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Background: Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. Methods: We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. Results: We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. Interpretation: Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people. [ABSTRACT FROM AUTHOR]

Background: Charting is an essential component of professional nursing practice and is arguably a key element of patient safety in surgery: without proper, objective, and timely documentation, both benign and tragical errors can occur. From surgery on wrong patients to wrong limbs, to the omission of antibiotics administration, many harms can happen in the operating room. Documentation has thus served as a safeguard for patient safety, professional responsibility, and professional accountability. In this context, we were puzzled by the practices we observed with respect to charting compliance with the surgical safety checklist (SSC) during a study of surgical teams in a large, urban teaching hospital in Canada (pseudonym 'C&C'). Methods: This article leverages institutional ethnography and a subset of data from a larger study to describe and explain the social organisation of the system that monitored surgical safety compliance at C&C from the standpoint of operating room nurses. This data included fieldnotes from observations of 51 surgical cases, on-the-spot interviews with nurses, formal interviews with individuals who were involved in the design and implementation of the SSC, and open-ended questions from two rounds of survey of OR teams. Findings: We found that the compliance form and not the SSC itself formed the basis for reporting. To meet hospital accuracy in charting goals and legislated compliance documentation reporting requirements nurses 'pre-charted' compliance with the surgical checklist. The adoption of this workaround technically violated nursing charting principles and put them in ethically untenable positions. Conclusions: Documenting compliance of the SSC constituted a moral hazard, constrained nurses' autonomy and moral agency, and obscured poor checklist adherence. The findings highlight how local and extra local texts, technologies and relations create ethical issues, raise questions about the effectiveness of resulting data for decision-making and contribute to ongoing conversations about nursing workarounds. [ABSTRACT FROM AUTHOR]

Background: Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, health care professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain management is essential to prevent the transition from acute to chronic pain after surgery. Aims: The aim of this study was to identify current pediatric surgical pain management practices and assess health system readiness for change at health care institutions conducting pediatric surgery in Canada. Methods: An online survey was completed by 85 multidisciplinary health care professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC). Results: Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and postsurgical pain care varied (38.1%-79.8% reported "yes, for every child"), with tertiary/ quaternary children's hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between health care institutions serving pediatric populations only versus those also serving adults. Health care professional experience/practice was the most reported strength in pediatric surgical pain care, with inconsistent standard of care the most common gap. Participants "somewhat agreed" that their institutions were committed and capable of change in pediatric surgical pain care. Conclusions: There is a continued need to improve pediatric pain care during the perioperative period at Canadian health care institutions to effectively prevent the development of pediatric postsurgical pain. [ABSTRACT FROM AUTHOR]

Neonatal tumors occur infrequently; sacrococcygeal teratoma (SCT) is a rare and abnormal mass often diagnosed on antenatal ultrasound. An SCT may cause serious antenatal complications, requires surgery in the neonatal period, and can lead to various long-term sequelae including fecal incontinence or constipation, urinary incontinence, and lower extremity mobility impairment. Even rarer are SCTs that include intraspinal extension necessitating complex neurosurgical intervention to relieve possible spinal cord compression or tumor tissue resection. A comprehensive understanding of the natural history of SCT provides frontline neonatal nurses and nurse practitioners with the expertise and language to support families during an infant's NICU admission. A glossary of key terms accompanied by a case review of a premature infant born with a large external SCT with intrapelvic and intraspinal components aids in enhancing knowledge related to the potential impact of an SCT on the central nervous system. [ABSTRACT FROM AUTHOR]

