Predicting nursing leadership roles of patient safety in the operating room / Roles de liderazgo de enfermería que predicen la seguridad del paciente en el quirófano / Papéis de liderança em enfermagem preditores da segurança do doente no bloco operatório

Objective: to identify the leadership perceived by perioperative nurses and to determine the role of leadership predictors of patient safety in the operating room. Method: descriptive and explanatory study in a sample of 1,001 nurses, using the patient safety questionnaire in the operating room and Quinn's leadership instrument adapted to health. The IBM SPSS Statistics application, version 25.0, was used in the data processing. Result: all leadership dimensions were higher than the midpoint of the scale (M>4). A minimum value was observed in the role of Innovator (M=4.63) and maximum in the Producer (M=5.04). The regression models allowed pointing out that leadership roles are predictors of patient safety in the operating room, especially the roles Monitor, Producer and Facilitator. Conclusion: perioperative nurses have moderately positive perception of leadership exercise, indicating the need to promote the development of different leadership roles exercised by perioperative management nurses.

Objetivo: identificar el liderazgo percebido por las enfermeras perioperatorias y determinar el papel de los predictores de liderazgo de la seguridad del paciente en el quirófano. Método: estudio descriptivo y explicativo en una muestra de 1.001 enfermeras, utilizando el cuestionario de seguridad del paciente en el quirófano y el instrumento de liderazgo de Quinn adaptado a la salud. La aplicación IBM SPSS Statistics, versión 25.0, se utilizó en el procesamiento de datos. Resultado: todas las dimensiones de liderazgo fueron superiores al punto medio de la escala (M>4). Se observó un valor mínimo en el rol de Innovador (M=4,63) y máximo en el Productor (M=5,04). Los modelos de regresión permitieron señalar que los roles de liderazgo son predictores de la seguridad del paciente en el quirófano, especialmente los roles Monitor, Productor y Facilitador. Conclusión: las enfermeras perioperatorias tienen una percepción moderadamente positiva del ejercicio de liderazgo, indicando la necesidad de promover el desarrollo de diferentes roles de liderazgo ejercidos por las enfermeras administradoras de quirofano.

Objetivo: identificar a liderança percecionada pelos enfermeiros perioperatórios e determinar os papéis de liderança preditores da segurança do doente no bloco operatório. Método: estudo descritivo e explicativo numa amostra de 1.001 enfermeiros, com recurso ao questionário de segurança do doente no bloco operatório e ao instrumento de liderança de Quinn adaptado à saúde. No tratamento de dados utilizou-se a aplicação IBM SPSS Statistics, versão 25.0. Resultado: todas as dimensões de liderança obtiveram valor superior ao ponto médio da escala (M>4). Observado um valor mínimo no papel de Inovador (M=4,63) e máximo no Produtor (M=5,04). Os modelos de regressão permitiram salientar que os papéis de liderança são preditores da segurança do doente no bloco operatório, destacando-se os papéis Monitor, Produtor e Facilitador. Conclusão: os enfermeiros perioperatórios têm perceção moderadamente positiva do exercício da liderança, indiciando a necessidade de se promover o desenvolvimento dos diferentes papéis de liderança exercidos pelos enfermeiros gestores perioperatórios.

Workforce issues: the blurring of boundaries in surgical care.

Bradley Russell and Nicholas Fletcher discuss the need for clear boundaries for those nurses practising at an advanced level in surgical specialties.

Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic-assisted surgery.

AIMS AND OBJECTIVES: To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic-assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic-assisted laparoscopic surgery (RALS). BACKGROUND: The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. DESIGN: A qualitative descriptive study. METHOD: Semi-structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April-24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. RESULTS: Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. CONCLUSIONS: The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well-trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and will ultimately impact patient outcomes.

Perioperative nurses' experiences of caring for donation after cardiac death organ donors and their family within the operating room.

