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Purpose The aim of this study was to compare Anxiety Specific to Surgery Questionnaire (ASSQ) with Spielberger State-Trait Anxiety Inventory (STAI) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the assessment of preoperative anxiety level and to evaluate the fears associated with surgery and anesthesia in surgical patients. Design This is descriptive, correlational, and cross-sectional study. Method The study sample included 507 surgical patients in four surgery wards who underwent elective surgery. All the data were collected using The Descriptive Characteristics and Clinical Information Form, STAI, APAIS and ASSQ. Findings A majority (70.8%) of the participants had fears associated with surgery and anesthesia and nearly half of them had a moderate level of preoperative anxiety. Anxiety prevalence was 46.4% according to the APAIS, 44.4% according to STAI and 49.3% according to ASSQ. Women, participants with no primary school education, participants undergoing major surgery and general anesthesia who did not have knowledge about the surgical procedure, and surgical complications had higher anxiety according to three scale scores. Conclusion Nearly half of the participants had moderate/high preoperative anxiety, there were consistent results among the scales and the tools were interchangeable to evaluate the preoperative anxiety level in the surgical patients.

Background Ambulatory surgery presents unique challenges regarding adequate pain management and education. Studies have documented issues with transfer of information and patient comfort. Our objective was to explore perioperative nurses’ perspectives of current practices and challenges with pain management and education. Materials and methods We used a qualitative descriptive design and conducted four focus group interviews, with 24 total participants from two perioperative areas of an academic medical center, using a standardized script. Using qualitative analysis software, two investigators reviewed the data and coded major themes and subthemes. The consolidated criteria for reporting qualitative studies guidelines were followed for reporting the data. Results We identified four major themes impacting current perioperative pain management and education practices: communication among the perioperative care team, sources of nurses’ frustrations in the perioperative setting, patient expectations for pain, and nurse-driven pain management and education. Nurses highlighted their work became easier with adequate information transfer and trust from physicians. Frustrations stemmed from surgeon, system, and patient factors. Nurses often use their clinical experience and judgment in managing patients throughout the perioperative period. Furthermore, nurses felt patients have limited pain education and stressed education throughout the surgical care pathway could improve overall care. Conclusions Perioperative pain management, assessment, and education practices are inconsistent, incomplete, and sources of frustrations according to participants. Participant experiences highlight the need for improved and standardized models. Patient pain education should use a multidisciplinary approach, beginning at the point of surgery scheduling and continuing through postoperative follow-up.

Twin-to-twin transfusion syndrome (TTTS) is a condition that results in unbalanced blood flow between two fetuses. Patients diagnosed with TTTS can experience maternal or fetal morbidity and mortality. Depending on the severity of TTTS, laser ablation of placental anastomoses may be the most effective treatment. The preferred treatment method requires percutaneous entry to the uterus; however, some patient circumstances (eg, placenta location) require a laparoscopic-assisted procedure. During the preoperative appointments, clinicians assess the condition of the fetuses and patients may participate in genetic counseling. Intraoperative care involves an interdisciplinary team that may include a pediatric general surgeon, maternal-fetal medicine specialists, an RN circulator, a scrub person, and an anesthesia professional. Perioperative nurses should have knowledge of the pathophysiology of TTTS, including its natural progression. They also should understand preoperative and intraoperative patient care requirements to provide safe and effective care for patients undergoing laparoscopic-assisted fetoscopic placental laser photocoagulation procedures.

Purpose To analyze the incidence of respiratory depression (RD) in patients undergoing anesthesia using opioids in a postanesthesia care unit. Design Retrospective cohort study. Methods Quantitative approach, performed by documentary analysis of medical records in the postanesthesia care unit. Findings A total of 330 patients were included in the study, with a prevalence of female (186; 56.36%) and nonobese patients (295; 89.39%). Five cases of RD in the immediate postoperative period were found, corresponding to an incidence of 1.52%. Each case in this study showed different risk factors related to opioid-induced RD. Conclusions Nursing surveillance is essential in the decision-making process regarding the knowledge of physiological, pharmacologic, and risk factors to detect clinical signs of RD.

The objective was to evaluate the efficacy of multi‐layered silicone foam (intervention) compared with transparent polyurethane film (control) in preventing heel pressure injuries caused by surgical positioning of individuals undergoing elective surgery. It was designed an intra‐patient, open, parallel, randomised controlled trial was conducted in a university hospital in southern Brazil, from March 2019 to February 2020, with patients undergoing elective surgeries of cardiac and gastrointestinal specialties. The patients who met the selection criteria constituted, simultaneously, a single group receiving the intervention and active control, through paired analysis of the cutaneous sites (right heel and left heel). The outcome was the occurrence of PI, within the follow‐up period was 72 hours. Brazilian Registry of Clinical Trials: RBR‐5GKNG5. There was analysis of 135 patients/270 heels, with an overall incidence of 36.7%. The pressure injury incidence was significantly lower in the intervention group (26.7%), compared with the control group (P = .001); relative risk of 0.57. In the intervention group, the estimated pressure injury‐free time (survival) was 57.5 hours and in the control group, 43.9 hours. It was concluded that Multi‐layered silicone foam (intervention) is more efficacious than transparent polyurethane film (control) in the prevention of pressure injuries caused by surgical positioning of individuals undergoing elective surgery.

AORN conducted its 18th annual compensation survey for perioperative nurses in June 2020. A multiple regression model was used to examine how several variables, including job title, education level, certification, experience, and geographic region, affect perioperative nurse compensation. Comparisons between the 2020 data and data from previous years are presented. The effects of other forms of compensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on total compensation are also examined. Additional analyses explore the current state of the nursing shortage, sources of job satisfaction and dissatisfaction, and the effects of the Coronavirus Disease 2019 pandemic.

The novel coronavirus SARS‐CoV‐2 first appeared in Wuhan, China, in December 2019 and led to the Coronavirus Disease 2019 (COVID‐19), which quickly spread globally. Protocols for surgical patients with COVID‐19 were lacking, particularly for pregnant women undergoing cesarean deliveries. Perioperative nurses at Tongji Hospital in Wuhan retrospectively analyzed the perioperative nursing process, including OR preparation, intraoperative care, and OR cleanup, for women with COVID‐19 undergoing cesarean deliveries. Preparation involved altering the layout of the surgical suite, educating staff members, providing personal protective equipment, and creating new in‐house guidelines to help protect personnel and patients. This article describes how perioperative personnel strategized to prevent the transmission of COVID‐19 in the OR and presents a multiple‐case summary of six pregnant patients with COVID‐19 who underwent cesarean deliveries at Tongji Hospital in January and February 2020.

PurposePromoting patient satisfaction is crucial for healthcare quality improvement. However, literature on patient satisfaction with nursing care in Ghana is limited. The aim of this study was to assess patient satisfaction with perioperative nursing care in Korle-Bu Teaching Hospital, the largest tertiary hospital in Ghana.Design/methodology/approachThe study was a cross-sectional study. A sample of one hundred (n = 100) in-patients in the surgical department were interviewed. Statistical Package for Social Science (SPSS), version 22, was used to analyze the data. The results were presented using univariate, bivariate and multivariate analyses.FindingsIt was found that majority of the respondents were males (53%), employed (56%) and insured (85%). It was also found that eight in ten respondents were satisfied with the perioperative nursing care. Overall patient satisfaction with perioperative nursing care was significantly associated with information provision (p p p p β = 0.430, p = 0.002).Originality/valueThere is limited literature on nursing care in surgical departments and rarely are patients' views considered in assessing quality of perioperative care, especially in Low- and Middle- Income Countries (LMICs). This study is a modest contribution to the literature on patient satisfaction with perioperative nursing care in Ghana.

