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A Feasibility Study Using The Essential Oil Lavender to Reduce Preoperative Anxiety in Females Undergoing Breast Surgery
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the PACU 48.286 % of the patient in Group B experienced PONV; while none experienced PONV in Group A (Chi Square 52.071,p, .001). 51.9% of Group B and 31.0% of Group A experienced PDNV at home. Discussion: This population had a high potential for PONV. Although this comparison was not statistically significant, the differences between the two groups were clinically meaningful. The intention of the investigators was to enroll 100 patients; however due to limitations encountered the statistical power may have been influenced. Conclusion: More interventions and methods are needed to decrease the incidence of PONV. The results of the study show the use of P6 stimulation in the perioperative arena is clinically meaningful. Implications: P6 stimulation is a suitable technique to prevent or treat PONV, with little or no side effects or risk to patient safety. More research on this topic is needed.
SLEEP APNEA: A WAKE UP CALL.FOR NURSES Primary Investigator: Janice Wilsey, BS, RN-BC, St. Peter’s Hospital, Albany, New York Co-Investigators: Marilyn LaParl, BS, RN-BC, Rosemarie Casale, BS, NE-BC, Lauren Adamczyk, BS, RN-BC, Andrea McCarthy, AD, RN, Theresa Legnard, BS, RN, Allison Whiting, AD, RN, Morgan Williams, AD, RN, Carole Wickham, DNS, CNS-BC
Background: Obstructive sleep apnea (OSA) is a sleep disorder with an estimated prevalence between 2% and 25% in the general population. In patients undergoing elective surgery, the prevalence is higher. Studies reveal that sedation and anesthesia increase the risk of postoperative complications. Identifying patients preoperatively to initiate appropriate interventions is prudent. Purpose: The purpose of this quantitative study was to develop and implement an interdisciplinary protocol to assist with early identification and interventions in targeted high risk OSA patients undergoing elective surgery. Methods: An evidence-based protocol was developed. Education on OSA and the protocol was provided for all direct patient caregivers. The population included patients undergoing elective colorectal and gynecologic oncology surgery over an 11 week time period. Patients who scored 3 or higher on the STOP-BANG screening tool were placed on the protocol: primary physicians were notified and results were reported to Anesthesia. Per PACU monitoring criteria, additional interventions i.e. positioning, continuous oximetry, telemetry and OSA adult analgesic orders were implemented on the surgical unit. Patient education included a video and discharge education. Results: The number of patients screened in this study was 365; 302 patients (83%) screened negative and 63 (17%) screened positive for high risk OSA. The identified 63 (17%) high risk patients were placed on the protocol. In this high risk group, protocol implementation resulted in earlier identification of events and intervention for the following high risk patients: 5 patients (8%) experienced two or more events in PACU that required cardiac and continuous pulse oximetry monitoring; 4 patients (6%) experienced two or more events in the PACU requiring C-PAP/BiPAP; 2 patients (3%) sustained oxygen desaturation below 90%; 2 patients (3%) developed arrhythmias; 23 patients (37%) had a minimum 20% change from admis-
ASPAN NATIONAL CONFERENCE ABSTRACTS sion heart rate and 32% had a minimum 20% change from admission blood pressure; none required transfer to ICU. The patients received lower analgesic doses. No reversal of analgesia was necessary. Implications: The findings are consistent with the literature. Implementation of the STOP-BANG screening tool and the protocol facilitated early identification and timely interventions. The findings suggest application to the broader surgical patient population.