Background: Worldwide, operating rooms have seen the re-emergence of donation after cardiac death organ donors to increase the number of available organs. There is limited information on the issues perioperative nurses encounter when caring for donor patients after cardiac death who proceed to organ procurement surgery. Objectives: The purpose of this paper is to report a subset of findings derived from a larger study highlighting the difficulties experienced by perioperative nurses when encountering donation after cardiac death organ donors and their family within the operating room during organ procurement surgery from an Australian perspective. Methods: A qualitative grounded theory method was used to explore perioperative nurses' (n = 35) experiences of participating in multi-organ procurement surgery. Results: This paper reports a subset of findings of the perioperative nurses' experiences directly related to donation after cardiac death procedures drawn from a larger grounded theory study. Participants revealed four aspects conceptualised as: 'witnessing the death of the donation after cardiac death donor'; 'exposure to family'; 'witnessing family grief' and 'stepping into the family's role by default'. Conclusion: Perioperative nurses' experiences with donation after cardiac death procedures are complex, challenging and demanding. Targeted support, education and training will enhance the perioperative nurses' capabilities and experiences of caring for the donation after cardiac death donor and their family with the operating room context.

Indicadores de qualidade em centro cirúrgico especializado em dermatologia / Indicadores de calidad en centro quirúrgico especializado en dermatología / Quality indicators at a surgical center specialized in dermatology

Objetivo: identificar e caracterizar os indicadores de qualidade mais frequentes utilizados em um Centro Cirúrgico público especializado em dermatologia. Método: estudo transversal seccional, pelo qual fez-se um levantamento, com registros diários, dos mais frequentes indicadores entre os 20 existentes na unidade, no período de agosto de 2015 a julho de 2016. Considerou-se: médias, medianas, valores mínimos/máximos, desvios padrões, frequências simples e percentuais. O valor de p<0,05 foi considerado como nível de significância. Resultados: das 595 cirurgias eletivas, destacaram-se as ambulatoriais (87,9%), as dermatológicas (81,3%), em pacientes do sexo masculino (52,6%), com média de 54,9 anos. Os cinco indicadores mais frequentes foram: cirurgias suspensas (17,6%); registros de enfermagem incompletos (14%); absenteísmo (6,5%); infecção em sítio cirúrgico em cirurgias limpas (2,7%) e acidentes de trabalho (2,2%). Conclusões: a identificação e a caracterização dos indicadores de qualidade proporcionaram visibilidade aos processos locais, viabilizando a tomada de decisões e o aperfeiçoamento dos serviços prestados(AU).

Objetivo: Identificar y caracterizar los indicadores de calidad más frecuentemente utilizados en un centro quirúrgico público especializado en dermatología. Método: Estudio transversal seccional, requiriendo relevamiento, con registros diarios de los indicadores más frecuentes entre los 20 existentes en la unidad, de agosto de 2015 a julio de 2016. Se consideraron: promedios, medianas, valores mínimos/máximos, desvíos estándar, frecuencias simples y porcentuales. Nivel de significancia establecido en p<0,05. Resultados: De 595 cirugías electivas, se destacaron las ambulatorias (87,9%), las dermatológicas (81,3%), en pacientes masculinos (52,6%) con promedio de 54,9 años. Los cinco indicadores más frecuentes fueron: cirugías suspendidas (17,6%); registros de enfermería incompletos (14%); ausentismo (6,5%), infección en sitio quirúrgico en cirugías limpias (2,7%) y accidentes laborales (2,2%). Conclusiones: La identificación y caracterización de indicadores de calidad otorgó visibilidad a los procesos locales, haciendo posible la toma de decisiones y el mejoramiento de los servicios brindados(AU).

Objective: to identify and characterize the most frequent quality indicators used at a public surgical center specialized in dermatology. Methods: cross-sectional study in which a survey consisting of daily records of the most frequent quality indicators among the 20 existing at the unit was carried out between August 2015 and July 2016. Mean, median minimum and maximum values, standard deviations, and absolute and percentage frequencies were obtained. A p-value lower than 0.05 (p<0.05) was considered as the level of significance. Results: in a total of 595 elective surgeries, outpatient (87.9%), dermatologic (81.3%), and those performed in men (52.6%) with an average age of 54.9 years stood out. The five most frequent indicators were: cancelled surgeries (17.6%), incomplete nursing records (14%), absenteeism (6.5%), infection in surgical sites in clean surgeries (2.7%), and occupational accidents (2.2%). Conclusions: identifying and characterizing quality indicators give visibility to local processes and enable decision-making and improvement of the offered services(AU).

