Who is satisfied with general surgery clinic visits?

BACKGROUND: Patient satisfaction is an important patient outcome because it informs researchers and practitioners about patients' experience and identifies potential problems with their care. Patient satisfaction is typically studied through physician-patient interactions in primary care settings, and little is known about satisfaction with surgical consultations. METHODS: Participants responded to questionnaires before and after a surgical consultation. The study was conducted in a diverse outpatient clinic within a county hospital in Southern California. Participants were patients who came to the surgery clinic for their first appointment after referral from a primary care provider for a surgical consultation. RESULTS: Patients' ethnicity, educational attainment, and insurance status predict their satisfaction, and patients reliably differed in their satisfaction with care providers and with the hospital where they received their care. CONCLUSIONS: These findings add to knowledge about patient care by highlighting associations between patients' demographic characteristics and patients' differential satisfaction with particular entities within the context of surgical care.

A study of clinical and information management processes in the surgical pre-assessment clinic.

BACKGROUND: Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. METHODS: As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team. RESULTS: The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team. CONCLUSION: Successful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial - yet unfulfilled - potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes.

Turkish pediatric surgical nurses' knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns' pain relief.

Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.

Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement.

[The experience of clinical assessment as lived by surgical nurses in the context of best practice guidelines' implementation]. / L'expérience d'evaluation clinique vécue par des infir- mières de chirurgie lors de l'implantation de pratiques exemplaires.

The purpose of this hermeneutic phenomenological study (Benner, 1994) was to understand the meaning of the experience of clinical assessment of surgery nurses in a context of implementation of best practices guidelines. The study was held in an affiliated university hospital (Québec, Canada) with nine registered nurses. Data were collected through an observation period of nursing assessment and semi-structured individual interviews. The results revealed four subthemes which, combined, compose this main theme: In a context of the implementation of best practices guidelines in nursing care, clinical assessment carried out by surgery nurses is an implicit, tactful, adapted and ongoing process, facilitated by the nurse's commitment to know the patient, his history and its future in order to promote positive outcomes.

The role of the medical science liaison in industry.

Health care vendors (ie, industry) can be credited with developing products and medications that improve perioperative clinician and patient safety. The role of the medical science liaison in industry is to provide education about these products and facilitate research partnerships between clinicians and industry that can result in new products and innovations.

Use of three evidence-based postoperative pain assessment practices by registered nurses.

To provide optimal postoperative pain relief, nursing practice should be based on the best evidence available. For over 20 years, results of studies regarding nurses' use of evidence-based practices, including postoperative pain assessment practices, have shown that nurses use the practices inconsistently. The present cross-sectional survey study was conducted to: 1) determine the extent to which registered nurses caring for postoperative patients experiencing pain used three evidence-based postoperative pain assessment practices; and 2) identify relationships among the level of adoption of evidence-based postoperative pain assessment practices and selected characteristics of registered nurses. Data were collected from a convenience sample of all nurses caring for adult postoperative patients in two Midwestern hospitals where 443 surveys (46.9%) were returned. Respondents were aware of, but not using, three evidence-based postoperative pain assessment practices consistently. Registered nurses who used multiple sources to identify solutions to clinical practice problems or read one or two professional journals regularly were more likely to have adopted the three evidence-based postoperative pain assessment practices. Registered nurses need to be encouraged to use multiple sources to identify solutions to clinical practice problems, including professional nursing journals. Innovative approaches to promote the application of research to education and practice settings are needed. It is important to identify opinion leaders, because opinion leaders are an important resource in overcoming the barriers so that adoption of pain of evidence-based postoperative pain assessment practices can proceed. Additional research is needed to identify what variables effect the adoption of evidence-based practices and identify interventions to improve the level of adoption.

Development and testing of a DVT risk assessment tool: providing evidence of validity and reliability.

BACKGROUND: Hospital-acquired deep vein thrombosis (DVT) and pulmonary embolisms (PE) are preventable problems that can increase mortality. Early assessment and recognition of risk as well as initiating appropriate prevention measures can prevent DVT or PE. AIMS: The purpose of this research project was to develop a DVT risk assessment tool and test the tool for validity and reliability. METHODS: Three phases were undertaken in developing and testing the JFK Medical Center DVT risk assessment tool. Investigation and clarification of risk and predisposing factors for DVT were identified from the literature, expert nursing knowledge, and medical staff input. Second, item development and weighting were undertaken. Third, parametric testing for content validity measured the differences in mean assessment tool scores between a group of patients who developed DVT in the hospital and a demographically similar group who did not develop DVT. Interrater reliability was measured by having three different nurses score each patient and compare the differences in scores among the three. FINDINGS: The DVT group had significantly higher scores on the JFK DVT assessment scale than did those who did not experience DVT. Interrater reliability showed a strong correlation among the scores of the three nurses (.98). DISCUSSION: Providing a valid and reliable tool for measuring the risk for DVT or PE in hospitalized patients will enable nurses to intervene early in patients at risk. Basing DVT risk assessment on the evidence provided in this study will assist nurses in becoming more confident in recognizing the necessity for interventions in hospitalized patients and decreasing risk. IMPLICATIONS: Nurses can now evaluate patients at risk for DVT or PE using the JFK Medial Center's risk assessment tool.

