Applying Conflict Management Strategies to the Pediatric Operating Room.

Effective communication is essential in today's health care environment, and poor communication can lead to conflict among health care providers. Differences in cultures and beliefs can further incite conflict among health care team members, families, and patients. Pediatric patient care has a higher potential for conflict because decision-making responsibilities are shared among patients, parents/guardians, and clinicians. It is important to understand the phases and types of conflict because each conflict situation requires a different approach to optimize management. Equally important is an understanding of styles used by individuals to manage conflict. The Thomas-Kilmann Conflict Mode Instrument and the Dutch Test for Conflict Handling are 2 validated tools used to assess conflict management styles. The different styles include competing/forcing, collaborating/problem solving, compromising, avoiding, and yielding/accommodating. A successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict.There are several techniques for managing conflict in the pediatric operating room. Acknowledging and managing one's own emotions during conflict is a pivotal first step toward diffusing the situation. Active listening is an important communication skill that improves team dynamics. Aligning the interests of the parties involved in conflict will encourage collaborative problem solving. Cultural competency training can improve communication and conflict management skills. Effective conflict management through formal education of all perioperative team members can lead to improved communication and teamwork and better patient outcomes.

The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms.

BACKGROUND: Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs). METHODS: This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis. RESULTS: 87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (ß=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate. CONCLUSION: The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.

Understanding stress in the operating room: a step toward improving the work environment.

Job-related stress is an important factor predicting staff satisfaction and position turnover among nursing staff, particularly in the operating room. The purpose of this study was to examine the perceived amount of stress elicited by events in the perioperative environment, the frequency of those events, and the impact of those events on the perceived stress of operating room nurses (ORNs) and operating room technologists (ORTs). The Survey on Stress in the OR instrument, which was used to query the subjects, exhibited high internal consistency of all items. The findings indicated that the ORNs and the ORTs exhibited remarkable similarities between stressful events perceived as high and low impact. The two groups agreed that the highest impact stressful event was "pressure to work more quickly." Using the results of this study, OR administrators may be able to redesign the OR environment to minimize the impact of stressful events and thereby improve job satisfaction and minimize nursing staff turnover.

Perceptions of student-observers in the operating room.

BACKGROUND: Student observation of surgical procedures is standard practice performed at the discretion of the attending surgeon and the participating medical facility. The goal of our study was to evaluate patient, physician, and operating room (OR) staff opinions concerning student observation of surgical procedures at different levels of academic training. MATERIALS AND METHODS: Following Institutional Review Board approval, patients undergoing elective surgery were consented to participate in the survey. An anonymous online survey was sent to attending surgeons and OR staff. RESULTS: The majority of patients (97), physicians (91), and OR staff (71) believe that OR observational experience is important to medical student training. Patients (92%) and OR staff (97%) more so than physicians (72%) rated OR observational experience as important for nursing student education (P < 0.001). Comparatively, all groups believe this experience is less important for college and high school students (P < 0.01). When asked if patients should be informed preoperatively of student-observer presence during procedures, more patients and OR staff replied affirmatively compared with physicians (P < 0.001). Similarly, patients and OR staff more frequently believed that informed consent for OR student-observers was necessary (P < 0.0001). CONCLUSION: All groups acknowledged the educational value of student observational experience, although significant disparity was noted relative to academic level and the group responding. Additionally, opinions of the OR staff were more closely aligned with those of patients. Further assessment of the role of informed consent for student-observer OR presence and potential implications is needed.

[Surgical team satisfaction levels between two preoperative hand-washing methods]. / Niveles de satisfacción del equipo quiúirgico entre dos métodos de lavado de mano.

INTRODUCTION: Recently, there have been new antiseptics for surgical scrub that do not require brushing. One of them contains 1% chlorhexidine gluconate and 61% ethyl alcohol; within its benefits, it may offer a low potential for skin sensitization, as well as cost savings and less use of water. OBJECTIVES: To evaluate satisfaction levels, washing time, safety, cost and amount of water between the traditional surgical scrub technique (group A) and brush-free surgical scrub procedure (group B). MATERIAL AND METHODS: One hundred clean and clean-contaminated surgeries with four hundred members of surgical teams were included. Satisfaction levels, hand-washing time, skin disorders and problems associated with placement of gloves were evaluated. Hands cultures were taken in 20% of the population and the amount of water used by patients in group A was measured. Total costs and wound infections were analyzed. RESULTS: Satisfaction scale in group A was 9.1 +/- 1.39 and 9.5 +/- 1.54 in group B (p = 0.004). The mean hand-washing time was 3.9 +/- 1.07 min in group A and 2.0 +/- 0.47 min in group B (p = 0.00001). Thirteen patients had dry skin in group A and four in group B (6.5% vs. 2%; p = 0.02). There were ten positives cultures in group A and five in group B (25% vs. 12.5%, p = 0.152). Wound infection rate was 3%. On average, five-hundred eighty liters of water were used by the former group, and the estimated hand-washing cost was lower in the second group. CONCLUSIONS: The handwashing technique with CGEA is as effective as traditional surgical scrub technique, and it is associated with less washing time, dry skin, cost and use of water.

