Distracting communications in the operating theatre

RATIONALE AND AIMS: Research suggests that there are problems of communication effectiveness in surgery. Here we describe the content, initiators and recipients of communications that intrude or interfere with individual surgical cases. We also consider the level at which the surgical team and its team members are distracted by these case-irrelevant communications (CICs). METHODS: Two psychologist observers sampled 48 general surgery procedures and they recorded the initiator and the recipient of CIC events, their content and the level of observable distraction that they caused. RESULTS: Irrelevant comments and queries (i.e. 'small-talk') accounted for half of the observed CICs. From the remaining CICs that we observed, most were related to the organization and administration of the case-list, to operating theatre provisions and to teaching junior staff. Surgeons initiated a third of the observed CICs, while receiving two thirds of them. External staff visiting the operating theatre initiated the most distracting communications. The CICs addressed to surgeons introduced significantly less distraction to the operating theatre than those addressed to anaesthetists and nurses. CONCLUSIONS: Some of the observed CICs contributed to the administration of the operating theatre case-list. Nonetheless, this communication can interfere with highly sensitive work. More effectively co-ordinated communication could reduce this interference. More research should assess the communication effectiveness and the impact of CICs on task performance in the operating theatre.     

Professional influences on the provision of mental health care for older people within a general hospital ward

Recent policy initiatives within the United Kingdom have recognized that effective care for older people can only be achieved if health care staff are willing and skilled enough to address patient needs in a holistic way. The preliminary stages of the action research project described here focused on the perceptions of nursing staff regarding the factors that impacted on their ability to address mental health needs within a general hospital ward. A phenomenological approach allowed us to identify the experience of addressing mental health needs in this setting from the perspective of the research participants. A focus group was facilitated with nursing staff whose primary professional focus was the provision of physical health care within an older adult unit. Thematic content analysis was used to analyse the focus group data, and four key themes emerged, namely 'disruption', 'role conflict', 'professional resources' and 'professional distress'. These themes provide a focus for the ongoing development of the action research methods and will embed future work in the experience of those charged with ensuring that mental health care is a key element of their practice. This study highlights the urgent need for further work in this area, as we contend that it is only by addressing the professional needs of the staff concerned, that effective patient-centred care can be ensured.     

Practical measures to ensure health and safety in theatres

It is essential for nurses to be aware of their legal and professional obligations regarding health and safety issues in the operating theatre. There should be strict policies and procedures in place to ensure a safe environment and to maintain the sterile field for the benefit of patients, staff and visitors.     

Adjusting team involvement: a grounded theory study of challenges in utilizing a surgical safety checklist as experienced by nurses in the operating room

ABSTRACT: BACKGROUND: Even though the use of perioperative checklists have resulted in significant reduction in postoperative mortality and morbidity, as well as improvements of important information communication, the utilization of checklists seems to vary, and perceived barriers are likely to influence compliance. In this grounded theory study we aimed to explore the challenges and strategies of performing the WHO's Safe Surgical Checklist as experienced by the nurses appointed as checklist coordinators. METHODS: Grounded theory was used in gathering and analyzing data from observations of the checklist used in the operating room, in conjunction with single and focus group interviews. A purposeful sample of 14 nurse-anesthetists and operating room nurses as surgical team members in a tertiary teaching hospital participated in the study. RESULTS: The nurses' main concern regarding checklist utilization was identified as "how to obtain professional and social acceptance within the team". The emergent grounded theory of "adjusting team involvement" consisted of three strategies; distancing, moderating and engaging team involvement. The use of these strategies explains how they resolved their challenges. Each strategy had corresponding conditions and consequences, determining checklist compliance, and how the checklist was used. CONCLUSION: Even though nurses seem to have a loyal attitude towards the WHO's checklist regarding their task work, they adjusted their surgical team involvement according to practical, social and professional conditions in their work environment. This might have resulted in the incomplete use of the checklist and therefore a low compliance rate. Findings also emphasized the importance of: a) management support when implementing WHO's Safe Surgical Checklist, and b) interprofessional education approach to local adaptation of the checklists use.     

