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ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession/and or Patient Care Reporting Method Patient or Public Contribution The study aimed to examine factors associated with the perceived feeling of safety and postoperative recovery in patients who have undergone orthopaedic day surgery under regional anaesthesia.The design was quantitative, descriptive, and cross‐sectional. The study participants comprised a consecutive sample (n = 209) of patients who underwent orthopaedic day surgery under regional anaesthesia.A questionnaire was sent to the home addresses of the study population approximately 3 weeks postoperatively. The questionnaire included the Feeling Safe During Surgery Scale (FSS), the Swedish version of the post‐discharge surgical recovery scale (S‐PSR), and questions concerning background variables. Multivariate regression models were used to examine the association of different variables with both feeling safe and postoperative recovery.The only factor associated with the feeling of safety was preoperative anxiety; higher levels of preoperative anxiety were associated with lower levels of perceived safety during surgery. The factors associated with postoperative recovery were the recovery process itself and the patient's feeling of safety. Higher levels of postoperative anxiety were associated with a lower level of postoperative recovery. Higher levels of perceived safety during surgery were associated with higher postoperative recovery.The perceived feeling of safety in the perioperative period could not be explained by factors such as age, gender, or level of education. Based on the results of this study, postoperative recovery was associated with the perceived feeling of safety in the perioperative period. Anxiety in the perioperative period was associated with patients' perceived feeling of safety and their postoperative recovery. Thus, this study's results emphasise the importance of ensuring that people undergoing surgery feel safe to promote their recovery. Based on previous research, the nurse–patient relationship seems to be an important part of making patients feel safe, which ultimately affects their recovery.This study examines the association between perceived feeling of safety in the perioperative period and patients' postoperative recovery after undergoing orthopaedic day surgery under regional anaesthesia. Previous research has shown that the nurse–patient relationship and patients' possibilities to participate in their care are important for them to feel safe. This study further emphasises the importance of fostering relationships in the perioperative period and making patients an active part in decision‐making, as it may positively impact their recovery. Creating a feeling of safety for the patient should be prioritised, as it benefits their perioperative experience and postoperative recovery.This research is reported in accordance with the STROBE guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusions Impact Patient and Public Contribution The aim of this secondary analysis was to explore newly graduated perioperative nurses' experiences of transitioning to clinical practice to gain more in‐depth knowledge of this phenomenon.A qualitative explorative study of secondary data was used, and this study was reported following the Consolidated Criteria for Reporting Qualitative Research checklist.A secondary analysis of data collected between March 2019 and November 2020 via 16 semi‐structured interviews with newly graduated perioperative nurses. The interviews were conducted 3 to 5 months after they graduated from five different educational institutions in Norway and entered clinical practice as perioperative nurses. A three‐step phenomenological hermeneutical analysis inspired by Ricoeur's theory was applied: naïve reading, structural analysis and comprehensive understanding.We identified three themes: expectations of competence, facilitation for newly graduated perioperative nurses and the transition from being a student to a newly qualified perioperative nurse.Newly graduated perioperative nurses emphasised the critical role of supportive facilitation, manageable expectations and support from leaders and colleagues, which seemed essential for a successful transition to clinical practice.This study addresses knowledge essential for universities, universities colleges and clinical practice, specifically healthcare organisations, to understand the transition process for newly graduated perioperative nurses. This can support the establishment of improved practices to ensure patient safety via more specific education and mentoring and more accurate expectations of competence.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims Design Data Sources Results Conclusion Implications for the Profession and/or Patient Care Reporting Method Patient or Public Contribution To map the existing literature describing medical device‐related pressure injuries in patients during surgery, including investigation of the incidence, types of medical devices, risk factors and strategies for preventing medical device‐related pressure injuries.A scoping review.In April 2023, three databases were searched. Studies about adult patients undergoing surgery, from 2014 onwards, in English and Chinese were included. Data were extracted about study characteristics and data related to research questions. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework were used to synthesize findings.Two different types of evidence were included in this review; 14 research studies and two quality improvement studies. The incidence of medical device‐related pressure injuries in the operating room was 0.56%–24.5% and respiratory devices were the most common medical devices investigated. Length of surgery, age and BMI were risk factors for medical device‐related pressure injuries in a few studies. The application of a prophylactic dressing and dressing maintenance was the most common prevention strategy.Ongoing research is needed to confirm the incidence of, and risk factors for, medical device‐related pressure injuries in the operating room. Additionally, more high‐quality evidence is needed to underpin current prevention strategies.Operating room nurses need to be aware of the risks of medical device‐related pressure injuries and assess and plan prevention strategies accordingly. Once more high‐quality evidence is available, operating room nurses could implement prevention strategies like prophylactic dressings.Scoping Reviews (PRISMA‐ScR) checklist.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To identify the roles of nurse‐surgeons in the provision of surgical care. Design: Scoping review. Methods: This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA‐ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse‐surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. Results: Ninety‐six included records indicated nurse‐surgeon practice in 26 countries. Forty‐one nurse‐surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse‐surgeons varying from laparotomies to biopsies. Nine records reported that nurse‐surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse‐surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse‐surgeons were cost‐effective according to five records. Thirteen records recommended the standardization of nurse‐surgeon practice. Conclusion: Nurse‐surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse‐surgeons play in global surgical care. Research gaps on nurse‐surgeon roles were discovered including the ambiguity in nurse‐surgeon titles and the need to regulate nurse‐surgeon practice. Impact: This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse‐surgeon performed surgeries, as well as the need to standardize nurse‐surgeon practice and use a more consistent nurse‐surgeon title to ensure role identification and monitoring. [ABSTRACT FROM AUTHOR]

Aim: To develop a parsimonious, shortened version of the Perceived Perioperative Competence Scale‐Revised for perioperative nurses to complete as part of their specialty training while retaining good psychometric properties. Design: A longitudinal online survey was adopted. Methods: A national sample of perioperative nurses from Australia completed an online survey at two different time points 6 months apart between February and October 2021. Confirmatory factor analysis was conducted for item reduction and construct validity, while criterion, convergent validity and internal consistency were examined. Results: Usable data for psychometric assessment were obtained from 485 operating room nurses at time 1 and 164 nurses at time 2. The original 40‐item revised scale was reduced to an 18‐item measure, maintaining its six domains. Cronbach's alpha for the 18‐item scale was.92 at time 1 and.90 at time 2. Scale validation demonstrated moderate to weak positive relationships in perceived competence scores relative to general self‐efficacy, years of operating room experience, postgraduate education and recency of training. Conclusions: Results suggest the 18‐item Perceived Perioperative Competence Scale‐Revised Short Form has initial robust psychometric properties and may be implemented in clinical settings as part of perioperative transition‐to‐practice, orientation programs and yearly professional development reviews. Implications for the Profession: This short‐form scale can help prepare perioperative nurses to demonstrate clinical competence in a climate of increasing professional demands using a valid measure of competence required in clinical practice. Impact: Short and validated scales of perioperative competence are needed in clinical practice. Assessment of practising operating room nurses' perceived competence is essential in quality care provision, workforce planning and human resource management. This study provides an 18‐item measure of the previously validated 40‐item Perceived Perioperative Competence Scale‐Revised. This scale can help provide an option for future testing of perioperative nurses' competence in clinical or research settings. Patient or Public Contribution: Perioperative nurses were involved in the design of the study, particularly in the assessment of validation of the tools used in the study. [ABSTRACT FROM AUTHOR]