Effects of music therapy on occupational stress and burn-out risk of operating room staff.

The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is toassess the impact of music therapy on stress levels and burnout risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased significantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool.

Attitudinal changes resulting from repetitive training of operating room personnel using of high-fidelity simulation at the point of care.

We investigated the impact of repetitive training using high-fidelity simulation (HFS) at the point of care on the teamwork attitudes of operating room (OR) personnel. Members of the general surgical OR teams at an academic medical center participated in two half-day point-of-care HFS team training sessions. Module 1 targeted teamwork competencies; Module 2 included a preoperative briefing strategy. Modules were separated by 1 month. For each training, participants completed pre- and postsession questionnaires that included a 15-item self-efficacy tool targeting teamwork competencies using a 6-point Likert-type scale. Pre- and postsession mean scores were compared with a t test. Matched pre- and postsessions questionnaires were collected from 38 and 39 participants for Module 1 and Module 2, respectively. Mean item improvement from pre- to posttraining was 0.43 units (range, 0.23 to 0.69 units) for Module 1 and 0.42 units (range, 0.15 to 0.53 units) for Module 2. After Bonferroni adjustment, statistically significant improvement in scores from pre- to posttraining increased from four items after Module 1 to nine items after Module 2. Repetitive training of interdisciplinary OR teams through HFS at the point of care increases the effectiveness of promoting attitudinal change toward team-based competencies among participants.

The effect of a one-time 15-minute guided meditation (Isha Kriya) on stress and mood disturbances among operating room professionals: a prospective interventional pilot study.

Background: Operating room professionals are exposed to high levels of stress and burnout. Besides affecting the individual, it can compromise patient safety and quality of care as well. Meditation practice is getting recognized for its ability to improve wellness among various populations, including healthcare providers. Methods: Baseline stress levels of perioperative healthcare providers were measured via an online survey using a Perceived Stress Scale (PSS) questionnaire. An in-person meditation workshop was demonstrated during surgical grand rounds and an international anesthesia conference using a 15-minute guided Isha Kriya meditation. The participants were then surveyed for mood changes before and after meditation using a Profile of Mood States (POMS) questionnaire.  Results: Surgeons and anesthesiologists were found to have higher median (interquartile range) Perceived Stress Scores as compared to nurses respectively (17 [12, 20] and 17 [12, 21] vs 14 [9, 19]; P = 0.01). Total mood disturbances were found to be significantly reduced after meditation in both the surgical grand rounds (pre-meditation median [IQR] 99 [85, 112] vs 87 [80, 93] post-meditation; P < 0.0001) and anesthesia conference cohorts (pre-meditation 92 [86, 106] vs 87 [81, 92] post-meditation; P < 0.0001). Conclusions: Isha Kriya, a guided meditation, is easy to learn and takes less than 15 minutes to complete. This meditation technique improves mood changes and negative emotions among operating room professionals and could be used as a potential tool for improving wellness.

Noise in the operating rooms of Greek hospitals.

This study is an evaluation of the problem of noise pollution in operating rooms. The high sound pressure level of noise in the operating theatre has a negative impact on communication between operating room personnel. The research took place at nine Greek public hospitals with more than 400 beds. The objective evaluation consisted of sound pressure level measurements in terms of L(eq), as well as peak sound pressure levels in recordings during 43 surgeries in order to identify sources of noise. The subjective evaluation consisted of a questionnaire answered by 684 operating room personnel. The views of operating room personnel were studied using Pearson's X(2) Test and Fisher's Exact Test (SPSS Version 10.00), a t-test comparison was made of mean sound pressure levels, and the relationship of measurement duration and sound pressure level was examined using linear regression analysis (SPSS Version 13.00). The sound pressure levels of noise per operation and the sources of noise varied. The maximum measured level of noise during the main procedure of an operation was measured at L(eq)=71.9 dB(A), L(1)=84.7 dB(A), L(10)=76.2 dB(A), and L(99)=56.7 dB(A). The hospital building, machinery, tools, and people in the operating room were the main noise factors. In order to eliminate excess noise in the operating room it may be necessary to adopt a multidisciplinary approach. An improvement in environment (background noise levels), the implementation of effective standards, and the focusing of the surgical team on noise matters are considered necessary changes.

[Staff knowledge of radiation protection in endovascular surgery]. / Connaissances du personnel de chirurgie endovasculaire en radioprotection.

