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.     

Nursing in a technological environment: nursing care in the operating room

Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.     

Evidence-based leadership: Nursing's new mandate

In its landmark report, “Keeping Patients Safe: Transforming the Work Environment of Nurses,” the Institute of Medicine (IOM) issued a startling wake-up call for nursing and health care leaders.¹ Acknowledging the critical role of nurses in patient safety, this exhaustive study concluded that inherent in the work environment of nurses are serious threats to patient safety. The pervasiveness of these threats is evident in key areas of the organization.     

人性化管理理念在手术室护理管理中的应用

目的探讨人性化管理理念在手术室护理管理中的应用。方法对手术室护理工作存在的问题进行分析，并提出相应的对策。结果手术室护理工作主要存在的问题是：工作劳动强度大，健康危害性较大，长期处于应激状态。结论护理管理者应用人性化管理激励下属，最大限度地调动护士的积极性，才能确保医疗护理质量，保证护理安全，共同创造和谐的手术室护理环境。     

We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work

MACKINNON K. Nursing Inquiry 2012; 19: 259-269 We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'.     

Collaboration in the Hybrid Operating Room: A Focus Group Study From the Perspective of the Nursing Staff

Technical advancements in the operating room setting continue, and the concept of the hybrid operating room is promoted and accepted worldwide. The hybrid setting means inclusion of radiology in the already complex environment of a traditional operating room. Collaboration in this type of environment becomes essential and investigating how the nursing staff experiences this collaboration in the hybrid operating room is needed. The aim of the study was to investigate how the nursing staff from the specialties of surgery, anesthesiology, and radiology experienced collaborating in a hybrid operating room. Explorative qualitative design was used. Five focus groups consisting of operating room nurses, operating room assistant nurses, nurse anesthetists, assistant nurse anesthetists, and radiographers were included in the study. Interviews using semistructured questions were conducted. Directive content analysis was used for the data analysis. The following categories revealed: (1) different patient safety perspectives; (2) responsibilities being shared and divided; (3) collaboration becoming better over time; (4) uneven division of labor in a strained work situation and different terms of employment; (5) lack of education and joint meetings; and (6) environmental constraints for satisfying collaboration. The nursing staff in the hybrid operating room highlighted they worked toward a common goal but prioritized their own specific tasks rather than the procedure as a whole. This, together with the uneven task distribution and unclear responsibilities, could create tension between the different staff categories, impacting procedures negatively. The results revealed the importance of proper preparation of the staff to work in the hybrid operating room. Having team building activities, common meetings, relevant training to meet educational needs, and adjusting the team composition could improve hybrid operating room collaboration and improve patient safety and outcomes.     

手术室护士工作压力源与心理健康水平关系的研究

目的探讨手术室护士工作压力源与心理健康水平的关系。方法选取浙江省5所综合性医院130名手术室护士,采用工作压力源、焦虑和抑郁量表进行问卷调查,并对结果进行相关性分析及t检验。结果手术室护士压力主要来自护理专业及工作方面、工作量及时间方面、工作环境及时间分配方面,其次为患者护理方面、管理及人际关系方面。手术室护士焦虑、抑郁水平显著高于健康人群。手术室护士的焦虑、抑郁得分均与工作压力源的护理专业及工作方面、工作量及时间方面、患者护理方面、管理及人际关系方面存在显著相关性。与工作环境及时间分配不存在显著相关性。结论手术室护士存在多种工作压力源,且心理健康水平较低。管理者应采取相应措施,缓解护士的工作压力,提高其心理健康水平。     

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。     

Foucault could have been an operating room nurse

BACKGROUND: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. AIM: Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. CONTENT: The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. CONCLUSIONS: This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.     

手术室护士工作压力源与心理健康水平关系的研究

目的 探讨手术室护士工作压力源与心理健康水平的关系.方法 选取浙江省5所综合性医院130名手术室护士,采用工作压力源、焦虑和抑郁量表进行问卷调查,并对结果 进行相关性分析及t检验.结果 手术室护士压力主要来自护理专业及工作方面、工作量及时间方面、工作环境及时间分配方面.其次为患者护理方面、管理及人际关系方面.手术室护士焦虑、抑郁水平显著高于健康人群.手术室护士的焦虑、抑郁得分均与工作压力源的护理专业及工作方面、工作量及时间方面、患者护理方面、管理及人际关系方面存在显著相关性.与工作环境及时间分配不存在显著相关性.结论 手术室护士存在多种工作压力源,且心理健康水平较低.管理者应采取相应措施,缓解护士的工作压力.提高其心理健康水平.     

