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Research focuses on preoperative instruction, cover gowns, wound infections
JANUARY 1987, VOL.45, NO 1
AORN JOURNAL
Research Reviews Research focuses on preoperative instruction, cover gowns, wound infections
D Hathaway, “Effect of preoperative instruction on postoperative outcomes: A meta-analysis,” Nursing Research 35 (September/October 1986) 269-274. Meta-analysis was used to examine previous research that studied the effect of preoperative instruction on postoperative outcomes. In this study, a numerical value, or effect size, of each study was determined, the average value indicated that a typical patient who had received preoperative instruction had more favorable outcomes than 67%of a similar group that did not. Altogether, 2,4 18 adults in experimental groups and 1,605 adults in control groups participated in the 68 previous research studies. The results of the effects of various types of instruction were examined: structured versus unstructured, group versus individual, and different levels of patient anxiety. Patients responded best to instruction that contained procedural content (ie, material that described a patient’s physical care regimen in a factual, concrete, and reality-based manner). Patients also responded well to instruction that contained psychological content. Patients’ levels of fearlanxiety inversely affected postoperative outcomes. For example, patients with low levels of anxiety had positive outcomes and patients with high levels of anxiety were least affected by preoperative instruction. The study indicated that instruction was more effective on individual patients as compared to patients who received instruction in a group. Nursing implicatiom. Intervention should focus 24
on identifying level of anxiety in the patient before instruction begins. Also, the nursing staff should consider conducting more individual instruction because of the increased benefits. Group instruction is not necessarily the most cost-effective use of nursing staff, even though it may save time and appear to be an efficient use of staff. CYNTHIASPRY, RN, MSN, CNOR CHAIRMAN 1986 NURSINGRESEARCHCOMMITTEE G Copp et al, “Cover gowns and the control of operating room contamination,” Nursing Research 35 (September/October 1986) 263-267. This study examines the effectivenessof cloth cover gowns in protecting surgical scrub suits from bacterial contamination if worn outside the OR. The following three hypotheses were tested (1) scrubsuits worn outside the O R without cover gowns increased bacterial contamination; (2) scrubsuits worn outside the OR with cover gowns decreased bacterial contamination; (3) fresh scrub suits worn after re-entering the OR decreased bacterial contamination. Bacterial samples were collected three times during the day: (1) within 30 minutes of arrival, (2) immediately before lunch, and (3) immediately after lunch. After arriving at work, participants donned clean scrub suits, tying both neck and back ties. After the first samples were taken, the nurses followed their normal work routines. After the second samples were taken, they left the department for their regular 30-minute lunch breaks.
AORN JOURNAL
Twenty O R nurses were randomly assigned to one of four groups. The nurses in Group 1 wore clean cover gowns over their scrub suits to lunch. After returning, they removed the cover gowns and continued to wear the same scrub suits. Participants in Group 2 wore only their scrub suits to lunch and continued wearing the same scrubs for the rest of the day. The nurses in Group 3 changed into outdoor clothes for lunch, and afterward, changed into clean scrub suits. Group 4 nurses also changed into outside clothes for lunch. They placed their scrub suits into clean paper envelopes and stored them in lockers. After lunch, they changed back into these same scrub suits. The study concluded that bacterial contamination increased when the scrub suits were excessively handled, stored in small spaces, or exposed to an outside environment. It also concluded that cover gowns reduced contamination because they absorb bacteria, and that bacterial counts below the waist were greater than those taken from above the waist. Nursing implications. Evidence from this study suggests a relationship between cover gowns and decreased bacterial contamination on scrub suits. Because the bacterial contamination is higher below the waist, scrub nurses are encouraged to avoid contact with the operative field. JACKLYN J. TAKAHASHI, RN, BSN, CNOR 1986 NURSINGRESEARCHCOMMITTEE
H Pelle et al, “Wound infection after cesarean section,” Znfecrion Control 7 (September 1986) 456-46 1. A study of incisional wound infections in 1,032 cesarean sections showed three major risk factors for surgical sepsis: (1) severe obesity, (2) more than three hours lapse between rupture of membranes and surgical incision, and (3) intrauterine fetal monitoring. The study included women (6,956) admitted for delivery between October 1983 and May 1984 who underwent cesarean sections (1,029). The study focused on the period of time from surgery to 14 days postoperatively. Incidence of infection was classified as “possibly” infected, infected, or 26
