Before operating room nursing journals: operating room nursing in the pages of the Canadian Nurse 1940-1960

The Canadian Nurses Association (CNA) values learning from nursing history to provide a contextual perspective in understanding how past events have shaped current nursing practice. Until the publication of operating room nursing journals, Canada's national nursing journal, The Canadian Nurse, served as an educational and professional resource for those nurses working in the operating room and for nurses whose work was related to, or connected with, the operating room. A historical review of early issues of The Canadian Nurse (first published in 1905) reveals a substantial amount of content related to operating room nursing in the twenty year period, beginning in the 1940s, that predated the existence of OR specialty journals. The content was, for the time, both detailed and informative. It was through this journal that operating room nurses, indeed all Canadian nurses, learned about new advances, employment opportunities, educational programs, professional associations, and the achievements of those in the profession. Operating Room Nursing, as an isolated and quickly emerging specialty, was introduced to other nurses via items in The Canadian Nurse journal.     

手术室护理工作环境现状及其对护士工作满意度的影响

目的：探讨手术室护理工作环境现状及其对护士工作满意度的影响。方法：采用中文版护士工作环境感知量表对天津市4所三级甲等医院的手术室护士进行问卷调查。结果：手术室护士工作环境感知各维度得分由高到低排序依次为：临床工作制度、专业实践、医护协作、护理管理、专业发展及参与决策、人力和物力。多重线性回归结果显示,社会学因素中的年资及工作环境中的人力及物力维度、专业实践维度、医护协作维度和临床工作制度维度为影响手术室护士工作满意度的主要因素（P＜0.05）。结论：手术室护士的工作环境感知水平不高,尤其是人力和物力维度的感知水平较低;工作环境感知水平会影响护士的工作满意度。医院管理者应采取针对性措施提高手术室护士对工作环境的认可度,从而提高其工作满意度。     

Nursing and patient safety in the operating room

AIM: This paper is a report of a study to identify what operating room nurses believe influences patient safety and how they see their role in enhancing patient safety. BACKGROUND: Research in health care shows that work experience, communication and the organization of work are key factors in patient safety. This study draws on Reason's definitions of active and latent errors to conceptualize the complex issues that affect patient safety in the operating room. METHOD: The study reported here is part of an action research project at a university hospital in Iceland. Semi-structured interviews were conducted in 2004 with eight nurses, followed by two focus groups of four nurses each in 2005. Data were analysed using interpretive content analysis. FINDINGS: Securing patient safety and preventing mistakes were described as key elements in operating room nursing by all survey participants. In the interviews, the nurses identified the existing culture of prevention and protection that characterizes operating room nursing as crucial in enhancing safety. The organization of work into specialty teams was considered essential. Increased speed of work in an environment where enhanced productivity is imperative, as well as imbalance in staffing, was identified as the main threats to safety. CONCLUSION: Operating room nurses have a common understanding of the core of their work, which is to ensure patient safety during operations. The work environment is increasingly characterized by latent error, i.e. system-based threats to patient safety that can materialize at any time. Interventions to enhance patient safety in operating room nursing are needed.     

Specialist nurse: an investigation of common and distinct aspects of practice

Over the past decade the discipline of nursing has been reviewing its practice, especially in relation to specialty areas. There has been an appreciation by nursing leaders that specialisation brings with it concerns related to a disuniting effect on the discipline and a fragmentation of nursing's traditional generalist practice. Accompanying these concerns is a debate over what is a specialty and how to define a specialist. This qualitative study drew upon a constructivist methodology, to explore how nurses, working in specialty areas, define and give meaning to their practice. Three groups of nurses (n=20) from the specialty of critical care were interviewed using a focus group technique. The data were analysed to build constructions of specialty practice. A distinct and qualitative difference was recognised in the practice behaviours of nurses working in the specialty area. The qualitatively different practice behaviours have been identified as 'nursing-in-a-specialty' and 'specialist nurse'. Two constructions emerged to differentiate the skill behaviours, these were 'practice' and 'knowledge'. The specialist nurse practices were based on two distinct types of practice, that of 'discretion' and 'incorporation'. 'Knowledge' was constructed as a synthesis of propositional and practice knowledge. By Carrie Fairweather and Glenn Gardner.     

