A New Model Of Preoperative Visit Established And Application Research

Surgery as a stress source, the patient often can lead to a more intense psychological and physiological responses, and even interfere with the smooth progress of surgery and anesthesia, affects the patient's treatment. American Nurses Association "basic program for operating room nurses," states:operating room nursing practice is the first phase of baseline preoperative visit, to grasp the patient's physical, social, and psychological state. International Association of Operating Room Nurses (AORN) states:operating room preoperative visit is one of the functions and responsibilities of nurses. Preoperative interview change the operating room nurses, focuses only on the traditional care model with the surgery, operating room nursing is a new task, is the operating room care towards the concrete implementation of scientific, how to preoperative surgical patient visits to help reduce anxiety and fear, so that patients smoothly through the operation difficulties, is an urgent need for operating room nurses to solve the problem.In China, the old medical model of the biological and historical reasons, operating room nursing has lagged behind, although the majority of hospitals are carrying out the preoperative visit, but there are limitations, there is lack of manpower, uneven quality of personnel, implementation of the preoperative interview nurse the lack of effective communication skills, the form of a single preoperative visit, the implementation of methods and content of the lack of standardized, it is difficult to achieve the specific requirements of the preoperative visit.Research purposesApplication of Delphi method that constructs the operating room preoperative interview mode to achieve the preoperative visit and standardize and systematize for operating room nurses provide preoperative visit its reference, and build working models of preoperative visits clinical application, as well as the implementation of a new preoperative interview to evaluate the effect of the mode.Objects and Methods1.The first part of the application of the Delphi method of preoperative visits to build a new model of work.Subject of investigation by experts (Delphi Method) of the 23 experts two surveys, from the preoperative visit of the executor, the time of preoperative visit, the contents of the preoperative visit, the way of the preoperative visit andpreoperative supervision of five main parts object to the expert's opinion and suggestion, according to the results of construct preoperative counseling work mode. This study were invited from nine hospitals, three level of first-class hospital of Guangzhou, the 23 famous doctors and the nursing profession, academics, senior experts and professors involved in our consultation, minimum 17 years in professional life, up to 42 years, average age 24.55±14.08 in the professional years, including senior professional titles and 4 (20%), associational professional titles and 13 (65%), intermediate grade 3 (15%). In the literature review, theoretical analysis, based on the actual situation in our country to explore the construction work of the preoperative visit the basic framework of the new model, questionnaire design experts, based on two expert advisory survey of expert views and collate results, statistics and analysis, combined with expert opinions preoperative interview mode selection indicators. Data using EXCEL documents, SPSS 13.0 statistical software for statistical analysis. Experts said recovery coefficient of positive with questionnaires, Experts with the authority of the coefficient of authoritative expert level to say, Experts with the importance of index concentration mean values, The coordination of expert opinion with variable coefficient and experts said, coordinate coefficient by expert advice on the coordination degree, and actively coefficient and authoritative coefficient of expert consultation, the index of representative test reliability and the workplace preoperative nursing operating mode.2.The second part of the preoperative visit the New Model of implementation and evaluation.Select the hospital orthopedic ward patients, aged 20-60 years old, with junior middle school or above, no serious anxiety, no nerves and mental illness and defects, no serious lung disease, and who need surgical treatment. To conform to the above criteria were randomly divided into experimental group of 50 patients, 32 male and 18 female patients,50 patients were treated,27 males and 23 females. Experimental group by the full-time nurses in preoperative interview in this study in accordance with established modes of implementation of the preoperative interview, the control group were nurses from the operating room before surgery visits. Measured preoperative and anxiety after entering the operating room, systolic blood pressure, diastolic blood pressure, heart rate and other indicators, intraoperative care and psychological effects of surgery and postoperative evaluation of patient satisfaction surveys. Data using EXCEL, SPSS13.0 statistical software for statistical analysis, the two groups were comparable in the data between the two group's t test using statistical analysis, patient satisfaction surveys and evaluation of psychological