JANUARY 1987,VOL. 45, NO I
not infected. Two groups of women were reported to be at reduced risk of wound infection. Women undergoing elective cesarean sections had less risk than those undergoing nonelective emergent surgery (ie, 3.8% rate of wound infection as compared to 7.5% rate of wound infection). Also, the risk of wound infection was reduced in women who had plastic skin drapes and a wound disinfection of 70% ethanol with 2.5% iodine applied to the wound before closure. Factors that did not affect the wound infection rate were use of absorbable suture versus nonabsorbable suture, use of midline incision versus transverse incision, number of persons present during surgery, or time of day surgery occurred. Nursing implications. Perioperative documentation should include factors, such as intrauterine monitoring, ruptured membranes, and obesity, in a preoperative assessment and a patient care plan with the nursing diagnosisof potential for infection. SUSAN V. M. KLEINBECK, RN, MS 1986 NURSINGRESEARCHCOMMITTEE A K Derdiarian, “Informational needs of recently diagnosed cancer patients,” Nursing Research 35 (September/October 1986) 276-28 1. Preoperative patient assessments by perioperative nurses identify nursing care needs during surgery. This study suggests that cancer patient needs may be general enough for the perioperative nurse to anticipate types of information that a patient will request. In this study, a researcher interviewed 60 patients that had been recently diagnosed with cancer and identified significant differences in information requested. Depending upon gender, age, and stage of cancer, patients rated their needs differently. Patients reported a high need for information regarding treatments and prognoses; physical and psychological well-being; effect on spouses and children; and impact on jobs and careers. Most information requested by patients corresponded with information provided by perioperative nurses: clarification of the surgical intervention (treatment); plans for physical safety and psychological
AORN JOURNAL
Research Reviews Research focuses on preoperative instruction, cover gowns, wound infections
D Hathaway, “Effect of preoperative instruction on postoperative outcomes: A meta-analysis,” Nursing Research 35 (September/October 1986) 269-274. Meta-analysis was used to examine previous research that studied the effect of preoperative instruction on postoperative outcomes. In this study, a numerical value, or effect size, of each study was determined, the average value indicated that a typical patient who had received preoperative instruction had more favorable outcomes than 67%of a similar group that did not. Altogether, 2,4 18 adults in experimental groups and 1,605 adults in control groups participated in the 68 previous research studies. The results of the effects of various types of instruction were examined: structured versus unstructured, group versus individual, and different levels of patient anxiety. Patients responded best to instruction that contained procedural content (ie, material that described a patient’s physical care regimen in a factual, concrete, and reality-based manner). Patients also responded well to instruction that contained psychological content. Patients’ levels of fearlanxiety inversely affected postoperative outcomes. For example, patients with low levels of anxiety had positive outcomes and patients with high levels of anxiety were least affected by preoperative instruction. The study indicated that instruction was more effective on individual patients as compared to patients who received instruction in a group. Nursing implicatiom. Intervention should focus 24
on identifying level of anxiety in the patient before instruction begins. Also, the nursing staff should consider conducting more individual instruction because of the increased benefits. Group instruction is not necessarily the most cost-effective use of nursing staff, even though it may save time and appear to be an efficient use of staff. CYNTHIASPRY, RN, MSN, CNOR CHAIRMAN 1986 NURSINGRESEARCHCOMMITTEE G Copp et al, “Cover gowns and the control of operating room contamination,” Nursing Research 35 (September/October 1986) 263-267. This study examines the effectivenessof cloth cover gowns in protecting surgical scrub suits from bacterial contamination if worn outside the OR. The following three hypotheses were tested (1) scrubsuits worn outside the O R without cover gowns increased bacterial contamination; (2) scrubsuits worn outside the OR with cover gowns decreased bacterial contamination; (3) fresh scrub suits worn after re-entering the OR decreased bacterial contamination. Bacterial samples were collected three times during the day: (1) within 30 minutes of arrival, (2) immediately before lunch, and (3) immediately after lunch. After arriving at work, participants donned clean scrub suits, tying both neck and back ties. After the first samples were taken, the nurses followed their normal work routines. After the second samples were taken, they left the department for their regular 30-minute lunch breaks.
