Made available in DSpace on 2015-04-22T22:06:33Z (GMT). No. of bitstreams: 1 Ana Patricia Gomes Vasconcelos.pdf: 543917 bytes, checksum: 9391b06b87c7412f12b1f5c235e33002 (MD5) Previous issue date: 2012-10-08 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study intends to evaluate the surgical patient s view about the nursing pre-surgical visit made by the surgical center nurse, submitted to surgery at the University Hospital João de Barros Barreto. The conceptual bases used here were the nursing assistance systematization in the perioperative period and the pre-operative visitation from the surgical center nurse. It is a descriptive and exploratory study, with a quantitative analysis, using an interview technique applying a formulary. The place used for this research was the University Hospital João de Barros Barreto. In this study 130 patients were interviewed after surgery. The methods applied were description methods, which the data were tabulated through Microsoft Excel and the entire statistic processing happened under the computational support Epi-info, in which tables were developed and a critical analysis of the results was done. The obtained results were a predominance of the female sex, being represented by the 61% (79). Among the surgeries made in this period, the main occurrence was the cholecystectomy with the 42% (54). As about the question referred to the information in the pre-operative period, the care related to surgery and the 54, 62% (71) received VPOE made by the surgical center nurse. The investigation confirmed that the nursing pre-operative visitation realization brings benefit to the surgical patient being possible the adoption by the surgical center nursing service, inside the perioperative nursing assistance systematization theme. / Este estudo teve por objetivo avaliar a visão do paciente cirúrgico sobre a visita pré-operatória de enfermagem realizada pelo enfermeiro de centro cirúrgico, submetidos a cirurgia no Hospital Universitário João de Barros Barreto. As bases conceituais utilizada foram a sistematização da assistência de enfermagem no período perioperatório e a visita pré-operatória do enfermeiro de centro cirúrgico. Trata-se de um estudo do tipo descritivo, exploratório, com análise quantitativa, utilizando uma técnica de entrevista com a aplicação de um formulário. O local de pesquisa foi o Hospital Universitário João de Barros Barreto. No estudo foram entrevistados 130 pacientes após cirurgia. Os métodos aplicados foram descritivos, onde os dados foram tabulados através do programa Microsoft Excel e todo o processamento estatístico se realizou sob o suporte computacional Epi-info, onde foram desenvolvidas tabelas e realizada análise critica dos resultados. Os resultados obtidos foram predominância do sexo feminino, sendo representado por 61% (79). Dentre as cirurgias realizadas no período, a maior ocorrência foi a colecistectomia com 42% (54). Quanto à questão referente às informações no período pré-operatório os cuidados referentes ao ato cirúrgico e 54,62% (71) receberam VPOE realizada pelo enfermeiro do centro cirúrgico. A investigação confirmou que a realização da visita pré-operatória de enfermagem traz benefício ao paciente cirúrgico podendo ser possível sua adoção pelo serviço de enfermagem do centro cirúrgico, dentro da temática da sistematização da assistência de enfermagem perioperatória.

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications after cardiac surgery. Specific aim one was addressed through a secondary analysis of data collected during the Patient Response to Myocardial Infarction following a Teaching Intervention Offered by Nurses trial to determine whether hostility was a predictor of ACS recurrence and mortality. Hostility was common after ACS and predicted all-cause mortality. Hostility did not predict recurrent ACS. Specific aim 2 was addressed in a secondary analysis of baseline data from a randomized controlled trial in male prisoners. Participants completed the BSI at baseline prior to the intervention. Internal consistency reliability was good for both subscales (Cronbach’s alpha - hostility 0.83, anxiety 0.81). Items from the two dimensions were analyzed together using exploratory factor analysis with varimax rotation. Two dimensions, anxiety and hostility, were identified. Construct validity was supported; those with high anxiety and hostility reported a greater number of days where their self-reported health was rated as fair or poor. Those prisoners with less perceived control had higher levels of anxiety and hostility. Specific aim 3 was addressed through a prospective, descriptive correlational study that measured patient and caregiver anxiety, hostility and depressive symptoms, at baseline to determine whether these predicted quality of life using a multilevel dyadic analysis; and to evaluate the association of baseline anxiety, hostility and depressive symptoms and quality of life with postoperative complications and mortality. Anxiety, hostility, and depressive symptoms were common in both cardiac patients and their caregiver. Psychological state influenced quality of life in both dyad members, but was not associated with complications.

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical. Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity and mortality is on the horizon unless aggressive measures are taken at mitigating risk. Similarly, as the obesity epidemic expands, obesity-related comorbid conditions including obstructive sleep apnea (OSA) are likely to grow. The purpose of this research was to explore the relationship between ambulatory orthopedic patient-reported activities (quality of life metrics) and diagnostic factors (physical and perioperative care data) in the immediate postoperative period that are predictive of arterial oxygen desaturation. Data was obtained using a novel patient journal exploring sleep, pain, nausea, tobacco use, alcohol use, and appetite in conjunction with a valid and reliable portable, wrist-worn pulse oximeter. Additional assessment data was taken from the preanesthetic assessment. All participants were scored according to the STOP-Bang questionnaire, an accepted survey of OSA risk. Patients were recruited from a busy metropolitan ambulatory surgery center in Richmond, Virginia that sees approximately 500 cases monthly, and a 309-bed tertiary care hospital in West Burlington, Iowa. The target sample included 52 individual patients with data collected over the first two post-operative nights following discharge. Two patients were excluded. Negative binomial regression, log10 transformation, and least-squares regression examined the relationships the STOP-Bang questionnaire, quality of life data, and physical perioperative data had on postoperative desaturation events. Results suggested the STOP-Bang score predicted desaturation events and that age and BMI were significant individual predictors. Opiate pain medication treatment, a happy mood, and home CPAP use were associated with decreased events. This study provided a unique perspective in patient safety research, relating human behaviors and experiences with postoperative oxygen desaturation. Future research projects aligned with postoperative monitoring, pulse oximetry, patient safety, and obstructive sleep apnea are potential following the findings of this study.