A FEASIBILITY STUDY USING THE ESSENTIAL OIL LAVENDER TO REDUCE PREOPERATIVE ANXIETY IN FEMALES UNDERGOING BREAST SURGERY Primary Investigators: Maggie Colabuono, RN, BSN, CPAN, CAPA, Jackie Murauski, RN, MSN, APN, CNS, CCRN, CPAN, Patrice Stephens, RN, MSN, APN, AOCN Advocate Christ Medical Center, Oak Lawn, Illinois Co-Investigators: Dr. Adam Riker, MD, Dawn Corey, RN, Christine Danielski, RN, ADN, CAPA, Joann Quinn, RN, BSN, CAPA, Linda Sobek, RN, BSN
Introduction: Preoperative anxiety is a common finding in patients waiting to have surgery that can lead to increased physical discomfort, delayed recovery time, and need for additional medications. Perianesthesia nurses are in the unique position to manipulate the preoperative environment with aromatherapy to decrease some of this anxiety. Problem: Research shows preoperative anxiety as an issue for breast cancer patients. Studies using aromatherapy to decrease anxiety in varying populations have reported mixed results. Would inhalation of lavender aromatherapy reduce preoperative anxiety in patients awaiting breast cancer surgery? Purpose: This study sought to describe the change in anxiety score from before to after aromatherapy; compare the difference in anxiety between treatment groups; describe subject’s satisfaction with aromatherapy. Methodology: A randomized control trial of 40 breast cancer surgery patients was conducted. Anxiety was measured using the State Trait Anxiety Inventory (STAI) at three time points before surgery. Patient satisfaction was measured using a onetime self-report questionnaire. The changes in STAI score over time and between groups were tested using repeated measures analysis of variance (ANOVA). Results: Twenty subjects were in the treatment group (mean age 60611 yrs) and 19 in the control group (mean age 55610 yrs). ANOVA indicated a significant decrease in anxiety over time (F13.3, p50.000). The type of treatment had no significant effect on the anxiety scores. Yet, at 10 minutes, the treatment group declined from 45.2 to 38.7, while the control group decreased from 42.16 to 41.79. Questionnaire responses showed the treatment group was more satisfied with the use of aromatherapy and more likely to recommend the therapy to others. Discussion: Aromatherapy is an effective nursing intervention to improve preoperative patient care. The randomized controlled study design with nasal inhaler aromatherapy improves upon previous studies. Conclusion: This study provided a simple, low risk, costeffective nursing intervention using direct delivery method of lavender inhalation showing it has the potential to alleviate situational anxiety for this specific cancer population.
ASPAN NATIONAL CONFERENCE ABSTRACTS Implications: These findings suggest that perianesthesia nurses can impact patient’s anxiety by changing the surgical environment. Further studies are needed showing its effectiveness with other high anxiety surgical populations.
EFFECTS OF AN EDUCATIONAL PROGRAM ON PERCEIVED VALUE AND BARRIERS TO CERTIFICATION Primary Investigator: Carol Pehotsky, MSN, RN, CPAN, ACNS-BC Cleveland Clinic, Cleveland, Ohio Co-Investigators: James F. Bena, MS, Shannon M. Morrison, MS, Nancy M. Albert, PhD, CCNS, CCRN, NE-BC, Victoria L. Butler, MS, RN, CNOR, FACHE, NE-BC
Background: It is unknown if self-study education increases value and decreases barriers toward certification. Purpose: Determine if perceptions toward certification change after participating in an education intervention. Methods: Perianesthesia nurses completed the Perceived Value of Certification (ÓCCI, 18 items, score range 1-4; , 3, higher value) and Perceived Barriers to Certification (13 items, score range 0-10; higher score, greater barriers) scales pre-post a 47-day self-study education program. Education included testing information, daily questions/answers regarding perianesthesia knowledge, and independent clinical study materials. Nurse demographics and scale scores were compared pre-post education using chi-square or Fisher’s exact tests (categorical data) or two-sample t-tests (continuous data). Results: Of 25 nurses that completed both pre and post scales, mean (SD) age was 42.2(8.7) years, level of experience was 17.8(10.3) years, and years as a Perianesthesia nurse was 11.1(7.7) years. Mean (SD) perceived value and barriers scores pre- vs. post-education were 2.9(0.6) vs. 3.0(0.5), p50.31 and 4.3(1.5) vs. 4.1(1.7), p50.44, respectively. There were no changes in factor scores (intrinsic and extrinsic factors, personal value, recognition from others and professional practice) from pre- to post-education, p values, 0.45-0.94. Barriers to certification were not associated with nurse demographics. In nurses aged $ 43 years and those with $ 17 years nursing experience, total perceived value for certification (p50.027), intrinsic value (p50.041) and personal value (p50.041) were higher than in younger and less experienced nurses. There were no differences in pre-education scores based on highest nurse education or workplace, post anesthesia care or same day surgery. Conclusions: Nurses’ perceptions of certification were slightly positive at baseline and remained unchanged after a self-study education intervention. Barriers to certification were moderately low and did not alter post-education. Selfstudy education was ineffective in altering perceptions of certification. Active education or other interventions may be needed to facilitate nurses’ desire to become certified.