Definitive treatment for patients diagnosed with locally advanced cervical cancer includes chemoradiation and image-based brachytherapy. This requires significant multidisciplinary and intradepartmental coordination. Our goal was to assess and share gynecologic brachytherapy best practices from high volume brachytherapy centers within the United States and Canada. A brachytherapy best practices survey was developed using our institution's Qualtrics software. The survey was sent to 42 centers that perform a high volume of complex gynecologic brachytherapy procedures. Complex brachytherapy was defined as non-vaginal cylinder intracavitary and interstitial brachytherapy. Data was analyzed and descriptive statistics were performed using Excel. Responses were collected from 32/42 (76%) institutions. 41% of responding institutions perform >100 complex brachytherapy procedures per year, 26% perform 51-100, 29% perform 11-50 and 3% perform 1-10. 97% of surveyed centers receive 25-75% of their complex brachytherapy patients as referrals from an in-network satellite or out of network facility. External beam plan acquisition from referring institutions was viewed as important but difficult to consistently coordinate. Most departments have >1 brachytherapist performing procedures. 85% of respondents complete 1-2 complex brachytherapy procedures per day, 59% complete all their own cases and 59% perform complex brachytherapy procedures 2 days per week. The majority have specified days of the week that are devoted to brachytherapy (65%), though most respondents see patients in clinic on their procedure days (74%). 91% of departments have dedicated nurses, physicists, and other staff devoted to brachytherapy, which is pivotal for a successful program. Scheduling includes a combination of brachytherapy coordinators (33%), nursing staff (20%), department schedulers (20%), physicians (16%), and advanced practice practitioners (7%), and requires physicians to enter orders for each procedure. Respondents spend a median of 30 minutes on scheduling per week. 56% of tandem-based intracavitary procedures and 52% of interstitial hybrid procedures take place in a brachytherapy suite within a department while 50% of interstitial template procedures take place in an operating room. Surveyed institutions use MRI (35%), CT (24%) or a combination (24%) for treatment planning. 88% of respondents use sedation for tandem based procedures which include general (28%), MAC (23%), epidural/spinal (15%), oral medication (11%) and paracervical block (5%). Coordination with Anesthesiology and Gyn Onc is variably approached but an essential component of a successful program. Respondents cite high complexity of care, insufficient reimbursement, untimely referrals from external beam radiation oncologists, shared operative and clinical duties, expensive applicator acquisition and complex scheduling as the most challenging aspects of providing brachytherapy services. Conversely, respondents cite a dedicated team, a departmental brachytherapy suite, well organized coordination of procedures and personnel, anesthesia support, a full range of applicators, image-based planning near the department and supportive administration as integral components in providing high volume complex brachytherapy. Most institutions performing a high volume of complex gynecologic brachytherapy have >1 brachytherapist who perform 1-2 procedures per day and a dedicated brachytherapy space and team that assists with coordination and scheduling efforts. A well supported multidisciplinary team is vital to ensure state of the art brachytherapy which is essential in curing these challenging malignancies. [ABSTRACT FROM AUTHOR]

This article reports a qualitative study about informational and emotional needs of women who had surgery for breast cancer on an outpatient basis. Nineteen women volunteered for the study. The interviews, lasting approximately 60 minutes, were audio taped and transcribed verbatim. Data were analyzed using content analysis outlined by Hsieh and Shannon (2005). Findings are organized according to: 1) emotional and informational needs prior to and immediately after surgery; 2) emotional and informational supports while recovering at home; and 3) emotional responses to the outpatient surgery experience. Overall, women were satisfied with the experience of surgery for breast cancer on an outpatient basis, but there were several aspects that warrant closer attention, such as the amount and timing of information delivery, discharge care, and the need for consistent community nursing support and follow-up. [ABSTRACT FROM AUTHOR]

HIGGINS B.L. & MACINTOSH J. (2010) Operating room nurses' perceptions of the effects of physician-perpetrated abuse. International Nursing Review 57, 321–327 Background: Operating room (OR) nurses experience abuse perpetrated by physicians; however, little research has been conducted to examine nurses' perceptions of the effects of such abuse. Aims: The aim of this research was to understand participants' perceptions of physician-perpetrated abuse on their health and ability to provide patient care. Materials/Methods: In this qualitative descriptive study, ten operating room nurses working in Eastern Canada participated in open-ended, individual audiotaped interviews that were transcribed for analysis using Boyatzis' method for code development. Results: Three categories of factors contributing to abuse were developed. The first, culture of the OR, included environment and hierarchy. The second, catalysts of abuse, included nurses' positions and experience as well as non-nurse factors such as resources and interpersonal relationships among physicians. The third category, perceived effects, included psychological, physical and social health consequences for nurses. Effects on patient care consisted of safety and potential challenges to access. Discussion: Nursing practice implications included mentoring, support and accountability for action. Educational implications related to interdisciplinary education and increased education on communication, assertiveness, and awareness of abuse. Implications for research included studying perceptions of other health-care providers including physicians, studying recruitment and retention in relation to abuse, and studying other abuse in health care such as horizontal violence. Conclusion: We suggest a proactive approach for empowering OR nurses to address abuse and an increased focus on interdisciplinary roles. [ABSTRACT FROM AUTHOR]