This article explores the roles of anaesthetists in positioning surgical patients. Patient positioning is crucial for surgical access and patient safety, and anaesthetists play a vital role in maintaining physiological stability during positioning. The study emphasizes the importance of teamwork and communication among the surgical team in patient positioning. Challenges include the risk of nerve injury, maintaining respiratory function, and preventing pressure-related injuries. Clear guidelines and protocols, as well as standardized checklists, are recommended to enhance patient safety. Overall, anaesthetists play a critical role in balancing surgical needs with patient safety during positioning. [Extracted from the article]

The article discusses the challenges and strategies for preventing pressure injuries in the operating room. Pressure injuries, also known as pressure ulcers or bedsores, are a significant concern in surgical settings due to their association with increased morbidity, longer hospital stays, and higher healthcare costs. Risk factors for developing pressure injuries during surgery include patient-related factors, surgical factors, and environmental factors. The knowledge and practices of healthcare professionals, as well as organizational and systemic challenges, also play a role in preventing pressure injuries. The article suggests a comprehensive approach that includes risk assessment, the use of support surfaces and positioning techniques, education and training, and a multidisciplinary approach and collaboration among healthcare professionals. By implementing these strategies, healthcare facilities can significantly reduce the incidence of pressure injuries and improve patient outcomes. Continued research and innovation in this field are necessary to further enhance prevention efforts and the quality of care provided to surgical patients. [Extracted from the article]

The article titled "Commentary on 'Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: A cohort study'" discusses the impact of patient states during the perioperative period on Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnostic of 'risk for perioperative positioning injury'. The study highlights the importance of surgical position in ensuring safe and effective operative operations, while also acknowledging the dangers associated with patient positioning on the operating table. The article emphasizes the need for accurate risk identification and appropriate preventive measures to address pressure injuries resulting from surgical placement. However, further research is required to make these findings applicable in a broader context. [Extracted from the article]

The article is a commentary on a qualitative study conducted by Leppänen et al. on nurses' and nurse managers' perceptions of sustainable development in perioperative work. The study found that although nurses and nurse managers are aware of ecological and economic sustainability, they do not actively incorporate it into their jobs. The article highlights the importance of the United Nations' Sustainable Development Goals (SDGs) and how nurses and midwives can contribute to achieving these goals. It also emphasizes the need for partnerships and comprehensive care plans to promote sustainable development in healthcare. However, the study has limitations in terms of its sample size and potential bias. Further research is needed to fully investigate the impact of sustainable development in operating rooms. [Extracted from the article]

Aim: To understand how the COVID‐19 pandemic impacted nurse educators' and novice nurses' experience with the perioperative transition to specialty practice program. Design: A qualitative descriptive study. Methods: Semi‐structured interviews were conducted with five perioperative nurse educators and five perioperative transition to specialty practice program participants from a major metropolitan health service in Melbourne. Data were collected between April and July 2021. Interviews were audio‐recorded and transcribed verbatim, and data were analysed using reflexive thematic analysis. Results: Five themes were identified. The value of the perioperative transition to specialty practice program in supporting novice nurses was recognized in the theme 'Nurturing our novices'. Widespread changes to clinical practice were demonstrated in the theme 'Every day is different', including changes to elective surgery, redeployment of staff and the transmission risk of COVID‐19. 'The perils and joys of online learning' revealed both challenges and benefits of transitioning theoretical education from face‐to‐face to online delivery. 'Roller coaster of emotions' represented the heightened emotions participants experienced due to the COVID‐19 pandemic. 'Looking back to move forward' encompassed participants' reflections on the year, considering the challenges, adaptive strategies and the future of perioperative nursing education. Conclusion: The perioperative transition to specialty practice program was significantly impacted by the COVID‐19 pandemic. Participants needed to adapt to rapid and frequent changes, which contributed to feelings of emotional distress, affected consolidation of clinical learning and reduced engagement with theoretical education. Impact Perioperative nurses should acknowledge that opportunities for learning were decreased for transition to specialty practice program participants during the pandemic. Ongoing support and education should be provided, to nurture the future generation of perioperative nurses. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study is to explore and compare the strength of associations between work‐related potential traumatic events and burnout among operating room nurses based on three different approaches. Design: The study followed a multisite cross‐sectional design. Methods: A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work‐related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis‐derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. Results: Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work‐related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work‐related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. Conclusion: Operating room nurses who reported specific or multiple work‐related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. Impact: This study is the first to focus on work‐related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health. [ABSTRACT FROM AUTHOR]

Aims: To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. Design: A cross‐sectional design. Methods: Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care‐Nurses' Attitudes (FINC‐NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. Results: Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. Conclusion: This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. Impact: Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child‐centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe how nurses and nurse managers consider sustainable development principles in their daily work, how well they recognise these principles and how these principles are considered in decision‐making in perioperative work. Background: Sustainable development involves interpersonal social and cultural relations and long‐term economic and ecological thinking in societal decision‐making. These dimensions are well‐suited for a foundation of decision‐making in acute health care. No previous research has been performed on perioperative work from the sustainable development perspective. Design: Qualitative descriptive design was used. Data were collected from perioperative nurses (n = 20) and nurse managers (n = 6) working in five surgical departments in a Finnish university hospital. Data were analysed by content analysis. The reporting follows qualitative research checklist (COREQ). Results: The principles of sustainable development were poorly known among the participants. Nurse managers considered their opportunities to influence decision‐making were reduced by their limited economic knowledge. Resource use, individuality, and ecological viewpoints were emphasised in the decision‐making process in perioperative work. Conclusions: Findings reveal that perioperative nurses and nurse managers are aware of economic and ecological sustainability, but they do not actively consider it as part of their work. Social and cultural sustainability must be developed further in decision‐making in perioperative work. Relevance to clinical practice: Perioperative nurses and nurse managers consider that it is important to develop the principles of sustainable development in perioperative work. This research indicates that economic understanding is not guiding decision‐making, and there is a lack of knowledge about the benefits of ecological procedures. Social and cultural sustainability are not connected in perioperative work, although there is collaboration between the surgical team and the patient is essential. This study helps to organise operating room management effectively and diversely. [ABSTRACT FROM AUTHOR]