Background The rarity of perianesthetic catastrophic events creates a challenge in training support staff in the treatment of emergencies such as local anesthetic systemic toxicity (LAST). Simulation learning offers a unique venue in which to safely encounter rare events. Aims This study aimed to evaluate knowledge retention regarding LAST in perianesthetic nursing staff using high-fidelity simulation and a short didactic session. Design Nurses were recruited from perioperative locations to participate in a simulated scenario of LAST and engage in a short didactic session. Settings Simulation and education occurred in the high-fidelity simulation center at the University of Wisconsin Hospital. Participants/Subjects Thirteen nurses from the preoperative, post-anesthesia, and block nursing teams participated in the study. Methods Participants completed a pre-test before participating in the simulation, followed by a formal debrief and short lecture. They then completed post-tests and a short survey focused on self-efficacy and review of the simulation experience. Results Test scores, compared to the pre-test, improved significantly on the immediately-post, 1-month, and 3-month assessments. Participants felt more equipped to handle crisis scenarios. Conclusions Experiential learning often results in significant knowledge acquisition and retention. Participants in this study improved their test scores regarding LAST and increased their sense of self-efficacy and ability to handle crisis scenarios after taking part in a high-fidelity simulation.

Aim To determine whether outcomes for people with diabetes undergoing elective surgery improve following the introduction of innovations in the peri-operative care pathway. Methods Following a baseline audit of 185 people with diabetes listed for elective surgery (July to December 2017) with a length of stay > 24 hours, a number of changes in practice were implemented. These included dissemination of a 'diabetes peri-operative passport' to participants preoperatively, formation of a diabetes surgery working group, recruitment of surgical diabetes champions and the roll-out of surgical diabetes study days. Crucial was recruitment of a diabetes peri-operative nurse, whose role included engaging and educating others and supporting individuals throughout their peri-operative diabetes care. Records of 166 individuals listed for surgery during the implementation period (July to December 2018) were then audited using the same methodology. Results The availability of a recent HbA1c measurement significantly increased (63% vs 92%; P ≤ 0.001). The mean HbA1c of those seen for optimizations by the diabetes peri-operative nurse significantly decreased [84 mmol/mol (9.8%) vs 62 mmol/mol (7.8%); P ≤ 0.001]. Recurrent hypoglycaemia significantly decreased (7.0% vs 0.6%; P = 0.002) and the mean number of hyperglycaemic events in people experiencing hyperglycaemia almost halved (3.0 vs 1.7; P=0.007). The mean length of hospital stay significantly decreased (4.8 vs 3.3 days; P=0.001) and, crucially, 30-day readmissions did not increase (12% vs 9%; P=0.307). Postoperative complications significantly decreased (28% vs 16%; P=0.008), including a composite of dysglycaemic complications, poor wound healing, wound infection and other infections (12% vs 5.4%; P=0.023). Conclusion The new pathway improved important peri-operative outcomes for people with diabetes undergoing elective surgery with the potential for cost savings. These findings could have important implications for peri-operative care on a wider scale.

BackgroundNon-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate.AimTo learn what ethical issues operating room nurses perceive as important regarding non-technical skills.Research designQualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis.Participants and research contextEleven experienced perioperative/operating room nurses working in an operating unit at a Norwegian university hospital.Ethical considerationsApproval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer.FindingsThree main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety.DiscussionDefending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner.ConclusionBeing respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team.

Purpose Stress-induced hyperglycemia during the perioperative period is associated with adverse outcomes after spinal surgery, which increases both patient-related burden and hospital costs. This quality improvement project describes the development and implementation of a perioperative blood glucose monitoring protocol for patients undergoing spinal surgery. Design An evidence-based perioperative blood glucose monitoring protocol was developed by a multidisciplinary committee of specialists in endocrinology and anesthesiology with utilization of the American Diabetes Association diabetes screening criteria. Methods The protocol was implemented in the perioperative areas of a regional hospital in the Southeastern United States. The project sample included patients with and without a prior diagnosis of diabetes who met protocol inclusion criteria during a 3-month implementation period. Findings Preoperative glycated hemoglobin (HbA1c) testing identified more than 54% of previously undiagnosed patients with levels consistent with either prediabetes or diabetes according to the American Diabetes Association criteria for diagnosis. Patients with diabetes and those without diabetes experienced a perioperative increase in blood glucose with levels remaining elevated above preoperative baseline through postoperative day 1. Conclusions A perioperative blood glucose monitoring protocol enables preoperative identification of patients with undiagnosed prediabetes and diabetes, allowing for optimization before elective surgery and establishment of appropriate postoperative follow-up care. In addition, a blood glucose monitoring protocol increases the detection of perioperative hyperglycemia and may lead to a reduction in postoperative complications after spinal surgery.

Purpose: The purpose of this study was to determine the use of nonpharmacologic methods by surgical nurses for postoperative pain management and to identify the influencing professional factors. Design: A regional survey model. Methods: The sample of the study consisted of 443 surgical nurses working in regions of Turkey. The data were collected using a personal information form and questionnaire. Findings: Hot-cold application (53.3%), exercise (50.8%), positioning (68.8%), movement restriction (35.7%), resting (55.5%), and distraction (42.2%) were among the methods usually used by nurses. The nurses who were working in the Black Sea region chose the nursing profession willingly, received the training on pain management, and used nonpharmacologic methods at higher rates (P < .030, P < .004, P < .033, and P < .000, respectively). Conclusions: Gender, geographic region of work, choosing the profession willingly, and receiving training on pain management affected the nurses' rate of using nonpharmacologic methods. (C) 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved.

