Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study.

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.

Determining the Use of Nonpharmacologic Methods by Surgical Nurses for Postoperative Pain Management and the Influencing Professional Factors: A Multicenter Study.

PURPOSE: The purpose of this study was to determine the use of nonpharmacologic methods by surgical nurses for postoperative pain management and to identify the influencing professional factors. DESIGN: A regional survey model. METHODS: The sample of the study consisted of 443 surgical nurses working in regions of Turkey. The data were collected using a personal information form and questionnaire. FINDINGS: Hot-cold application (53.3%), exercise (50.8%), positioning (68.8%), movement restriction (35.7%), resting (55.5%), and distraction (42.2%) were among the methods usually used by nurses. The nurses who were working in the Black Sea region chose the nursing profession willingly, received the training on pain management, and used nonpharmacologic methods at higher rates (P < .030, P < .004, P < .033, and P < .000, respectively). CONCLUSIONS: Gender, geographic region of work, choosing the profession willingly, and receiving training on pain management affected the nurses' rate of using nonpharmacologic methods.

International Nursing: Use of a Commercially Available Smartphone Application to Solve Information Needs of Orthopedic Scrub Nurses.

The purpose of this article is to describe the use of a commercially available smartphone application to solve information needs of scrub nurses in orthopedic surgery. A semistructured, focus group interview was conducted with orthopedic scrub nurses. These nurses had solved their information needs about orthopedic surgery by using a commercially available smartphone application. Because of smartphone technology's convenience, accessibility, mobility, ease of use, and use at no charge, it is worth considering in nursing practice, education, and research.

Adult Perianesthesia Do Not Resuscitate Orders: A Systematic Review.

PURPOSE: The purpose of this systematic review is to assess if Do Not Resuscitate (DNR) orders should be routinely rescinded during anesthesia, determine if consensus on retaining DNR orders exists in the literature, and explore the current state of clinical practice. DESIGN: This systematic review followed preferred reporting items for systematic reviews and meta-analyses guidelines. METHODS: In June 2018, the Cumulative Index to Nursing and Allied Health Literature and PubMed databases were systematically searched using defined inclusion/exclusion criteria. FINDINGS: Ninety-one articles from the databases were pooled with 16 works identified as formative to the research questions. Forty-nine articles were analyzed and included in this study. CONCLUSIONS: It is unethical to automatically rescind DNR orders during anesthesia. Patients have the right to retain their DNR orders unaltered or modify them for the perianesthesia period. Sufficient evidence exists to create meaningful policy at every level. A consensus exists among professional organizations that the standard of care is a required reconsideration of DNR orders before anesthesia.

Standardising fast-track surgical nursing care in Denmark.

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.

The future of surgical nursing and enhanced recovery programmes.

Patients undergoing surgery in the UK are seeing a rise in the development of enhanced recovery programmes as a result of increasing medical advances. Enhanced recovery is concerned with helping patients get better sooner after an operation by following a meticulous regime of care. The practical application of these programmes is undertaken largely by nurses, despite encompassing explicit, medically-driven protocols. However, beyond the professional knowledge and skills required to aid the programmes, nursing knowledge has contributed little to this rapidly developing aspect of surgery to date. Nursing has much to offer through future creation of centrally coordinated, surgical nursing units focusing on patients' holistic experience. This article will briefly describe enhanced recovery, identify aspects of nursing knowledge that can have a positive influence, and outline practical changes to assist the development of such programmes, thereby benefiting all patients undergoing elective surgery.

Surgical smoke: articulating the problem.

This six-part series focuses on surgical smoke evacuation legislation and policy. It provides answers to important frequently asked questions (FAQs) about surgical smoke from policymakers and people not working in perioperative services and suggests resources and tools to help you become a strong advocate for surgical smoke evacuation. The FAQs and legislative checklists that will be shared will cover the basics of surgical smoke and its harmful effects, strategies and solutions for eradicating surgical smoke in the OR, the role of regulatory agencies, and how to lay the groundwork for successful state legislation on your own and in tandem with AORN's Government Affairs Department.