Aim: To explore the postsurgical management experiences of bariatric patients after receiving telenursing follow‐up care, using a telemonitoring platform for approximately 1 month. Background: Obesity prevalence rates among adult Canadians are increasing, and as such the number of bariatric surgeries. Adapting to life following bariatric surgery is challenging, and patients are often experiencing difficulties to adhere to the postsurgical behavioural recommendations. The use of technology has been introduced in bariatric aftercare programmes, yet patients voiced a desire to communicate with a clinician between routine visits to improve continuity of care. To our knowledge, there is a lack of research on emerging practice of telenursing to provide monitoring, support and aftercare to bariatric patients remotely. Design: A qualitative descriptive design was used. Methods: A total of 22 semi‐structured interviews were thematically analysed. The SRQR checklist was used. Results: Participants embraced the idea of integrating telenursing care in bariatric aftercare programmes, as they viewed this novel approach to care as a way to overcome the current challenges of accessing bariatric services. The most salient benefit reported by participants was the timely advice and care provided by the telenurse. The provision of tailored nursing care and the accessibility to a first‐line professional empowered participants to exercise greater control over their recovery process, which promotes self‐management and enhances feelings of security and reassurance. Lastly, participants voiced areas of improvement to better the system and to render it most accessible and user‐friendly. Conclusion: Despite its novelty in bariatric aftercare, our findings indicated that patients are eager to integrate telenursing in mainstream services. Discussions are needed regarding patient adherence to telemonitoring, and the need to develop clinical follow‐up protocols. Relevance to Clinical Practice: Results provide new insights into the importance of a telenurse in providing individualised care to bariatric patients. [ABSTRACT FROM AUTHOR]

Aim: To identify the non‐technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses. Design: A three‐round modified online Delphi technique was used for this study. Methods: Eligible participants (n = 106) with a minimum of 2 years of operating room nursing experience were selected for the expert panel by self‐recruitment from a population (N = 1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds. Results: A consensus was obtained to maintain the non‐technical skills categories of situation awareness, leadership, decision‐making, communication and teamwork. The qualitative data revealed several novel non‐technical skills, including independent decision‐making and leadership skills. Conclusion: The non‐technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non‐technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared. Impact: This study addresses the lack of research on the non‐technical skills of operating room nurses. When exploring the non‐technical skills of scrub and circulating nurses, a diversity of novel non‐technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non‐technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non‐technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery‐related patient safety. [ABSTRACT FROM AUTHOR]

Aim: To compare and evaluate operating room nurses' opinions about robotic surgery with their individual innovativeness metric scores. The aim was also to identify the experiences, adaptation processes and influencing factors of operating room nurses working in robotic surgery rooms in Turkey. Design: This was a comparative descriptive study. Methods: The sample included 114 operating room nurses working in 12 institutions that performed robotic surgery in Turkey. Data were collected between January 2018 and September 2019 using the Demographic Characteristics of Nurses and Robotic Surgery Evaluation Form and the Individual Innovativeness Scale, and were analysed using a quantitative statistical approach (independent samples t‐test, one‐way analysis of variance and Kruskal–Wallis H test). The data obtained from the Robotic Surgery Evaluation section, which consisted of open‐ended and closed‐ended questions, were analysed with appropriate steps. In particular, answers to open‐ended questions were grouped and coded according to their content. Results: Operating room nurses held positive opinions about robotic surgery. Only 35.8% of the nurses had received training before joining the robotic team, while 55.2% had individually searched for information. Operating room nurses with robotic surgery experience had significantly higher (p <.001) individual innovativeness scores. Over 85% of nurses who received training adapted to robotic surgery in 3 months or less, while nurses with higher individual innovativeness scores adapted in a statistically significantly (p <.05) shorter period. Training, teamwork, and practical experience were mentioned as facilitating factors; inadequate training and technical problems were reported as obstructing factors. Conclusion: Operating room nurses hold positive opinions about robotic surgery; nurses with robotic surgery experience have higher levels of individual innovativeness; and nurses who have received training are significantly better adapted. Impact: What problem did the study address? This study addresses the need for a better understanding of operating room nurses' opinions and experiences about robotic surgery and the influencing factors of adapting to it. This study also offers an evaluation and comparison of the nurses' individual innovativeness characteristics and the correlation with their adaptation processes to the new role. What were the main findings? The main findings show a correlation between specific education/training and nurses' adaptation to the new role of robotic surgery, the individual innovativeness characteristics metric of nurses with or without robotic surgery experience and the time frame of their adaptation. Where and on whom will the research have an impact? This research traces the profile of current operating room nurses working in the robotic surgery field and the factors influencing their experience. These findings and conclusions have a much broader impact than in Turkey alone. The findings raise awareness of the importance of educating and preparing operating room nurses before introducing them to the new roles and responsibilities inherent to robotic surgery. [ABSTRACT FROM AUTHOR]

Background: Incorrect surgical counts are closely related to retained surgical items, which pose a threat to patients. However, the risk factors for incorrect surgical counts have not been identified yet. Aim: To identify the risk factors associated with incorrect surgical counts during surgery in a tertiary hospital. Design An observational case–control study. Methods: Seventy cases of incorrect surgical counts were reviewed in this study. Data were collected from January 1, 2014, to April 4, 2019. For each case, we included four randomly selected control cases involving the same surgical procedures by the same surgeon within a 6‐month period for comparison. The medical data of these cases were extracted for further statistical analysis. Results: A higher incidence of incorrect surgical counts was observed among surgical counts performed between 8:00 a.m. to 12:00 a.m., emergency operations, prolonged procedures, and/or after addition of surgical items. Conclusion: Prolonged surgical procedures, emergency operations, time of occurrence, and addition of surgical items were the risk factors related to incorrect surgical counts during surgery. Summary statement: What is already known about the topic? Incorrect surgical count is a perplexing problem during operation.Incorrect surgical count is closely associated with retained surgical items which can cause patient injury.The underlaying risk factors of incorrect surgical count were still unknown. What this paper adds? This was the first case–control study for incorrect surgical counts in China.The present research demonstrated that several risk factors were significantly associated with the occurrence of incorrect surgical counts, including the time period, the type of surgery, and the duration of the procedure.Vigilance should be maintained during an emergency operation or a long procedure to reduce the incidence of incorrect surgical counts. The implications of this paper: It is important for nurses to be aware of the factors that can interfere with correct surgical counts, thereby ensuring vigilance during emergency operations or long procedures.By identifying these risk factors, a more comprehensive safety policy in the operation room can be implemented to reduce incorrect surgical counts.Novel technological adjuncts should be promoted in the operating room gradually to improve overall patient safety. [ABSTRACT FROM AUTHOR]