Factors influencing perioperative nurses' error reporting preferences.

To explore the influence of scope of practice and patient outcomes on error reporting, 13 nurses were interviewed after they reviewed four "error" scenarios ranging in both scope of practice and seriousness of outcome. Of 52 theoretical incidents, only 30 were identified as errors. The nurses indicated they would formally report errors for only eight of the incidents. For another 10 incidents, the nurses would have reported using an informal reporting system only. Qualitative analysis of the interviews revealed that perceived scope of practice influenced reporting preferences, and seriousness of outcome was only a secondary consideration. Selective error reporting and the reasons for selective reporting have negative implications for patient safety.

Improving care for children requiring surgery and their families.

Despite the publication over many years of guidance and policies related to children in hospital and children having surgery, concerns remain about the standards of care provided to children and families. A survey of 63 nurses working with children was carried out by members of the Royal College of Nursing Children's Surgical Nurses Forum to evaluate the extent of implementation of guidance related to: children's choices in relation to theatre garments, whether parents or the main carer can accompany the child into the anaesthetic room and be with their child in the recovery area, and which healthcare professionals are available to support the child and family during transfer to theatre and in the theatre environment. Forty four nurses responded (70 per cent). Results indicated that at least one parent was almost always given the opportunity to be present at induction and in recovery. Only 36 per cent said that children are always offered a choice of what to wear The presence of qualified children's nurses in theatres was reported to be limited. Policy principles and guidance documents can be used by nurses to influence new ways of working to ensure practices are appropriate for children undergoing surgery.

Patient subjective experience and satisfaction during the perioperative period in the day surgery setting: a systematic review.

This systematic review used the Joanna Briggs Institute Qualitative Assessment and Review Instrument to manage, appraise, analyse and synthesize textual data in order to present the best available information in relation to how patients experience nursing interventions and care during the perioperative period in the day surgery setting. Some of the significant findings that emerged from the systematic review include the importance of pre-admission contact, provision of relevant, specific education and information, improving communication skills and maintaining patient privacy throughout their continuum of care.

Bloodborne pathogen exposure in the OR--what research has taught us and where we need to go.

Contracting a disease from bloodborne pathogens has been identified as an occupational hazard for perioperative personnel for more than two decades. Perioperative staff members are particularly vulnerable to percutaneous exposure. Despite known hazards, research has shown that perioperative staff members continue to take risks by not consistently complying with standard precautions and not reporting all percutaneous injuries. Health care workers (HCWs) and their employers need to work together to ensure that workplaces are safe. This article discusses mechanisms of bloodborne pathogen transmission, compliance with standard guidelines, and the social and economic costs of contracting a bloodborne illness. Steps to ensure that HCWs are protected also are outlined.

AORN guidance statement: creating a patient safety culture.

AORN believes all health care organizations must strive to create a culture of safety. Such a culture will provide an atmosphere where all members of the perioperative team can openly discuss errors, process improvements, or system issues without fear of reprisal. A culture of safety places an emphasis on flexibility and learning as a means of improving safety and reducing errors. Characteristics of a culture of safety include the following: communication is open and honest; the emphasis is on the team rather than the individual; standards and practices are developed in a multidisciplinary framework; staff members are helpful and supportive of each other; staff members trust each other; surgical team members have a friendly, open relationship emphasizing credibility and attentiveness; the environment is resilient, encourages creativity, and is patient outcomes-driven; the focus is on work flow and process; and these attributes are supported by an informed culture that learns from incidents and near misses. A commitment to safety must be articulated at all levels of the organization. Safety must be valued as the top priority, even at the expense of efficiency. Health care organizations must allocate an appropriate amount of resources and provide the necessary incentives or rewards to promote a robust patient safety culture. AORN recognizes that most patient safety initiatives will fail in the absence of a viable safety culture.

Making sense of your employment contract.

Whether you work in the NHS or the independent sector you do not need reminding of the changes that are occurring within the delivery of perioperative services, as employers strive to comply with Agenda for Change, the Working Time Regulations and the Modernisation Agenda within the UK. The impact of such change is that you the employee may have to change your shift patterns or take on more responsibilities and extra workload.