PROSPECTIVE EVIDENCE ON THE USE OF CLINICAL INDICATORS AS DISCHARGE CRITERIA IN PERIANESTHESIA PHASE II RECOVERY Primary Investigator: Aletha Rowlands, PhD, RN, CNOR West Virginia University School of Nursing; Morgantown, West Virginia
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Co-Investigators: Raquel Evans, BSN, RN, Stacy Ross, BSN, RN, Tracy Underwood, BSN, RN, CPAN, Hassan Ramadan, MD, MSc, FACS
Introduction: Research demonstrates registered nurses who provide direct patient care are well poised to design systems and processes to accomplish the goals of safe quality care. However, many processes of patient care are richly steeped in tradition and are not evidence-based. Identification of the Problem: One long-standing tradition in our organization centers on discharging tonsillectomy patients using a “pre-specified period of time” (360 minutes). The presumption is using a “pre-specified time” provides ample opportunity for patients to recovery. This current practice has resulted in inefficiency, increased hospital cost, and a decrease in patient satisfaction. Purpose of the Study: We designed this study to determine “discharge-readiness” of tonsillectomy patients using clinical indicators. We hypothesized that discharge-readiness could be determined using clinical indicators. Methodology: A descriptive comparative approach was used to test the hypothesis. Using a convenience sample, patients (. 3 years) were recruited on the day of surgery. Although patients were discharged using the pre-specified time (comparison), discharge-readiness was determined. Data (45 data points) were collected on each patient’s progression (preoperative baseline, perianesthesia phase I and II, and a phone call 24-48 hours after discharge). Perianesthesia nurses recorded all data on the “Patient Information Form”. ASPAN’s Guidelines and Aldrete Score served as resources for clinical indicators. The study was approved by the Institutional Review Board and informed written consent for participation was obtained from all participants. Results: Descriptive statistics were used to analyze data from 93 patients. The sample included 47(50.5%) males and 46 (49.5%) females with ages ranging from three to 34 with a mean of 9.95 and SD of 7.005. The majority of participants were white (88/94.6%). The surgery length ranged from 14-125 minutes (mean 41.7; SD 20.702) and the recovery time includes: Phase 1: 44-246 minutes (mean 88.95; SD 38.410); and Phase II: 92-480 minutes (mean 256.28; SD 63.974). Discharge-readiness ranged from 84-481 minutes with a mean of 253.36; SD 79.001. Discharge-readiness “time” was less than the pre-specified time (360 minutes) for 77 (82.8%) patients. Of the 77 patients, no complications occurred after the documented discharge-readiness time. Discharge-readiness for 11(11.3%) patients’ was greater than the pre-specified time. Patients’ complications include pain, nausea, and vomiting. Five of the 11 patients needed to contact their surgeon after returning home for vomiting (4); pain (1); and slight bleeding (1). Of the five patients, none returned to the hospital (ED). Key data elements were missing on seven patients (5.4%) so we could not determine discharge-readiness. Discussion: Perianesthesia nurses were able to determine discharge-readiness for their patients. Of the 77(82.8%) patients whose discharge-readiness was less than the pre-specified time, no complications occurred. The discharge-readiness time for 11(11.3%) patients was greater than the pre-specified time. Patients’ Patients’ complications include pain, nausea, and
the PACU 48.286 % of the patient in Group B experienced PONV; while none experienced PONV in Group A (Chi Square 52.071,p, .001). 51.9% of Group B and 31.0% of Group A experienced PDNV at home. Discussion: This population had a high potential for PONV. Although this comparison was not statistically significant, the differences between the two groups were clinically meaningful. The intention of the investigators was to enroll 100 patients; however due to limitations encountered the statistical power may have been influenced. Conclusion: More interventions and methods are needed to decrease the incidence of PONV. The results of the study show the use of P6 stimulation in the perioperative arena is clinically meaningful. Implications: P6 stimulation is a suitable technique to prevent or treat PONV, with little or no side effects or risk to patient safety. More research on this topic is needed.
