https://orcid.org/0000-0003-3596-5235
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Abstract
Purpose
Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation.
Methods
This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014–19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated.
Results
From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident.
Conclusion
Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.
Abbreviations
APAIS, Amsterdam Preoperative Anxiety and Information Scale; AORN, Association of periOperative Registered Nurses; ASA, American Society of Anesthesiologists; ASPAN, American Society of PeriAnesthesia Nurses; BPU, bordered polyurethrane; CINAHL, Cumulative Index for Nursing and Allied Health Literature; CO2, carbon dioxide; CRBSI, catheter-related bloodstream infection; DBP, diastolic blood pressure; ENT, ear, nose and throat; FLACC, Faces, Legs, Activity, Cry, Consolability Scale; GSQS, Groningen’s Sleep Quality Scale; HR, heart rate; JBI, Joanna Briggs Institute; IV, intravenous; LOS, length of stay; MAP, mean arterial pressure; mYPas, modified Yale Preoperative Anxiety Scale; mYPAS-SF, modified Yale Preoperative Anxiety Scale Short Form; NHMRC, National Health and Medical Research Council; NRS, Numerical Visual Anxiety Scale; NVAAS, Numerical Visual Analog Anxiety Scale; OT, operating theatre; P6, pericardium 6; PACU, post anesthetic care unit; PCA, patient-controlled analgesia; PONV, post-operative nausea and vomiting; RCT, randomized controlled trial; RR, respiratory rate; SBP, systolic blood pressure; SSD, sutureless securement device; STAI, State-Trait Anxiety Inventory; STAIC, State-Trait Anxiety Inventory for Children; STAI-Y, State-Trait Anxiety Inventory (Form Y); STTI, Sigma Theta Tau International; TA, tissue adhesive; VAS, Visual Analog Scale; Y-PAS, Yale Preoperative Anxiety Scale.
Ethical Considerations
This review did not involve primary research and therefore ethical approval was not required. However, a potential conflict of interest relating to one of the primary review authors also being the author of one of the included randomized controlled trials was noted. In this instance, the review author was not involved with the critical appraisal of this study.
Acknowledgments
This review is one of a series of scoping reviews currently being conducted by researchers within the Acute and Critical Care research group at Queensland University of Technology (QUT). They aim to identify current nurse-led research activities in acute and critical care settings (including perioperative care) and nursing research priorities. This collaborative group includes a number of university-based researchers and clinician researchers working in acute and critical care settings to ensure that the review outcomes are clearly linked to clinical practice. Within this group, we wish to acknowledge the input of Dr Petra Lawrence for assistance in critical appraisal and data extraction.
Disclosure
A potential conflict of interest related to one of the primary review authors also being the author of one of the included randomized controlled trials was noted. However, in this instance, the review author was not involved with the critical appraisal of this study. SK reports that her employer (QUT) has received monies on her behalf from BD Medical for educational consultancies, outside the submitted work. The authors report no other possible conflicts of interest in this work.