Orthopaedics: patient assessment before surgery

Swedish patients' perceptions of a preoperative skin test

PREOPERATIVE PREPARATION is an important aspect of creating a safe and pleasant hospital experience for surgical patients. Evaluating patient satisfaction, however, also depends on determining patients' perceptions of the care they receive. THIS STUDY used a descriptive, qualitative method with a phenomenographic approach to determine how patients perceived undergoing a preoperative skin test that was developed to ascertain what substances might result in intraoperative reactions in patients with allergies, asthma, or eczema. OVERALL, the patients had positive perceptions of the skin test; however, the results indicate a need for improved and individualized preoperative instruction that focuses on patients from a holistic perspective.

Day surgery preoperative anxiety reduction and coping strategies

Hospitalization, even in patients who are not faced with the prospect of surgery, is known to cause anxiety. One may, therefore, expect some degree of anxiety in patients attending for day surgery. Anxiety provokes a physiological stress response, which impedes the healing process. Thus, the reduction of preoperative anxiety is widely accepted as part of nursing care. This article investigates the coping strategies that patients adopt and the suitability of current anxiety-reduction interventions. It argues that individual coping styles do not remain static but adapt according to need and proposes that, as a result of lack of awareness, the therapeutic potential of the nurse-patient relationship in anxiety-reduction is being overshadowed by uncertainty-reduction approaches which place a disproportionate emphasis on the provision of information.

Reducing patient stress in theatre. Alison Bell Memorial Award

For most patients, admission to hospital for surgery can be very stressful. It is well recognised that stress, created by prolonged anxiety, can produce harmful effects and may even delay a patient's recovery following surgery. This article, submitted for the 1999 Alison Bell award (sponsored by NATN and Regent Medical), looks at key ways to reduce the effects of such stress.

Preoperative assessment criteria and patient teaching for ambulatory surgery patients

Today's trend is to have the surgical patient return to the comfort of his or her home rather than be admitted to the hospital for expensive nursing and medical care. The perioperative team must initially assess the patient's American Society of Anesthesiology status, anxiety level, food and drugs to which he or she may be allergic, and skin integrity; obtain a medical and surgical history and consent; review laboratory, electrocardiogram, and radiological results; and perform preoperative teaching (e.g., which medications to take or withhold preoperatively, when to withhold food and fluids) and postoperative teaching (e.g., catheter care, dressing changes). In addition, the nurse needs to anticipate and be prepared for medical emergencies such as airway management problems and malignant hyperthermia. The age of the patient (e.g., pediatric and geriatric age groups) and preoperative disease states and their severity also need to be recognized as they impact on the perioperative outcome. The assessment phase is one of the most important phases in the perioperative experience. Proper evaluation is the key to success for positive surgical outcomes. Given the time constraints in the ambulatory surgical setting, assessing and teaching the patient on the day of surgery is not feasible or appropriate. Reaching out to the patient a few days before surgery either in the patient's home, in the ambulatory surgery center, or by telephone is the ultimate goal.

Value of an orthopaedic pre-admission clinic for total knee and hip replacements in a rural health service

The emphasis on orthopaedic pre-admission clinics within hospital settings is very recent in Australia. Tamworth Base Hospital, a large rural hospital, started a compulsory clinic in mid-1995. The purpose of this study was to determine the value of orthopaedic education in a pre-admission clinic for patients who were undergoing total knee and total hip replacements. Regarding total knee replacement patients, the average length of stay for those who attended the clinic after it had become compulsory, compared with before, was 3.8 days shorter. For total hip replacement patients, the reduction was 1.1 days. This study found that the major value of the clinic was not so much in reduced lengths of stay, rather it related more to increased patient satisfaction, and perhaps more so in the rural setting where patients are disadvantaged in many cases by the large distances they travel for services.