Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit Nurses.

PURPOSE: This study investigated organizational communication satisfaction and safety climate among perianesthesia care unit (PACU) nurses and factors affecting safety climate. DESIGN: A cross-sectional study of 103 registered nurses currently working in PACUs in Korea. METHODS: Organizational communication satisfaction was measured using the Communication Satisfaction Questionnaire, and safety climate was assessed using the Safety Attitudes Questionnaire-Korean version 2. Additional questions covered the demographics of the respondents and the characteristics of the hospital where they worked. FINDINGS: Factors affecting teamwork climate included communication climate and horizontal informal communication. Safety climate was affected by media quality and organizational integration; job satisfaction by working in secondary hospitals, communication climate, and media quality; perception of management by working in public hospitals, media quality, and personal feedback; and working conditions by working in public hospitals, media quality, and personal feedback. CONCLUSIONS: The results show that Korean PACU nurses experience poorer safety climate compared with other countries. One suggestion is to enhance nurses' satisfaction using organizational communication (eg, by developing effective communication media that satisfy users) and to promote communication at an organizational level so that individual health care professionals are aware of their organizations' vision and policies.

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.

Clinical analysis of perioperative nursing of aortic coarctation.

BACKGROUND: The aim of this study is to explore the treatment experience of the perioperative nursing of coarctation of the aorta. METHODS: From June 2012 to December 2013, a total of 15 children diagnosed with coarctation of the aorta were retrospectively studied and sorted into the observation group in our hospital. Also, 12 children admitted between January 2010 and December 2012 was sorted into control group. Combined intravenous anesthesia and cardiopulmonary bypass were conducted on all the children. Children in observation group underwent perioperative nursing, including preoperative nursing (evaluating disease conditions, improving preoperative preparation and preoperative discussion) and postoperative nursing (transferred into ICU, respiratory management, circulation system management, nutrition support nursing, using intravenous drugs). Children in the control group were treated with common nursing. Clinical effects of both groups were compared. RESULTS: Fourteen of 15 cases in the treatment group were cured and discharged from the hospital after a 6~12-month follow-up. All patients had good prognosis, except one case quit the treatment and left hospital for obstinate low output syndrome. CONCLUSIONS: With the improvement in the skills of a repair operation, extracorporeal circulation and monitoring as well as nursing, the restenosis incident rate and morality rate were effectively reduced. Meanwhile, taking an initiative for comprehensive prevention nursing measures during peri-operation is an important guarantee to a successful operation and prognosis.

COVID-19: Initial Perioperative and Perianesthesia Nursing Response in a Military Medical Center.

Nurses have historically led efforts to improve the health of populations while simultaneously and unselfishly providing care during pivotal moments of national need. The COVID-19 pandemic has placed an unprecedented strain on the US health care system, including severe shortages of hospital beds, supplies, equipment, pharmaceuticals, and healthy frontline clinicians. Perioperative and perianesthesia leaders and clinicians have unique opportunities to provide patient care during the COVID-19 crisis. In this manuscript, we describe the initial changing roles and contributions of perioperative and perianesthesia registered nurses during the COVID-19 pandemic and share recent experiences from a military medical center. Perioperative and perianesthesia nurses are vital to the overall nursing viability of the health care system, as they possess the requisite knowledge and skills to provide expert clinical care in many hospital settings and meet the demands of a global pandemic.

Care of the Patient With a Peripheral Nerve Block.

Long-acting peripheral nerve blocks provide effective postoperative pain management, but there are risks associated with rendering an extremity insensate. Perianesthesia nurses play a major role in anticipating and mitigating risks and carefully monitoring patients for potential complications. This article presents uncommon but important considerations related to the care of patients with a peripheral nerve block. These include compartment syndrome, local anesthetic systemic toxicity, thermal injuries, falls, and fractures as well as their management and prevention. The nurse's responsibility in discharge education after a peripheral nerve block is also discussed.

I Stay-Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace.

PURPOSE: To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace. DESIGN: Qualitative design. METHODS: Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud. FINDINGS: Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone's equal value and resulting in a feeling of homelikeness. (2) Sustained development in one's own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them. CONCLUSIONS: In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.

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.

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.

Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

AIMS AND OBJECTIVES: To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. BACKGROUND: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. DESIGN: A focused ethnographic approach. METHOD: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. RESULTS: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. CONCLUSION: Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. RELEVANCE TO CLINICAL PRACTICE: Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery.

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.

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.

Coping and caring: support resources integral to perioperative nurses during the process of organ procurement surgery.

AIMS AND OBJECTIVES: To discuss and explore the levels of support provided to perioperative nurses when participating in multi-organ procurement surgery and the impact to their overall well-being. BACKGROUND: Assisting within multi-organ procurement surgical procedures has been recognised to impact on the well-being of perioperative nurses leaving little opportunity for them to recover from their participation or to seek available support resources. To date, this area has remained largely unexplored with limited evidence of how nurses manage and cope with these procedures, in addition to the support received in the workplace. DESIGN: A qualitative grounded theory method. METHODS: The study was informed by perioperative nurses (n = 35) who had previous participatory experience in these surgical procedures from two Australian states. Theoretical sampling directed the collection of data via semistructured in-depth interviews. Data were analysed using the constant comparative method. RESULTS: Three components of levels of support were identified from the data: lacking support within the operating room organisation; surgical team support and access to external professional support. CONCLUSION: These findings offer new insights into how nurses manage and cope with their participation in organ procurement surgical procedures and what types of support resources can be seen as barriers or enablers to their overall experiences. The need for timely and adequate support is vital to their overall well-being and future participation in organ procurement surgery. These findings have the potential to guide further research with implications for clinical initiatives and practices, looking at new ways of supporting perioperative nurses within the clinical environment both locally and internationally. RELEVANCE TO CLINICAL PRACTICE: Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health and well-being of nurses impacted by these surgical procedures and provide appropriate and timely clinical support within the work environment.