INTRODUCTION: Image intensification exposes the endovascular surgery staff to ionizing radiation. The aim of this study was to determine awareness of ionizing radiation risks among personnel working in the endovascular surgery environment and the availability of radiation protection clothes and to propose appropriate corrective measures. METHODS: This descriptive study was performed in the endovascular operating theatre equipped with a mobile image intensifier unit in La Rabta vascular department in September 2017. We visited the endovascular theatre to identify the availability of radiation protection clothes. We used a questionnaire to identify personnel knowledge about ionizing radiation. We established a global score of knowledge to classify our population. RESULTS: We identified 85 professionals exposed to ionizing radiation. Sixty-four of them (75%) responded to our questionnaire; 65% were male; median age was 34 years (range: 25-61). Endovascular theatre personnel were surgeons (35%), nurses (34%), qualified technicians (18%) and other department employees (13%). The mean global score of knowledge was 8.15/20 (2-18). This score increased significantly with grade and seniority (Kruskal-Wallis test). CONCLUSION: In the present study, the results indicate insufficiency knowledge about radiation exposure among the endovascular staff and in radioprotection tools availability. In order to minimize all unnecessary radiation, attempts should be made to increase vascular theatre staff knowledge about radiation protection. Safety culture is a referral method to reduce radiation exposure as low as possible.

Estrés en graduados y técnicos en cuidados auxiliares de enfermería en las áreas quirúrgicas hospitalarias / Stress in nursing graduates and healthcare assistants in surgical areas of hospital

OBJETIVOS: Analizar el nivel de estrés que presentan los Graduados de Enfermería y los Técnicos en Cuidados Auxiliares de Enfermería en las áreas quirúrgicas de los Hospitales Públicos de Gran Canaria. MATERIAL Y MÉTODO: Estudio cuantitativo, descriptivo/observacional de prevalencia transversal, de 143 sujetos (Grado de Enfermería y Técnicos en Cuidados Auxiliares de Enfermería, en adelante T.C.A.E.), en Hospital Universitario de Gran Canaria Doctor Negrín, en adelante H.U.G.C. Dr. Negrín, y Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, en adelante C.H.U. Insular-Materno Infantil de Canarias, en los servicios de Quirófano, Unidad de Reanimación y Cuidados Críticos (R.E.A.), Unidad de Recuperación Post-anestésica (U.R.P.A.) y Cirugía Mayor Ambulatoria (C.M.A.), durante los años 2016-2019. Mediante una encuesta autocumplimentada de carácter anónimo y voluntario formado por la Escala de estrés percibido (PSS) de Cohen, S., Kamarck, T., y Mermelstein, R. Dispuesta en 14 ítems, además se realizó un cuestionario de 19 ítems de carácter demográfico y sociolaboral, efectuándose cruce de variables dependientes e independientes. RESULTADOS: Presentan un nivel de estrés con una mediana de 22%. La media es 21.79, la desviación típica 7.26, el percentil 25 da como resultado 17%, el percentil 50 es 22% y el percentil 75 es 39%. La fiabilidad total da como resultado 0.86 en el Alfa de Cronbach. CONCLUSIONES: Los trabajadores TCAE y Graduados de Enfermería, de las unidades mencionadas presentan un nivel moderado de estrés, pero las instituciones deberían intervenir para minimizarlo lo máximo posible

OBJECTIVES: To analyse the stress level in Nursing Graduates and Healthcare Assistants in surgical areas of the Public Hospitals in Gran Canaria. MATERIAL AND METHODS: Quantitative, descriptive/observational study of cross-sectional prevalence in 143 subjects (Nursing Degree and Healthcare Assistant, henceforth (H.C.A.), in the University Hospital of Gran Canaria Doctor Negrín, henceforth U.H.G.C. Dr. Negrín and Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias(Children and maternity care hospital of the Canary Islands), henceforth the C.H.U. Insular-Materno Infantil de Canarias, in the surgery services/operating rooms, Trauma Resuscitation Unit (TRU) , Post-Anesthesia Care Unit (P.A.C.U.), and Major Outpatient Surgery (M.O.S.), from 2016 to 2019. By means of an anonymous and voluntary self-completion survey based on the Perceived Stress Scale (PSS) from Cohen, S., Kamarck, T., and Mermelstein, R. It was distributed in 14 items, a questionnaire of 19 demographic and socio-labour items was also carried out, applying a cross-sectional design of dependent and independent variables. RESULTS: They show a stress level with a median of 22%. The mean is 21.79, the standard deviation is 7.26, the 25th percentile results in 17%, the 50th percentile is 22% and the 75th percentile is 39%. Total reliability is 0.86 using Cronbach's Alpha. CONCLUSIONS: H.C.A. workers and Nursing Graduates from the aforementioned units show a moderate level of stress, but institutions should intervene to minimize it as much as possible

[Gadamer: grounding a proposal for the study of stress in the surgical center]. / Gadamer: fundamentando uma proposta para o estudo do estresse no Bloco Cirúrgico.