Swallowing and feeding in older people with lifelong disability

University staff are in the unique position of having access to knowledge regarding the “cutting edge” of clinical practice issues and also the concerns and challenges faced by speech pathologists at the “coal face” of clinical practice. This article describes a recent workshop organised by the School of Communication Sciences and Disorders, at the University of Sydney, to address a number of concerns evident in the field of lifelong disability. By listening to the needsof clinicians in this area, we identified there was a need to provide professional development opportunities related to dysphagia management. We also heard that clinicians were worried about ensuring best practice in dysphagia and communication management. Finally, we heard that clinicians often felt unsupported in their work as they faced daily ethical challenges in the area of dysphagia management. The 1-day workshop was organised to begin addressing these needs. This article reports on the issues raised during the workshop and gives an evaluation of the workshop.     

Biogel Skinsense N: surgical glove management for latex allergies

Healthcare staff with a high occupational exposure to latex gloves, such as those who work in the operating theatre, have a higher than average incidence of latex allergies. Certain patient groups are also known to be considered "high risk" for latex allergies. When wearing gloves, staff allergic to latex and those working with patients allergic to latex must wear latex-free gloves to protect themselves and their patients. Of all the different types of gloves available--examination, medical or diagnostic--surgical gloves have to meet the highest standards, offering both protection and comfort. However, latex-free surgical gloves have previously lacked some of the "comfort" qualities of natural latex. This article describes appropriate glove management for latex allergies and looks at the new generation of latex-free surgical gloves.     

A narrative review of thermoregulation techniques used by paediatric theatre staff during intra hospital transfer from paediatric theatres to the Neonatal Intensive Care Unit ( NICU)

IntroductionEffective thermoregulatory care during neonatal transfer for surgical procedures is crucial in preventing inadvertent neonatal hypothermia. This narrative review thereby aims to investigate thermoregulation techniques used by paediatric theatre staff to prevent neonatal hypothermia during the neonate's surgical journey from theatres to Neonatal Intensive Care Unit (NICU).Key findingsThe review highlights the importance of continual temperature monitoring in ensuring prevention and diagnosis of hypothermia during intra hospital transfer. Additionally considerations for prevention of hypothermia in the theatre setting are identified including pre warming the theatre environment and equipment. The literature also identified that during intra hospital transfer of neonates following surgery there is a lack of specific guidelines relating to the exact combination of thermoregulation techniques required during such transfers. To prevent practices which are guided by theatre staff preference, findings suggest that guidelines are implemented that are clear, specific and standardised within surgical neonatal intra hospital transfer.ConclusionsThere is a lack of clinical guidelines pertaining specifically towards neonatal intra hospital transfer following neonatal surgery. Consequently, neonatal hypothermia has been reported post-transfer in research and the practice setting following transfers between Theatres to NICU. Thereby, further investigation of paediatric theatre staff neonatal thermoregulatory care is required along with the introduction of national standardised guidelines and paediatric theatre staff education to ensure evidence based practice.     

Nursing staff''s perceptions of work in acute and long-term care hospitals

The survey study compared perceptions of work in the nursing staff of acute and long-term care hospitals. The focus was on professional challenges, career prospects, independence, responsibility, the social requirements of work, time pressure and workload. Consistent differences were found in the extent to which the two groups experienced their work as challenging: the scores were lower in the long-term care hospital than in the general hospital. For example, 40% of the respondents in the long-term hospital felt their work was too easy compared with their knowledge and skills, while the figure was only 9% in the general hospital. Among these workers, a simultaneous decline was found in personal resources, as measured by psychosomatic symptoms, and in the individual's commitment to the organization. In the theoretical discussion the experience of lacking challenges is related to the concepts of work orientation, coping strategies and work culture.     

The challenges of IRB review and human subjects protections in practice-based research

Practice-based research raises unique challenges with respect to human subjects protections and institutional review board (IRB) review. In this paper, three challenges posed by practice-based research are analyzed: (1) IRB review for clinician investigators who are not affiliated with an institution that has an IRB; (2) multiple IRB review; and (3) required human subjects protection training of key personnel. Investigators should be proactive in addressing required IRB review in practice-based research. In particular, they need to ensure that appropriate IRB review is obtained for all performance sites and plan for review for unaffiliated investigators. Practice-based research investigators and professional societies should educate IRB members and policy makers and publish articles regarding how IRBs might best address human subjects concerns in practice-based research. Furthermore, practice-based research investigators and professional societies should work with IRBs and the Office for Human Research Protections to facilitate centralized or cooperative review of practice-based research. Finally, practice-based research investigators need to ensure that their clinician investigators receive appropriate training in human subjects protection. Practice-based research investigators and professional societies can facilitate this process by helping to define and implement the appropriate training for busy practice-based research clinicians and office staff.     

Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country

Data on all patients scheduled to have elective and emergency surgeries during the period of 6 weeks from September 1999 to October 1999 were prospectively collected to determine scheduled starting times, actual starting times, completion times, causes for delays and cancellations. Of 840 procedures scheduled during the study period, 594 (71%) were available for analysis. Eighty-nine per cent of cancellations occurred in patients undergoing elective surgery. The common causes of cancellations were non-availability of beds in recovery room (RR) (15%), patients not showing up (9%), improper pre-operative patient preparation (13%), unavailability of nurses (11%) and anaesthetists (8%). Twenty-three per cent of the cancellations were day cases. Public patients were cancelled more frequently than private patients. Surgical procedures started on time in only 7% of patients. The most common cause of delay was due to delayed transport of patients to the operating theatre (17%). Optimal utilisation of operating theatres in our situation may be effected by increasing the bed-strength of ICUs to free the RR, proper pre-operative work up, adequate counselling of day-care surgery patients and efficient floor management of the operating theatre.     

The role of simulation in developing surgical skills

Surgical training has followed the master-apprentice model for centuries but is currently undergoing a paradigm shift. The traditional model is inefficient with no guarantee of case mix, quality, or quantity. There is a growing focus on competency-based medical education in response to restrictions on doctors’ working hours and the traditional mantra of “see one, do one, teach one” is being increasingly questioned. The medical profession is subject to more scrutiny than ever before and is facing mounting financial, clinical, and political pressures. Simulation may be a means of addressing these challenges. It provides a way for trainees to practice technical tasks in a protected environment without putting patients at risk and helps to shorten the learning curve. The evidence for simulation-based training in orthopedic surgery using synthetic models, cadavers, and virtual reality simulators is constantly developing, though further work is needed to ensure the transfer of skills to the operating theatre.     

Making the surgical beds go around

A planned surgical admission is a major event for a patient and, when cancelled, not only causes great distress to the patient and relatives but is also a frustrating waste of resources if a fully staffed operating theatre lies idle. At Westmead Hospital, a bed management team was established with the appointment of a Clinical Nurse Consultant as Bed Manager to co-ordinate admissions in conjunction with all staff involved in the processing of surgical patients. Despite a reduced number of available surgical beds, throughput was maintained with a significantly reduced number of cancelled booked cases, which decreased to zero and have remained so since the end of 1995. It has been found that it is possible to achieve a situation where all booked surgical patients can be admitted as planned while still providing for emergency patients. This requires a co-ordinated approach with an emphasis on teamwork led by a dedicated Bed Manager working with medical and nursing staff on surgical wards together with the bookings office, pre-admission clinic, operating theatre and anaesthetics department.     

An international exploration of blended learning use in pre-registration nursing and midwifery education

AimTo explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy.BackgroundThe global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere.DesignCross-sectional, sequential, mixed methods studyParticipants/settingsNursing/nurse education leaders from across International Council of Nurses regionsMethodsExploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants’ knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes.ResultsParticipants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation.ConclusionsBlended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.Tweetable abstractBlended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.     

Vulnerable populations and multicentred research

There are many challenges facing researchers with projects requiring multicentred ethics approval. Achieving ethical approval at multiple sites, whether statewide or nationally, is a complex and time‐consuming experience, compounded by the research process itself, as well as the recruitment of clinical sites and participants. Human ethics and research committees act as research gatekeepers and, as many research activities involve multiple applications and multiple approvals, can considerably delay the commencement of a project. A delay in ethics approval results in delays recruiting staff and participants, delays in the utilization of funding, and in delays regarding the progress and completion of projects. Such problems are additional problems for researchers of vulnerable populations, such as those in mental health or palliative care, where multicentred research is necessary to ensure the validity of the project itself. A current example of work that has required multicentred human ethics and research approval from around Australia is the establishment of the National Register of Antipsychotic Medication in Pregnancy. The guidelines for embarking on such a project with the requirement of multicentred ethical approval are described. Some of the issues, recommendations, and guidelines presented by the authors are taken from their experiences in establishing multicentred research projects.     