手术室护理专科分组的实施与效果评价

目的：探讨手术室实施护理专科分组的方法及效果。方法：将我院手术室护士分为普外科、骨科/脑外科、妇产科、眼科4个专科组,制定护理专科组培训内容并对护士进行培训及考核,调整手术室护理工作内容,改变护理工作模式。结果：实施手术室护理专科分组后,医生及患者对手术室护理工作满意度、手术室护士的自我评价比实施前明显提高,差异有统计学意义（P〈0.05）。结论：通过实施手术室护理专科分组,提高了手术室护理工作质量,提升了患者和医生对手术室护理工作的满意度,提高了手术室护士的专科技术水平,提升了其工作满足感,体现了其自身价值。     

A global view of competency in neonatal care

Neonatal Care is one specialty within nursing as a whole where the repertoire of skills and knowledge for practice is broad. Competence in skills, an important component of today's nursing agenda, must extend to any post-basic specialty a nurse opts to work within. To become ‘qualified in specialty’ (QIS) is an aim of nurses who work within the neonatal area of practice following qualification, a term that pertains to the competencies required to learn to progress in their career in a chosen field. To be deemed clinically competent should apply to all neonatal nurses across the world caring for neonates and their families in any setting. This paper focuses on a global perspective in relation to what competency means in neonatal care. The neonatal discipline is discussed as one example within nursing to raise issues for further discussion on an international level.     

Governing time in operating rooms

Aim. This paper examines how time is controlled and governed in operating rooms through interpersonal communication between nurses and doctors. Background. Time is a valuable commodity in organizations with improvements often directed towards maximizing efficiencies. As a consequence, time can be a source of tension and interpersonal conflict as individuals compete for control of its use. Methods. The data in this paper emanate from an ethnographic study that explored a range of communication practices in operating room nursing. Participants comprised 11 operating room nurses. Data were collected over two years in three different institutional settings and involved participant observation, interviews and the keeping of a personal diary. A deconstructive analysis of the data was undertaken. Results. Results are discussed in terms of the practices, in which clinicians are engaged in, to govern and control their use of time. The four practices presented in this paper include; questioning judgment and timing, controlling speed, estimating surgeons’ use of time and coping with different perceptions of time. Conclusions. Time and speed were hotly contested by nurses. They used their personal knowledge of individual surgeon's habits of time to govern and control practice. Nurses thought about surgeons in terms of time and developed commonly accepted understandings about the length of surgical procedures. They used this knowledge to manage the scheduling of operations in the departments and to control the workflow in individual operating rooms. Knowledge of individual surgeons was a source of power for operating room nurses. Relevance to clinical practice. Nurses have more power in the operating room than might be imagined but they exercise this power in subtle ways. If operating rooms are to work effectively, the operating room team must understand each others' work better.     

Reworking professional nursing identity

In spite of professional socialization through nursing education programs, new graduates experience stress as they become working professionals. This grounded theory study explores experienced nurses' perceptions of how they became professional. The central problem for nurses was dissonance between expectations and experiences; they addressed this through an iterative, three-stage process of reworking professional identity. The stages of this process are assuming adequacy, realizing practice, and developing a reputation. Iterations of this process occur as new discrepancies are noticed, enhanced awareness dawns, practice changes, learning is undertaken, or experienced nurses become relative novices in another work area. Nurses move through stages more quickly and at different levels with each iteration. Three contextual factors influence the process: expectation; perception of the status accorded by others to nursing; and supportiveness by acceptance, assistance, and advocacy from others in the workplace. These findings expand knowledge about professional socialization and how nurses themselves understand developing professional identity.     