Perioperative Care of Children Undergoing Intra-arterial Chemotherapy for Retinoblastoma.

Retinoblastoma (RB) is a rare cancer of the eye, most commonly seen in children. Intra-arterial chemotherapy for RB is a relatively new treatment modality that has gained increasing popularity worldwide. The principal underlying the intra-arterial approach is delivery of chemotherapeutic agents directly to the site of the tumor. This avoids system toxicities normally associated with higher dose of these drugs. The purpose of this continuing education article was to review the features of RB and its treatment, with a focus on the perioperative management of children undergoing intra-arterial chemotherapy at our institution. Intra-arterial chemotherapy for RB is an outpatient procedure and is well tolerated. Adverse events, most often bronchospasm, occur most often during the procedure itself, and tend to be easily managed. We focus on the role of perianesthesia nursing in the care of the pediatric RB patient, before, during, and after intra-arterial chemotherapy.

Segurança e satisfação de pacientes com os cuidados de enfermeiros no perioperatório / Safety and satisfaction of patients with nurse's care in the perioperative / Seguridad y satisfación del paciente con los cuidados de enfermeros en el perioperatorio

Objetivo: investigar a segurança e a satisfação de pacientes e sua relação com os cuidados dos enfermeiros no perioperatório. Método: estudo multinível, transversal, correlacional, realizado com 105 enfermeiros da área cirúrgica e 150 pacientes operados em um hospital terciário espanhol. Para os enfermeiros foram coletadas as variáveis sociodemográficas, a percepção do ambiente de trabalho, o desgaste profissional e a satisfação no trabalho. Para os pacientes, a segurança de eventos adversos e nível de satisfação, por meio de registros e questionários. Utilizou-se análise multinível, univariada e multivariada. Resultados: satisfação no trabalho, compromisso profissional e participação em questões hospitalares foram preditores negativos para eventos adversos relacionados ao paciente, enquanto o cuidado do enfermeiro no pós-operatório foi um preditor positivo. Conclusão: observa-se aumento dos eventos adversos quando os enfermeiros têm insatisfação no trabalho, menor compromisso profissional e baixa disponibilidade para participar nos assuntos de sua unidade. Por outro lado, os eventos adversos diminuem quando os enfermeiros realizam os cuidados no pós-operatório. A satisfação foi boa e não houve associação com as características do cuidado dos enfermeiros. Recomenda-se melhorar esses preditores para aumentar a segurança de pacientes cirúrgicos.

Objective: to investigate the safety and satisfaction of patients and their relationship with nurse's care in the perioperative period. Method: cross-sectional, multi-level, correlational study with 105 nurses in the surgical area and 150 patients operated in a Spanish tertiary hospital. For the nurses the sociodemographic variables, the perception of the work environment, the professional burnout and the satisfaction in the work were collected. For patients, the safety of adverse events and level of satisfaction, through the application of questionnaires. Univariate and multivariate analysis were used. Results: job satisfaction, professional commitment, and participation in hospital issues were negative predictors for adverse events related to the patient, while postoperative nurse care was a positive predictor. Conclusion: there is an increase in adverse events when nurses are dissatisfied at work, less professional commitment and low availability to participate in the subjects of their unit. On the other hand, adverse events decrease when nurses perform the care in the postoperative period. Satisfaction was good and there was no association with the characteristics of nurses' attention. It is recommended to improve these predictors to increase the safety of surgical patients.