Aims: To determine job stress among Chinese operating room nurses, test the mediating effect of burnout and verify the moderating effect of over‐commitment between job stress and mental health. Design: A descriptive, cross‐sectional study. Methods: A multistage sampling method was adopted. First, a random sampling method was used to select 30 tertiary hospitals in Beijing, after which 509 operating room nurses were selected by convenience sampling from March‐June 2017. Self‐administered questionnaires were used to evaluate job stress, burnout, and organizational commitment among participants. Multiple‐group path analysis was used to test the mediating effect and the moderating effect. Results: Of all nurses, 70.3% were in a state of job stress, which had negative effects on organizational commitment mediated by emotional exhaustion and depersonalization. The result of multiple‐group path analysis showed that the path coefficients are different between the low and high groups of over‐commitment. When facing job stress, operating room nurses with low over‐commitment were more likely to have emotional exhaustion (β = 0.750 vs. 0.602), while those with high over‐commitment were more likely to have low organizational commitment (β = −0.641 vs. −0.594). Conclusion: The job stress of operating room nurses in China was high. Burnout played a mediating role between job stress and organizational commitment. Over‐commitment played a moderating role in the relationship among job stress, burnout, and organizational commitment. Impact: This study analysed the relationship among operating room nurses' job stress, burnout, and organizational commitment. The findings provided confirmatory support on the mediated effect of burnout between job stress and organizational commitment and the moderation effect of over‐commitment. Different measures are needed to reduce job stress, as for easing burnout and improving organizational commitment among different groups of nurses. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore nurses' constructions of the concept of evidence‐based practice through their understandings of and experiences with evidence‐based practice in a clinical care setting. Background: The primary purpose of evidence‐based practice is high‐quality patient outcomes. However, the adoption of evidence‐based practice is described as a complex process, and research shows that evidence‐based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence‐based practice. Yet there is limited knowledge on how nurses construct the concept in practice. Design: This study has a constructivist approach and follows COREQ guidelines. Method: Ten semi‐structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach. Results: Three key constructions emerged. Understandings of evidence‐based practice were based on the original concept of evidence‐based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence‐based practice, the nurses were doing evidence‐based practice portrayed through outcomes from management‐supported nursing‐based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence‐based practice appeared and was especially evident when the nurses' primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks. Conclusion: The nurses' constructions of evidence‐based practice indicate a discrepancy between the theoretical understanding of evidence‐based practice and the practical doing of evidence‐based practice, which hinders the basis of working according to the concept. Relevance to clinical practice: Theoretical discussions of evidence‐based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence‐based medicine. [ABSTRACT FROM AUTHOR]

Aim: To explore perioperative nursing students' experiences of interprofessional simulation‐based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes. Background: Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation‐based learning. There is a need to specify how interprofessional simulation‐based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high‐quality nursing care are required. Design: The study's qualitative and explorative design is reported in accordance with the COREQ guideline. Method: Between May–October 2019, thirty‐four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation‐based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding. Results: Three themes were identified the following: customised interprofessional simulation‐based learning; reality of the experience of interprofessional simulation‐based learning; and preparedness for clinical practice. Conclusion: Customised interprofessional simulation‐based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation‐based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice. Relevance to clinical practice: The study findings contribute to the further expansion of interprofessional simulation‐based learning in perioperative nursing education as a means of developing students' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety. [ABSTRACT FROM AUTHOR]

Aims: To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures. Background: International operating room nurses are likely to form unique attitudes towards multi‐organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds. Design: Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen. Methods: A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure. Results: Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four‐colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange—"The surreality of experiencing death," Red—"Personal and professional challenges," Green—"Becoming stronger" and Purple—"My beliefs, my wishes." Conclusion: Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice. Relevance to clinical practice: Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses. Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations. [ABSTRACT FROM AUTHOR]

Background: Preoperative skin preparation is performed differently by different operating room nurses. Aim: To deepen the understanding of skin preparation within an orthopaedic surgical setting from the operating room nurse perspective and to explore their experiences. Methods: A qualitative exploratory design was used. Four focus group interviews were conducted during 2016–2017, at four hospitals in Sweden, using procedures developed by Krueger and Casey. A total of 19 operating room nurses were recruited through purposive sampling. Results: Statements were categorized into four categories of experiences: (1) Knowing, which related to learning and sources of knowledge; (2) Doing, which related to skin preparation and activities based on tradition and evidence; (3) The Team, which related to the assignment of responsibility and collaboration with patients and other professions; and (4) The Setting, which related to factors around the patient and included feelings of time pressure and access to supplies. Conclusions: Theory and practice differ, and some skin preparation used are based on tradition rather than on evidence or recommendations. Elements both within the team in the operating room and within the organization influence the result. Operating room nurses' duty to perform safe skin preparation must be respected in the team. SUMMARY STATEMENT: What is already known about this topic? Skin preparation before surgery is performed differently at different clinics and by different operating room nurses.The procedures used deviate from manufacturers' recommendations and available guidelines.Several skin preparation methods are based on traditional routines that lack scientific support. What this paper adds? Skin preparation is mostly taught and learned in a traditional manner, and a knowledge/practice gap exists.The organization, the team, the patient and the availability of supplies influence the performance and results of skin preparation.A rising demand for keeping up with productivity made operating room nurses concerned for patient safety. The implications of this paper: To provide safe care, skin preparation needs to be based on evidence.To ensure patient safety, management and head nurses must address the insufficiency of resources, the most prominent of which is insufficient time for the assessment and performance of careful skin preparation to prevent surgical site infections. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore gains and impacts of job rotation through the experiences of involved nursing personnel responsible for different parts of care during the elective orthopaedic patient's pathway. Background: When patients undergo elective orthopaedic surgery, they encounter nurses from different wards. So far, job rotation has only been described through the experiences of the job rotating nurses. This study includes all involved nursing personnel and bases the job rotation on the pathway of the elective orthopaedic patient. Design: This study has an exploratory‐descriptive and qualitative approach and follows the Consolidated Criteria for Reporting Qualitative Research guidelines. Method: A total of nine focus groups including 16 informants were conducted before, during and after a 5‐month trial period. The data were analysed using thematic analysis. Results: The findings show that existing work structures and work content combined with a lack of a common understanding of the job rotation impacted the expectations of the nursing personnel regarding (in)dependence, individual and collegial involvement and investment, as well as the collegial belongingness expressed through terminologies of "home" and "culture." The personal gains among the job rotating nurses showed increased knowledge, skills and influence. When knowledge was shared and exchanged, the job rotating nurses became "cultural translators" of the care to the elective orthopaedic patient. Conclusions: This study shows personal gains among the job rotating nurses through increased knowledge, skills and influence as well as collegial gains by sharing and exchanging knowledge. When this exchange was utilised, the job rotation was evaluated positively, and contrary, when not utilised the job rotation had a negative impact on the work environment. Relevance to clinical practice: Job rotation among nurses following the care of the patient's pathway can be a way of promoting patient safety and quality through increased knowledge across wards by including every aspect and element of the patient's pathway. [ABSTRACT FROM AUTHOR]