Praise matters: the influence of nurse unit managers' praise on nurses' practice, work environment and job satisfaction: a questionnaire study.

AIM: The aim of this study was to investigate the associations between praise from nurse unit managers and job satisfaction, professional practice, workload, work climate and organizational commitment of nurses caring for surgical patients. BACKGROUND: Praise influences experiences of employees. DESIGN: Web-based, cross-sectional explorative survey design. METHODS: A structured questionnaire was used to measure praise given by nurse unit managers as perceived by nurses (n = 383; 49% response rate) working with surgical patients. Data were collected between December 2009-January 2010. Several variables assessed the major concepts under study. Binary logistic regression analysis was employed to compare nurses who receive praise very rarely/rarely as compared with very often/rather often. RESULTS: Praise was received often/very often by 31·6% of participants. Compared with nurses receiving praise rarely/very rarely those who received it often/rather showed more job satisfaction, stated they had more opportunities to practice professionally, described a more positive work climate and were more committed to the organization such as being proud to work at and willing to make effort for the unit and hospital. There was no difference between the groups regarding workload. Main findings of the regression analysis were that nurses display their organizational commitment by not thinking about leaving the current workplace and those who value professional recognition are likelier to receive praise than their counterparts. CONCLUSION: Nurse unit managers should praise their staff in a realistic fashion. Such praise is cost-effective, takes short time, produces positive influences on members of their staff and may improve patient safety.

Nurses in post-operative heart surgery: professional competencies and organization strategies.

OBJECTIVE: To analyze nurses' competencies with regard to their work in post-operative heart surgery and the strategies implemented to mobilize these competencies. METHOD: This was an exploratory study with a qualitative approach and a methodological design of collective case study. It was carried out in three post-operative heart surgery units, consisting of 18 nurses. Direct observation and semi-structured interviews were employed to collect data. Data were construed through thematic analysis. RESULTS: nine competencies were found, as follows: theoretical-practical knowledge; high-complexity nursing care; nursing supervision; leadership in nursing; decision making; conflict management; personnel management; material and financial resources management; and on-job continued education. Organizational and individual strategies were employed to develop and improve competencies such as regular offerings of courses and lectures, in addition to the individual pursuit for knowledge and improvement. CONCLUSION: the study is expected to lead future nurses and training centers to evaluate the need for furthur training required to work in cardiac units, and also the need for implementing programs aimed at developing the competencies of these professionals. OBJETIVO: Analisar as competências dos enfermeiros para atuarem no pós-operatório de cirurgia cardíaca e estratégias implementadas para a mobilização dessas competências. MÉTODO: Estudo exploratório, com abordagem qualitativa e desenho metodológico estudo de caso coletivo. Foi realizado em três unidades pós-operatórias de cirurgias cardíacas, com 18 enfermeiros. Na coleta de dados utilizou-se observação direta e entrevista semiestruturada. Para interpretação dos dados optou-se pela análise temática. RESULTADOS: Foram identificadas nove competências, sendo: conhecimento teórico-prático, cuidados de enfermagem de alta complexidade, supervisão e liderança em enfermagem, tomada de decisão, gerenciamento de conflitos, de recursos humanos, materiais, financeiros e educação continuada em serviço. Estratégias organizacionais e individuais são realizadas a fim de desenvolver e aprimorar competências, tais como: oferecimento de cursos e palestras periodicamente, além da busca individual por conhecimento e aperfeiçoamento. CONCLUSÃO: O estudo deve provocar a reflexão de futuros enfermeiros e dos centros formadores quanto à formação necessária para atuar em unidades cardíacas e sobre a necessidade de implementação de programas que visam desenvolver competências nestes profissionais.

The Perioperative Nurse Surgeon's Assistant: Issues and challenges associated with this emerging advanced practice nursing role in Australia.

AIMS: The aim of this study was to obtain Perioperative Nurse Surgeon's Assistants' views about their emerging new role in contemporary nursing practice in Australia. BACKGROUND: Internationally advanced practice nursing has led to a range of specialist roles aimed at delivering higher quality, efficient nursing care. In 2005 an Australian university developed the Perioperative Nurse Surgeon's Assistant graduate education and training program to provide nurses with an opportunity to gain advanced practice knowledge and extended skills specifically in the perioperative setting. DESIGN: This study was a qualitative research design that used online surveys and in-depth interviews to explore the issues and challenges associated with the introduction of the (currently non-accredited) Perioperative Nurse Surgeon's Assistant role in Australia. METHODS: Experienced Australia perioperative nurses who had undertaken graduate education and training in this field were recruited for this study. Data were collected between August and October 2011. An inductive thematic analysis was used to interpret the findings. RESULTS: Eighteen nurses completed the online survey and six were interviewed (n = 24). Nurses cited their commitment to professional development and the delivery of high quality patient care, along with surgeons' encouragement for them to complete specialist clinical training, as key reasons for undertaking Perioperative Nurse Surgeon's Assistant education and training. CONCLUSIONS: The Perioperative Nurse Surgeon's Assistant role led to greater job satisfaction and autonomy, and assisted nurses to better meet the needs of patients, surgeons and clinical perioperative teams. Without formal recognition of the Perioperative Nurse Surgeon's Assistant role its future in the Australian health care system is under threat.