优化手术配合专业组轮转流程的实践及效果

目的:探讨手术配合专业组轮转流程及成效。方法:根据外科手术专科特点进行分组,实行相对固定制,每年轮转一次。各专科组设立一名组长,以护士长—组长—专科护士—专业护士—护士为各分组体系管理。实行优化手术配合专业组流畅式轮转及"一对一"手术配合方式,以理论授课、业务学习、分组训练及转组前集中训练相结合为轮转流程,采取自我评价、组长评价、外科医生评价反馈及理论考试等评价方式进行考核。结果:手术护士专科技术和手术配合技能均有所提高,从而提高了医生对手术护士的满意度。结论:通过优化手术配合专业组轮转流程的管理,缩短了轮转过程中存在的空档期,增加配合熟练度,同时使护理活动更规范,管理更科学,提高了手术室护理质量。     

手术室护士在职培训效果的评估

目的 :进一步提高手术室护理人员的业务素质、实际操作能力和护理管理水平 ,适应外科医疗技术的飞速发展需要。方法 :选取佛山市直属 4所医院的手术室护士 112名 ,其中 5 2名按在职培训计划实施培训 (实验组 ) ,其余 60名作为对照组。培训结束后进行护士自评和医生满意度调查。结果 :实施组护士在解决实际问题能力、潜力发挥、器械保养、仪器使用、手术配合到位、主动参与管理等方面明显好于对照组 (P <0 .0 5 )。结论 :在职培训是培养临床第一线高质量专业护士的有效方法     

163名手术室护士核心能力的现状调查与分析

目的了解手术室护士核心能力的现状,并探讨其影响因素。方法应用中国注册护士核心能力测评量表对163名手术室护士进行问卷调查。结果手术室护士核心能力总分为(172.38±28.94)分,伦理法律实践维度均分最高(3.29±0.57)分,评判性思维科研能力维度均分最低(2.70±0.60)分;从事手术室护理工作时间是影响手术室护士核心能力的主要因素。结论手术室护士核心能力处于中等水平,管理者应根据不同层次的护士合理安排岗位工作,有针对性地制订手术室护士核心能力培训及评价体系,以利于提高护理质量,促进手术室护士自身职业发展。     

A 'domains of practice' approach to the standards of psychiatric and mental health nursing

A'domains' of practice approach to the standards of psychiatric and mental health nursina
Standards have considerable influence on the practice of a discipline. As the written and explicit expectations of nurses held by their professional group, nursing practice standards serve as a basis for performance evaluation and as a clarification of the areas of nurses' accountability. Delineated here are the issues that the Canadian Federation of Mental Health Nurses faced as they attempted to identify and describe the nursing behaviours essential to this specialty area. A rationale for the 'domains of practice' approach is provided. The problems inherent in creating such a national document are addressed. Seven practice domains are described; the standards for two domains, the 'Helping' and the 'Effective Management of Rapidly Changing Situations', are outlined in detail.     

Newly trained operating room nurses’ experiences of nursing care in the operating room

There is limited research on nurses’ experiences of nursing care in the operating room. The operating room nurses’ responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses’ experiences of nursing care in an operating room. Semi-structured interviews were performed with ten operating room nurses with a maximum three years’ work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses’ searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses’ experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients’ well-being and working in teams for the patients’ best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.     

The lived experience of nursing advocacy

Nursing advocacy for patients is considered to be an essential component of nursing practice. This phenomenological qualitative pilot study explored registered nurses' lived experience of nursing advocacy with patients using a sample of three medical-surgical registered nurses. The guiding research questions were: (1) how do registered nurses practicing in the medical-surgical specialty area describe their experiences with nursing advocacy for their patients; and (2) what reflections on educational preparation for their professional roles do registered nurses identify as related to their practices of nursing advocacy with their patients? Data analysis procedures were based on Moustakas' data analysis method, and Lincoln and Guba's criteria were applied for rigor. The emergent themes were: speaking out and speaking for patients; being compelled to act on unmet needs of patients; fulfillment and frustration; the patient is changed; primarily learned on the job; and confidence gained through practice. The findings increase the body of knowledge surrounding nursing advocacy as practiced by nurses.     