Objetivo: investigar la seguridad y la satisfacción de los pacientes y su relación con el cuidado de los enfermeros en el perioperatorio. Método: estudio multinivel, transversal, correlacional, realizado con 105 enfermeros del área quirúrgica y 150 pacientes operados en un hospital terciario español. Para los enfermeros fueron recolectadas las variables sociodemográficas, la percepción del ambiente de trabajo, el desgaste profesional y la satisfacción en el trabajo. Para los pacientes, la seguridad de eventos adversos y el nivel de satisfacción, mediante la aplicación de cuestionarios. Se utilizó análisis univariante y multivariante. Resultados: satisfacción en el trabajo, compromiso profesional y participación en cuestiones hospitalarias fueron predictores negativos para eventos adversos relacionados al paciente, mientras que el cuidado del enfermero en el postoperatorio fue un predictor positivo. Conclusión: se observa aumento de los eventos adversos cuando los enfermeros tienen insatisfacción en el trabajo, menor compromiso profesional y baja disponibilidad para participar en los asuntos de su unidad. Por otro lado, los eventos adversos disminuyen cuando los enfermeros realizan los cuidados en el postoperatorio. La satisfacción fue buena y no hubo asociación con las características de la atención de los enfermeros. Se recomienda mejorar estos predictores para aumentar la seguridad de los pacientes quirúrgicos.

Implementation process of the Surgical Safety Checklist: integrative review / Processo de implementação da Lista de Verificação de Segurança Cirúrgica: revisão integrativa / Proceso de implementación del Listado de Verificación de Seguridad Quirúrgica: revisión integrativa

ABSTRACT Objective: to analyze the evidence available in the literature on the process of implementing the Surgical Safety Checklist, proposed by the World Health Organization, in the practice of health services. Method: integrative review, the search for primary studies was performed in three relevant databases in the health area, and the sample consisted of 27 studies, which were grouped into three categories. Results: the synthesis of the evidence indicated the different strategies that can be adopted in the implementation process (introduction and optimization) of the Surgical Safety Checklist, and the facilitators and barriers that determine the success in using this tool. Conclusion: in health services, implementing the checklist is a complex and challenging process that requires effective leadership, clear delegation of responsibilities from each professional, collaboration between team members, and institutional support. The synthesis of the generated knowledge can assist nurses in decision making, especially in identifying strategies for the effective implementation of the Surgical Safety Checklist, since nursing has the potential to be a protagonist in the planning and implementation of best practices for patient safety.

RESUMO Objetivo: analisar as evidências disponíveis na literatura sobre o processo de implementação da Lista de Verificação de Segurança Cirúrgica, proposta pela World Health Organization, na prática dos serviços de saúde. Método: revisão integrativa. A busca dos estudos primários foi executada em três bases de dados relevantes na área da saúde, sendo a amostra composta por 27 pesquisas, as quais foram agrupadas em três categorias. Resultados: A síntese das evidências indicou as diferentes estratégias que podem ser adotadas no processo de implementação (introdução e otimização) da Lista de Verificação de Segurança Cirúrgica, e os facilitadores e barreiras determinantes para o sucesso no uso dessa ferramenta. Conclusão: nos serviços de saúde, a implementação do checklist é um processo complexo e desafiador que exige liderança efetiva, delegação clara das responsabilidades de cada profissional, colaboração entre os membros da equipe e suporte institucional. A síntese do conhecimento gerado pode auxiliar os enfermeiros na tomada de decisão, principalmente na identificação de estratégias para a implementação efetiva da Lista de Verificação de Segurança Cirúrgica, uma vez que a enfermagem tem potencial para ser protagonista no planejamento e na implementação das melhores práticas em prol da segurança do paciente.

RESUMEN Objetivo: analizar las evidencias disponibles en la literatura sobre el proceso de implementación del Listado de Verificación de Seguridad Quirúrgica, propuesto por la Organización Mundial de la Salud, en la práctica de los servicios de salud. Método: revisión integrativa, la búsqueda de los estudios primarios fue ejecutada en tres bases de datos relevantes en el área de salud, siendo la amuestra compuesta por 27 investigaciones, las cuales fueron agrupadas en tres categorías. Resultados: la síntesis de las evidencias indicó las diferentes estrategias que pueden ser adoptadas en el proceso de implementación (introducción y optimización) del Listado de Verificación de Seguridad Quirúrgica, los facilitadores y barreras determinantes para el éxito en el uso de esa herramienta. Conclusión: en los servicios de salud, la implementación del listado de verificación es un proceso complejo y desafiador que exige liderazgo efectivo, delegación clara de las responsabilidades de cada profesional, colaboración entre los miembros del equipo y soporte institucional. La síntesis del conocimiento generado puede auxiliar a los enfermeros en la toma de decisión, sobre todo en la identificación de estrategias para la implementación efectiva del Listado de Verificación de Seguridad Quirúrgica, una vez que la enfermería tiene un potencial para ser protagonista en la planificación e implementación de las mejores prácticas en beneficio de la seguridad del paciente.

