Nursing Students' Operating Room Experiences: A Qualitative Meta-Synthesis.

PURPOSE: Missed nursing care is a condition that is likely to be encountered frequently in the surgical care process and is generally related to the educational and emotional needs of the patients. Perception of and witnessing missed care can affect nursing images, expectations, and experiences by causing nursing students to experience professional disappointment. The purpose of the study was to explore nursing students' perception of missed perioperative nursing care according to "role theory" and Benner's "novice to expert" theories. METHODS: The study used a qualitative design based on Heidegger's hermeneutical phenomenological approach. Study data were collected using a semistructured interview form prepared by the researchers through face-to-face interviews lasting approximately 50 minutes. The analysis of the data was conducted using van Manen's thematic analysis. The Standards for Reporting Qualitative Research (SRQR) checklist was used in reporting the study. RESULTS: This study, which was conducted to explore awareness of perioperative missed nursing care (PMNC), consisted of 12 students, including five males and seven females. Nursing students who noticed PMNC in clinical practice experienced internal conflict about the issue, were concerned about the image of nursing, and experienced role and professional identity confusion. The themes of the study were formed in light of these experiences of nursing students. Three themes and 11 subthemes emerged in the study. The themes of the study were (1) perceived PMNC applications-behavior patterns (2) internal reflections of PMNC-its impact on professional identity development and (3) perceptions of professionalism in perioperative nursing CONCLUSIONS: This study provided important data about the awareness of PMNC in the surgical clinical practice of nursing students in Turkey and the effects of this awareness on the professional roles and professional identity process. Students were aware of the behavioral patterns of PMNC and experienced internal conflict, anxiety about the nursing image, role confusion, and professional identity confusion due to this awareness. Some students justified the PMNC behaviors of the nurses and others saw themselves as the power to change the PMNC behaviors.

The Distraction Perceptions of Health Care Professionals in the Operating Room: The Disruptions in Surgery Index (DiSI).

PURPOSE: The purpose of the study was to evaluate the psychometric properties of the Disruptions in Surgery Index (DiSI) in operating room health care professionals and to determine the frequency of distractions DESIGN: Methodological study. METHODS: The sample consisted of 152 health care professionals. Data were collected online using the DiSI scale. The language validity was ensured, and the data were analyzed with the content validity index, Cronbach α coefficient, and item-total score correlation. Data on distractions of health care workers were given as percentages and averages. FINDINGS: The mean age of health care professionals was 27.3 ± 6.0 years, and 77.0% of them were operating room nurses. The content validity index of the scale was found to be 0.95. The Cronbach α coefficient of the scale was 0.953 for frequency, 0.967 for contribution to error, and 0.971 for obstruction of goals. The correlation between the item and the total item was positive and significant (p < .001). Tiredness was determined as the most common distraction factor, causing errors and making it difficult to achieve goals. CONCLUSIONS: The DiSI was found to be a valid and reliable tool. The most common distractions, contributing to errors and obstructing to goals, were related to individuals' skills, performance, and personality. Health care professionals perceived the distractions related to the surgical processes and the situations of the team members in the coordination and situational awareness subdimension as the least distracting factor.

Comparison of interface pressures on three operating table support surfaces during surgery.

AIM OF THE STUDY: To investigate the effect of support surface usage and positions on interface pressure during surgery. MATERIALS AND METHODS: This randomized controlled experimental study was conducted between October 2018 and June 2019. The study included patients who had planned surgery in supine and prone positions. The sample size was 72 patients. Patients were assigned to three groups (gel support surface, viscoelastic support surface and standard operating table) according to the determined randomization table. During the surgery, the pressure in the patients' body was recorded. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data. RESULTS: There was no statistically significant difference between the total body average interface pressure (mmHg) values between the supporting surfaces in the prone position. There was a statistically significant difference between the total body average interface pressure (mmHg) values between the support surfaces in the supine position, and the average interface pressure measured on the viscoelastic foam support surface was significantly lower than the gel support surface and the standard operating table. CONCLUSION: In the study, the use of viscoelastic foam support surface was found to be more effective than the use of a standard operating table and gel support surface. Viscoelastic foam support surface is recommended for patients at risk for pressure injury in the operating room.

Comparison of Body Temperature, Normothermia, and Extubation Times of Patients Heated with Forced Air Warming Method Based on Whether Patients Underwent On-Pump or Off-Pump Coronary Artery Bypass Graft.

