The Nurse Liaison in Perioperative Services: A Family-Centered Approach

Surgery is a stressful time for patients, their family members, and their significant others. A perioperative nurse liaison can offer support, reinforce preoperative teaching, answer questions, and provide information during the surgical procedure that may help family members manage stress and view the process more positively. To provide the best possible care to patients and their family members, perioperative leaders at the Exempla Good Samaritan Hospital, Lafayette, Colorado, started a nurse liaison program when the facility opened in 2004. Although OR nurses were the first choice for the position, the director of perioperative services soon found that postanesthesia care unit nurses were the best candidates for this role. Positive outcomes of the program have included letters from patients praising the nurse liaison, better informed patients, and less anxious family members. As a result of this program, the facility's patient satisfaction survey scores related to communication had a marked improvement by June 2009.     

Patient subjective experience and satisfaction during the perioperative period in the day surgery setting: a systematic review

This systematic review used the Joanna Briggs Institute Qualitative Assessment and Review Instrument to manage, appraise, analyse and synthesize textual data in order to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting. Some of the significant findings that emerged from the systematic review include the importance of pre-admission contact, provision of relevant, specific education and information, improving communication skills and maintaining patient privacy throughout their continuum of care.     

The emerging role of the breast care nurse in Australia

It is well documented that educated breast care nurses can provide essential support and information to empower a woman with breast cancer to participate in treatment decisions and take more control over her health and life. An evaluation of Breast Cancer Support Services, a dynamic unit within the Anti-Cancer Council of Victoria, Australia, conducted in 1994, recommended that breast cancer support service nurses should increase their knowledge of breast cancer treatment and management throughout the whole continuum from diagnosis to death. Greater knowledge would enhance the nurse's role as a vital member of a multidisciplinary team and a resource to women experiencing breast cancer at any stage in their journey. Acting on these recommendations, the Anti-Cancer Council of Victoria, in conjunction with La Trobe University, designed and developed the first national, tertiary-level training program for breast care nurses. The Breast Cancer Distance Education program, which has graduates from all states in Australia, has been accredited by the Royal College of Nursing and positively evaluated by the Centre for Behavioural Research in Cancer. The evaluation found that students rated the course highly, and many planned to change their nursing practice as a result of taking the course. Accredited breast care nurses are taught to use accurate and up-to-date information in combination with advanced communication skills. They do not hesitate to confer with other members of the multidisciplinary team to ensure that women with breast cancer receive the individualized support and continuity of care they deserve.     

When resources are scarce, consider growing your own

Many health care facilities have difficulty finding and hiring properly trained perioperative nurses. Educators who are trying to alleviate this problem should consider setting up their own programs to educate new RNs and experienced nurses from other health care areas into the perioperative arena. This article provides basic information about setting up a perioperative nursing education program, including how to select the participants and preceptors and how to structure the program.     

Determining the impact of a surgical liaison nurse role in the paediatric operating room

A two-group (N = 92) quasi-experimental pre-post test design was used to examine the effects of intra-operative communication by a surgical liaison nurse (SLN) on parental anxiety. Group I received in person progress reports from the SLN. Group II received routine perioperative care. The Speilberger's State-Trait Anxiety Inventory (STAI) Scale and investigator developed family rating scales were distributed to both groups and used as a quantitative as well as a qualitative approach to determine what was helpful for the family members during the operative period. Two hundred and eighty feedback forms were dispersed to various health care professionals including all anaesthetists, surgeons, nurses and other staff in the perioperative care team, including the operating room, day surgery unit and the post anaesthetic recovery room areas. Feedback forms were also circulated to staff from the intensive care unit and the surgical in-patient units. The results showed the anxiety levels were lower for the families who received in person progress reports but the difference by group was not statistically significant. Thematic written responses provided examples of improved care and effective time management behaviours on the part of the health care professionals. Written responses provided validation for the scale scores for both families and health care professionals and were an indication of the support for the role of the surgical liaison nurse. Qualitative findings implied that the surgical liaison nurse facilitated the transfer of necessary information between the perioperative care team and the family thus providing a support mechanism for families under stress.     