Addressing the nursing work environment to promote patient safety

TOPIC: The nursing work environment has a critical impact on patient safety. Yet confusion on the specific roles and competencies of nurses, staff ratio issues, and lack of nurse empowerment create weaknesses that result in safety risks. PURPOSE: These interrelated issues must be addressed systemically to impact the nursing care system. DISCUSSION: Educational reform focusing upon standardized, higher level nursing education using a military model, appropriate staff ratio laws derived from the outcomes literature, and recurrent training incorporating policy-making powers can result in nurse empowerment and improved patient safety. CONCLUSION: Improving the nursing environment requires a broad approach to benefit patient safety. By treating the work environment as a complex system, approaches can result in greater nurse professionalism, empowerment, and patient safety.     

手术室护士的心理压力源分析与对策

目的了解手术室护士心理压力源，采取针对性的心理护理．预防及减轻各种压力，增强手术室护士的心理防护能力和应急能力，不断提高手术室护理质量。方法采用问卷调查法了解29名手术室护士的工作压力源。结果手术室护士心理压力源依次为：处理危急情况时、针刺伤等职业危害、面对患者突然死亡、急救技能与急救知识的缺乏、害怕发生差错和事故等。心理压力与年龄、护龄成正相关，年龄越大、护龄越长所承受的压力越大。结论手术室护士的心理压力源与手术室护理工作的环境和性质有关。     

手术室护士灾害护理能力网络化培训模式的构建设想

为充分做好灾害应急准备，提高手术室护士抗灾、救灾、减灾能力，通过建立网络化培训平台、招募网络成员、选择适当培训方法、对培训效果进行评价及动态管理的方法，构建具备计算机及互联网技术支持和各医疗部门组织、管理保障，能够突破传统集中授课模式的时空限制，具有学习行为自主化、终身教育等优势的手术室护士灾害护理能力网络化培训模式。从而为手术室护士营造良好的学习环境和机会，促进灾害护理知识的交流、分享，推动于术室护士灾害护理能力培训工作的深入开展。     

河北省综合医院护理工作环境现状及与护理质量安全的相关性研究

目的调查河北省综合医院护理工作环境的现状,并分析其与护理质量安全的相关性。方法采用护士工作环境量表和护理质量安全问卷对河北省20所二级、三级综合医院的1023名护士进行问卷调查。结果护理工作环境得分为（3．45±0．55）分,得分最高的维度为医护合作,最低的维度为充足的人力和物力。良好的医护合作可使护士对病区护理质量和出院后患者自我护理有正性影响;鼓励护士参与医院事务、重视高质量护理服务的基础工作,对护士的患者安全评价有正性影响。结论河北省综合医院护理工作环境总体较好,良好的护理工作环境有利于护理质量和患者安全的保障,医疗主管部门和护理管理者应当继续优化护理工作环境的各要素,以进一步提升护理质量和患者安全。     

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。     

Patient safety and job-related stress: a focus group study.

This study focused on work-related stress among nurses working with critically ill patients. The aim of the study was to examine the effects of work-related stress with regard to patient safety. The study uses a qualitative design based on focus group interviews with nurses who work with acute, critically ill patients in hospitals. Two regional hospitals were chosen. Inclusion criteria for the focus group panels included the following: nurses with advanced training in anesthesiology, intensive care, or operating-room nursing. Twenty-three nurses were chosen and they were divided into four groups. This study shows that a demanding work environment together with minimal control and social support from colleagues results in increased stress that can often have an effect on patient safety.     

老年护理院护理安全管理评价指标体系的研制

目的：研制一套适合老年护理院护理安全管理的评价指标体系。方法：通过专家访谈、文献研究以及改良的Delphi法对备选指标进行筛选,采用层次分析法确定指标权重。结果：拟定出以组织管理因素、护理人员因素、环境设施因素和患者因素4项一级指标、10项二级指标和39项三级指标构成的综合指标体系。结论：建立老年护理院护理安全管理评价指标体系,为规范老年护理院的建设和管理提供了参考依据;也为护理院的老人获得安全、高质量的照护提供了有力的保障,方便行业比较以及行业监督。