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

Current procedures for cleaning anesthesia airway equipment have been reported to be ineffective. The potential for cross-contamination from some airway equipment to a patient has been documented in several studies. In order to prevent potential infections, it should be ascertained as to why all anesthesia providers are not using disposable laryngoscope blades. The purpose of this evidence based project is to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade before and after an in-service program designed to increase the use of disposable blades will be determined. Once Institutional Review Board (IRB) approval and written consent were obtained, anesthesia providers were asked to complete an anonymous one page questionnaire on their knowledge and practice regarding disposable laryngoscope blades. Immediately following the completion of the questionnaire, participants were given an investigator developed article to read. Participants completed the same anonymous questionnaire 3 months following the pre-intervention questionnaire. Inventory of the disposable laryngoscope blades were collected at the start of the project, at one month, and then again at three months. A total of 12 anesthesia providers participated in the evidence based practice project. An increased number of providers stated that they felt disposable laryngoscope blades were easy to use at the completion of the project and there was an increased use of disposable laryngoscope blades. At post-intervention, anesthesia providers described performance (25%) as their reason for not using the disposable laryngoscope blade which was down from the start of the project (60%). A single proportion Z-Test showed that the 23% increase in use of disposable laryngoscope blades after the intervention was statistically significant (Z=2.046, p=0.041). This evidence based project has shown that despite initial apprehension, a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades which should translate to improved patient outcomes.

The purpose of the present study was to examine general loneliness, hospital loneliness, and the patient-physician relationship in regards to their associations with Bone Marrow Transplant (BMT) recovery outcome variables (days until engraftment and quality of life). Fifteen (66.7% female, 33.3% male; 93.3% white, 6.7% Black/African American; average age 61.73) individuals who had an allogeneic or autologous BMT at The Mayo Clinic of Jacksonville completed the FACT-BMT, UCLA-Loneliness Scale Version 3, the CARE Measure, and provided disease and treatment information at the 6 month posttransplant date (+/- 30 days). Patients recovering from BMT indicated significantly higher scores of hospital loneliness in comparison to their general loneliness scores. This increase is believed to represent the outcome of experiencing hospital isolation during the post-transplant recovery process. Increases in hospital loneliness were marginally significant in predicting decreases in the patients overall quality of life. The patient physician consultational relationship was found to have a significant relationship with the number of days until engraftment, however the direction of the relationship was opposite the hypothesized direction. This may suggest that engraftment influences the quality of the relationship instead of vice versa. These results imply that there is a relationship between hospital isolation and increases in the amount of loneliness experienced during recovery from a BMT. Loneliness has been found to have a negative relationship with a number of physiological and quality of life outcomes. The present study also elucidates possible correlates with the patient-physician relationship.

Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction. Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level. Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.

The purpose of this study was to explore and describe the surgical nurses’ perceptions about the management of post-operative pain and strategies employed in management of pain in patients who have undergone total hip or knee replacement surgery in King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Qualitative, exploratory-descriptive research design was applied. Purposive nonprobability sampling was used and data collected by means of audio-recorded semistructured individual interviews. Data saturation was reached after interviewing twenty surgical nurses. Themes and categories emerged from adopting Creswell’s (2013) “data analysis spiral”. One of the key findings was that patients reportedly experience moderate to severe pain during the first three days after surgery, before it is controlled on mild to moderate levels or before the patient is pain free. Conclusions were drawn, and one of the major ones was that multimodal strategies are employed by the surgical to manage post-operative pain. Recommendations were also made from findings of this study, and one key recommendation was that expatriate nurses to have access to Arabic speakers to overcome language barriers. / Health Studies

The purpose of this study was to explore and describe the surgical nurses’ perceptions about the management of post-operative pain and strategies employed in management of pain in patients who have undergone total hip or knee replacement surgery in King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Qualitative, exploratory-descriptive research design was applied. Purposive nonprobability sampling was used and data collected by means of audio-recorded semistructured individual interviews. Data saturation was reached after interviewing twenty surgical nurses. Themes and categories emerged from adopting Creswell’s (2013) “data analysis spiral”. One of the key findings was that patients reportedly experience moderate to severe pain during the first three days after surgery, before it is controlled on mild to moderate levels or before the patient is pain free. Conclusions were drawn, and one of the major ones was that multimodal strategies are employed by the surgical to manage post-operative pain. Recommendations were also made from findings of this study, and one key recommendation was that expatriate nurses to have access to Arabic speakers to overcome language barriers. / Health Studies / M.A. (Health Studies)