The changing role of the nurse in neonatal care: a study of current practice in England

The boundaries of nursing in neonatal care, and the interface between the work of nursing and medical staff in delivering care, are changing The enhanced or expanding role of the neonatal nurse is not a universally accepted one If this professional development is to be widely accepted and implemented, some key issues will need to be addressed so that the changing role of the nurse and associated skill base are well founded As part of a large-scale national study of neonatal nursing in England, data were collected from nurses working in 24 different units Regional centres, subregional centres and district units from six widely separated health regions participated, and individual data were collected from 718 nurses (599 D-I grades and 119 A-C grades) While indicating that there is inter-unit variation in nursing practice, the results also show that many nurses are already in the process of changing their role in this acute specialty Nurses doing so are more likely to have a qualification in this specialty, though not all of them have A small number of nursery nurses and nursing auxiliaries were undertaking tasks that could be considered part of an expanded role The implications of the findings are discussed     

Standards of perianesthesia nursing practice: advocating patient safety.

The practice continuum of perianesthesia nursing interacts in concert with other nursing and medical professional organizations. Professional standards of care establish frameworks that guide these practitioners in the delivery of care. ASPAN is charged with the ethical responsibility of defining and promulgating minimum standards of perianesthesia nursing practice. This article discusses the various definitions and uses of standards, as well as the vital importance of using ASPAN Standards. How standards differ from position statements, laws, and regulations, and how standards advocate for patient safety and protect the nurses in their specialty practice are also discussed. In addition, case scenarios will be presented to show how the American Society of Anesthesiologists' (ASA) standards play a major role in the surgical patient's care.     

The professional self-concept of nurses: a review of the literature from 1992-2006.

OBJECTIVE: This paper will discuss some recent concerns about research in the area of the professional self-concept of nurses, and trace the development of the literature on professional self-concept of nurses over the last 14 years. PRIMARY ARGUMENT: Professional self-concept or how nurses feel about themselves as nurses is vital in examining current and future nursing practice and education, as it affects patient care. CONCLUSION: The essence of the paper is the identification of three streams of literature: (1) which has 'emerged from the development of the Professional Self-Concept of Nurses instrument'; (2) literature which fails to consider recent or current research in the area; and (3) 'well-conducted work in the topic area'. The implications for nurses, educators and students are presented.     

手术室耳鼻咽喉科护士培训方法的探讨

目的 探讨手术室耳鼻咽喉科护士系统化、规范化专科培训方法,有效提高手术配合质量.方法 在护士长指导下,由耳鼻咽喉科组长负责,对不同工作年限的护士进行系统化、规范化的专科理论、工作程序、专科技术操作和综合素质培训.结果 经过系统规范化培训,手术室耳鼻咽喉科护士的医生满意度、围术期配合及专科理论知识都有了明显提高(P:＜0.05).结论 手术室耳鼻咽喉科护士培训能提高专科手术整体配合水平,加快专科护理队伍的建设,从而提高手术室护理工作质量.     

Positioning impact on the surgical patient

The operating room is unknown territory to most health care providers. It frequently brings up thoughts of blood, strange smells, and cold temperatures. Many nursing programs have scheduled little, if any, time in this environment for students. As a result, few nurses who practice outside of this specialized area understand the patient care events that occur in the operating room. Those who have selected the operating room for their work environment know that it is a somewhat isolated period in the perioperative experience. This article provides insight into this area of patient care and a greater understanding of how patients are positioned, the physiologic impact of these positions, and some consequences that may impact the postoperative care of these patients.