Aims and objectives: Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia. Background: Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice. Design: Prospective comparative design using structured observations and chart audit. Methods: A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients' clinical characteristics from patients' electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Results: In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ2: 8.93, p =.347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ2: 7.736, p =.021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ2: 8.313, p =.016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p <.05). Conclusions: Clinical variations in wound care practice are likely influenced by clinical context. Relevance to clinical practice: Using an evidence‐based approach to surgical wound management will help reduce patients' risk of wound‐related complications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic‐assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic‐assisted laparoscopic surgery (RALS). Background: The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. Design: A qualitative descriptive study. Method: Semi‐structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April–24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. Results: Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. Conclusions: The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well‐trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. Relevance to clinical practice: The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and will ultimately impact patient outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis 'Risk for perioperative positioning injury'. Background: Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. Design: Longitudinal concept validation cohort study. Methods: Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. Results: A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes—Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation—and 13 clinical indicators. Conclusions: Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at 'Risk for perioperative positioning injury' are sensitive to patient states during the perioperative period. Relevance to clinical practice: Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography. Design: A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses. Methods: A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log‐transformed dose levels and reported as geometric means and associated 95% confidence intervals. Results: It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases. Conclusion: Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure. Impact: There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation. [ABSTRACT FROM AUTHOR]

Aim: To describe operating theatre nurses' experience of preconditions for safe intraoperative nursing care and teamwork. Background: Surgical interventions are often needed for patients' well‐being and survival from health problems. Adequate information to professionals responsible within the surgical organisation is of importance for patient safety in connection to the surgery. The members in the surgical team need correct information about the patients' health and planned care. The information is mainly transferred by computerised systems that do not necessarily provide all information needed. Method: A qualitative descriptive design was chosen. Narrative interviews were carried out with 16 experienced operating theatre nurses in four different hospitals in rural and urban areas in Sweden. The data were analysed using qualitative content analysis. The study complied with criteria to Consolidated Criteria for Reporting Qualitative Research (COREQ). Result: Operating theatre nurses strived to get adequate information about the patients' care, the surgical intervention and the equipment to be well prepared for intraoperative nursing care. The information from the computerised systems was described as fragmented and obliged the operating theatre nurses to demand a preoperative dialogue between the members of the surgical team. Professional collegial teamwork and committed leadership were considered to enhance patient safety. Conclusion: From the operating theatre nurses' perspective, prerequisites for intraoperative safe nursing care and teamwork depend upon a preoperative dialogue between the members in the surgical team for collegial teamwork, obtaining a reliable preoperative overall picture based on adequate information transfer, and the support of a committed first‐line manager. Relevance to clinical practice: The operating theatre nurses need a reliable preoperative overall picture in advance, to be able to be well prepared for the patients' surgery. The overall picture should be based on adequate data about the patients' health status and needs, details about the surgical intervention and prescriptions. [ABSTRACT FROM AUTHOR]

Aims: To investigate: (a) the prevalence of overactive bladder among male and female operating room nurses; (b) the unhealthy toileting behaviours that nurses adopt to void their bladders; and (c) the mediating roles that different toileting behaviours play in the relationship between occupational stress and overactive bladder. Design: A cross‐sectional design was used. Methods: This study was conducted from July ‐ September 2016 in Jinan, China. Four hundred eligible operating room nurses in five hospitals were recruited. Data were collected through survey questionnaires including the nurse job stress scale, the toileting behaviours scale and the overactive bladder symptom score questionnaire. Multivariate linear or logistic regression models, as appropriate, were used to test the mediation effect of each toileting behaviour on the relationship between occupational stress and overactive bladder. Results: Overactive bladder was highly prevalent in both male and female nurses working in operating rooms. Approximately one of three nurses reported experiencing an overactive bladder. The most common unhealthy toileting behaviour was delayed voiding. Unhealthy toileting behaviours mediated the relationship between occupational stress and overactive bladder. With high levels of occupational stress, nurses tended to adopt unhealthy toileting behaviours to empty their bladders. The more the nurses engaged in unhealthy toileting behaviours (e.g. delayed voiding and straining to void), the greater the likelihood of having overactive bladders. Conclusions: This study highlights the mediating role of toileting behaviours on occupational stress and overactive bladder. To accommodate occupational stress, nurses engaged in unhealthy toileting behaviours that were detrimental to their bladder health. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy in patients with bladder cancer. Background: Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well‐known after prolonged surgery, especially in robot‐assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient‐related and operative risk factors. Methods: A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study‐specific questionnaire 7–10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. Results: Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7–10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. Conclusion: A large proportion of the patients report postoperative extremity symptoms after robot‐assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow‐ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. Relevance to clinical practice: This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow‐ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence‐based positioning guidelines in the operating theatre for optimal positioning. [ABSTRACT FROM AUTHOR]

Aims and objectives: (a) To explore the factors affecting quality in postoperative handovers as perceived by the different professional groups of clinicians involved. (b) To explore possible differences in perceptions of postoperative handover quality across professional groups and level of experience. Background: High quality patient handovers after surgery and anaesthesia are important to ensure patient safety. There is a paucity of research describing contextual factors related to handover quality and the perspectives of different professional groups involved. Design: A qualitative exploratory design was applied. Method: A total of eight focus group interviews with 37 participants (29 nurses, eight doctors) were conducted. Anaesthesiologists, resident anaesthesiologists, nurse anaesthetists, postoperative care nurses and operating room nurses participated in the study. The interviews were conducted according to profession with two groups per profession: one with experienced clinicians and one with less experienced clinicians. The data were analysed using thematic analysis. The study adheres to the COREQ guidelines. Results: The data analysis identified the following factors affecting postoperative handover quality: "timing and concurrency conflicts," "handover structure," "patient conditions," "individual characteristics of clinicians involved" and "team composition." Differences across professional groups and level of experience were related to responsibility, structure and adaptation. Conclusion: The professional groups involved describe the postoperative patient handover as a complex and variable process that needs to be carefully planned and executed according to the influencing factors. Variability exists across professional groups and level of experience. Relevance to clinical practice: Health care providers need to be aware that postoperative handovers are affected by a set of factors related to internal (patient conditions, individual characteristics of clinicians involved and team composition) and external (timing and concurrency conflicts, handover structure) characteristics. These issues need to be acknowledged when procedures and routines for handover quality are designed, implemented and used. [ABSTRACT FROM AUTHOR]