Objectives: To assess the actions performed by the operating room nurse during anesthesia and their behavior for patient safety regarding the reporting on adverse events, and to analyze their knowledge about anesthetic practices. Method: This is a cross-sectional study carried out using an electronic questionnaire consisting of socio-demographic, professional practice, knowledge in anesthesia, patient safety, and professional practice questions, conducted from January to March 2019 with operating room nurses. Results: One hundred nurses participated, 89 (89%) being women, with a mean age of 41.09 years (SD = 9.36), time of undergraduate completion of 14.33 years (SD = 8.34). The average attendance was 4.69 operating rooms (SD = 2.07) per nurse, with an emphasis on action before induction (49; 49%). Professionals reported performance of simultaneous activities (72; 72%) and insufficient number of employees (57; 57%) as difficulties of their daily practice. Among the participants, 77 (77%) correctly cited the periods of general anesthesia and 80.4% always reported the occurrence of an adverse event. Conclusion: Nurses identified their role in anesthesia, with limitations for assistance from multiple activities and lack of professionals. RESUMEN Objetivos: Evaluar las acciones realizadas por los enfermeros en el quirófano durante la anestesia y sus conductas para la seguridad del paciente en la notificación de eventos adversos, analizando sus conocimientos sobre prácticas anestésicas. Método: Estudio transversal realizado con un cuestionario electrónico compuesto por preguntas sociodemográficas, práctica profesional, conocimientos en anestesia, seguridad del paciente y cuestiones de ejercicio profesional, realizado de enero a marzo de 2019 con enfermeros de quirófano. Resultados: Participaron 100 enfermeros, 89 (89%) mujeres, con una edad media de 41,09 años (DE = 9,36), tiempo de formación de 14,33 años (DE = 8,34). La asistencia media fue de 4.69 quirófanos (DE = 2.07) por enfermero, con énfasis en la actuación antes de la inducción (49; 49%). Los profesionales informaron como limitación de su práctica diaria la ejecución de actividades simultáneas (72; 72%) y la insuficiencia de empleados (57; 57%). Entre los participantes, 77 (77%) citaron correctamente los períodos de anestesia general y el 80,4% siempre reportaron la ocurrencia de un evento adverso. Conclusión: Los enfermeros identificaron su papel en la anestesia, con limitaciones en la atención por múltiples actividades y falta de profesionales. RESUMO Objetivos: Avaliar as ações executadas pelo enfermeiro de centro cirúrgico durante a anestesia e suas condutas para segurança do paciente quanto à notificação de eventos adversos, analisar o seu conhecimento sobre as práticas anestésicas. Método: Estudo transversal realizado com questionário eletrônico composto por perguntas sócio-demográficas, prática profissional, conhecimento em anestesia, segurança do paciente e questões de exercício profissional, conduzido de janeiro a março de 2019 com enfermeiros de centro cirúrgico. Resultados: Participaram 100 enfermeiros, sendo 89 (89%) do sexo feminino, com média de idade de 41,09 anos (DP = 9,36), tempo de formação de 14,33 anos (DP = 8,34). A média de atendimento foi de 4,69 salas operatórias (DP = 2,07) por enfermeiro, com destaque para a atuação antes da indução (49; 49%). Os profissionais relataram como limitação de sua prática diária a execução de atividades simultâneas (72; 72%) e funcionários insuficientes (57; 57%). Entre os participantes, 77 (77%) citaram corretamente os períodos da anestesia geral e 80,4% sempre notificavam a ocorrência de um evento adverso. Conclusão: Os enfermeiros identificaram seu papel na anestesia, com limitações para assistência devido a múltiplas atividades e carência de profissionais.

Aims and objectives To compare mentholated popsicle with usual care (absolute fasting) in the change of thirst intensity and discomfort of patients in the preoperative fasting. Background Thirst is defined as the desire to drink water, and it is considered to be a multifactorial symptom. In the preoperative fasting, the patient may experience intense thirst, often for a long time, that can lead to feelings of suffocation, desperation, fear and anxiety. Design A randomised controlled trial. Methods Forty patients, aged between 18-60 years, were randomised to mentholated popsicle group or absolute fasting group (twenty in each). The primary outcomes were thirst intensity, evaluated by a numeric scale ranging from 0 (no thirst)-10 (the worst possible thirst), and discomfort from thirst (evaluated by the Perioperative Thirst Discomfort Scale), both measured twice (baseline and after 20 min of intervention). The CONSORT checklist was used to report this study. Results Mean age was similar in both groups (38 years in the mentholated popsicle group and 39 in the absolute fasting group). At baseline, the mentholated popsicle group had higher median for the scales of intensity (6.5) and discomfort (7.5) from thirst than the absolute fasting group (5.0 and 5.0, respectively). At the end of 20 min, the popsicle group had a statistically significant decrease in intensity and discomfort from thirst (median decreases of 5.0 and 7.0 points, respectively) when compared to the absolute fasting group (median increases of 0.5 and 1.0 points, respectively). Conclusions The use of mentholated popsicle decreased the intensity and discomfort from thirst, and it is a viable strategy for the management of thirst in the preoperative fasting. Relevance to clinical practice In the preoperative fasting, making mentholated popsicles available to patients is an easy strategy to manage thirst, which might lead to better care.

Describe prevalence of burnout in perianesthesia nurses, explore risks, mitigating factors.Cross-sectional descriptive.Survey containing Maslach Burnout Inventory, Short Form-12, and Social Support and Personal Coping was emailed to American Society of PeriAnesthesia Nurses. Regression analysis examined relationships between burnout and health, social support, personal coping, substance use, and demographics.Of 2,837 respondents, 18% were currently and 35% were formerly burned out, with lower incidence in those40 years. Currently burned out nurses had worse health and also perceived a lack of advancement opportunities and organizational investment in the individual. Lower burnout was associated with regular participation in physical (P.001), creative (P = .004), or mindfulness hobbies (P .001) and ease in discussing work problems with spouse or partner (P = .001).Despite burnout nurses' empathy for their patients is maintained. Interests outside of work, personal and work support, healthy work environment, and regular physical activities can improve burnout.

Nurse leaders have a responsibility to nurture a work environment that prioritizes meaningful recognition. This quality improvement project explored the perceptions of meaningful recognition of inpatient pediatric surgical nurses. Meaningful recognition provides a chance to honor all voices, particularly those that have not been previously heard. To be heard is to be honored and to be recognized is to be valued.

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.

Study Design Retrospective chart review. Objectives To investigate the effect of different surgeons, anesthesiologists, and cRNAs individually and in teams on various perioperative and operative time intervals in a large, high-volume children's hospital. Summary of Background Data Along with individual factors, studies have indicated that team factors play a role in efficiency, with larger teams leading to increased procedure times. An operating room (OR) staff dedicated to orthopedics has been reported to decrease turnover time; however, the characteristics and behaviors of surgical team members, to our knowledge, have not been analyzed as possible factors contributing to pediatric OR efficiency, and limited research has been conducted in the field of orthopedic personnel. Methods Chart review identified consecutive pediatric and adolescent patients who had primary posterior spinal fusion (PSF) of ≥7 levels for correction of spinal deformity. Time intervals and delays were recorded based on previous studies looking at OR efficiency and adjusted to the specific time points available in our perioperative nursing records. Results Adjusted for etiology, osteotomy, fusion levels, distance from hospital, staff switch, and body mass index, there was a significant difference in patient wait time among anesthesiologists, surgeon-anesthesiologist, and anesthesiologist-certified registered nurse anesthetist (cRNA) teams; in surgery prep time and total prep among surgeons and SA teams; and in surgery time and total room time among surgeons. There were no significant differences among cRNAs, individually, in any time interval. Conclusions Anesthesiologists have a significant effect before and surgeons have a significant effect after entry into the OR. Identification of this variability provides an opportunity to study the differences in habits and processes of high- and low-efficiency teams, which can then be applied to all teams with the goal of improving performance of all surgical teams. Level of Evidence Level IV, case series.