AORN JOURNAL
Twenty O R nurses were randomly assigned to one of four groups. The nurses in Group 1 wore clean cover gowns over their scrub suits to lunch. After returning, they removed the cover gowns and continued to wear the same scrub suits. Participants in Group 2 wore only their scrub suits to lunch and continued wearing the same scrubs for the rest of the day. The nurses in Group 3 changed into outdoor clothes for lunch, and afterward, changed into clean scrub suits. Group 4 nurses also changed into outside clothes for lunch. They placed their scrub suits into clean paper envelopes and stored them in lockers. After lunch, they changed back into these same scrub suits. The study concluded that bacterial contamination increased when the scrub suits were excessively handled, stored in small spaces, or exposed to an outside environment. It also concluded that cover gowns reduced contamination because they absorb bacteria, and that bacterial counts below the waist were greater than those taken from above the waist. Nursing implications. Evidence from this study suggests a relationship between cover gowns and decreased bacterial contamination on scrub suits. Because the bacterial contamination is higher below the waist, scrub nurses are encouraged to avoid contact with the operative field. JACKLYN J. TAKAHASHI, RN, BSN, CNOR 1986 NURSINGRESEARCHCOMMITTEE
H Pelle et al, “Wound infection after cesarean section,” Znfecrion Control 7 (September 1986) 456-46 1. A study of incisional wound infections in 1,032 cesarean sections showed three major risk factors for surgical sepsis: (1) severe obesity, (2) more than three hours lapse between rupture of membranes and surgical incision, and (3) intrauterine fetal monitoring. The study included women (6,956) admitted for delivery between October 1983 and May 1984 who underwent cesarean sections (1,029). The study focused on the period of time from surgery to 14 days postoperatively. Incidence of infection was classified as “possibly” infected, infected, or 26
JANUARY 1987,VOL. 45, NO I
not infected. Two groups of women were reported to be at reduced risk of wound infection. Women undergoing elective cesarean sections had less risk than those undergoing nonelective emergent surgery (ie, 3.8% rate of wound infection as compared to 7.5% rate of wound infection). Also, the risk of wound infection was reduced in women who had plastic skin drapes and a wound disinfection of 70% ethanol with 2.5% iodine applied to the wound before closure. Factors that did not affect the wound infection rate were use of absorbable suture versus nonabsorbable suture, use of midline incision versus transverse incision, number of persons present during surgery, or time of day surgery occurred. Nursing implications. Perioperative documentation should include factors, such as intrauterine monitoring, ruptured membranes, and obesity, in a preoperative assessment and a patient care plan with the nursing diagnosisof potential for infection. SUSAN V. M. KLEINBECK, RN, MS 1986 NURSINGRESEARCHCOMMITTEE A K Derdiarian, “Informational needs of recently diagnosed cancer patients,” Nursing Research 35 (September/October 1986) 276-28 1. Preoperative patient assessments by perioperative nurses identify nursing care needs during surgery. This study suggests that cancer patient needs may be general enough for the perioperative nurse to anticipate types of information that a patient will request. In this study, a researcher interviewed 60 patients that had been recently diagnosed with cancer and identified significant differences in information requested. Depending upon gender, age, and stage of cancer, patients rated their needs differently. Patients reported a high need for information regarding treatments and prognoses; physical and psychological well-being; effect on spouses and children; and impact on jobs and careers. Most information requested by patients corresponded with information provided by perioperative nurses: clarification of the surgical intervention (treatment); plans for physical safety and psychological