AIM: This study aimed to compare the body temperature, normothermia, and extubation times of patients heated with forced air warming method based on whether they underwent on-pump or off-pump coronary artery bypass graft. METHOD: This quasi-experimental study comprised 109 patients who underwent coronary artery bypass graft operation in the cardiovascular surgery department of a university hospital and a private hospital in Afyonkarahisar. Patients were divided into the following two groups: group 1 comprised 65 patients who underwent on-pump coronary artery bypass graft and group 2 comprised 44 patients who underwent off-pump coronary artery bypass graft. All patients included in the study were heated with forced air warming method. Preoperative and postoperative data were collected using the Patient Identification Form and the Patient Tracking Form, consisting of 16 items in total. Data were analyzed using the Statistical Package for the Social Sciences 18.0 software. RESULTS: Even though the preoperative body temperature, postoperative first body temperature, second hour body temperature, and extubation time did not exhibit a significant difference depending on the operating method, a significant difference was observed regarding the first, third, fourth, and fifth hour body temperatures and time to reach normothermia based on the operating method (p<0.05). Notably, the off-pump group's body temperatures in the first, third, fourth, and fifth hours were higher compared with the on-pump group. Furthermore, the off-pump group reached normothermia (145.22±72.54 minutes) earlier or faster compared with the on-pump group (206.84±89.30 minutes). The body temperatures, extubation times, and normothermia were not observed to exhibit significant differences based on the gender (p>0.05). A statistically significant relation was not observed between the patient's body temperature and their age (p>0.05). However, a low but positive and significant (p<0.05) correlation was observed between the extubation times (r=0.197) and age, as well as time to reach normothermia (r=0.237) and age. CONCLUSION: This study concluded that forced air warming method is an effective technique to minimize the time to regain normothermia among patients who underwent the on- and off-pump coronary artery bypass graft.

Forensic Cases in the Operating Room: Knowledge and Practices of Physicians and Nurses.

PURPOSE: The purpose of this study was to investigate physicians' and nurses' knowledge and practices regarding forensic cases in the operating room. DESIGN: This is a descriptive study. METHODS: The sample consisted of 139 physicians and 59 nurses working in the operating rooms of a university hospital. Data were collected via a question form prepared by the researchers. FINDINGS: Approximately half of the physicians and nurses did not know whether a patient brought to the operating room was a forensic case. Most of the physicians and nurses working in the operating room felt their knowledge and practice regarding the preservation and storage of evidence in forensic cases was inadequate. CONCLUSIONS: The results of this study highlight the necessity of an increased focus on forensic case process.

Environment-Friendly Practices in Operating Rooms in Turkey.

BACKGROUND: Environment-friendly practices refer to decreasing energy consumption, using resources carefully and sustainably, and reducing environmental pollution. An environment-friendly hospital is defined as a hospital where energy is saved, carbon emissions are decreased, and productivity and quality are increased. Operating rooms (ORs) account for most wastes generated daily by hospitals. Thus, adopting environment-friendly healthcare practices in ORs will have a positive impact on the environment. PURPOSE: The aim of this study was to identify and recommend environment-friendly practices that are feasible for implementation in ORs in Turkey. METHODS: Data on the environment-friendly practices that are currently being practiced in the ORs of hospitals in Izmir Province were collected using face-to-face interviews with nurses who were in charge of ORs in Izmir Province. The interviews were conducted using an OR identification form and Greening the OR Checklist. The study population included all of the hospitals in Izmir Province, and the study sample included 18 ORs in the 11 hospitals that consented to take part in the research. Permission to conduct this research was obtained from the ethics committee of the nursing school as well as from the participating hospitals where the study was conducted. RESULTS: The hospitals included in the study had, on average, 7.44 ± 7.32 ORs, each of which employed an average of 16.83 ± 17.16 nurses. Four fifths (83.3%) of the ORs always monitored their wastes, and 88.9% gave their batteries to recyclers. In addition, 72.2% renewed their surgical sets to reduce excessive use of materials, and 72.2% preferred using reusable materials instead of single-use materials in their surgical sets. However, 66.7% of the ORs had no environmental team, 93% did not use an environmentally safe surface cleaner, 83.3% did not use sensor controls on lights, and 66.7% did not use LED lights. CONCLUSIONS: Although most hospitals did not have a special team to recommend and enforce environment-friendly procedures, the OR nurses did their best to protect the environment.

The examination of problems experienced by nurses and doctors associated with exposure to surgical smoke and the necessary precautions.

AIMS AND OBJECTIVES: This study aims to investigate the problems experienced by nurses and doctors as a result of exposure to surgical smoke and the precautions that need to be taken. BACKGROUND: Electrosurgery is carried out in almost all operating rooms, and all of those who work in these rooms are exposed to surgical smoke, especially doctors and nurses. A review of the literature reveals that there are very few studies that have been carried out on surgical smoke, and there are no studies researched on the problems experienced by those working in operating rooms. DESIGN: This descriptive study was conducted between April and June 2015. METHODS: The study was carried out in the operating rooms of Training and Research Hospital with 81 nurses and doctors. Descriptive statistical analyses were performed using the IBM SPSS Statistics 23 (Windows), Hacettepe University, Ankara. RESULTS: The problems experienced by the nurses and doctors as a result of exposure to surgical smoke included: headache (nurses: 48·9%, doctors: 58·3%), watering of the eyes (nurses: 40·0%, doctors: 41·7%), cough (nurses: 48·9%, doctors: 27·8%), sore throat, bad odours absorbed in the hair, nausea, drowsiness, dizziness, sneezing and rhinitis. Regarding the precautions taken to protect themselves from surgical smoke, 91·1% of the nurses and 86·1% of the doctors reported using surgical masks. CONCLUSIONS: It was found that they did not report taking any effective protective measures, and only a few of the nurses reported using special filtration masks. It was observed that the participants widely used surgical masks, which are ineffective in protecting from the effects of surgical smoke. RELEVANCE TO CLINICAL PRACTICE: Attention brought to the effects of surgical smoke. Presentation of the harmful effects of surgical smoke reported by doctors and nurses. Identification of the precautions that can be taken against surgical smoke.

Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients.

BACKGROUND: Endotracheal tube cuff pressure must be maintained within 20-30mH2O to prevent complications. There is limited literature reporting the impact of nursing care on endotracheal cuff pressure. However, few studies have reported the effect of nursing care on endotracheal cuff pressure. OBJECTIVES: This study was performed to investigate the effects of body position on endotracheal cuff pressure. METHODS: Twenty-five patients receiving mechanical ventilatory therapy were placed in a baseline position (semirecumbent position with the head of the bed elevated at 30° and head in a neutral position) with endotracheal tube cuff was adjusted to 25cmH2O. The patients were moved into 16 different positions: anteflexion of the head; hyperextension of the head; left lateral flexion of the head; right lateral flexion of the head; rotation of the head to the left; rotation of the head to the right; semirecumbent position with 45° elevation of the head of the bed; recumbent position with 10° elevation of the head of the bed; supine position; trendelenburg position 10°; left lateral position at 30°, 45°, and 90°; and right lateral position at 30°, 45°, and 90°. The endotracheal tube cuff pressure was measured and recorded after each position change. RESULTS: Among the 400 endotracheal tube cuff pressure measurements (25 patients×16 positions) 10 (2.5%) were lower than 20cmH2O; 201 (50.3%) were between 20-30cmH2O and 189 (47.3%) were higher than 30cmH2O. Mean endotracheal tube cuff pressure increased from 25 to 32.59±4.08cmH2O after changing the patients' position. Friedman test indicated a statistically significant deviation in the ETCP across the 16 positions (X2: 122.019, p: 0.0001). CONCLUSIONS: Body positioning during daily nursing care effected the endotracheal tube cuff pressure, suggesting that endotracheal tube cuff pressure should be measured after changing a patient's position and adjusted within the recommended range.

The Operating Room Experiences of Nursing Students: A Focus Group Study.

PURPOSE: The purpose of this study was to evaluate operating room (OR) experiences of student nurses. DESIGN: The focus group interview from qualitative research methods was used. METHODS: This study was carried out between February and March 2011 in an OR practice at a university school of nursing. The grounded theory method was used to collect and analyze semistructured interview. Interviews were held with a total of 26 students in three focus group interviews. Each interview was tape recorded and was supported by taking notes. The audiotapes were listened and relistened by the researchers and transcribed. FINDINGS: Four themes were determined as a result of this study. These are information, determination of career preference, period of internship and/or rotation, and fear and/or anxiety. CONCLUSIONS: The students stated that the period of OR practice was insufficient, the opportunities for being able to implement were limited, they mostly observed, and they experienced feelings of being alone and fear in the OR. Despite all of these, the students stated that the OR practice provided a major contribution to their education and was effective in the determination of their career preferences after graduation.

Nurses' attitudes towards pressure ulcer prevention in Turkey.

BACKGROUND: Pressure ulcers remain a major problem in healthcare system. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Positive attitudes towards pressure ulcer prevention have positive impacts on preventive care. AIMS AND OBJECTIVES: The aim of this study was to identify nurses' attitude towards pressure ulcer prevention. DESIGN: The study design was descriptive. SETTING AND SAMPLE: The study was carried out in a university hospital in Izmir, Turkey. The study population consisted of 660 nurses who work in medical and surgical clinics and intensive care units. The study sample consisted of 426 nurses who agreed to participate. METHOD: Attitude towards Pressure Ulcer Prevention Instrument was used in order to evaluate nurses' attitudes. Written permissions for ethical considerations and Attitude towards Pressure Ulcer Prevention Instrument permission were obtained. Data were collected between June and July 2014. The statistics program SPSS 18 packaged software was used in the analyses of data. RESULTS: The average age of the nurses who took part in the study was 31.86 ± 7.09 years and the average work experience was 8.88 ± 7.41 years; 36.9% (n: 157) were working in intensive care units. The nurses' average score on the Attitude towards Pressure Ulcer Prevention Instrument was 43.74 ± 4.29 (84.12%). CONCLUSION: It was seen that the attitudes of the nurses towards the prevention of pressure ulcers was positive. To read guidelines and training time about pressure ulcer prevention affect positively attitudes towards the prevention of pressure ulcers.