Purpose: The purpose of this study was to develop a scale to measure person-centered perioperative nursing (PCPON) and validate its psychometric properties. Methods: The preliminary items of the PCPON scale were developed through a literature review, in-depth interviews, and content validity analysis. A total of 459 nurses working in the operating rooms of 21 hospitals in Korea responded to the questionnaire from September to October 2017. The collected data were analyzed by exploratory factor analysis (EFA) and confirmative factor analysis (CFA) using SPSS and AMOS programs. Results: The final PCPON scale consists of 20 items. Through EFA, five factors, compassionate interaction, respect, providing comfort, information sharing, and nursing expertise, were derived. The internal consistency of each factor of the PCPON scale, as represented by Cronbach α, was .76–.88. The model fit of the scale was satisfactory, and the items of the scale demonstrated convergent and discriminant validity. Conclusion: The evaluation of the new PCPON scale indicated good reliability and validity. The PCPON scale is easy to administer and implies factors of person-centered care. This scale can be used to assess the person-centered care in the perioperative nursing field. Keywords: factor analysis, statistical, patient-centered care, perioperative nursing, reproducibility of results

Patients undergoing operative and other invasive procedures are at high risk for developing pressure injuries. This study aimed to determine the incidence of perioperative pressure injuries in patients who underwent procedures lasting two hours or more in Turkey and the risk factors that affect the development of pressure injuries. Data were collected during the perioperative period. The incidence of perioperative pressure injuries was 40.4%. The results of univariate logistic regression analysis showed that intraoperative vasopressor use, skin turgor, and diastolic blood pressure less than or equal to 60 mm Hg were significantly related to the development of pressure injuries. There was no significant difference between patients who developed pressure injuries and patients who did not when comparing their preoperative Braden Scale scores. Perioperative nurses should assess each patient for pressure injury risk and perform interventions to prevent pressure injuries during each stage of the patient's perioperative course.

AIMS AND OBJECTIVES: To explore the perceptions and experiences of surgical nurses before and after introducing the Medications and Oral Restrictions Policy (the Policy). BACKGROUND: The Policy was developed following extensive consultation, and evidence-based strategies were considered for its implementation. However, it is possible uptake did not meet expectations. DESIGN: Focus group interviews. METHODS: Three focus groups were conducted in November 2015 around 'what worked, what didn't and why, before and after hospital-wide implementation of the Policy.' Data were coded and analysed using an inductive-deductive thematic analysis approach. The COREQ checklist guided reporting. RESULTS: The three groups consisted of 16, 14 and six surgical nurses. Before the Policy, there was confusion, lack of clarity and guidance, and lack of experience and confidence in managing medications when patients had oral restrictions. After the Policy rollout, there was a sense of 'knowing what to do' because of improved clarity and decision support; but there were also problems with: not everyone knowing about the policy, particularly due to staff movement and turnover; and, individual interpretation of the policy including use of its signs outside of context, and decision-making processes. CONCLUSION: Exploration of nurses' perceptions of a medication-related policy change found that while the Policy provided clarity and decision support for some, it made little difference for others. Limited reach of the policy was an issue despite an effort to address this at the outset, as well as variations in interpretation of the policy and subsequent decision-making. RELEVANCE TO CLINICAL PRACTICE: How individuals interpret information and their understanding of the context behind the policy or guideline may affect implementation and should be considered alongside other barriers when implementing medication-related initiatives. Furthermore, implementation strategies that are independent of ongoing resources and/or key champions to sustain should be prioritised for all initiatives.

Intraoperative pressure injury is still a major problem of perioperative nursing. Reducing the peak interface pressure is a valid clinical intervention for reducing the incidence of intraoperative pressure injuries. However, studies of repositioning and pressure-redistributing for surgical patients are still lacking. In this context we aimed to evaluate the effect of a curvilinear supine position on incidence of pressure injury with surgical patients in a hospital setting.This was a prospective, randomized, controlled study, carried out from May to December 2016, included 104 surgical patients from a university hospital in China (experimental group, n = 52; control group, n = 52). Incidence of pressure injury, interface pressure, comfort and satisfaction scores from surgeons, anesthesiologists, OR nurses were recorded. Mann-Whitney U Chi-square test was used for difference of pressure injury's incidence and mixed linear model was used for interface pressure.Overall the intervention group had significant fewer intraoperative pressure injuries than the control group (0 patients [0%] vs. 9 patients [17.65%], p = 0.002). Compared with control group, the experimental group had significantly lower interface pressures in the sacrum and heel regions (F = 23.81, p0.001; F = 60.71, p0.001). The subjects felt comfortable in two groups were 40(80%) vs. 3(5.88%) (experimental group vs. control group), respectively (p0.001).Curvilinear supine position could significantly decrease the incidence of perioperative pressure injuries in surgical patients with surgery duration more than three hours. Considering these results, we recommend that curvilinear supine position use as effective interventions to inform perioperative care delivery, reducing perioperative pressure injuries. These findings may serve to guide the application of pressure redistribution in the surgical positioning of patients during prolonged surgery.

Purpose The purpose of this study was to measure nurses' knowledge, attitudes, and barriers regarding pain management (PM) of postoperative patients in Jordan. Design A descriptive survey research design was used. Methods This descriptive study adopted a modified version of the “Knowledge and Attitudes Survey Regarding Pain” tool, administered to 120 nurses working in surgical wards. Findings Nurses had inadequate knowledge of PM, with a mean knowledge score of 63.9%. Knowledge of PM and attitudes toward PM were associated positively with the age of the participant (P = .001), years of experience in the surgical area (P = .026), and academic degree of participants (P = .026). Conclusions Surgical nurses in this study had low knowledge levels and poor attitudes regarding PM in postoperative patients. Unless identified barriers to PM are seriously addressed, this vital aspect of holistic care will continue to be marginalized.

The primary considerations for any health care facility construction or renovation project are the design and function of the new areas, assessment of environmental risks for airborne contamination, and containment of dust and moisture created during construction activities. Disruptions created by construction inside or outside a health care facility can increase airborne organisms, such as Aspergillus, that can lead to infections; thus, infection prevention and control are integral parts of construction planning. The AORN "Guideline for design and maintenance of the surgical suite" provides guidance to perioperative team members for developing a functional program to guide the construction/renovation project, use of evidence-based design principles, measures to contain construction-related dust and debris, and maintenance of utilities after planned or emergent utility failures. Perioperative nurses should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

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.

Purpose: To examine the relationship between nurses’ knowledge, attitudes, and beliefs about medicines, in general, and complementary and alternative medicine (CAM) and identify the predictors of referrals for pain management. Method: This descriptive, correlational study utilized an online survey to collect data from direct care nurses at a large medical center in southeastern United States. The online survey consisted of the Complementary and Alternative Medicines and Beliefs Inventory (CAMBI), the Beliefs about Medicine Questionnaire, and four open-ended questions. Referral data were obtained from the Information Management Department at this medical center. Results: Among the 218 nurses who completed the survey (15.12%), majority (85%) supported CAM use, but only 32% reported utilizing CAM therapies with patients. Medical surgical, emergency department, and perioperative nurses scored higher on their CAMBI total score and were more likely to refer for CAM therapies when compared with intensive care unit nurses. Conclusions: Beliefs about CAM specifically were not related to referrals for CAM therapies. This study suggests the need for further education on the nurse’s role in CAM usage. Understanding the link between nurses’ knowledge, attitudes, and treatment beliefs and their relationship to CAM usage provides direction for future educational interventions.