SLEEP APNEA: A WAKE UP CALL.FOR NURSES Primary Investigator: Janice Wilsey, BS, RN-BC, St. Peter’s Hospital, Albany, New York Co-Investigators: Marilyn LaParl, BS, RN-BC, Rosemarie Casale, BS, NE-BC, Lauren Adamczyk, BS, RN-BC, Andrea McCarthy, AD, RN, Theresa Legnard, BS, RN, Allison Whiting, AD, RN, Morgan Williams, AD, RN, Carole Wickham, DNS, CNS-BC
Background: Obstructive sleep apnea (OSA) is a sleep disorder with an estimated prevalence between 2% and 25% in the general population. In patients undergoing elective surgery, the prevalence is higher. Studies reveal that sedation and anesthesia increase the risk of postoperative complications. Identifying patients preoperatively to initiate appropriate interventions is prudent. Purpose: The purpose of this quantitative study was to develop and implement an interdisciplinary protocol to assist with early identification and interventions in targeted high risk OSA patients undergoing elective surgery. Methods: An evidence-based protocol was developed. Education on OSA and the protocol was provided for all direct patient caregivers. The population included patients undergoing elective colorectal and gynecologic oncology surgery over an 11 week time period. Patients who scored 3 or higher on the STOP-BANG screening tool were placed on the protocol: primary physicians were notified and results were reported to Anesthesia. Per PACU monitoring criteria, additional interventions i.e. positioning, continuous oximetry, telemetry and OSA adult analgesic orders were implemented on the surgical unit. Patient education included a video and discharge education. Results: The number of patients screened in this study was 365; 302 patients (83%) screened negative and 63 (17%) screened positive for high risk OSA. The identified 63 (17%) high risk patients were placed on the protocol. In this high risk group, protocol implementation resulted in earlier identification of events and intervention for the following high risk patients: 5 patients (8%) experienced two or more events in PACU that required cardiac and continuous pulse oximetry monitoring; 4 patients (6%) experienced two or more events in the PACU requiring C-PAP/BiPAP; 2 patients (3%) sustained oxygen desaturation below 90%; 2 patients (3%) developed arrhythmias; 23 patients (37%) had a minimum 20% change from admis-
ASPAN NATIONAL CONFERENCE ABSTRACTS sion heart rate and 32% had a minimum 20% change from admission blood pressure; none required transfer to ICU. The patients received lower analgesic doses. No reversal of analgesia was necessary. Implications: The findings are consistent with the literature. Implementation of the STOP-BANG screening tool and the protocol facilitated early identification and timely interventions. The findings suggest application to the broader surgical patient population.
