Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists,nurse anesthetists and anesthesiologist assistants

Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among anesthesia care providers. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists, and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among nurse anesthetists compared to the other anesthesia care providers. Successful management of waste anesthetic gases should include scavenging systems, hazard awareness training, availability of standard procedures to minimize exposure, regular inspection of anesthesia delivery equipment for leaks, prompt attention to spills and leaks, and medical surveillance.     

Family versus individual therapy for anorexia: Impact on family conflict

This study evaluated the impact on family relations of behavioral family systems therapy (BFST) versus ego-oriented individual therapy (EOIT) as treatments for adolescents with anorexia nervosa. Twenty-two adolescents meeting DSM-III-R anorexia nervosa criteria were randomly assigned to receive approximately 16 months of either BFST or EOIT along with a common medical and dietary regimen. BFST emphasized parental control over eating, cognitive restructuring, and problem-solving communication training. EOIT emphasized building ego strength, adolescent autonomy, and insight. Measures included body mass index, self-reported general and eating-related conflict, and observed general and eating-related communication. Both treatments produced significant reductions in negative communication and parent-adolescent conflict, with some differences between conditions and between eating and non-eating related conflict measures; the improvements in eating-related conflict were maintained at a 1-year follow-up. The study demonstrated that structured therapies for adolescent anorexia do impact family relations, even when the family is never seen as a unit during the therapy. © 1995 by John Wiley & Sons, Inc.     

Nurse managers and budgeting: Professional/bureaucratic conflict?

Professional/bureaucratic conflict theory suggests that the extent to which nurse managers use management control systems will depend on whether their goal orientation is to system rather than output or derived goals. This article examines the use of budgeting as a management control strategy, in relation to the goal orientation of nurse managers, in four large teaching hospitals. The goal orientations and use of budgeting by nurse managers is also compared with those of physician managers and other sub-unit managers. The results indicate that nurse managers appear to be developing their goals of professionalization without a diminution of their organizational focus or their orientation towards providing a high standard of patient care.     

太原市三甲医院麻醉医生职业倦怠及相关因素分析

目的了解麻醉医生职业倦怠现状及职业倦怠与年龄、学历、工龄、性别的关系。方法采用马斯勒职业倦怠量表,对78名麻醉医生进行调查。结果麻醉医生的情绪衰竭和去人性化明显高于国内常模,低成就感明显低于国内常模。年龄与职业倦怠成负相关;学历高者情绪衰竭和去人性化要高于学历低者;工龄短者在情绪衰竭和去人性化要高于工龄长者。结论麻醉医生职业倦怠较严重。应重点关注学历高、工龄短的麻醉医生,以提升医疗质量,缓解医患矛盾。     

Predicting Nurses’ Turnover: The Aversive Effects of Decreased Identity,Poor Interpersonal Communication,and Learned Helplessness

Through a social identity theoretical lens, this study examines how nurses’ identification with their working small group, unit, or floor, nursing role (e.g., staff ER nurse, nurse practitioner), and nursing profession relate to nurses’ interaction involvement, willingness to confront conflict, feelings of learned helplessness, and tenure (employment turnover) intentions. A cross-sectional survey (N = 466) was conducted at a large, quaternary care hospital system. Structural equation modeling uncovered direct and indirect effects between the five primary variables. Findings demonstrate direct relationships between nurse identity (as a latent variable) and interaction involvement, willingness to confront conflict, and tenure intentions. Feelings of learned helplessness are attenuated by increased nurse identity through interaction involvement and willingness to confront conflict. In addition, willingness to confront conflict and learned helplessness mediate the relationship between interaction involvement and nurses’ tenure intentions. Theoretical extensions include indirect links between nurse identity and learned helplessness via interaction involvement and willingness to confront conflict. Implications for interpersonal communication theory development, health communication, and the nursing profession are discussed.     