Risk assessment for perioperative pressure injuries / Classificação de risco de desenvolvimento de lesões decorrentes do posicionamento cirúrgico / Clasificación de riesgo de desarrollo de lesiones derivadas del posicionamiento quirúrgico

ABSTRACT Objectives: to evaluate and classify patients according to the Risk Assessment Scale for Perioperative Pressure Injuries; verify the association between sociodemographic and clinical variables and the risk score; and identify the occurrence of pressure injuries due to surgical positioning. Method: observational, longitudinal, prospective and quantitative study carried out in a teaching hospital with 278 patients submitted to elective surgeries. A sociodemographic and clinical characterization questionnaire and the Risk Assessment Scale for Perioperative Pressure Injuries were used. Descriptive, bivariate and logistic regression analyses were applied. Results: the majority of patients (56.5%) presented a high risk for perioperative pressure injury. Female sex, elderly group, and altered body mass index values were statistically significant (p < 0.05) for a higher risk of pressure injuries. In 77% of the patients, there were perioperative pressure injuries. Conclusion: most of the participants presented a high risk for development of perioperative decubitus ulcers. The female sex, elderly group, and altered body mass index were significant factors for increased risk. The Risk Assessment Scale for Perioperative Pressure Injuries allows the early identification of risk of injury, subsidizing the adoption of preventive strategies to ensure the quality of perioperative care.

RESUMO Objetivos: avaliar e classificar pacientes segundo a Escala de Avaliação de Risco para Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico; verificar se há associação entre variáveis sociodemográficas, clínicas e escore de risco; e identificar a ocorrência de lesões por pressão, decorrentes do posicionamento cirúrgico. Método: estudo observacional, longitudinal, prospectivo e quantitativo, realizado em hospital de ensino, com 278 pacientes submetidos a cirurgias eletivas. Utilizaram-se questionário de caracterização sociodemográfica e clínica e Escala de Avaliação de Risco para Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico. Empregaram-se análises descritiva, bivariada e de regressão logística. Resultados: a maioria dos pacientes (56,5%) apresentou alto risco para lesão perioperatória por posicionamento. Sexo feminino, idoso e valores de índice de massa corporal alterados foram estatisticamente significativos (p<0,05) para maior risco de ocorrência dessas lesões. Em 77% dos pacientes houve lesões por posicionamento. Conclusão: a maioria dos participantes apresentou alto risco para desenvolvimento de lesão perioperatória por posicionamento. Sexo feminino, idoso e índice de massa corporal alterado foram fatores significativos para aumento do risco. A Escala de Avaliação de Risco para Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico possibilita identificar risco de lesão precocemente, subsidiando a adoção de estratégias preventivas para assegurar a qualidade do cuidado perioperatório.

RESUMEN Objetivos: evaluar y clasificar pacientes según la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Derivadas por Posicionamiento Quirúrgico, verificar si hay asociación entre variables sociodemográficas, clínicas y escore de riesgo e identificar si existen lesiones por presión, derivadas del posicionamiento quirúrgico. Método: estudio observacional, longitudinal, prospectivo y cuantitativo, realizado en hospital de enseñanza, con 278 pacientes sometidos a cirugías electivas. Se utilizó un cuestionario de caracterización sociodemográfica y clínica y Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Derivadas por Posicionamiento Quirúrgico. Empleamos análisis descriptivos, bivariados y de regresión logística. Resultados: la mayoría de los pacientes (56,5%) presentó alto riesgo para lesión peri operatoria por posicionamiento. El sexo femenino, ancianos y valores de índice de masa corporal alterados fueron estadísticamente significativos (p <0,05) para mayor riesgo de existencia de esas lesiones. En el 77% de los pacientes hubo lesiones por posicionamiento. Conclusión: la mayoría de los participantes presentó alto riesgo de desarrollo de lesión peri operatoria por posicionamiento. El sexo femenino, ancianos e índice de masa corporal alterado fueron factores significativos para el aumento del riesgo. La Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Derivadas del Posicionamiento Quirúrgico posibilita identificar precozmente el riesgo de lesión, subsidiando la adopción de estrategias preventivas para asegurar la calidad del periodo perioperatorio.

