian Hausa Language. Phase 2- administering the translated scale to assess the prevalence of pre-operative anxiety among the study participants. Phase 3 - finding out which non-pharmaceutical pre-operative anxiety reduction interventions would the Hausa speaking elective surgical patients prefer in reducing their anxiety before they undergo elective surgery. Results: The translated Hausa and validated version of the scale (APAIS-H) has shown a good psychometric property with Cronbach's alpha of 0.82 for anxiety related to surgery subscale and 0.71 for information desire subscale respectively. The finding of phase 2 revealed that there is high prevalence of pre-operative anxiety among the Hausa speaking elective surgical patients. The patients' anxiety continues to increase in intensity as they approach their time of operation. Results of phase 3 shows that the Hausa speaking elective surgical patients have high preference for counselling services, information and education, video-film intervention and low preference for music therapy. Conclusion: There is high prevalence of pre-operative anxiety among the Hausa speaking elective surgical patients. It is therefore recommended that, before undergoing elective surgery, clinicians should assess the Hausa patients' pre-operative anxiety so as to provide them with their preferred pre-operative anxiety reduction interventions proportionate to their level of anxiety. The thesis argued that the translated and validated APAIS-H is be a good measure of assessment particularly of those Hausa patients who could not read and understand the English Language version of assessment tool. / Yobe State University

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)

The purpose of this study was to identify the strengths and weaknesses of a pre-operative health education programme provided to cardiac surgery patients at a private hospital in Gauteng. A questionnaire was used to collect data and indicated that most patients were satisfied with the pre-operative education that they received before their cardiac surgery procedure, and therefore felt well prepared for the operation. It is, however, evident that family involvement with pre-operative education was not satisfactory. This lack of family involvement is a limitation in the present programme. The study also noted that patients must be informed about visiting hours, and the intense feeling of the endotracheal tube post-operatively should be emphasised. / Health Studies / M.A. (Health Studies)

Discharge readiness following total knee replacement (TKR) has often been defined using quantitative factors, such as knee range of motion or walking a specified distance. These measurements fail to include other features that could impact readiness for discharge, such as social support or patient perceptions. Most patients have positive results following TKR surgery, however others experience negative outcomes such as falls, reduced functional performance, and hospital readmission. Readiness for returning home after TKR begins with pre-operative education to prepare patients for surgery and the post-operative phase. Health care providers must have a clear understanding of patients’ perceptions of readiness to return home after surgery. It is also essential to describe the current structure of pre-operative education nationally as a mechanism for better preparing patients to return home following knee replacement. This dissertation includes three studies that explore aspects of discharge readiness following TKR including patients’ perceptions of readiness for discharge as well as the structure of pre-operative education for TKR across the United States. The first study examined patients’ experiences preparing for discharge home from the acute care setting following TKR surgery. Results indicated that patients felt prepared overall for discharge and received appropriate supports for returning home after surgery, but some felt unprepared for certain aspects of recovery such as the amount of pain experienced in the post-operative phase. The second study surveyed health care providers who participated in pre-operative education before TKR to identify the current structure of education programs in the United States. This pilot study revealed that pre-operative education teams were commonly interprofessional with education being typically provided in a group format in a single session lasting between 1 and 1.5 hours. Verbal and written instruction were common delivery methods to provide education. The final dissertation study used mixed-methods to explore the current structure of pre-operative education for TKR in the United States with a large, national sample. Orthopedic nurses completed an online survey to describe their pre-operative education program. The majority of participants provided pre-operative education as part of interprofessional teams in either a group format or a format that included both group and individual education. Verbal instruction was the most common educational delivery method followed by written instruction. Most pre-operative education classes lasted between 1 and 1.5 hours, were delivered in a single session, and included a variety of topics. Ten orthopedic nurses were then interviewed and interview transcripts were analyzed qualitatively for common themes among participants. Participants expressed that pre-operative education was a significant component impacting patient outcomes following surgery. Interprofessional pre-operative education was valued by participants, but pragmatic factors were identified as barriers to the inclusion of other disciplines within these programs. Education programs were constantly evolving based on current evidence-based practice and changes to orthopedic protocols. Descriptions of pre-operative programs nationally combined with providers’ perceptions provides a strong basis for determining best practice to support better post-operative patient outcomes. This dissertation research culminated in recommendations for best practice as well as the creation of a model, the ICF-I-EDUCATE, which combines the International Classification of Health, Functioning and Disability (ICF), interprofessional practice, and the EDUCATE model for providing patient and family education. Research is needed to examine the ICF-I-EDUCATE model in clinical practice for patients with planned TKR.

<p>This thesis was performed at the research centre CINECA in Bologna, Italy. An interface with six degrees of freedom, 6DOF, to be used in a virtual environ- ment for the positioning of medical components was developed in co-operation with IOR, one of the most important orthopaedic hospitals in Italy. The main reason for doing this was to find out whether or not a virtual en-viron-ment and 6DOF interaction could make the pre-operative planning of an ope-ration more efficient compared to other techniques. Is it easy to posi-tion an object using stereovision and a 6DOF tracker tool? Further-more, the interface might also be used in other applications and areas in the future. </p><p>Described is the development of an interaction class especially constructed for the use of a tracking tool called a stylus pen. This tool takes advantage of all 6DOF, i.e. it recognises movements in the x, y and z directions and likewise the orientation of the tool around the three axis. Moreover, an application which uses the interaction class was created in order to evaluate its usefulness. The application enables the user to load, save and position objects within a virtual environment. The result of this evaluation is then described and discussed. </p><p>In the evaluations it was shown that the stylus pen with 6DOF is an intuitive in-ter-action tool which works well for positioning. The stereovision also seems to further improve the users ability to position objects. However, the created interaction class needs to be further developed before itcan be implemented in a pre-operative planning tool.</p>

Hip resurfacing is an alternative to total hip arthroplasty for the young and active patient likely to outlive traditional means of hip joint replacement. The acetabular cup is implanted in much the same fashion as an uncemented total hip arthroplasty, however, implantation of the femoral component is unique to hip resurfacing, presenting both distinct benefits and limitations. Hip resurfacing spares much of the proximal femur including the femoral neck and portions of the femoral head. This may be advantageous if the patient requires revision surgery; however, preservation of the femoral neck bears with it the risk of femoral neck fracture. The exact mechanism of neck fracture is not fully understood. Avoiding potential fracture risks is vital to ensuring optimal patient outcomes. The current work investigated mechanical femoral head preparatory factors that may predispose to femoral neck fracture. Intra-operative computer navigation is emerging as the gold-standard in orthopaedic care. In hip resurfacing, navigation may improve the surgeon’s ability to optimally implant the resurfacing prosthesis; however, much of this technology is still in its infancy and requires investigation into the accuracy and repeatability of this peri-operative tool. Pre-operative planning can assist the surgeon in optimally determining the size and position of the resurfacing components, specifically in reference to the patient’s unique anatomy, prior to performing the operation. This may aid in correct implant selection and provide a basis on which to conduct intra-operative navigation. However, the accuracy and repeatability of pre-operative planning for hip resurfacing has not yet been established. Thus, this body of work looked to establish a clear methodology for pre-operative planning, intra-operative computer navigation and surgical technique in order to optimize preparation of the femoral head, ultimately reducing the risk of femoral neck fracture in hip resurfacing.