care and use of chi-square test results and concluded.Results1.Preoperative interview mode of construction index selection The importance of alternative indicators of the degree classification method using Li Ke 5, through expert investigation to the mode of preoperative visits the importance of the various build targets are greater than 3.5 and assign the coefficient of variation less than 0.3 for the index selection criteria combined with expert advice and research group collective deliberations, for index selection.2.The reliability of expert advice and activeIn this study, Guangzhou and selected experts distribution three level of first-class hospital nursing management, clinical nursing and medical professionals engaged in professional work more than 15 years, with better representation. In this study, two rounds of questionnaires were more than 86% recovery rate shows that the experts on the survey of enthusiasm and participation are very high. Delphi method used familiarity with experts and key indicators to evaluate the judge based on the authority of an expert level, this study showed that an expert consultation on the authority of the indicators coefficients were 0.86, the expert forecast is based on practical experience and theoretical basis, the authority of a higher degree, with high credibility. Survey the views of the experts are more consistent, coordinated coefficient W to 0.22, and significant to meet the requirements of the subject, the final results desirable.3.Preoperative interview mode of implementation of the new EvaluationTwo groups on the operation of satisfaction, the difference was statistically significant (p<0.05), the experimental group than the control group, indicating the experimental group patients on operating room nursing job satisfaction higher. Evaluation of two groups of patients with scores of psychological care, the difference was statistically significant (p<0.05), the experimental group than the control group, indicating the experimental group preoperative visit by the surgical care for patients with psychological effects than the control group.ConclusionThis issue through consultation of 23 senior experts built the operating room nursing preoperative visit a new model of work content and work before the visit was the implementation of the new model Evaluation.1.Initially established mode of preoperative visits related contentMeet the standards established 30 indicators to build working models of preoperative visit the five parts:Before the implementation of those visits, the time of preoperative visit, the contents of the preoperative visit, the way the preoperative visit the preoperative visit of the object, the initial construction of the preoperative visit of a New Model. Positive coefficient of expert advice and authoritative coefficient, coefficient of variation coefficient and coordination of consultants showed high representation and credibility.2.New work mode features of the preoperative interviewThis study is the preoperative visit model is a standardized, procedures, and easy to operate the nursing model, with certain conditions by a full-time nurses, full-time nurses required standard under the new model the contents of the preoperative visit and Methods Patients implementation of the preoperative visit, to ensure that the effect of preoperative interview.3.Preoperative interview new work model was applied to evaluate the effect of surgical patientsCode of practice through the establishment of full-time nurse in the preoperative visit can effectively relieve preoperative anxiety; reduce blood pressure, heart rate and other physiological stress response, so blood pressure, heart rate more stable, better meet the psychological needs of surgical patients to improve preoperative visit results.4.Preoperative interview to establish the significance of the new work patternThe establishment of a new preoperative interview mode of operation by a full-time nurse for patients with standard and specialized preoperative visit, to a greater extent to meet the psychological needs of patients with surgery, so patients feel themselves respected by a great extent increase. It makes nursing procedures, and significantly reduces the difficulty of nurses, can significantly improve the quality of nursing work, and further embodies the "patient-centered" purpose. Preoperative interview new work patterns, full-time nurse preoperative interview raised higher requirements to require full-time nurses in preoperative interview with good communication skills, and extensive experience in clinical nursing practice, full-time preoperative visit invisible in the selection of nurses to our operating room nurses also provide a good development platform, can fully arouse the curiosity nurses, help to improve the overall quality of nursing itself. Full-time nurses through access to a large number of documents, consulting medical experts, etc., greatly enhanced the ability of comprehensive analysis is conducive to the accumulation in the work of the preoperative visit on the experience of psychological care, preoperative visits by patients and family members working full recognition of, thereby increasing self-confidence and enthusiasm, will carry out the work of preoperative visits may be more solid and effective.