This article makes a reflection on philosophical foundation to support the methodology in order to study the stress of professionals who work in the operating theater. The qualitative research allows a comprehensive access to the world of each subject, revealing the individual perception of whom experiences the phenomenon. Gadamer understands that the language reveals and is suitable to evaluate properly, through hermeneutics, the symbolic dimension of the subject's speech. Hermeneutics is not only just a theory of the comprehension and interpretation art but much more than that, it is close to the practical philosophy, having to respond for the methodological feature of things whose understanding it provides.

Relationship between physiologic and psychological measures of autonomic activation in operating room teams during a simulated airway emergency.

BACKGROUND: Emotional stability is important for individual and team performance during operating room (OR) emergencies. We compared physiologic and psychological anxiety assessments in OR teams during simulated events. METHODS: Twenty-two teams participated in a "cannot intubate/cannot ventilate" simulation. Participants completed the State-Trait Anxiety Inventory and wore a galvanic skin response (GSR) sensor. Differences in State-Trait Anxiety Inventory scores and GSR levels were analyzed. Anxiety scores were correlated with GSR levels. RESULTS: Resident physicians had significantly higher trait anxiety than the nurses, certified registered nurse anesthetists, and surgical technicians (43.9 ± 9.9 vs 38.3 ± 9.3, P < .01). Senior practitioners had significantly higher trait anxiety than junior practitioners (43.7 ± 9.6 vs 40.0 ± 9.9, P = .03). All groups showed significant increases in GSR. Psychological and physiologic data did not correlate. CONCLUSIONS: Senior practitioners and residents have higher levels of baseline trait anxiety for unclear reasons. Also, OR team training results in physiological signs of anxiety that do not correlate to self-reported psychological measurements.

Not just money: quality of working life as employment strategy.

Scarcities of qualified personnel are becoming a common phenomenon in The Netherlands. At the same time, increasing wages to secure an adequate workforce is not always possible or sufficiently effective, and other ways of retaining and recruiting personnel have to be found. Investigates the importance of various job characteristics for retaining and recruiting employees and presents the results from a survey among employees of a Dutch hospital experiencing a tight labour market. Job characteristics other than wages, such as labour relations and work content, were found to play a major role in individuals' choices to resign or stay. Discusses consequences for employment strategies in other organizations.

Teaching affective competencies to surgical technologists.

Learning in the affective domain encompasses behaviors and beliefs concerned with values, morals, and caring, and surgical technologists have not been well trained in affective competencies. This article describes the development of a curricular model based on Martha Rogers' Science of Unitary Human Beings and on humanistic learning theory.

Absentee patterns among OR staff. Identifying aspects of the problem.

Absenteeism continues to be a great concern to hospital administrators. Nursing personnel should have a clear idea of acceptable attendance parameters based on written policies that are routinely administered. Efforts are now directed toward exploring strategies that reward personnel for good attendance records. Early development of professional attitudes related to absenteeism should continue to be supported and fostered. Implications from this preliminary study indicate that it may be more cost-effective to hire RNs than STs to work in ORs.

The support worker in theatres.

This article will consider various aspects of the use of the support worker in theatre and will propose that the support worker can undertake the scrubbed role. The position of NATN is that it 'does not recommend that the role of the support worker encompasses the scrub role' (NATN 1996): it will be argued here that this stance is based on arguments which are fundamentally flawed.

Standardization of operative equipment reduces cost.

BACKGROUND: We hypothesize that standardizing operative equipment, and reducing variability can safely achieve cost reduction. METHODS: We retrospectively measured supply costs, operative time, intra-operative complications, and length of stay in a cohort of 145 patients at a children's hospital who underwent a laparoscopic appendectomy. A standardized preference card for laparoscopic appendectomy was developed and implemented. Data were prospectively collected on 101 consecutive patients and compared to the retrospective cohort using multiple linear regression. A survey assessing the perception of surgeons, nurses and scrub technologists of the impact of standardization on patient safety, patient care, OR efficiency, and cost was conducted. Wilcoxon rank sum test was used to evaluate associations between clinical role and years of experience with the total level of agreement on the survey. RESULTS: A 20% average reduction was achieved in supply cost per case, with no significant change in operative time (p=0.14), total time in OR (p=0.15), or length of stay (p=0.60). No intra-operative complications were identified in either group. Survey participants agreed that standardization improves cost and safety. Nurses tended to have greater agreement that standardization improved efficiency and patient care compared to other roles (p=0.06). CONCLUSIONS: Standardization of operative equipment can result in a significant cost reduction without impacting quality or delivery of care. Based on average case number per year, a total annual cost savings of >$41,000 could be realized. Survey participants agree that standardization improves cost and patient safety, yet perceptions regarding the impact on efficiency and patient care varied by occupation.