Malignant Hyperthermia: A Review.

Malignant hyperthermia is an uncommon, but potentially lethal condition that may be encountered during the perioperative period. There is wide variability in the manner in which malignant hyperthermia may manifest. For a patient to survive a malignant hyperthermia crisis, prompt recognition and treatment is of paramount importance. Perioperative nurses play a pivotal role in the successful management of malignant hyperthermia. The fictitious case study presented in this paper describes the identification, presentation, pathophysiology, and treatment of a general anesthesia patient with fulminant malignant hyperthermia.

Patient Care During Minimally Invasive Lateral Spine Surgery: 1.7 www.aornjournal.org/content/cme.

Perioperative nurses care for patients undergoing a wide range of surgical procedures. One fast-growing surgical specialty is spine surgery performed using minimally invasive techniques. Patients may be candidates for minimally invasive spine surgery based on their presenting signs and symptoms and medical imaging test results. Open anterior and posterior surgical approaches to spine surgery are how surgeons traditionally have performed these procedures. However, new technology has enabled a minimally invasive lateral approach to the spine. This approach minimizes many of the risks and challenges associated with both the anterior and posterior approaches. Minimally invasive lateral interbody fusion requires the perioperative nurse to have a thorough understanding of the necessary patient positioning, spinal anatomy, and OR suite setup to ensure a safe and successful surgical experience for the patient.

Sleep, Snoring, and Surgery: OSA Screening Matters.

PURPOSE: This study was aimed to identify potential obstructive sleep apnea (OSA) in ambulatory surgical patients and create perianesthesia nursing protocols using a reliable and validated screening tool. DESIGN: Descriptive survey. METHODS: A nurse-initiated OSA survey was conducted in 1,118 preoperative ambulatory patients using the STOP-Bang Questionnaire to identify patients at risk for OSA. The findings resulted in the development of protocols, patient education, and interventions. FINDINGS: Ambulatory surgical patients were not routinely assessed for OSA before this study. The study verified that 10% of patients scheduled for ambulatory elective surgery had undiagnosed OSA and, because of the OSA identification, 16% of all scheduled surgeries were canceled. There were no unnecessary hospitalizations after the nurse-initiated OSA protocol. CONCLUSIONS: The STOP-Bang Questionnaire is a useful tool for screening patients with risks of OSA in the ambulatory surgical setting. This study supports using nursing best practices and safe patient care.

Postoperative Symptom Distress of Laparoscopic Cholecystectomy Ambulatory Surgery Patients.

PURPOSE: The purposes of this study were to (1) identify symptoms that cause postoperative distress in ambulatory surgery patients; (2) identify symptom management techniques that effectively reduce distress of laparoscopic cholecystectomy (LC) postoperative symptoms at home after ambulatory surgery; and (3) identify facilitators and barriers to self-management of postoperative symptoms. DESIGN: A qualitative descriptive study. METHODS: Two focus groups of ambulatory surgery patients who had experienced a laparoscopic cholecystectomy procedure and their caregivers were queried to elicit understanding of postoperative symptoms and symptom management techniques. FINDINGS: Themes identified included distressing symptoms and consequences of surgery, symptom management, and self-management facilitators and barriers. Pain was a major symptom after surgery and impacted mobility and sleep. Participants in our study wanted realistic information about symptoms and more specific information on symptom management. Caregivers were important to the success of symptom management but experienced their own stress. CONCLUSIONS: Perianesthesia nurses should focus not only on the immediate recovery, but also prepare patients and their caregivers for the more prolonged issues of recovery at home.

Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting.

AIMS AND OBJECTIVES: To explore and explain how nurses minimise risk in the perioperative setting. BACKGROUND: Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. DESIGN: Classic grounded theory. METHODS: Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. RESULTS: Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. CONCLUSION: Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. RELEVANCE TO CLINICAL PRACTICE: This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting.