Background: Surgical recovery can be defined as the days required to initiate activities that maintain life, health, and well-being. Aim: The main study objective was to compare the effectiveness of telephone versus conventional follow-up in postsurgical older adult patients. Methods: This is a quasi-experimental study with random sampling. Postsurgical patients over 60 years old who had undergone gastrectomy and colectomy were selected from 2 hospitals and randomly divided into intervention group (22 patients) and control group (21 patients). Data collection was performed from January to September 2014. The differences in surgical recovery between the control and intervention groups were measured at 48 hours, 4 weeks, and 8 weeks after surgery. Results: Patients in the control group took significantly longer duration in the length of surgical recovery from the first to the second (P = .007) and to the third evaluation time points (P = .013). Patients in the intervention group had significant less impaired mobility (P = .003), need for assistance for self-care (P = .009), fatigue (P = .048), and time required for recuperation (P = .048). Conclusion: Telephone follow-up reduced the occurrence of delayed surgical recovery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To screen the factors of intraoperatively acquired pressure ulcer and establish a new risk assessment model of intraoperatively acquired pressure ulcer. Design: This is a prospective study. Methods: A total of 1,963 patients who received neurosurgery, orthopaedics, paediatric surgery and cardiac surgery therapy in Sichuan Academy of Medical Science and Provincial People's Hospital in China from October 2015–October 2016 were enrolled in the study, and their clinical parameters were collected. Multivariable logistic regression analysis and decision tree analysis were used to analyse and screen the factors of intraoperatively acquired pressure ulcer and establish the risk assessment model of intraoperatively acquired pressure ulcer. Results: The risk factors for intraoperatively acquired pressure ulcer included the application of external force during operation (β = 1.10, OR = 3.20), lean body mass (β = 1.08, OR = 2.95), time of operation ≥6 hr (β = 2.66, OR = 14.30), prone position operation (β = 1.13, OR = 3.10), cardiopulmonary bypass during operation (β = 1.72, OR = 5.59) and intraoperative blood loss (β = 0.67, OR = 1.95). The new risk assessment model showed that the AUC of ROC curve was 0.897 (p < .001). According to the maximum principle of Youden's index, the sensitivity, specificity and Youden's index J of the model were 0.81, 0.88 and 0.69, respectively, when the cut‐off point was set at π = 0.025. Conclusions: A new and relatively reliable assessment model for intraoperatively acquired pressure ulcer is established. Relevance to clinical practice: Pressure ulcers remain a challenge in clinical nursing. A new risk assessment model of pressure ulcers that is applicable to surgical patients is highly recommended. [ABSTRACT FROM AUTHOR]

Abstract: Background: Undergoing surgery is an anxious experience for children. Applying anxiety reduction age‐appropriate programs by nurses would be beneficial in reducing anxiety to children. Aim: To test the effectiveness of age‐appropriate preoperative information session in reducing anxiety levels of school‐age children undergoing elective surgery in Jordan. Design: The study used a quasi‐experimental design. Methods: One hundred and twenty‐six children were recruited from an educational hospital in Amman from January to June 2012 and were randomly assigned to intervention and control groups. The anxiety levels of children were assessed using the State Anxiety Scale for children, and children's levels of cooperation after surgery were assessed using Children Emotional Manifestation Scale. The heart rate and blood pressure of children were also measured 1 hour before going to operation room. Results: The study results revealed that children in the intervention group reported lower anxiety levels and more cooperation than children in the control group. Also, they displayed lower heart rate and blood pressure than children in the control group. Conclusion: The application of age‐appropriate preoperative intervention for children could be beneficial in decreasing anxiety levels and increasing their cooperation post surgery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. Background: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high‐quality, person‐centred care, it is important to understand how these factors affect patients' experiences and care needs. Design: A focused ethnographic approach. Method: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. Results: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high‐tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Conclusion: Patients with acute abdominal pain were cared for in the high‐tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Relevance to Clinical Practice: Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well‐being and recovery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and test a clinical tool to guide nurses’ assessment of postoperative patients for Deep Vein Thrombosis. Background: Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high‐level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. Methods: A two‐stage sequential multi‐method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. Results: Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%–94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. Conclusion: Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. Relevance to clinical practice: This study identified a possible risk to patient safety related to under‐recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate whether warming the feet with socks would prevent hypothermia among patients undergoing spinal surgery. Background: Perioperative hypothermia is a common health problem among spinal surgery patients. Research design: This study used a quasi‐experimental design. Methods: Seventy‐two patients were assigned to two groups. The control group (n = 36) received usual care without the warmed socks. The intervention group (n = 36) received usual care plus warmed socks during operation and recovery period. Data were collected during (180 min) and after the surgery (30 min) during the period of 7 February–10 April 2015. Core body temperature, shivering response and subjective thermal comfort of the two groups were compared over time using the repeated‐measures ANOVA. Results: The oesophageal temperature of the socks‐wearing group was maintained between 36.36–36.45°C during surgery (mean = 36.41 ± 0.03, 95% CI = 36.34–36.47), whereas that of the control was between 35.75–35.97°C (mean = 35.98 ± 0.03, 95% CI = 35.92–36.04). The tympanic temperature in the recovery room of the socks‐wearing group was between 36.28–36.38°C (mean = 36.37 ± 0.04, 95% CI = 36.29–36.45) and that of the control group was 35.90–36.04°C (mean = 35.95 ± 0.04, 95% CI = 35.88–36.05). Shivering response of the intervention group (mean = 0.04 ± 0.08, 95% CI = −0.13 to 0.21) was significantly lower than that of the control group (mean = 0.47 ± 0.08, 95% CI = 0.30–0.64) in the recovery room (F = 4.28, p < .001). As for subjective thermal comfort, the intervention group (mean = 4.86 ± 0.13, 95% CI = 4.62–5.13) was significantly lower than that of the control group (mean = 3.08 ± 0.13, 95% CI = 2.82–3.33) in the recovery room (F = 98.13, p < .001). As for the frequency of pethidine medication, the intervention group was significantly lower than that of the control (χ2 = 5.14, p = .023). Conclusion: The use of perioperative warmed socks for spinal surgery patients was effective in maintaining perioperative core temperature, preventing shivering and maintaining subjective thermal comfort. Relevance to clinical practice: Considering cost‐effectiveness of warmed socks, it might be worth trying option for the maintenance of core temperature in spinal surgery patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: (i) To compare knowledge and compliance with good clinical practices regarding control of postoperative pain among nurses employed at hospitals with and without a “Hospital without Pain” certificate, (ii) to identify the determinants of nurses’ knowledge and (iii) to define barriers to effective control of postoperative pain. Background: Only a slight improvement in postoperative pain control has been observed recently, if any. Implementation of good clinical practices in the control of postoperative pain requires involvement of nurses. Design: A cross‐sectional study. Methods: The study included 257 nurses from hospitals with a “Hospital without Pain” certificate and 243 nurses from noncertified hospitals, with mean job seniority of 17.6 ± 9.6 years. All respondents answered 26 questions regarding postoperative pain control‐related issues. Based on the answers, overall scores were calculated for (i) nurses’ knowledge, (ii) compliance with good clinical practices and (iii) barriers to effective control of postoperative pain. Results: Nurses from the certified hospitals presented with significantly higher levels of knowledge and compliance with good clinical practices and identified significantly more barriers to effective control of postoperative pain. Apart from certification of a hospital, better knowledge of postoperative pain control was determined by higher education, participation in postgraduate training programmes and other relevant courses, self‐education from medical journals, employment at paediatric ward or intensive care unit. The most commonly reported barriers to effective control of pain included too low doses of painkillers prescribed by physicians and inability to modify the protocol of pain treatment by the nurse. Conclusions: Control of postoperative pain can be improved by enrolling nurses in various forms of continuous training and by providing them with greater autonomy in administering painkillers to surgical patients. Relevance to clinical practice: Better quality of care offered to patients with postoperative pain can be achieved by continuous education of nurses and physicians, and greater compliance with relevant good clinical practices. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore and explain how nurses minimise risk in the perioperative setting. Background Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. Design Classic grounded theory. Methods Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. Results Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. Conclusion Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. Relevance to clinical practice This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting. [ABSTRACT FROM AUTHOR]