Conflict and Stress in Hospital Nursing: Improving Communicative Responses to Enduring Professional Challenges

Nurses function as central figures of health teams, coordinating direct care and communication between team members, patients, and their families. The importance of nurses to health care cannot be understated, but neither can the environmental struggles nurses routinely encounter in their jobs. Organizational communication and nursing scholarship show conflict and stress as two visible and ongoing challenges. This case study aims to (a) explore the ways conflict communication and communicative stress are experienced and endure in nursing and (b) understand how nurses discursively (mis)manage conflict and stress. Open-ended survey comments from nurses (N = 135) employed at a large teaching and research hospital were qualitatively analyzed. Weick’s model of organizing, specifically his notion of communication cycles, emerged as a conceptual lens helpful for understanding cyclical conflict and stress. Results show that exclusionary communication, specifically nonparticipatory and unsupportive messages, contribute to nurse conflict and stress. Nurses tend to (mis)manage conflict and stress using respectful and disrespectful discourse. These communication patterns can facilitate or prohibit positive change. Metaphorically, nurse communicative conflict and stress can be depicted as fire. Relationships can go up in flames due to out-of-control fires in the form of destructive conflict. However, conflict and stress, like fire, can be harnessed for positive ends such as organizational decision making and innovation. Findings suggest conveying respect may help nurses manage and even avoid flames of conflict and stress. Solutions are offered to mitigate the effects of conflict and stress while developing respectful organizational cultures.     

麻醉专科护士临床培训的探索

目的研究麻醉专科护士的临床培训方法,为临床麻醉护士专业化队伍建设提供参考依据。方法以新护士岗位培训为切入点,借鉴其他专科护士培训经验,通过实行ICU与临床麻醉序贯培训模式,探索麻醉专科护士培训的时间安排、培训内容、培训与考核方法等。结果实施ICU与临床麻醉序贯培训5年来,20名麻醉护士均能在5个月内适应专业角色,理论与操作考核成绩均优秀,综合能力满意度达到87.5%,协助麻醉医师完成了大量围麻醉期患者的监护管理工作,取得显著成绩。结论培训并使用麻醉专科护士是规范麻醉管理、促进护理专业化发展的必然趋势,是为围麻醉期患者提供无缝隙优质护理服务的有效途径。     

An exploratory study of the correlates of intent to quit among certified registered nurse anesthetists in North Dakota.

Certified registered nurse anesthetists (CRNAs) provide the majority of anesthesia services in rural hospitals. Some services provided by CRNAs are routine, while others are for emergency conditions. The effect of the current nurse shortage on the potential pool of nurse anesthetists becomes a critical concern when considering the nature of CRNA services in rural areas. This study investigated the potential factors that relate to the desire of CRNAs to continue practicing in rural hospitals of North Dakota. All CRNAs licensed in North Dakota (n = 125) were mailed survey questionnaires. Approximately five weeks later responses were received from 54 respondents for an overall return rate of 43 percent. Correlational analyses were used to examine responses of the subjects. A moderate degree of relationship was found among the work-related variables. The average interscale correlation, calculated using an r to z transformation, for the seven work-related variables was 0.47. Overall, pay and promotion satisfaction exhibited strong (r greater than 0.60) correlations with turnover intentions. Supervisory satisfaction was only moderately (r = -0.33) related to intention to quit. These results are discussed in terms of their implications for the management of CRNAs in rural hospitals. Revised salary schedules, clinical ladders for promotions, supervisory training, and the identification of potential performance constraints are suggested as areas in which rural hospitals should focus attention in an attempt to manage turnover in CRNAs.     