Cirurgia segura: as evidências científicas para elaboração de uma intervenção educativa / Safe surgery: the scientific evidence for drawing up an educational intervention

Resumo: A segurança na assistência cirúrgica é um grande desafio nas instituições hospitalares, sendo que a implantação da lista de verificação de cirurgia segura tem mobilizado os profissionais de saúde, principalmente os enfermeiros, que atuam em centros cirúrgicos. Objetivos: este estudo objetivou analisar as evidências científicas sobre a lista de verificação de cirurgia segura; e propor uma estratégia educativa para a implantação da lista de verificação de cirurgia segura com base nestas evidências. Materiais e método: Trata-se de um estudo metodológico, de revisão integrativa (RI), fundamentada na Prática Baseada em Evidências, cuja busca foi realizada com os descritores segurança do paciente e enfermagem perioperatória/patient safety e perioperative nursing, nas base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE), com a questão de pesquisa "Quais as evidências científicas nacionais e internacionais sobre a lista de verificação de cirurgia segura, que podem subsidiar a proposição de uma estratégia educativa para a sua implantação?". Mediante critérios de inclusão e de exclusão, a amostra final foi constituída por 16 artigos científicos, que foram categorizados em dois temas. No tema "Participação para implantação do checklist" houve indicação de estratégias que podem favorecer a participação ativa dos profissionais de saúde, tanto para a sua implantação como seu aperfeiçoamento; e no tema "Avaliação da implantação do checklist" evidenciou-se aspectos importantes para a avaliação do processo de implantação na prática clínica, mas também há necessidade de estratégias para melhorar o comprometimento interprofissional. Com a análise destas evidências, elaborou-se a proposição de uma estratégia educativa para favorecer a implantação da lista de verificação de cirurgia segura em unidades de centro cirúrgico. Acreditamos que a estratégia proposta favorecerá a implantação e aperfeiçoamento da segurança na assistência cirúrgica aos pacientes, bem como a participação interprofissional

Abstract: Safety in surgical care is a great challenge in hospital institutions, and the implementation of a surgical safety checklist has mobilized health professionals, mainly nurses, who work in surgical centers. Objectives: This study was intended to analyze the national and international scientific evidence on surgical safety checklist; and to propose an educational strategy for its implementation, based on such evidence. Materials and methods: This is a methodological study, typified as integrative review (IR), underpinned by Evidence-Based Practice, whose search was held using the descriptors "segurança do paciente", "enfermagem perioperatória"/"patient safety", "perioperative nursing", in the Latin American & Caribbean Health Sciences Literature (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases, with the research question "What can the national and international scientific evidence on surgical safety checklist offer to subsidize the proposal of an educational strategy for its implementation?". After applying the inclusion and exclusion criteria, the final sample consisted of 16 scientific articles, which were categorized into two topics. In the topic "Participation for implementation of the checklist", strategies capable of fostering the active participation of health professionals were indicated, both for their implementation and for their enhancement; and in the topic "Evaluation of the implementation of the checklist", important aspects for the evaluation of the implementation process in clinical practice were evidenced, but there was also an emphasis on the need for strategies to improve the interprofessional commitment. With the analysis of such evidence, we drew up the proposition of an educational strategy to foster the implementation of the surgical safety checklist in surgical centers. We believe that the proposed strategy will foster the implementation and enhancement of the safety in the surgical care to patients, as well as the interprofessional participation

Perioperative Palliative Care Considerations for Surgical Oncology Nurses.

OBJECTIVES: To explore the opportunities to incorporate palliative care into perioperative oncology patient management and education strategies for surgical oncology nurses. DATA SOURCES: Articles related to palliative care and surgical oncology to determine the degree of integration, gaps, and implications for practice. CONCLUSION: Although evidence supports positive patient outcomes when palliative care is integrated in the perioperative period, uptake of palliative care into surgical settings is slow. Palliative care concepts are not adequately integrated into surgical and nursing education. IMPLICATIONS FOR NURSING PRACTICE: With appropriate palliative care education and training, surgical oncology nurses will be empowered to foster surgical-palliative care collaborations to improve patient outcomes.