Background Prelicensure nursing students seeking to enter perioperative nursing need preparatory fire safety knowledge and skills training to participate as a member of an operating room (OR) team. Purpose This pilot study examined the effectiveness of the Virtual Electrosurgery Skill Trainer (VEST) on OR fire safety skills among prelicensure nursing students. Methods An experimental pretest-posttest design was used in this study. Twenty nursing students were randomized to a control or an intervention group. Knowledge and skills acquisition of OR fire safety were assessed. Results There were no statistically significant findings in knowledge for either group. Fisher exact test demonstrated significant relationships between the skills performance criteria of following emergency procedures for a fire and demonstrating PASS (pull-aim-squeeze-sweep) technique (P = .001). Conclusions Academic and hospital educators may consider incorporating virtual reality simulation to teach fire safety education or reinforce general fire safety practices to nursing students and novice nurses.

Perioperative management of the liver transplant recipient is a team effort that requires close collaboration between intensivist, surgeon, anesthesiologist, hepatologist, nephrologist, other specialists, and hospital staff before and after surgery. Transplant viability must be reassessed regularly and particularly with each donor organ. Regular discussions with patient and family facilitate realistic determinations of goals based on patient aspirations and clinical realities. Early attention to hemodynamics with optimal resuscitation and judicious vasopressor support, respiratory care designed to minimize iatrogenic injury, and early renal support is key. Preoperative and postoperative nutritional support and physical rehabilitation should remain a focus.

Purpose This study was aimed to identify potential obstructive sleep apnea (OSA) in ambulatory surgical patients and create perianesthesia nursing protocols using a reliable and validated screening tool. Design Descriptive survey. Methods A nurse-initiated OSA survey was conducted in 1,118 preoperative ambulatory patients using the STOP-Bang Questionnaire to identify patients at risk for OSA. The findings resulted in the development of protocols, patient education, and interventions. Findings Ambulatory surgical patients were not routinely assessed for OSA before this study. The study verified that 10% of patients scheduled for ambulatory elective surgery had undiagnosed OSA and, because of the OSA identification, 16% of all scheduled surgeries were canceled. There were no unnecessary hospitalizations after the nurse-initiated OSA protocol. Conclusions The STOP-Bang Questionnaire is a useful tool for screening patients with risks of OSA in the ambulatory surgical setting. This study supports using nursing best practices and safe patient care.

Purpose To illustrate a means to calculate allostatic load in hospitalized patients using big data from the electronic medical record (EMR). Organizing construct To describe the development of the Troubled Outcome Risk (TOR) scale using signal detection in big data. Methods Using both retrospective and prospective observational studies, I describe a mechanism to determine meaning from retrospective data then use the results to improve nursing surveillance to reduce length of stay (LOS) and nursing sensitive indicators on an inpatient medical surgical unit. Findings Results from the retrospective study contained over 290,000 individual data points and established an interpretation standard for the TOR score using an algorithm to detect signals. The prospective observational study used the TOR scale and developed an interpretation standard to assist unit charge nurses in assigning staff to patients based on a fully objective measure of patient allostatic load. Conclusions The TOR scale in conjunction with existing nurse staffing methodology reduced inpatient LOS by 0.3 days, reduced allostatic load as measured by the TOR scale, and changed staffing patterns from purely geographic to patient-need based. Clinical relevance The TOR scale demonstrates that careful evidence-based criteria can be easily gathered from the EMR and used to positively impact nursing practice and patient outcomes.

This study aims to investigate the effect of applying enhanced recovery after surgery methods (ERAS) in perioperative nursing of choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of biliary calculus. Clinical data from 161 patients who underwent ERCP surgery in Wuhan Union Hospital from January 2017 to December 2019 were retrospectively analyzed. A total of 78 patients received perioperative nursing using the ERAS concept (experimental group) and 83 patients received conventional perioperative nursing (control group). Group differences were compared for the time to first postoperative ambulation, exhausting time, time to first defecation and eating, intraoperative blood loss, postoperative complication incidence (pancreatitis, cholangitis, hemorrhage), white blood cell (WBC), and serum amylase (AMS) values at 24 hours, duration of nasobiliary duct indwelling, length of hospital stay, and hospitalization expenses. No significant between-group differences were noted for demographic characteristics (age, sex, BMI, ASA score, and comorbidity) (P > .05). Time to first ambulation, exhausting time, time to defecation and eating, and nasobiliary drainage time were shorter in the experimental group than the control group, and the differences were statistically significant (P .05), but the experimental group's AMS values at 24 hours postoperation were significantly lower than those of the controls (154.93 ± 190.01 vs 241.97 ± 482.64, P = .031). Postoperative complications incidence was 9.1% in the experimental group, which was significantly lower than the 20.4% in the control group, and this difference was statistically significant (P = .039). Compared with the control group, nasobiliary drainage time (26.53 ± 7.43 hours vs 37.56 ± 9.91 hours, P

Nurses and surgeons must identify and handle specialized instruments with high temporal and spatial precision. It is crucial that they are trained effectively. Traditional training methods include supervised practices and text-based study, which may expose patients to undue risk during practice procedures and lack motor/haptic training respectively. Tablet-based simulations have been proposed to mediate some of these limitations. We implemented a learning task that simulates surgical instrumentation nomenclature encountered by novice perioperative nurses. Learning was assessed following training in three distinct conditions: tablet-based simulations, text-based study, and real-world practice. Immediately following a 30-minute training period, instrument identification was performed with comparable accuracy and response times following tablet-based versus text-based training, with both being inferior to real-world practice. Following a week without practice, response times were equivalent between real-world and tablet-based practice. While tablet-based training does not achieve equivalent results in instrument identification accuracy as real-world practice, more practice repetitions in simulated environments may help reduce performance decline. This project has established a technological framework to assess how we can implement simulated educational environments in a maximally beneficial manner.

Hysteroscopy is a gynecological procedure that may be indicated for abnormal uterine bleeding, diagnosis and management of infertility, contraception, or sterilization. Surgeons use distending media during hysteroscopy to view the uterine cavity. Media options include carbon dioxide gas and both electrolytic and nonelectrolytic fluids. All distending media is absorbed by the patient's body, but the manner in which each media is absorbed is unique to its chemical composition. Understanding the properties of each distending medium and the risks involved with its use is critical to safe perioperative nursing care for patients undergoing hysteroscopy. This article provides perioperative nurses with a review of uterine anatomy and evidence-based information on the types of distending media used during hysteroscopy and the corresponding perioperative nursing implications.

Introduction In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents Methods Over a 3-year period, all FRSTs were surveyed at one civilian center. Results Six hundred and thirteen FRST soldiers were provided surveys and 609 responded (99.3%), including 499 (81.9%) non-physicians and 110 (18.1%) physicians/physician assistants. The non-physician group included 69% male with an average age of 34 ± 11 years and consisted of 224 AR (45%) and 275 AD (55%). Rank ranged from Private to Colonel with officers accounting for 41%. For AD vs. AR, combat experience was similar: 50% vs. 52% had ≥1 combat deployment, 52% vs. 60% peri-deployment patient load was trauma-related, and 31% vs. 32% had ≥40 patient contacts during most recent deployment (all P > .15). However, medical experience differed for AD and AR: 18% vs. 29% had >15 years of experience in practice and 4% vs. 17% spent >50% of their time treating critically injured patients (all P Conclusions This is the first study of clinical practice patterns in AD vs. AR, non-physician members of Army FRSTs. In concordance with previous studies of military surgeons, FRST non-physicians seem to be lacking clinical experience as well. To maintain readiness and to provide optimal care for our injured warriors, the entire FRST, not just individuals, should embed within civilian centers.

