Assessment of Nursing Deficiencies in the Postoperative Care of Microsurgical Patients

Purpose:  Ideally, all patients undergoing microvascular reconstruction should be evaluated in a dedicated unit with specialized nurses; however, this is not always possible and there is often a varied skill mix of nursing staff.  We aim to identify deficiencies in microsurgical education among nursing staff across several different hospital settings in an effort to target future educational efforts.

Methods:   A 29 question electronic survey was sent out to all nursing staff at three sampled hospitals that manage microsurgical patients.  The three hospitals sampled included one tertiary care academic institution (AMC) and two community hospitals (CMC).  T-Test and one-way ANOVA was performed to identify factors that predicted aptitude and deficiencies in the treatment of microsurgical patients.

Results:  Of the 160 registered nurses sampled, 106 completed the survey completely (66%).  Fifty-nine nurses worked at AMCs (55%) and the remaining 47 nurses worked at one of two CMCs (45%). Ninety percent of all respondents had more than one year of experience.  There was no significant difference in the proportions of intensive care nurses or experience levels between the respondents from AMCs when compared with CMCs. 

Nurses from an AMC or those with greater than 5 years of experience were significantly more comfortable with their ability to care for microsurgical patients when compared with their CMC counterparts or nurses with less than 5 years experience. (p<0.05) Furthermore, nurses from CMCs were significantly less comfortable with Doppler assessment of flaps and their ability to differentiate between different Doppler sounds than their AMC counterparts. (p<0.05) Nurses from CMCs were also significantly less comfortable with interpretation of various forms of flap monitoring including changes in capillary refill and implantable Doppler monitoring. (p<0.05)  There was no correlation with comfort level and ability to interpret various postoperative flap-monitoring technologies between intensive care unit nurses and floor nurses.

Conclusions:  We have identified that irrespective of the amount of flap patients encountered, nurses with less than 5 years experience or nurses in a community setting may be less comfortable with the care of postoperative microsurgical patients, especially if newer flap monitoring technologies are employed.  This data provides a framework to identify which providers would be best served with intensive educational efforts to mitigate costs.