A FEASIBILITY STUDY USING THE ESSENTIAL OIL LAVENDER TO REDUCE PREOPERATIVE ANXIETY IN FEMALES UNDERGOING BREAST SURGERY Primary Investigators: Maggie Colabuono, RN, BSN, CPAN, CAPA, Jackie Murauski, RN, MSN, APN, CNS, CCRN, CPAN, Patrice Stephens, RN, MSN, APN, AOCN Advocate Christ Medical Center, Oak Lawn, Illinois Co-Investigators: Dr. Adam Riker, MD, Dawn Corey, RN, Christine Danielski, RN, ADN, CAPA, Joann Quinn, RN, BSN, CAPA, Linda Sobek, RN, BSN
Introduction: Preoperative anxiety is a common finding in patients waiting to have surgery that can lead to increased physical discomfort, delayed recovery time, and need for additional medications. Perianesthesia nurses are in the unique position to manipulate the preoperative environment with aromatherapy to decrease some of this anxiety. Problem: Research shows preoperative anxiety as an issue for breast cancer patients. Studies using aromatherapy to decrease anxiety in varying populations have reported mixed results. Would inhalation of lavender aromatherapy reduce preoperative anxiety in patients awaiting breast cancer surgery? Purpose: This study sought to describe the change in anxiety score from before to after aromatherapy; compare the difference in anxiety between treatment groups; describe subject’s satisfaction with aromatherapy. Methodology: A randomized control trial of 40 breast cancer surgery patients was conducted. Anxiety was measured using the State Trait Anxiety Inventory (STAI) at three time points before surgery. Patient satisfaction was measured using a onetime self-report questionnaire. The changes in STAI score over time and between groups were tested using repeated measures analysis of variance (ANOVA). Results: Twenty subjects were in the treatment group (mean age 60611 yrs) and 19 in the control group (mean age 55610 yrs). ANOVA indicated a significant decrease in anxiety over time (F13.3, p50.000). The type of treatment had no significant effect on the anxiety scores. Yet, at 10 minutes, the treatment group declined from 45.2 to 38.7, while the control group decreased from 42.16 to 41.79. Questionnaire responses showed the treatment group was more satisfied with the use of aromatherapy and more likely to recommend the therapy to others. Discussion: Aromatherapy is an effective nursing intervention to improve preoperative patient care. The randomized controlled study design with nasal inhaler aromatherapy improves upon previous studies. Conclusion: This study provided a simple, low risk, costeffective nursing intervention using direct delivery method of lavender inhalation showing it has the potential to alleviate situational anxiety for this specific cancer population.
ASPAN NATIONAL CONFERENCE ABSTRACTS Implications: These findings suggest that perianesthesia nurses can impact patient’s anxiety by changing the surgical environment. Further studies are needed showing its effectiveness with other high anxiety surgical populations.
EFFECTS OF AN EDUCATIONAL PROGRAM ON PERCEIVED VALUE AND BARRIERS TO CERTIFICATION Primary Investigator: Carol Pehotsky, MSN, RN, CPAN, ACNS-BC Cleveland Clinic, Cleveland, Ohio Co-Investigators: James F. Bena, MS, Shannon M. Morrison, MS, Nancy M. Albert, PhD, CCNS, CCRN, NE-BC, Victoria L. Butler, MS, RN, CNOR, FACHE, NE-BC
Background: It is unknown if self-study education increases value and decreases barriers toward certification. Purpose: Determine if perceptions toward certification change after participating in an education intervention. Methods: Perianesthesia nurses completed the Perceived Value of Certification (ÓCCI, 18 items, score range 1-4; , 3, higher value) and Perceived Barriers to Certification (13 items, score range 0-10; higher score, greater barriers) scales pre-post a 47-day self-study education program. Education included testing information, daily questions/answers regarding perianesthesia knowledge, and independent clinical study materials. Nurse demographics and scale scores were compared pre-post education using chi-square or Fisher’s exact tests (categorical data) or two-sample t-tests (continuous data). Results: Of 25 nurses that completed both pre and post scales, mean (SD) age was 42.2(8.7) years, level of experience was 17.8(10.3) years, and years as a Perianesthesia nurse was 11.1(7.7) years. Mean (SD) perceived value and barriers scores pre- vs. post-education were 2.9(0.6) vs. 3.0(0.5), p50.31 and 4.3(1.5) vs. 4.1(1.7), p50.44, respectively. There were no changes in factor scores (intrinsic and extrinsic factors, personal value, recognition from others and professional practice) from pre- to post-education, p values, 0.45-0.94. Barriers to certification were not associated with nurse demographics. In nurses aged $ 43 years and those with $ 17 years nursing experience, total perceived value for certification (p50.027), intrinsic value (p50.041) and personal value (p50.041) were higher than in younger and less experienced nurses. There were no differences in pre-education scores based on highest nurse education or workplace, post anesthesia care or same day surgery. Conclusions: Nurses’ perceptions of certification were slightly positive at baseline and remained unchanged after a self-study education intervention. Barriers to certification were moderately low and did not alter post-education. Selfstudy education was ineffective in altering perceptions of certification. Active education or other interventions may be needed to facilitate nurses’ desire to become certified.