BackgroundFailure to effectively recruit Newly Graduated Nurses (NGN) to perioperative nursing in the face of an anticipated nursing shortage will adversely impact patient outcomes. Development of interventions that address the recruitment problem is hampered by lack of a comprehensive understanding of factors that influence Student Nurse Intention (SNI) regarding perioperative nursing.PurposeThis descriptive quantitative study aims to test a Theory of Planned Behavior (TPB) questionnaire and validate factors that influence SNI.MethodQuantitative sequence of exploratory sequential design. Item analysis, and principal component analysis of data are completed.ResultsThe instrument demonstrated satisfactory psychometrics. Immediate exposure or immersion, affirmation by nurse managers, and availability of positions were the most influential attitudinal, normative, and control beliefs respectively. Generational values have some influence on intention to choose perioperative nursing.ConclusionA TPB questionnaire is useful for measuring factors that influence SNI.

Traumatic cataract is a common complication of ocular contusion. Caused by various forms of trauma, the course and prognosis of traumatic cataract are also different. Intraocular lens (IOL) implantation is the most effective treatment at the present time and can provide good visual quality and near, medium, and far vision. In this study, an adaptive medical ultrasound image denoising algorithm was constructed based on the biological vision mechanism and was applied to observe IOL implantation and postoperative care of 30 patients with traumatic cataract. Results showed that eyesight could be restored to the original healthy state after IOL implantation, and eyesight was close to normal 3 months after surgery. The corresponding noise pixel block of the noise reduction algorithm was obviously the lowest. A total of 30 patients (9 patients with contusion, 13 patients with intraocular foreign body, and 8 patients with perforation) were treated with aspheric and multifocal IOL to achieve the expected outcome. The noise reduction algorithm constructed in this study effectively reduced the speckle noise of ultrasound images, improved the clarity of ultrasound images, and achieved the effective observation of medical nursing outcome after traumatic cataract IOL implantation. After IOL implantation, the retinal nerves of patients with traumatic cataract were affected to different degrees.

Objectives: to evaluate the effectiveness of educational intervention in the knowledge and attitude of candidates for gastroplasty. Methods: randomized controlled clinical trial with 56 preoperative patients (intervention=28; control=28). The control group received routine care from the health institution and the intervention group participated in a book-mediated educational intervention. Forms were used for clinical-epidemiological characterization and evaluation of knowledge/attitude about bariatric surgery, which were reapplied seven weeks after intervention. RBR-297fzx. Results: in the pre-test there was no significant difference between the groups (p=0.254). In the post-test, the group that received verbal guidance had a mean score of 19.5 (± 6.17) and the group reading the booklet averaged 31.1 (± 2.96), p=0.000. The attitude is adequate, especially for care such as vitamin supplement intake, water intake and physical activity practice. Conclusions: the educational intervention mediated by booklet was effective in improving knowledge and attitude when compared to verbal guidance. Thus, it can be replicated during the preoperative preparation. RESUMEN Objetivos: evaluar la efectividad de la intervención educativa en el conocimiento y la actitud de los candidatos a la gastroplastia. Métodos: ensayo clínico controlado aleatorizado con 56 pacientes del preoperatorio (intervención=28; Control=28). El grupo control recibió la atención de rutina de la institución de salud y el grupo intervención participó de intervención educativa mediada por un folleto. Se utilizaron formularios para la caracterización clínico-epidemiológica y evaluación del conocimiento/actitud sobre cirugía bariátrica, que se volvieron a aplicar siete semanas después de la intervención. RBR-297fzx. Resultados: en la pre-prueba, no hubo diferencias significativas entre los grupos (p=0,254). En la prueba posterior, el grupo que recibió orientación verbal tuvo un promedio de aciertos de 19,5 (± 6,17) y el grupo que leyó el folleto tuvo un promedio de aciertos de 31,1 (± 2,96), p=0,000. La actitud es adecuada, especialmente para los cuidados como tomar el suplemento vitamínico, tomar agua y practicar actividad física. Conclusiones: la intervención educativa mediada por un folleto demostró ser efectiva para mejorar el conocimiento y mantener una actitud positiva hacia la cirugía bariátrica, en comparación con la orientación verbal. Por lo tanto, se puede replicar durante la preparación preoperatoria. RESUMO Objetivos: avaliar efetividade de intervenção educativa no conhecimento e atitude de candidatos à gastroplastia. Métodos: ensaio clínico controlado randomizado com 56 pacientes do pré-operatório (intervenção=28 e controle=28). O grupo controle recebeu cuidados de rotina da instituição de saúde e o grupo intervenção participou de intervenção educativa mediada por cartilha. Foram utilizados formulários para caracterização clínica-epidemiológica e avaliação do conhecimento/atitude sobre cirurgia bariátrica, os quais foram reaplicados sete semanas após intervenção. RBR-297fzx. Resultados: no pré-teste, não houve diferença significativa entre os grupos (p=0,254). No pós-teste, o grupo que recebeu orientação verbal teve média de acertos de 19,5 (± 6,17) e o grupo que leu a cartilha acertou, em média, 31,1 (± 2,96) p=0,000. A atitude é adequada, principalmente, para cuidados como tomada do suplemento vitamínico, ingesta hídrica e prática de atividade física. Conclusões: a intervenção educativa mediada por cartilha mostrou-se eficaz na melhoria do conhecimento e manutenção de atitude positiva em relação à cirurgia bariátrica, quando comparada à orientação verbal. Assim, pode ser replicada durante o preparo pré-operatório.

OBJECTIVE The grid-based orthogonal placement of depth electrodes (DEs), initially defined by Jean Talairach and Jean Bancaud, is known as stereo-electroencephalography (sEEG). Although acceptance in the United States was initially slow, advances in imaging and technology have spawned a proliferation of North American epilepsy centers offering sEEG. Despite publications highlighting minimal access techniques and varied indications, standard work for phase I targeted DE has not been defined. In this article, the authors propose the term “dynamic sEEG” and define standard work tools and related common data elements to promote uniformity in the field. METHODS A multidisciplinary approach from July to August 2016 resulted in the production of 4 standard work tools for dynamic sEEG using ROSA: 1) a 34-page illustrated manual depicting a detailed workflow; 2) a planning form to collocate all the phase I data; 3) a naming convention for DEs that encodes the data defining it; and 4) a reusable portable perioperative planning and documentation board. A retrospective review of sEEG case efficiency was performed comparing those using standard work tools (between July 2016 and April 2017) with historical controls (between March 2015 and June 2016). The standard work tools were then instituted at another epilepsy surgery center, and the results were recorded. RESULTS The process for dynamic sEEG was formally reviewed, including anesthesia, positioning, perioperative nursing guidelines, surgical steps, and postoperative care for the workflow using cranial fixation and ROSA-guided placement. There was a 40% improvement in time per electrode, from 44.7 ± 9.0 minutes to 26.9 ± 6.5 minutes (p = 0.0007) following the development and use of the manual, the naming convention, and the reusable portable perioperative planning and documentation board. This standardized protocol was implemented at another institution and yielded a time per electrode of 22.3 ± 4.4 minutes. CONCLUSIONS The authors propose the term dynamic sEEG for stereotactic depth electrodes placed according to phase I workup data with the intention of converting to ablation. This workflow efficiency can be optimized using the standard work tools presented. The authors also propose a novel naming convention that encodes critical data and allows portability among providers. Use of a planning form for common data elements optimizes research, and global adoption could facilitate multicenter studies correlating phase I modality and seizure onset zone identification.