宫腔镜治疗剖宫产切口瘢痕妊娠病人的护理

[目的]探讨宫腔镜治疗剖宫产切口瘢痕妊娠病人的护理程序。[方法]总结10例宫腔镜治疗剖宫产切口瘢痕妊娠病人的护理过程。[结果]10例病人均安全渡过围术期,无发生术前大出血,术中、术后水中毒,膀胱损伤,大出血等并发症。[结论]结合剖宫产切口疤痕妊娠疾病特点和宫腔镜手术操作的特点和风险,加强针对性的护理为病人安全渡过围术期、取得治疗成功,创造了条件。     

强直性脊柱炎患者围手术期的心理体验及应对的质性研究

目的:探讨强直性脊柱炎患者从入院到术后三个月间的心理体验及应对。方法：采用质性研究中的现象学研究法对12例强直性脊柱炎患者进行半结构式访谈,采用Colaizzi分析法处理资料。结果：按照时间阶段提取出强直性脊柱炎患者围手术期心理体验及应对的四大主题:1.疾病日渐进展,疾病信息支持不足,入院后对做出手术的决策犹豫不决及紧张焦虑;2.手术过程中的煎熬与自我舒缓,手术后躯体症状问题突出,对预后的困惑与期待医患沟通;3.出院前心理问题突出,对医生护士的感恩以及对出院后生活的迷茫;4.出院后,居家照护支持不足,对康复锻炼的努力尝试以及对社会功能尽快恢复的无限向往。结论:强直性脊柱炎患者在围手术期的心理体验及其应对呈阶段性和动态变化,医护人员应根据研究结果提供个体化服务,给予治疗照护、心理、信息等多维度的支持,并保障院外护理的延续性,从而促进患者身心全面康复。     

Interactive microcomputer for acquisition of patient information

Written records and first-generation hospital information systems do not meet their primary purpose to assist physicians in solving patients' problems. Simply automating the present chart formats is not the answer. An example of the concept needed for charting is the intensive care unit chart. Anesthesiology charts provide little useful information for the continued care of the patient postoperatively. They serve principally as legal archival documents. Automation of the anesthesia record should free the anesthesiologist of the need to search for preoperative information and to manually record most information intraoperatively. Decisions about how much data to archive and how to extract the data pertinent to continuing care are the challenges for physicians. The technologic tools are available for the design and implementation of a software system that focuses on effective communication of the patient's problems throughout the perioperative period as the patient moves from ward to operating room, through the recovery room and intensive care unit, and to the ward and home.     

儿童眼角膜、晶体外伤围手术期程序化护理体会

目的:探讨儿童眼外伤合并角膜、晶体损伤的围手术期程序化整体护理方法。方法:对13例因眼外伤引起角膜、晶体损伤患儿实施程序化整体护理。结果:本组患儿均渡过手术期,视力较术前明显改善(P<0.05)。结论:程序化护理有利于术前心理护理、术后病情观察、出院健康指导及复诊随访计划的实施,可提高手术成功率,保证手术效果。     

SWITCH for Safety: Perioperative Hand-off Tools

Communication breakdown is the leading cause of reported sentinel events in the perioperative setting. Barriers to optimal communication include noise, stress, multitasking, and rapid turnover between procedures. AORN has identified communication during personnel changes (ie, hand offs) as a point of vulnerability for the surgical patient. A standardized hand-off method provides an opportunity for personnel to ask and answer questions and should be available in the perioperative setting. At one facility, the standardization of hand-off reporting resulted in the development of new hand-off tools specific to the perioperative environment. A standardized reporting method enabled health care providers to address communication barriers and to maintain their focus on the patient during critical moments (eg, shift changes), thereby improving patient safety.     

心理干预对恶性肿瘤围手术期患者的影响

目的 探讨心理干预对恶性肿瘤围手术期患者的影响.方法 采用方便抽样方法选取62例肿瘤住院患者,入院第2天和手术后第10天,进行心理干预并通过症状自评量表和生活质量核心量表对患者进行测试与评定.结果 心理干预前后,症状自评量表评分中除精神病性因子外,在总分、总均分、阳性项目数、阳性症状均分及其他因子得分差异均有统计学意义(P＜0.001);生活质量核心量表评分在心理干预后,患者躯体功能、角色功能、情绪功能、认知功能明显增强;单项症状量表提示患者疲乏感、恶心呕吐、呼吸困难、睡眠障碍、食欲减退症状得到明显改善.结论 实施心理干预能有效减轻围手术期肿瘤患者的心理应激状态,改善肿瘤患者的不良情绪,提高其生活质量.     