Aims and objectives To discuss and explore the levels of support provided to perioperative nurses when participating in multi-organ procurement surgery and the impact to their overall well-being. Background Assisting within multi-organ procurement surgical procedures has been recognised to impact on the well-being of perioperative nurses leaving little opportunity for them to recover from their participation or to seek available support resources. To date, this area has remained largely unexplored with limited evidence of how nurses manage and cope with these procedures, in addition to the support received in the workplace. Design A qualitative grounded theory method. Methods The study was informed by perioperative nurses ( n = 35) who had previous participatory experience in these surgical procedures from two Australian states. Theoretical sampling directed the collection of data via semistructured in-depth interviews. Data were analysed using the constant comparative method. Results Three components of levels of support were identified from the data: lacking support within the operating room organisation; surgical team support and access to external professional support. Conclusion These findings offer new insights into how nurses manage and cope with their participation in organ procurement surgical procedures and what types of support resources can be seen as barriers or enablers to their overall experiences. The need for timely and adequate support is vital to their overall well-being and future participation in organ procurement surgery. These findings have the potential to guide further research with implications for clinical initiatives and practices, looking at new ways of supporting perioperative nurses within the clinical environment both locally and internationally. Relevance to clinical practice Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health and well-being of nurses impacted by these surgical procedures and provide appropriate and timely clinical support within the work environment. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing. Background Person-centred care is used, but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts. Design Integrative Review. Methods A two-part search strategy was employed: first, a computerised database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004-2014, was performed, and second, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected, and an integrative review was conducted. Results Four themes were discovered: 'being recognised as a unique entity and being allowed to be the person you are', 'being considered important by having one's personal wishes taken into account', 'the presence of a perioperative nurse is calming, prevents feelings of loneliness and promotes well-being, which may speed up recovery' and 'being close to and being touched by the perioperative nurse during surgery'. Conclusions Person-centred care means respecting the patient as a unique individual, considering the patient's particularities and wishes and involving the patient in their own care. Person-centred care also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone. Relevance to clinical practice By having a common understanding of the concept of person-centred care, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient, resulting in personalisation of care rather than simply defining the concept. [ABSTRACT FROM AUTHOR]

Aims and objective To explore and present the existing knowledge of the documentation practices of perioperative nurses in the operating room. Background Studies demonstrate that the documentation of nursing care provided is important for the continuity of patient care as well as patient safety. Nurses find that documenting their perioperative services is important to the surgical pathway; however, a number of studies indicate that the documentation practices of perioperative nurses are characterised by subjectivity, randomness and poor quality. Design A literature review with a systematic search of scientific material. Method The content of the studies included was analysed using content analysis as suggested by Krippendorff. The materials were acquired by searching electronic databases. The search was performed for the period 1995-2015 and resulted in 12 studies. Results Three general themes were found to be important for perioperative nurses' documentation practices: (1) the documentation tool must be adapted to the clinical practice; (2) nurses document to improve patient safety and protect themselves legally; and (3) traditions and conditions for documentation. Conclusion Nurses considered documenting their perioperative practices very important. It was of vital importance that the tool used be adapted to the actual clinical practice and to relevant regulations regarding form and content. Nurses' subjective perceptions of and opinions on the effect of documentation influenced their documentation practices, which were widely governed by habits and traditions. Nurses document to safeguard patients against errors but also to protect their own legal status. Nurses also use documentation as proof of their nursing and as 'a window' to gain recognition for their professional practice. Relevance to clinical practice Our review demonstrates that a focus on the documentation traditions of perioperative nurses combined with training, structure and improved technical tools may facilitate the documentation and thereby improve patient safety. [ABSTRACT FROM AUTHOR]