Incomplete pretransfusion testing leads to surgical delays

BACKGROUND: The Joint Commission has highlighted the importance of having appropriate and complete pretransfusion testing before surgery begins. The maximum surgical blood ordering schedule (MSBOS) indicates which patients require preoperative transfusion testing. We determined the number of times surgical delays were caused due to the lack of completed pretransfusion testing. STUDY DESIGN AND METHODS: All transfusion events reported through the common medical event reporting system of eight networked hospitals over a 12‐month period were evaluated to determine how often patients experienced surgical delays due to not having complete pretransfusion testing. RESULTS: During this 12‐month period 12 patients were identified who were either in or en route to the operating room with incomplete pretransfusion testing leading to a delay in providing crossmatched red blood cells (RBCs). In 6 of 12 cases a new antibody was discovered, which required extra time for the provision of crossmatched RBCs, while in 4 of 12 patients the samples were not sent or were lost on the way to the blood bank. In the remaining two patients other parts of the pretransfusion testing process were not followed according to hospital policy. The median surgery start time delay was approximately 12 hours (range, 1‐168 hr) in 11 of 12 cases. One patient's case was not aborted when it was discovered that crossmatched RBCs were not immediately available due to newly detected alloantibodies. CONCLUSIONS: We identified three mechanisms by which delays in completing pretransfusion testing in surgical patients occurred. Adherence to the MSBOS and sample collection policies should reduce delays.     

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PurposeInternational operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia.DesignThe phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences.MethodsSemistructured interview data were transcribed verbatim.FindingsInternational OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice.ConclusionsRecognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.     

Describing the essential elements of a professional practice structure

The proliferation of program management coupled with the Introduction of the Regulated Health Professions Act, prompted many healthcare organizations in Ontario to introduce professional practice models. In addition, the Magnet Hospitals research (Kramer and Schmalenberg 1988) identified the existence of a professional practice model as a key element for recruitment and retention of professional staff. Professional practice models were introduced to address issues of accountability, identity and overlapping scopes of practice as experienced by healthcare professionals and organizations across the continuum of care. The authors of this paper describe exploratory work done through the Professional Practice Network of Ontario to identify the essential elements of the "ideal" professional practice structure, key areas of challenge and strategies for adapting these elements into an organization. The paper presents a list of 16 essential elements of an ideal professional practice structure with a further discussion on four key areas consistently identified as areas of challenge. This paper is intended to report, not the findings of a formal research study, but rather the result of facilitated dialogue among professional practice leaders in Ontario. The information will be of interest to healthcare organizations across the continuum of care and to professional associations and academic institutions, as we all address the challenges of creating a quality work environment that supports and fosters excellence in professional practice.     

Health promotion: a role for perioperative nurses

• ? British theatre nurses are reluctant to identify health promotion as part of their work and when asked if they are involved in health promotion the answer is likely to be an emphatic ‘no’.
• ? Many theatre nurses would be surprised by the shift of emphasis within nursing away from the medical model and towards a more holistic approach to care which encompasses the concept of health promotion.
• ? British perioperative nursing should draw on health promotion for the benefit of surgical patients and operating department staff.
• ? This paper outlines the contribution perioperative nurses can make to the creation of healthy life not only in their patients but also their co-workers using established health-promotion techniques. It is suggested that health promotion should be an essential part of the education of modern perioperative nurses.

     

Responding to nursing's agenda for the future. Where do we stand on recruitment and retention?

How can the nursing profession address the escalating shortage of registered professional nurses? A multifaceted approach is important to ensure success. One domain of Nursing's Agenda for the Future (American Nurses Association [ANA], 2002) is recruitment and retention. Through the Agenda, creative strategies are being sought to attract and retain qualified nurses. This article describes one institution's response to addressing this critical shortage. Strategies were developed to present a continuum of learning and advancement opportunities across the career span of the professional nurse. They include recruiting student nurses, increasing NCLEXRN pass rates, providing financial support for further education or specialty certification, and using shared governance to increase retention. Institutions must look to their own resources as well as federal and state resources to offer these opportunities to nursing staff. The goal is to build an environment that both attracts nurses and supports them in their career and life goals.