A strategic approach for managing conflict in hospitals: responding to the Joint Commission leadership standard, Part 1

BACKGROUND: The Joint Commission's leadership standard for conflict management in hospitals, LD.02.04.01, states, "The hospital manages conflict between leadership groups to protect the quality and safety of care." This standard is one of numerous standards and alerts issued by The Joint Commission that address conflict and communication. They underscore the significant impact of relational dynamics on patient safety and quality of care and the critical need for a strategic approach to conflict in health care organizations. Whether leadership conflicts openly threaten a major disruption of hospital operations or whether unresolved conflicts lurk beneath the surface of daily interactions, unaddressed conflict can undermine a hospital's efforts to ensure safe, high-quality patient care. DEVELOPING A STRATEGIC APPROACH TO CONFLICT MANAGEMENT: How leaders manage organizational conflict has a significant impact on achieving strategic objectives. Aligning conflict management approaches with quality and safety goals is the first step in adopting a strategic approach to conflict management. A strategic approach goes beyond reducing costs of litigation or improving grievance processes--it integrates a collaborative mind-set and individual conflict competency with nonadversarial processes. UNDERTAKING A CONFLICT ASSESSMENT: Conflict assessment should determine how conflicts are handled among the leaders at the hospital, the degree of conflict competence already present among the leaders, where the most significant conflicts occur, and how leaders think a conflict management system might work for them. CONCLUSIONS: Strategically aligning a conflict management approach that addresses conflict among leadership groups as a means of protecting the quality and safety of patient care is at the heart of LD.02.04.01.     

Strategies for resolving conflict

In thinking through conflict management, there can be no quick fix that is a lasting one. This is not a threat to the integrity of the administrator, but rather a challenge to his or her ability to carry learned principles of management through to a satisfactory conclusion. While communication is only one of the keys to the process, concrete managerial ability and confidence in subordinates will prove to be the method of choice.     

Work-home conflict in the European nursing profession

This study investigated predictors of the work-home conflict among registered nurses (n = 27,603) in eight European countries. Two scales were used to assess work-family conflict (WFC) and family-work conflict (FWC). Based on a distinction of time- and strain-based and individual factors for WFC, bivariate correlations and multiple linear regression analysis were computed. The relationship between WFC and intention to leave the nursing profession was also analyzed. Quantitative demands indicating intensity of work, regularity of working time, and being pressured to work overtime were the dominating predictors for WFC, explaining 13-23% of the observed variance. The association between WFC and intention to leave the nursing profession was pronounced in all countries except one. Most European countries lack qualified nurses. Attempts to retain nurses in their profession should take into consideration the WFC, the regularity of working time in particular, and overtime issues.     

Armed conflict,health spending,and HIV

Among current studies, there is still question as to whether conflict increases, decreases, or has no effect on HIV prevalence. This lack of clarity can be attributed to the scarcity of quantitative analysis in this field. Thus, studies about conflict and HIV have failed to specify the ways conflict affects HIV prevalence, if indeed it does. In this paper, I argue that armed conflict increases HIV prevalence by reducing total per capita health spending. Using HIV prevalence data from 1990 to 2009, I find supporting evidence in the case of civil conflicts for these arguments. In addition, I find that as the severity of civil conflict increases, so do HIV rates. These findings have significant policy implications for individual governments, as well as for the international community.     

Nurse-nurse manager conflict: how do nurse managers manage it?

This study was conducted to determine the conflict management styles used by nurse managers when in conflict with nurses and to ascertain the differences between sociodemographic characteristics and the style used. The study was conducted on 71 nurse managers working in 3 different hospitals in Antalya (Turkey). A personal information form and Rahim Organizational Conflict Inventory II were used for data collection. The most commonly used style by nurse managers when in conflict was integrating, and the least commonly used was avoiding. There was no difference between the style used and the nurses' educational status, marital status, and years of employment. The obliging style was used the most by those 45 years and older and those with 20 years or more of management experience, whereas the avoiding style was used by nurse managers with 6 to 10 years of management experience. This study suggests that nurse managers who are older and have management experience need to be encouraged to use effective conflict management and that there is a need for further research of the subject of factors that affect conflict management style.     

Interpersonal conflict and health perceptions in long-distance caregiving relationships

With job markets expanding globally and life expectancy continually increasing, more demands are being placed on distant relatives to provide care for their aging family members, creating a health care situation known as long-distance caregiving. An online survey explored the relations between negative health perceptions by long-distance caregivers and conflict frequency and conflict strategy usage. The authors observed positive significant relations between distant caregiver negative health perceptions and conflict frequency and usage of the distributive and avoidance conflict strategies. However, they observed no significant associations between distant caregiver negative health perceptions and usage of the two integrative strategies. Implications for long-distance caregiving communication are discussed.     