PROSPECTIVE EVIDENCE ON THE USE OF CLINICAL INDICATORS AS DISCHARGE CRITERIA IN PERIANESTHESIA PHASE II RECOVERY Primary Investigator: Aletha Rowlands, PhD, RN, CNOR West Virginia University School of Nursing; Morgantown, West Virginia
e45
Co-Investigators: Raquel Evans, BSN, RN, Stacy Ross, BSN, RN, Tracy Underwood, BSN, RN, CPAN, Hassan Ramadan, MD, MSc, FACS
Introduction: Research demonstrates registered nurses who provide direct patient care are well poised to design systems and processes to accomplish the goals of safe quality care. However, many processes of patient care are richly steeped in tradition and are not evidence-based. Identification of the Problem: One long-standing tradition in our organization centers on discharging tonsillectomy patients using a “pre-specified period of time” (360 minutes). The presumption is using a “pre-specified time” provides ample opportunity for patients to recovery. This current practice has resulted in inefficiency, increased hospital cost, and a decrease in patient satisfaction. Purpose of the Study: We designed this study to determine “discharge-readiness” of tonsillectomy patients using clinical indicators. We hypothesized that discharge-readiness could be determined using clinical indicators. Methodology: A descriptive comparative approach was used to test the hypothesis. Using a convenience sample, patients (. 3 years) were recruited on the day of surgery. Although patients were discharged using the pre-specified time (comparison), discharge-readiness was determined. Data (45 data points) were collected on each patient’s progression (preoperative baseline, perianesthesia phase I and II, and a phone call 24-48 hours after discharge). Perianesthesia nurses recorded all data on the “Patient Information Form”. ASPAN’s Guidelines and Aldrete Score served as resources for clinical indicators. The study was approved by the Institutional Review Board and informed written consent for participation was obtained from all participants. Results: Descriptive statistics were used to analyze data from 93 patients. The sample included 47(50.5%) males and 46 (49.5%) females with ages ranging from three to 34 with a mean of 9.95 and SD of 7.005. The majority of participants were white (88/94.6%). The surgery length ranged from 14-125 minutes (mean 41.7; SD 20.702) and the recovery time includes: Phase 1: 44-246 minutes (mean 88.95; SD 38.410); and Phase II: 92-480 minutes (mean 256.28; SD 63.974). Discharge-readiness ranged from 84-481 minutes with a mean of 253.36; SD 79.001. Discharge-readiness “time” was less than the pre-specified time (360 minutes) for 77 (82.8%) patients. Of the 77 patients, no complications occurred after the documented discharge-readiness time. Discharge-readiness for 11(11.3%) patients’ was greater than the pre-specified time. Patients’ complications include pain, nausea, and vomiting. Five of the 11 patients needed to contact their surgeon after returning home for vomiting (4); pain (1); and slight bleeding (1). Of the five patients, none returned to the hospital (ED). Key data elements were missing on seven patients (5.4%) so we could not determine discharge-readiness. Discussion: Perianesthesia nurses were able to determine discharge-readiness for their patients. Of the 77(82.8%) patients whose discharge-readiness was less than the pre-specified time, no complications occurred. The discharge-readiness time for 11(11.3%) patients was greater than the pre-specified time. Patients’ Patients’ complications include pain, nausea, and