Coronary artery disease in surgical patients. Perioperative management.

With effective communication, optimal use of perioperative therapeutic techniques, and postoperative follow-up, the medical, surgical, and anesthetic teams can prevent or minimize cardiac complications that occur during the postoperative period. Up to 50% of postoperative myocardial infarctions may be silent, or they may present as congestive heart failure, hypotension, or arrhythmia. Dyspnea is a common finding. All high-risk patients should be monitored in the intensive care unit during the first 7 days after surgery, when adverse cardiac events are most common.     

慢性心力衰竭患者行心脏再同步化治疗的围术期护理

报告12例慢性心力衰竭患者行心脏再同步化治疗的围术期护理.术前做好心理护理,改善患者的心功能,以便更好地耐受手术.术中备好各种用物及抢救器材,严密观察并及时处理病情变化.术后严密进行心电监护,预防切口感染,注重体位护理,及时观察和处理并发症.本组12例均康复出院.随访1-6个月,心衰症状明显改善,活动度增加.     

Development of a family liaison model during operative procedures.

The essence of family-centered care is the provision, by all health professionals, of psychosocially supportive care that fosters family integrity and functioning. Data from a hospital-based satisfaction survey at The Children's Hospital of Philadelphia (CHOP) indicated that the primary reason for parents being "less than completely satisfied" was lack of communication. A search of recent literature suggests also that breakdown in family-centered care in intensive care units is neither new nor unique. The purpose of this article is to describe how efforts to improve communication with parents and families led to the development of a family liaison program and an expanded role for staff nurses in the Cardiac Intensive Care Unit (CICU). The goals of this family liaison program were three-fold: to facilitate establishment of a relationship between CICU nursing staff, parents, and families at the earliest possible point in time; to ensure communication with parents and families at regular intervals during their child's surgery; and to promote practice that incorporates principles of family-centered care within the CICU. The design and implementation of such a program presented nurses in the CICU with both a challenge and an opportunity to take an innovative approach to meeting the fundamental need for information reported by parents and families, and echoed throughout nursing literature. This family liaison program serves to educate parents and families, communicate updates, provide physical and emotional support, and establish continuity of care for the patient and family. Additionally, nurses involved in the program have given positive feedback regarding their expanded role in this family-centered care model.     

Communication skills training to address disruptive physician behavior

Disruptive behavior among health care providers has been linked to negative patient outcomes. High-stress areas, including the perioperative setting, are especially prone to this behavior. The purpose of this study was to develop, implement, and evaluate an educational communication skills intervention aimed at increasing the perceived self-efficacy of perioperative nurses to address disruptive physician behavior. Seventeen perioperative nurses participated in a two-day communication skills program presented by a certified Crucial Conversations trainer. By using paired t test analysis, I found that there was a statistically significant increase in total mean self-efficacy scores immediately after the intervention and four weeks after the intervention. In addition, four weeks after the intervention, participants reported the ability to address disruptive physician behavior 71% of the time. The results of this study suggest that one intervention strategy to address the serious threat of disruptive physician behavior to patient safety is to educate nurses in communication skills.     

围手术期临床路径管理应用及其效果

探讨围手术期临床路径管理效果,进一步提高医疗护理质量。通过文献回顾法,在Pubmed、Spring、Science、EBSCO等数据库中查阅大量相关文献,尤其是一些以循证为基础的系统评价性文献和多中心临床试验的结果。总结出围手术期临床路径应用效果,即多从优化医疗护理程序、提高满意度,降低住院日、医疗费用、术后并发症发生率、死亡率等角度加以分析。     

开角型青光眼患者行EX—PRESS青光眼引流钉植入围手术期护理

目的探讨开角型青光眼患者行EX-PRESS青光眼引流钉植入围手术期护理要点。方法给予18例患者行EX-PRESS青光眼引流钉植入术,并做好围手术期护理工作。结果18例患者均成功植入引流钉,手术时间25～45 min,平均（30.0±5.0）min,术后眼内压稳定。结论 EX-PRESS青光眼引流钉植入术是治疗开角型青光眼疾病的一种有效方法,做好围手术期护理工作是确保治疗效果的重要措施。