Anesthesia Provider Model, Hospital Resources, and Maternal Outcomes

Objective. Determine the ability of anesthesia provider model and hospital resources to explain maternal outcome variation.
Data Source/Study Setting. 1,141,641 obstetrical patients from 369 hospitals that reported at least one live birth in 2002 in six representative states.
Study Design. Logistic regression of death, anesthesia complication, nonanesthesia maternal complication, and obstetrical trauma for all patients and those having cesarean deliveries on anesthesia provider model, obstetrical and anesthesia, and patient variables.
Data Collection/Extraction Methods. Data was assembled from information given by hospitals to state agencies and from a 2004 survey of obstetrical organization resources.
Principal Findings. Anesthesia complication rates in anesthesiologist-only hospitals were 0.27 percent compared with 0.23 percent in certified registered nurse anesthetist (CRNA) only hospitals. Rates among other provider models varied from 0.24 to 0.37 percent with none statistically different from the anesthesiologist-only hospitals. A similar pattern was observed for rates of other outcomes. Multivariate analysis found no systematic differences between hospitals with anesthesiologist-only models and models using CRNAs. There was no consistent pattern of association of other hospital or patient characteristics with outcomes.
Conclusion. Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models.     

Alternative dispute resolution: a conflict management tool in health care

This article focuses on methods of resolving conflict either within or between health care organizations using an alternative dispute resolution (ADR) strategy. After identifying the principal sources of contemporary disagreements within health services settings, the authors describe the basis of ADR. This is followed by a discussion of some common obstacles to settling a dispute. The principal communication guidelines and stages of a mediation session are presented. An alternative dispute resolution framework is proposed that includes an Office of Dispute Resolution (ODR). Also provided is a series of attributes that together comprise the core of mediation as a discipline.     

完善麻醉协议书制度医疗纠纷防范于未然

麻醉协议书是医患之间重要的法律合同之一，为医患之间提供了法律保障依据。它既保护病人的健康和利益，也维护医院及麻醉医师的利益和信誉。为了减少和避免医患间不必要的医疗和法律纠纷，必须完善麻醉协议书制度，有效防范医疗纠纷。     

Planning safe anesthesia: The role of collective resources management

Objective: Anticipation and planning are essential steps of risk management but the mechanisms of planning behavior are incompletely understood, especially the factors including collective work. The aim of this research is to understand how anesthetists plan safe solution to perform anesthesia. Methods: A study based on interviews was conducted in two French hospitals. Data processing focused on the main decisions made by 20 anesthetists during two simulated pre-anesthetic consultation. The main decisions made have been identified and the decision criteria have been analyzed. Results: To ensure patient safety, all anesthetists do not plan the same solution. The rejection or the selection of solutions by each physician rests on two types of criteria: the assessment of risks for the patient and the assessment of resources available to handle the situation. For the latter, the knowledge on the individual skills of each and the adoption of "local benchmark practices" play an essential role. Conclusion: Ultra safe performance in highly variable systems cannot be achieved only through standardization but also through the possibility and ability of the subjects to adapt their practices to their own skills and to that of their colleagues. The conditions for the development of this "adaptative safety" are discussed.     

Preventing a perfect storm in your medical practice: understanding communication, collaboration, and conflict

Practice management can be both challenging and frustrating. In today's world of high turnover, decreased numbers of skilled workers, and increased regulatory requirements, it is more important than ever that practice managers understand the dynamics of creating a climate of motivation. There are three events that, when they hit all at once, can wreak havoc on the effective management of a medical practice. These are: (1) communica-tion breakdown; (2) lack of collaboration between employees and managers; and (3) the inability to prevent, manage, and/or resolve conflict. This article will present strategies to streamline communication, explore ideas on how to collaborate more effectively, and provide insight into the five styles of conflict management.