Aims and objectives The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a preoperative nursing care structure before a surgical patient arrives to an elective procedure. Background The development of medical care has impacted surgical processes, and patients are now spending less time in hospital settings. Patients often enter the hospital on the day of a procedure and are discharged as soon as it is medically safe, creating challenges for nursing care. Preoperative clinics have been opened, and the importance of preoperative nursing care has been widely understood. Previous literature has provided descriptions about the roles, tasks and outcomes of preoperative nurses; however, the terminology is heterogeneous, and the optimal model remains unknown. Design A systematic procedure for searching, selecting, and evaluating the literature was followed. The data were collected from PubMed and CINAHL between 1 January 2004 and 20 September 2014. In total, 41 articles were included in the study and were analysed by qualitative inductive content analysis. Results The data provided seven main tasks of a preoperative nurse, tools to support preoperative nursing and outcomes of structured preoperative nursing care. Conclusion A preoperative nurse is a specialised coordinator of patient care, and the main purposes of this role are to meet the patient's and the family's needs individually and to prepare them for the scheduled procedure and postoperative recovery. By following the structure of the seven main tasks and using different supportive tools, preoperative nursing can positively impact patient and provider satisfaction, patient safety, quality of care and cost savings. Relevance to clinical practice A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore patient preference and adherence to thigh and knee length graduated compression stockings for the prevention of deep vein thrombosis in surgical patients. Background Hospitalised patients are at risk of developing deep vein thrombosis. Mechanical methods of prophylaxis include compression stockings, available as knee or thigh length. Patient adherence to correct stocking use is of critical importance to their effectiveness. Design Systematic review of quantitative evidence. Data sources Eleven databases were searched from inception to 2013 for systematic reviews of compression stockings. Reviews were screened for relevant primary studies and update searches of eight electronic sources were undertaken (2010-2014). Review methods Randomised controlled trials and observational studies of surgical patients using compression stockings were quality assessed and data were extracted on patient adherence and preference. A narrative summary is presented. Results Nine randomised controlled trials and seven observational studies were included in the systematic review. There was substantial variation between studies in terms of patient characteristics, interventions and methods of outcome assessment. Conclusion Patient adherence was generally higher with knee length than thigh length stockings. However, the studies reflect patient adherence in a hospital setting only, where patients are observed by healthcare professionals; it is likely that adherence reduces once patients have been discharged from hospital. Patients preferred knee length stockings over thigh length stockings. In many clinical settings, any difference in efficacy between thigh length and knee length stockings may be rendered irrelevant by patient preference for and likely better adherence to knee length stockings. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore and evaluate perioperative nurses' experience of organ procurement. Background Organ procurement is part of the organ donation process, and is typically performed in the perioperative setting. This experience may contribute to perioperative nurses' feelings of distress and negative attitudes towards organ donation. Design Systematic review of the literature. Method Primary research studies, published in the English language between 1990-2014 were identified, screened and appraised using Joanna Briggs Institute appraisal tools. Data extraction and analysis followed. Results The quality assessment resulted in seven qualitative and three quantitative research studies. The main findings were: (1) Perioperative nurses reported feeling emotionally distressed, challenged, lonely and physically drained throughout the entire organ procurement procedure. (2) Perioperative nurses reported finding their own unique self-coping strategies and ways of eliciting support. (3) Perioperative nurses had positive and negative attitudes towards organ donation. Conclusion Perioperative nurses reported feelings of sadness, feeling challenged and physically drained through the entire organ procurement procedure, which were influenced by differing factors in the preoperative, intraoperative and postoperative stages. It is acknowledged that personal coping strategies and support are important to help perioperative nurses improve their psychological well-being, and their experiences and attitudes towards organ procurement and donation. The meaningfulness of these findings for practice policy and research is described. Relevance to clinical practice Perioperative nurses play a vital role in the organ procurement procedure and require ongoing support to ensure their psychological welfare, in particular, newly qualified or inexperienced nurses' participating in organ procurement. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine selection and delivery of preoperative verbal information deemed important by nurses to relay to patients immediately prior to day surgery. Background Elective day-case surgery is expanding, patient turnover is high and nurse-patient contact limited. In the brief time-frame available, nurses must select and precisely deliver information to patients, provide answers to questions and gain compliance to ensure a sustained, co-ordinated patient throughput. Concise information selection is therefore necessary especially given continued day surgery expansion. Study design Electronic questionnaire. Methods A survey investigating nurses' choice of patient information prior to surgery was distributed throughout the UK via email addresses listed on the British Association of Day Surgery member's website (January 2015-April 2015). Results Participants were requested to undertake the survey within 2-3 weeks, with 137 participants completing the survey giving a 44% response rate. Verbal information deemed most important by nurses preoperatively was checking fasting time, information about procedure/operation, checking medication, ensuring presence of medical records/test results and concluding medical investigations checks. To a lesser extent was theatre environment information, procedure/operation start time and possible time to discharge. Significant differences were established between perceived importance of information and information delivery concerning the procedure/operation and anaesthesia details. Conclusion Nurses working with competing demands and frequent interruptions, prioritised patient safety information. Although providing technical details during time-limited encounters, efforts were made to individualise provision. A more formal plan of verbal information provision could help ease nurses' cognitive workload and enhance patient satisfaction. Relevance to clinical practice This study provides evidence that verbal information provided immediately prior to day surgery may vary with experience. Nurse educators and managers may need to provide greater guidance for such complex care settings as delivery of increasingly technical details during brief encounters is gaining increasing priority. [ABSTRACT FROM AUTHOR]

Aims and objectives To analyse the evidence reported in the literature concerning the surgical count process for surgical sponges, surgical instruments and sharps and to identify knowledge gaps for future research on the surgical count process. Background The surgical count process stands out among the practices advocated by the World Health Organization to ensure surgical safety. The literature indicates that this practice should be performed in all surgical processes. However, surgical items are still retained. Design Integrative review. Methods The literature search was conducted in the PubMed, CINAHL and LILACS databases and included studies on the surgical count process published in English, Spanish and Portuguese from January 2003-December 2013. Results A total of 28 primary studies were included in the sample, allowing the knowledge on the surgical count process to be summarised and grouped into three categories: risk factors for retained surgical items, how the surgical count process should be performed in the intraoperative period and the accompanying technologies that collaborate to improving the manual count process. Conclusions The correct implementation of the surgical count process by the perioperative nurse may contribute to preventing retained surgical items, thereby improving surgical patient safety. Relevance to clinical practice Nurses can use this review to assist in decision-making directed towards preparing, updating and implementing a reliable system for the surgical count process based on recent evidence because the perioperative nurse plays a key role in the implementation of this practice in health services. [ABSTRACT FROM AUTHOR]

Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires ( APS- POQ- R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race ( P = 0.038), education level ( P ≤ 0.001), previous operation status ( P = 0.032) and operation status ( P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effect of the use of a clinical nursing pathway for patients undergoing endoscopic thyroidectomy by conducting a meta-analysis. Electronic databases were searched for relevant controlled trials published prior to August 2013. Only papers that compared the use of a clinical nursing pathway to usual care for patients undergoing endoscopic thyroidectomy were selected. The outcome measures were mean difference and 95% confidence interval for length of hospital stay and hospital charges and risk ratio for patient satisfaction. Six controlled trials were identified. The use of a clinical nursing pathway reduced the length of hospital stay and hospital charges. Furthermore, it improved patient satisfaction. This meta-analysis indicates that application of a clinical nursing pathway appears to reduce length of hospital stay and hospital charges and improve patient satisfaction for patients undergoing endoscopic thyroidectomy. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to investigate the effects of mentoring on the clinical perioperative competence of nursing operating room students in Iran. Background Mentoring is an essential part of clinical education, which has been studied in different populations of students. However, there is a need to assess its effectiveness in operating room students' competence. Design A randomised controlled trial was performed. Methods Sixty nursing operating room students were randomly assigned to experimental and control groups. Both the control and experimental groups had routine training in the form of faculty supervision. The experimental group had an additional mentoring program. Using the Persian Perceived Perioperative Competence Scale-Revised, clinical competence was compared between the two groups, before and after the intervention. Using SPSS 19, descriptive and inferential statistics, including chi-square and t-tests, were conducted. Results In the experimental group, the difference between the mean scores of clinical competence before (19·43 ± 2·80) and after (27·86 ± 1·87) the intervention was significant ( p ≤ 0·001). After intervention, the difference between the mean scores of the control (3·9 ± 0·15) and experimental (8·61 ± 0·68) groups was significant ( p ≤ 0·003). Conclusion Findings affirmed the positive effect of mentorship programmes on clinical competence in nursing operating room students. Relevance to clinical practice Mentoring is an effective method for preparing nursing students in practice. Health care systems may improve as a result of staff-student relationships that ultimately increase the quality care for patients. [ABSTRACT FROM AUTHOR]