Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Background Research shows that the majority of patients feel anxiety before and during anesthesia. It has been shown in several studies that preoperative anxiety may cause adverse effects in the postoperative course. Nurse anesthetists have a key role in creating a safe environment and the opportunity to use different interventions to reduce the degree of anxiety. Aim The aim of the study was to examine which interventions may reduce anxiety in adult patients before and during both general, local and regional anesthesia. Design Systematic literature review with a quantitative approach. Results Several studies indicate that gabapentin and pregabalin can reduce anxiety before and during anesthesia. The anxiety reducing effect appeared to be dose dependent. The naturopathic drugs Citrus aurantium blossom and Passiflora incarnata Linneaus were found to reduce anxiety before anesthesia. Music on headphones was also found to reduce the patient´s anxiety before and during anesthesia. In this study information provided as video and electronic information material did not demonstrate a reduction in pre-and perioperative anxiety, with exception of one study. Conclusions Several studies indicated that pharmacological interventions could reduce anxiety before and during anesthesia. Listening to music in connection with anesthesia was also found to reduce the degree of anxiety. Music is a simple intervention for the nurse anesthetist to initialize and the patients themselves may be given the opportunity to participate in their treatment by selecting the music. Considerably more research is needed on non-pharmacological interventions to complement all pharmacological research being conducted. / Bakgrund Forskning visar att majoriteten av patienterna känner oro inför och under anestesi. Det har visat sig i flera studier att preoperativ oro kan ge negativa konsekvenser i det postoperativa förloppet. Anestesisjuksköterskan har en viktig uppgift i att skapa en trygg miljö och möjlighet att med olika interventioner minska graden av oro. Syfte Syftet med studien var att undersöka vilka interventioner som kan minska vuxna patienters oro inför och under såväl generell som lokal och regional anestesi. Design Systematisk litteraturstudie med kvantitativ ansats. Resultat Flera studier visade att gabapentin och pregabalin kunde minska patientens oro före och under anestesi. Den orosreducerande effekten visade sig emellertid vara dosberoende. Naturläkemedlen Citrus aurantium Blossom och Passiflora incarnata Linneaus visade sig minska oro inför anestesi. Musik i hörlurar sågs också minska patientens oro före och under anestesi. I denna studie påvisade information i form av video och elektroniskt informationsmaterial inte någon reducering av pre- och peroperativ oro, med undantag för en studie. Slutsats Flera studier pekade på att farmakologisk behandling kunde minska oro före och under anestesi. Att lyssna på musik i samband med anestesi visade sig också minska graden av oro. Musik är en enkel intervention för anestesisjuksköterskan att initiera och patienten kan ges möjlighet till delaktighet i sin behandling genom att själv välja musiken. Betydligt mer forskning behövs dock om icke-farmakologiska interventioner som komplement till all farmakologisk forskning som bedrivs.

Thesis (Ed.D.)--University of Tulsa, 1981. / Bibliography: leaves 43-46.

Thesis (Ed.D.)--University of Tulsa, 1981. / Bibliography: leaves 43-46.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.A.)--Northern Kentucky University, 2007. / Made available through ProQuest. Publication number: AAT 1447084. ProQuest document ID: 1414126921. Includes bibliographical references (p. 36-37)

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

Thesis (M.N.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Nursing, Faculty of Nursing. Title from pdf file main screen (viewed on April 22, 2010). Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1982.

Thesis (M.S.)--University of Michigan, 1982.