Accidental IV administration of heparinized irrigation solution occurs frequently. Two cases from ISMP Canada offer some safe practice recommendations. [ABSTRACT FROM AUTHOR]

Background: Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses’ perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room. Methods: We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses’ reported perceived perioperative competence. Results: Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses’ number of years of experience in the operating room. Nurses from Sweden with 6–10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland. Conclusion: Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence. [ABSTRACT FROM AUTHOR]

A calendar of various upcoming events in 2013 is presented including 38th Annual Scientific Meeting of the New Zealand Pain Society, to be held in Claudelands Conference Centre, Hamilton, New Zealand; International Alliance for Perioperative Best Practice, The Ottawa Convention Centre Ottawa, Ontario, Canada and AORN (Australian College of Operating Room Nurses) 60th Annual Congress, San Diego, U.S.

Health Canada recommends that hospitals should have procedures in place to ensure Reusable Medical Devices (RMD) are cleaned, disinfected and sterilized according to the manufacturer's instructions. For the purpose of this paper, reusable medical devices will be referred to as RMDs and include all instrumentation and devices that the Central Processing Department (CPD) resterilizes for use in the hospital. Patient safety in surgery begins in CPD. Manufacturer recommendations for the decontamination and sterilization of surgical instrumentation are of utmost importance to Operating Room (OR) and CPD staff. With recommendations that are unclear, nonspecific or unattainable there was a need to define what it means institutionally to meet standards and provide safe patient care while continuing to support the advancement of surgical technology. The purpose of this paper is to describe the challenges faced by one multisite organization (The University Health Network) in managing the sterilization of surgical instrumentation. The development of The Guidance Matrix by the network's inter-professional Reusable Medical Device (RMD) Committee, will be discussed along with information about the elements of this tool and an illustration of how it is used. The key benefits of The Guidance Matrix, including how its use has facilitated transparent decision-making, communication and collaboration regarding sterilization issues across the sites, will be described. Sterilization processes in Central Processing Departments (CPD) include chemical indicators, dated load indicators, and tamperproof locks and filters. The lack of an indicator of sterilization can be a frustrating experience for an OR Nurse. But do we really understand the critical importance of all these indicators? The foundation of sterilizing reusable medical devices (RMDs) begins with proper processes, standards and subsequent scientific validation from the vendors. According to AORN, patient safety is vital and it begins with proper cleaning and processing of the surgical instruments. Surgical site infections can increase the length of stay and the cost of the patients' hospitalization, as well as increased risk, morbidity and even mortality. 1 Today's patients are far more informed than they were in the past. They can gather information from the internet as well as from television, radio, and print media. This knowledge empowers the patient to expect that their healthcare providers are practicing due diligence. It is the ethical duty and responsibility of nurses to provide safe, competent care while protecting the rights of the patient and being accountable to the professional governing bodies. In other words, we are advocates for both our patients and the healthcare system.2 Using both new and innovative instruments in the OR was, in the past, as simple as a surgeon requesting an instrument, the perioperative nurse ordering the instrument and CPD processing it for use in the OR. That is no longer the case. With a wide range of more complex instrumentation and an increasing focus on sterilization strategies, healthcare facilities have had to adopt a more rigorous approach. There are many challenges in the world of sterile processing. A common one, faced on a regular basis, is the provision of vague, inaccurate reprocessing recommendations from the medical device manufacturer. Canadian centres are not able to meet European standards for reprocessing. European cycles, often referred to as "Fractionated Steam Cycles", are different than the pre-vacuum steam cycles run in Canada.