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Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps.
J Reconstr Microsurg. 2020 Jul 05 [Online ahead of print]JR

Abstract

BACKGROUND

Microsurgical free flaps require careful monitoring to detect early signs of compromise. At many hospitals, nursing staff provides the majority of postoperative monitoring of free flap patients and it lies within their responsibility to alert physicians of a failing free flap. The aim of this study is to identify knowledge gaps in the monitoring of microvascular free tissue transfer in both novice and experienced nurses and to provide appropriate education to address these gaps.

METHODS

This was a pre- and postintervention study. An initial pilot survey was administered to identify knowledge deficiencies. A nursing educational session on free flap physiology and monitoring was then designed to address these deficiencies. An 18-question multiple choice quiz was administered before and after the educational session. Pre- and post-test scores were compared based on nursing experience. At 6 months, the participating nurses completed a survey rating their confidence with free flap patient care as a result of the educational session.

RESULTS

A total of 72 nurses completed the in-service training course and quiz. The average quiz score increased from 61.9 to 89.3% after the in-service (p < 0.001). There was no correlation between precurriculum test scores and nursing experience as referenced by total number of years in the profession (r s = -0.038, p = 0.754). The follow-up survey showed that prior to the course 38% of respondents reported little or no confidence caring for free flap patients, decreasing to 6% after the course (p < 0.05).

CONCLUSION

Based on the results of this study, nursing knowledge of capillary refill, venous congestion, and basic microsurgical free flap physiology is inadequate. With implementation of a teaching in-service curriculum highlighting these key areas of deficiencies, nurses improved both their understanding and confidence levels, regardless of their level of experience.

Authors+Show Affiliations

Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada.Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada.Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada.Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada.Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada.Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada.Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32623706

Citation

Kleban, Shawna R., et al. "Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps." Journal of Reconstructive Microsurgery, 2020.
Kleban SR, Ogley SC, MacDavid JC, et al. Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps. J Reconstr Microsurg. 2020.
Kleban, S. R., Ogley, S. C., MacDavid, J. C., Goldman, J. J., Francis, A., Colombini, C. J., & Baynosa, R. C. (2020). Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps. Journal of Reconstructive Microsurgery. https://doi.org/10.1055/s-0040-1713671
Kleban SR, et al. Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps. J Reconstr Microsurg. 2020 Jul 5; PubMed PMID: 32623706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps. AU - Kleban,Shawna R, AU - Ogley,Scott C, AU - MacDavid,Joshua C, AU - Goldman,Joshua J, AU - Francis,Ashish, AU - Colombini,Cory J, AU - Baynosa,Richard C, Y1 - 2020/07/05/ PY - 2020/7/6/entrez PY - 2020/7/6/pubmed PY - 2020/7/6/medline JF - Journal of reconstructive microsurgery JO - J Reconstr Microsurg N2 - BACKGROUND: Microsurgical free flaps require careful monitoring to detect early signs of compromise. At many hospitals, nursing staff provides the majority of postoperative monitoring of free flap patients and it lies within their responsibility to alert physicians of a failing free flap. The aim of this study is to identify knowledge gaps in the monitoring of microvascular free tissue transfer in both novice and experienced nurses and to provide appropriate education to address these gaps. METHODS: This was a pre- and postintervention study. An initial pilot survey was administered to identify knowledge deficiencies. A nursing educational session on free flap physiology and monitoring was then designed to address these deficiencies. An 18-question multiple choice quiz was administered before and after the educational session. Pre- and post-test scores were compared based on nursing experience. At 6 months, the participating nurses completed a survey rating their confidence with free flap patient care as a result of the educational session. RESULTS: A total of 72 nurses completed the in-service training course and quiz. The average quiz score increased from 61.9 to 89.3% after the in-service (p < 0.001). There was no correlation between precurriculum test scores and nursing experience as referenced by total number of years in the profession (r s = -0.038, p = 0.754). The follow-up survey showed that prior to the course 38% of respondents reported little or no confidence caring for free flap patients, decreasing to 6% after the course (p < 0.05). CONCLUSION: Based on the results of this study, nursing knowledge of capillary refill, venous congestion, and basic microsurgical free flap physiology is inadequate. With implementation of a teaching in-service curriculum highlighting these key areas of deficiencies, nurses improved both their understanding and confidence levels, regardless of their level of experience. SN - 1098-8947 UR - https://www.unboundmedicine.com/medline/citation/32623706/Nursing_Monitoring_of_Microsurgical_Free_Flaps:_Identifying_and_Addressing_Knowledge_Gaps L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0040-1713671 DB - PRIME DP - Unbound Medicine ER -
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