Objetivo: investigar como o ambiente laboral perioperatório afeta a insatisfação laboral, a exaustão profissional e a percepção da qualidade do cuidado sobre a intenção de abandonar o trabalho, das enfermeiras perioperatórias. Método: estudo transversal com 130 enfermeiras que trabalham na área cirúrgica de um hospital universitário público espanhol de alta tecnologia. Foi utilizada a escala do ambiente da prática de enfermagem, o inventário de burnout de Maslach, as perguntas sobre a satisfação laboral, a percepção da qualidade do cuidado e a intenção de abandonar o trabalho, para a coleta de dados. Foram realizadas estatísticas descritivas, inferenciais e de regressão logística. Resultados: em geral, 20% das enfermeiras perioperatórias gostariam de abandonar o trabalho. A dimensão do ambiente laboral em relação aos investimentos em pessoal e recursos, a insatisfação e a exaustão emocional das enfermeiras foram os fatores preditores que indicaram a sua intenção de abandonar o trabalho. Conclusão: deve-se considerar implementar estratégias de retenção das enfermeiras perioperatórias, melhorando os fatores preditores que indicam, como o ambiente laboral, especialmente a dotação de pessoal e os recursos, a insatisfação e o esgotamento emocional. Criar ambientes de trabalho positivos, baseados nos valores magnéticos, pode ser uma estratégia-chave. Objetivo: investigar cómo el entorno de trabajo perioperatorio afecta la insatisfacción laboral, el agotamiento profesional y la percepción de la calidad del cuidado, sobre la intención de abandonar el trabajo de las enfermeras perioperatorias. Método: estudio transversal con 130 enfermeras que trabajan en el área quirúrgica de un hospital universitario público español de alta tecnología. Se utilizó la escala del entorno de la práctica enfermera, el inventario de agotamiento de Maslach, las preguntas sobre la satisfacción laboral, la percepción de la calidad del cuidado e intención de abandonar el trabajo para recoger datos. Se hicieron estadísticas descriptivas, inferenciales y de regresión logística. Resultados: en general, el 20% de las enfermeras perioperatorias desearían abandonar su trabajo. La dimensión del entorno de trabajo de dotación de personal y recursos, la insatisfacción y el agotamiento emocional en las enfermeras fueron factores predictores de la intención de las enfermeras perioperatorias de abandonar el trabajo. Conclusiones: Se ha de considerar implementar estrategias de retención de las enfermeras perioperatorias, mejorando los factores predictores como el entorno laboral, especialmente la dotación de personal y recursos, la insatisfacción y el agotamiento emocional. Crear entornos de trabajo positivos, basados en los valores magnéticos, puede ser una estrategia clave. Objective: to investigate how the perioperative work environment affects work dissatisfaction, professional exhaustion and the perception of the quality of care about the intention of abandoning the work of perioperative nurses. Method: cross-sectional study with 130 nurses working in the surgical area of a high-tech Spanish public university hospital. The scale of the nursing practice environment, Maslach’s exhaustion inventory, the questions about job satisfaction, the perception of the care quality and intention to abandon work to collect data were used. Descriptive, inferential and logistic regression statistics were made. Results: in general, 20% of perioperative nurses would want to quit their work. The dimension of the work environment of staff and resources, dissatisfaction and emotional exhaustion in nurses were factors that indicated the intention of perioperative nurses to abandon work. Conclusion: the implementation of strategies for the retention of perioperative nurses should be considered, improving the factors that indicate how the work environment, especially the allocation of personnel and resources, dissatisfaction and emotional exhaustion. Creating positive work environments based on magnetic values can be a key strategy.

Introduction Operating room (OR) fire can be a devastating and costly event to patients and health care providers. Prevention and effective management of such fires may present difficulties even for experienced OR staff. Methods This simulation involved a 52-year-old man presenting for excisional biopsy of a cervical lymph node to be performed under sedation. Participants were expected to identify and manage both contained and uncontained fires resulting from ignition by electrosurgical cautery. We conducted weekly multidisciplinary simulations in the mock OR at Massachusetts General Hospital. Participants included surgery and anesthesiology residents, certified registered nurse anesthetists, registered nurses, and surgical technicians. Participants were unaware of the scenario content. Each 90-minute session was divided into three parts: an orientation (10 minutes), the case with rapid cycle debriefing (65 minutes), and a final debriefing with course evaluations (15 minutes). Equipment consisted of a simulation OR with general surgery supplies, general anesthesia equipment, a high-fidelity Laerdal SimMan 3G simulator, a code cart, a defibrillator, dry ice for smoke effects, and a projector with a fire image. Results From April to June 2015, 86 participants completed this simulation. Participants reported that the simulation scenario was realistic (80%), was relevant to their clinical practice (93%), changed their practice (82%), and promoted teamwork (80%). Discussion Prevention and management of OR fire require collaboration and prompt coordination between anesthesiologists, surgeons, and nurses. This simulation case scenario was implemented to train multidisciplinary learners in the identification and crisis management of such an event.

Objective. The aim of this study was to summarize the perioperative nursing care of patients with recurrent parathyroid carcinoma. Methods. A retrospective analysis of 10 patients with recurrent parathyroid carcinoma was performed. The clinical data, diagnosis, treatment process, and nursing process (including clinical nursing intervention of various complications) were analyzed. The nursing experience and methods were discussed, summarized, and analyzed. Results. A total of 10 patients were reviewed (male : female 7 : 3; aged 48.6 ± 14.60 years). The mean interval between the initial operation and reoperation was 2.23 ± 1.65 years. The mean number of operations was 4.00 ± 1.41. Invasion of the trachea or esophagus was evident in 7 patients, larynx in 6 patients, recurrent laryngeal nerve in 1 patient, and cyclic cartilage in 2 patients. Serum calcium range was 3.20–4.68 mmol/L, and parathyroid hormone (PTH) range was 860–2830 pg/ml at admission. 6 patients underwent prophylactic tracheostomy, 2 patients underwent partial laryngectomy, and 2 patients underwent total laryngectomy. 1 patient experienced temporary water-electrolyte disorder and hypoproteinemia. The median serum calcium was 2.28 mmol/L (1.66–3.18 mmol/L) and median PTH level was 82.60 pg/ml (63.70–900.00 pg/ml) postoperatively. Serum PTH and calcium were still higher than the upper limit of normal in 2 patients after surgery. 2 of the other 8 patients relapsed within 8–11 months, and 6 patients remained normal for 11–40 months. Conclusion. For patients with reoperation of recurrent parathyroid carcinoma, high-quality, reasonable, and careful perioperative nursing ensured a successful operation and optimized outcome.

