Nurse competence in the post-anaesthesia care unit in Sweden: a qualitative study of the nurse’s perspective

Background To enable safe and successful recovery for surgery patients, nurses working in post-anaesthesia care units need competence in postoperative care. No consensus defines what this specific competence includes, and it has not been studied from the perspective of nurses working in post-anaesthesia care units. The aim of this study is twofold: 1) To explore and describe nurses’ perception of the competence needed to work in post-anaesthesia care units. 2) To explore and describe nurses’ perception of what characterizes an expert nurse in post-anaesthesia care units. Methods This qualitative inductive study uses individual interviews. Sixteen nurses were recruited from two post-anaesthesia care units located in different parts of Sweden. Inclusion criteria were nurses employed in the post-anaesthesia care units for ≥1 years. Semi-structured individual interviews were conducted; data were analysed using thematic analysis. Results The interview analysis identified six subthemes and three themes. The themes being adaptable in an ever-changing environment and creating safe care represent the overarching meaning of competence required when working as a nurse in a Swedish post-anaesthesia care unit. Nurses must possess various technical and nontechnical skills, which are core competences that are described in the sub-themes. The theme seeing the bigger picture describes the nurse’s perception of an expert nurse in the post-anaesthesia care unit. Conclusions Nurse competence in post-anaesthesia care units entails specific knowledge, acknowledging the patient, and working proactively at a fast pace with the patient and team to provide safe, high-quality care. An expert nurse in post-anaesthesia care units can see the bigger picture, helping share knowledge and develop post-anaesthesia care. The expert competence to see a bigger picture can be used in supervising novices and creating a knowledge base for postgraduate education in order to promote safe, high-quality post-anaesthesia care.

Anaesthetic Management of Left Temporal Glioma Undergoing Awake Craniotomy

For an awake craniotomy, a 49 year old (ASA 2), 78 kg woman with type II DM was given regional anaesthesia (scalp block) with monitored anaesthesia care (MAC). She had a headache, which was primarily caused by a left temporal glioma. She was very apprehensive about having this procedure done while she was awake. Fentanyl and Dexmedetomidine infusions in combination with scalp block initially provided adequate operating conditions. Because the patient needed to be fully awake, alert and cooperative during the language and motor mapping, all sedation was turned off. Patient was cooperative and obeyed commands during motor and language mapping as well as during tumour excision. Patient underwent complete excision of tumour without any postoperative neurological deficit. The success of the awake craniotomy is dependent on the patient cooperation, anaesthesiologist's experience, adequate intraoperative analgesia coverage, careful sedation titration, and meticulous planning.

Conceptualising sustainability in the surgical work of non-governmental organisations in low and middle-income countries : a scoping review protocol

IntroductionSustainability remains poorly defined in global surgery, yet is, nevertheless, crucial to the work of non-governmental organisations (NGOs) in low- and middle-income countries (LMICs) aimed at strengthening access to, and quality of, surgical and anaesthesia care. The objective of this protocol is to outline a scoping review that maps what is known in the literature about sustainability in NGO surgical work in LMICs.MethodsThe application of Arksey and O’Malley’s six-stage methodological framework is described: identifying research questions; identifying relevant publications; selecting publications; charting the data; reporting results; and stakeholder consultation. The review will include all study designs, as well as editorials, commentaries, sources of unpublished studies and grey literature. Three electronic databases will be searched. Two reviewers will use predefined and iteratively refined selection criteria based on the ‘Population–Concept–Context’ framework to independently screen titles and abstracts of citations from the search. Disagreements will be resolved together by the reviewers. Full-text screening will also be carried out independently by two reviewers. Disagreements at this stage will be resolved with a third party. The search strategy for grey literature will include searching in ProQuest Dissertations and Theses and the websites listed in a surgical NGO database. Further relevant citations will be identified by screening the reference lists of the included papers.Ethics and disseminationThis review will undertake a secondary analysis of data already collected and does not require ethical approval. The results will be disseminated through journals and conferences targeting surgical NGO stakeholders and global health academics.

National quality improvement indicators project: an initial descriptive study

Background Anaesthesia Quality Improvement New Zealand developed a set of five quality improvement indicators pertaining to postoperative nausea and vomiting, pain, respiratory distress, hypothermia and a prolonged post-anaesthesia care unit stay. This study sought to assess the proportion of eligible institutions that were able to measure and provide data on these indicators, produce an initial national estimate of these, and a measure of variability in the quality improvement indicators across hospitals in New Zealand. Methods All public hospitals that provide a representative to Anaesthesia Quality Improvement New Zealand were eligible for inclusion. Participating institutions were required to provide the number and proportion of patients with each of the five quality improvement indicators over a continuous 2-week period between 1 June 2019 and 25 October 2019. The overall percentage of patients and the median percentage with each outcome were calculated. Results A total of 79.2% of eligible hospitals participated. The median incidence of the indicators ranged from 1.67% for respiratory distress to 6.31% for prolonged post-anaesthesia care unit stay. The indicator with the largest interquartile range was hypothermia and the smallest was respiratory distress (13.48 and 2.29, respectively). A large variation was seen for prolonged post-anaesthesia care unit stay, hypothermia, pain and postoperative nausea and vomiting. Conclusion The majority of eligible institutions were able to measure and provide data on the quality improvement indicators. There was a low rate of respiratory distress with low variability. A large amount of variability was observed in the other indicators. Future studies are needed to explore the nature of this variability.

EFFECT OF DEXAMETHASONE GARGLE AND MgSO4 GARGLE ON INCIDENCE AND SEVERITY OF POST OPERATIVE SORE THROAT IN PATIENTS UNDERGOING SURGERY UNDER GA : A RANDOMISED COMPARATIVE STUDY

BACKGROUND: Post operative sore throat (POST) is an unpleasant and troublesome sequelae after endotracheal intubation . The present study compares the efcacy of dexamethasone gargle versus magnesium sulphate gargle on incidence and severity of post operative sore throat in patients under General Anaesthesia. METHODS : 60 patients were randomly allocated to receive either magnesium sulphate gargle or dexamethasone gargle . 15 mins prior to induction of GA , the dexamethasone gargle group (n=30) received 8mg dexamethasone dissolved in 20ml of 5% dextrose whereas the magnesium sulphate gargle group received 1 gm of MgSO4 dissolved in 20ml of 5% of dextrose. Patients were assessed for incidence and severity of post operative sore throat , cough and hoarseness of voice in post anaesthesia care unit at 0hr, 2hrs, 4hrs, 6hrs and 24 hrs . RESULTS : Our study revealed that there was signicant (p<0.01) difference in the severity of sore throat between the groups at 0 hr, 2 hrs, 4 hrs , 6 hrs with patients receiving MgSO4 gargles showing decreased severity than gargling with dexamethasone. The two groups were found to be demographically comparable . In our current study , the mean duration of surgery in both groups was 2-2.5 hours and difference was statistically insignicant . SUMMARY : Among patients who gargled with 1gm of MgSO4 exhibited lower incidence and severity of POST as compared to patients who gargled with 8mg of dexamethasone