Intraoperative Neuromonitoring: Principles and Considerations for Perioperative Nurses.

Intraoperative neuromonitoring (IONM) is a method used to warn the surgeon of impending neurological damage while it can still be corrected, ideally preventing a permanent neurological deficit in the surgical patient. It was originally used in neurosurgery, but now also applies to other surgical specialties. Comprehensive monitoring of a patient's neurological status requires using a variety of approaches. The IONM tests most frequently used in the OR are somatosensory evoked potentials; transcranial electrical motor evoked potentials; electromyography, including cranial nerve monitoring; and electroencephalography. With its increased use during a variety of operative and other invasive procedures, most perioperative nurses will be exposed to IONM at some point in their careers. This article provides perioperative nurses with a basic understanding of IONM, including the framework, purpose, associated terminology, and nursing implications.

Addressing the Perioperative Nursing Shortage Through Education: A Perioperative Imperative.

Perioperative nurse leaders are facing an unprecedented nursing shortage. Very few baccalaureate nursing programs in the United States prepare graduates for perioperative nursing, and many current perioperative nurses are retiring from practice or leaving the field for other reasons. It is a challenge for nursing administrators to fill the vacant positions because it takes several months to orient a novice perioperative nurse and it involves significant costs. This article provides current information about perioperative nurse and leader shortages, discusses the effects of the shortages on patient safety and health care facility finances, and reviews the available literature about perioperative nursing education from both an academic and health care facility administrative perspective. In addition, this article presents strategies for addressing the nursing shortage and describes implications for clinical practice, education, and research.

Guideline Implementation: A Safe Environment of Care.

The OR can be a hazardous environment for both patients and personnel. Low lighting, fluid on the floor, combustible and noxious chemicals, multiple pieces of equipment with cords, the fast pace, and numerous distractions are only some of the factors that can lead to an accident or injury. The AORN "Guideline for a safe environment of care" provides guidance to perioperative personnel on identifying hazards and implementing processes to mitigate risks in the perioperative setting. This article elaborates on key takeaways from the guideline, including precautions to reduce the risk of OR fires; occupational injuries associated with slips, trips, and falls; and handling, storing, and using hazardous chemicals. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

The process of nurse adaptation to robotic surgery: A qualitative study.

BACKGROUND: This study aimed to reveal the experiences of nurses in robotic surgery and their adaptation to this method. METHODS: This research was planned within the framework of qualitative research methods. The study population consisted of robotic surgery nurses in Turkey. Focus group interviews were conducted after the flow process was developed, and the interviews were supported using a semistructured interview form. Two focus interviews were conducted with 15 participants. RESULTS: As a result of the content analysis, 11 themes were created in four categories. The categories of the study were designed as follows: (1) Training in Robotic Surgery Nursing, (2) Adaptation to Technology in Robotic Surgery Nursing, (3) Changing Roles and Adaptation Process in Robotic Surgery Nursing, and (4) Future of Robotic Surgery. CONCLUSIONS: The lack of clarity regarding the roles and responsibilities of robotic surgery nurses and the lack of arrangements for working conditions are thought to cause professional dissatisfaction and disengagement from work.

Societal change and or nursing in the pages of the AORN Journal, 1963 to 1983.

The decades of the 1960s and 1970s were unlike any US society had previously experienced. The order of society was openly challenged, which resulted in diverse viewpoints about what was acceptable behavior and thinking. The effects of scientific discoveries were evident in health care, and demands for options in care influenced the delivery of health services. Many of these influences were felt by nurses in the OR, and OR nursing itself transformed in response to the changes in society. The AORN Journal is used in this article as a source of information to ascertain how changes in society were reflected in OR nursing during the period from 1963 to 1983.