Objective: To understand the nursing team’s perception about the use of technology for safe perioperative pediatric care, through photographs. Method: A qualitative study using the theoretical framework of Nietsche Specific Nursing Technology, with a total of 18 perioperative nursing professionals from a general hospital in southern Brazil. Data collection occurred from June to August 2018, from a semi-structured interview and photograph production. They were analyzed through the Thematic Content Analysis. Approved by the Research Ethics Committee of the Federal University of Santa Catarina. Results: The Nursing Technologies category used for the safety of the pediatric patient in the perioperative period, with 250 photographs illustrating facts, situations and artifacts considered nursing technologies used in safe care. Conclusions: In the team’s perception, patient safety involves the use of technologies integrated to perioperative care and structural, physical and input aspects. RESUMEN Objetivo: Entender la percepción del equipo de Enfermería sobre el uso de la tecnología para una assistência segura en el perioperatory, por medio de la imagen. Método: Investigación cualitativa, utilizó la referencia teórica a la Tecnología de Enfermería Específica de Nietsche, con 18 profesionales de enfermería perioperatoria de un hospital general de la región sur de Brasil. La recopilación de datos se llevó a cabo de junio a agosto de 2018, a partir de una entrevista semiestructurada y la producción de imágenes. Analizado a través del Análisis de Contenido Temático. Aprobado por el Comité de Ética de la Universidad Federal de Santa Catarina. Resultados: La categoría Tecnologías de enfermería utilizadas para la seguridad del paciente pediátrico en el período perioperatory, con 250 fotografías que ilustran hechos, situaciones y artefactos considerados tecnologías de enfermería utilizadas en la atención segura. Conclusiones: Según la percepción del equipo, la seguridad del paciente implica el uso de tecnologías integradas en la atención perioperatoria y aspectos estructurales, físicos y de insumos. RESUMO Objetivo: Compreender a percepção da equipe de enfermagem quanto ao uso da tecnologia para uma assistência segura no perioperatório pediátrico, por meio da imagem. Método: Pesquisa qualitativa, utilizou o referencial teórico a Tecnologia Específica de Enfermagem de Nietsche, com 18 profissionais de enfermagem do perioperatório de um hospital geral da região sul do Brasil. A coleta de dados ocorreu de junho a agosto de 2018, a partir de entrevista semiestruturada e a produção de imagens. Analisados por meio da Análise Temática de Conteúdo. Aprovado pelo Comitê de Ética da Universidade Federal de Santa Catarina. Resultados: A categoria Tecnologias de Enfermagem utilizadas para a segurança do paciente pediátrico no perioperatório, com 250 fotografias ilustrando fatos, situações e artefatos considerados tecnologias de enfermagem usadas na assistência segura. Conclusões: Na percepção da equipe, a segurança do paciente envolve uso de tecnologias integradas à assistência perioperatória e a aspectos estruturais, físicos e de insumo.

Aim To describe reasons why nurse managers in perioperative settings decide to leave their employment. Background Current literature has shown that perioperative nurse managers’ reasons to leave their positions are formed through an interaction of factors. Methods Individual in‐depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using systematic text condensation. Results Five key themes were identified: (a) to end where I started, as a frontline nurse; (b) I wanted to develop further to the next level in my career; (c) I ran out of ideas; (d) I lost trust in my head manager and did not believe in the new organisation and (e) I had had enough of being offended by my superior manager and my employees. Conclusion Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organisation together with time for discussions. Implications in Nursing Management The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect and appreciation. Paid Open Access

Objective To explore the effect of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients treated with total hip arthroplasty (THA). Methods We enrolled 70 patients diagnosed with avascular necrosis who were treated with a THA. All patients were randomly divided into either a control or a study group. The control group received routine nursing during the perioperative period while the study group received a fast-track surgery combined with a clinical nursing pathway. Results There was no significant difference in general condition between the two groups, including the Harris hip score and the SF-36 scale of health. At the third week and the third month after the operation, the Harris hip score and the health SF-36 score of the study group increased significantly compared with the control group. In addition, the study group had a lower incidence of total complications and a shorter hospitalization time, as well as higher satisfaction scores for nursing work compared with the control group. Conclusion Fast-track surgery combined with a clinical nursing pathway can effectively improve the clinical symptoms and self-efficacy of patients undergoing THA, and improve the patients' satisfaction with hospitalization.

Aim The American Society of Anesthesiologists scale is used worldwide for the assessment of the physical status of patients proposed for anaesthesia interventions. This study aims to assess the level of agreement of the last updated American Society of Anesthesiologists classification version, with the introduction of examples for each class, and search for variables that could promote inconsistency. Methods An online questionnaire was sent to anaesthesiology specialists and residents in Portugal, describing 10 fictitious clinical cases. Sociodemographic and labour data were also correlated. Results/findings: A total of 243 anaesthesiology physicians participated. There was a high diversity in responses. Years of practice influence this diversity (P

Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees’ interpersonal skills is essential to preventing communication issues. © AORN, Inc, 2020

Made available in DSpace on 2020-12-12T02:08:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Objective: We evaluated whether educational material about hydrocephalus and its treatment previously developed by health professionals corresponded with the daily life of caregivers of children with hydrocephalus. Methods: We conducted a qualitative study at a university hospital in Brazil, interviewing 32 informal caregivers of children with hydrocephalus. The methodological framework of Bardin content analysis was used to analyze the data. Results: The educational material adequately represented caregivers' experience regarding daily life, surgery experiences, and care needed by children with hydrocephalus. In addition, the educational material may help to identify the signs and symptoms of ventriculoperitoneal shunt. However, the material did not address the limitations of children disabled with hydrocephalus in daily life. Conclusions: From the perspective of informal caregivers of children with hydrocephalus, the educational material corresponded with families' daily life and surgical experience and may be used by health professionals to reinforce important points for the care for children with hydrocephalus, facilitating the health education process. Department of Nursing Botucatu Medical School UNESP – Universidade Estadual Paulista Department of Neurology Botucatu Medical School UNESP – Universidade Estadual Paulista Department of Nursing Botucatu Medical School UNESP – Universidade Estadual Paulista Department of Neurology Botucatu Medical School UNESP – Universidade Estadual Paulista

Successful surgery depends on collaboration and mutual trust among interdisciplinary team members. We compared teamwork quality as perceived by surgeons, anesthesia care providers, and perioperative nurses using two surveys in the same hospital. The general survey sent to the homes of the OR personnel revealed teamwork climate scores in the medium to high range. Attending surgeons were significantly more satisfied than perioperative nurses and resident surgeons; anesthesiologists were significantly more satisfied than perioperative nurses. A second single-item survey administered immediately after elective open abdominal surgical procedures also showed relatively high satisfaction with teamwork. Results of the second survey, however, showed that attending surgeons were significantly less satisfied than the members of all the other professions, and perioperative nurses were significantly more satisfied than the members of all the other professions. We conclude that general surveys about teamwork quality among members of surgical teams may not necessarily reflect teamwork quality during actual surgical procedures.