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

Quantification of Aerosol Particle Concentrations During Endoscopic Sinonasal Surgery in the Operating Room.

BACKGROUND: Recent indirect evidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission during endoscopic endonasal procedures has highlighted the dearth of knowledge surrounding aerosol generation with these procedures. As we adapt to function in the era of Coronavirus Disease 2019 (COVID-19) a better understanding of how surgical techniques generate potentially infectious aerosolized particles will enhance the safety of operating room (OR) staff and learners. OBJECTIVE: To provide greater understanding of possible SARS-CoV-2 exposure risk during endonasal surgeries by quantifying increases in airborne particle concentrations during endoscopic sinonasal surgery. METHODS: Aerosol concentrations were measured during live-patient endoscopic endonasal surgeries in ORs with an optical particle sizer. Measurements were taken throughout the procedure at six time points: 1) before patient entered the OR, 2) before pre-incision timeout during OR setup, 3) during cold instrumentation with suction, 4) during microdebrider use, 5) during drill use and, 6) at the end of the case prior to extubation. Measurements were taken at three different OR position: surgeon, circulating nurse, and anesthesia provider. RESULTS: Significant increases in airborne particle concentration were measured at the surgeon position with both the microdebrider (p = 0.001) and drill (p = 0.001), but not for cold instrumentation with suction (p = 0.340). Particle concentration did not significantly increase at the anesthesia position or the circulator position with any form of instrumentation. Overall, the surgeon position had a mean increase in particle concentration of 2445 particles/ft3 (95% CI 881 to 3955; p = 0.001) during drill use and 1825 particles/ft3 (95% CI 641 to 3009; p = 0.001) during microdebrider use. CONCLUSION: Drilling and microdebrider use during endonasal surgery in a standard operating room is associated with a significant increase in airborne particle concentrations. Fortunately, this increase in aerosol concentration is localized to the area of the operating surgeon, with no detectable increase in aerosol particles at other OR positions.

Attitudes of the Surgical Team Toward Artificial Intelligence in Neurosurgery: International 2-Stage Cross-Sectional Survey.

BACKGROUND: Artificial intelligence (AI) has the potential to disrupt how we diagnose and treat patients. Previous work by our group has demonstrated that the majority of patients and their relatives feel comfortable with the application of AI to augment surgical care. The aim of this study was to similarly evaluate the attitudes of surgeons and the wider surgical team toward the role of AI in neurosurgery. METHODS: In a 2-stage cross sectional survey, an initial open-question qualitative survey was created to determine the perspective of the surgical team on AI in neurosurgery including surgeons, anesthetists, nurses, and operating room practitioners. Thematic analysis was performed to develop a second-stage quantitative survey that was distributed via social media. We assessed the extent to which they agreed and were comfortable with real-world AI implementation using a 5-point Likert scale. RESULTS: In the first-stage survey, 33 participants responded. Six main themes were identified: imaging interpretation and preoperative diagnosis, coordination of the surgical team, operative planning, real-time alert of hazards and complications, autonomous surgery, and postoperative management and follow-up. In the second stage, 100 participants responded. Responders somewhat agreed or strongly agreed about AI being used for imaging interpretation (62%), operative planning (82%), coordination of the surgical team (70%), real-time alert of hazards and complications (85%), and autonomous surgery (66%). The role of AI within postoperative management and follow-up was less agreeable (49%). CONCLUSIONS: This survey highlights that the majority of surgeons and the wider surgical team both agree and are comfortable with the application of AI within neurosurgery.

In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours.

BACKGROUND AND PURPOSE: Prior literature suggests after-hours delay leads to poor functional outcomes in stroke patients undergoing thrombectomy. We aimed to evaluate the impact of time of presentation on mechanical thrombectomy (MT) metrics and its association with long-term functional outcome in an Interventional Radiology (IR) suite equipped operating room (OR) setting. METHODS: Retrospective review of prospectively maintained database on all stroke patients undergoing mechanical thrombectomy between January 2015 and December 2018 at our CSC. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5 PM) and after-hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Primary outcome was 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin puncture time and procedural complications. RESULTS: A total of 315 patients were included in the analyses. 209 (66.4%) received mechanical thrombectomy after hours and 106 (33.6%) during work hours. There was no difference in the shift distribution of functional outcome on the mRS at 90 days (OR: 1.14, CI: 0.72-1.78, p=0.58) and the percentage of patients achieving functional independence (mRS 0-2) at 90 days (43.1% vs. 41.3%; p=0.83) between the after hour and work hour groups respectively. Similarly, there was no difference in median door to groin times and procedural complications among both groups, with significant year on year improvement in overall time metrics. CONCLUSIONS: Our study showed that undergoing MT during off-hours had similar functional outcomes when compared to MT during working hours in an OR setting. The after-hours deleterious effect might disappear when MT is performed in a system with 24-hours in-house Anesthesia and IR tech services.

Occupational eye dose to medical staff in various interventional cardiologic procedures: is the need for lead goggles the same in all groups of radiation workers?

Considering the increased use of interventional cardiologic procedures and concern about irradiation to the eyes, it is necessary to measure eye dose in radiation workers. The assessment of eye dose using collar dose is a routine but inaccurate method. Therefore this study was designed to measure eye dose in the radiation workers of various interventional cardiologic procedures. In this study eye dose was measured for left and right eyes in three groups of radiation workers in angiography ward of Afshar hospital in various procedures using TLD. Measurements were done separately for cardiologists, nurses and radio-technologists in 100 procedures. The nurses functioned as surgical assistants and were usually close to the table. The correlation of staff dose to exposure parameters was also investigated. Eye dose in physicians were higher than other staff in all procedures. Also the left eye dose was considerably higher than right one, especially for physicians. The median equivalent dose per procedure of left eye for physicians, nurses and radio-technologists were 7.4, 3.6, 1.4 µSv (PCI) and 3.2, 3.1, 1.3 µSv (Adhoc) and 3.2, 1.7, 1.1 µSv (CA), respectively. The annual left eye equivalent dose with (without) using lead goggles were 2.4 (15.3), 1.4 (2.2), 1.0 (1.1) mSv for physicians, nurses and radio-technologists, respectively. There were also a positive correlation between eye dose and KAP for procedures without lead goggles. The lead goggles showed lower protection effects for radio-technologists than other staff. Only 30% of physicians received a dose higher than 1/3 of the ICRP annual dose limit, therefor only physician eye dose should be monitored in catheterization labs.

A Proposal for a Standardized Nomenclature of the C-arm Movements.

No formal didactic source exists concerning terminology for movement of the C-arm in the operating room (OR). Many terminologies exist, breeding confusion among OR staff. The objective of this study was to survey the existing C-arm movement terminologies among orthopaedic surgeons and radiologic technologists and propose a standardized nomenclature moving forward. Methods: Forty-six orthopaedic surgeons and 70 radiologic technologists were surveyed. Pertinent product manuals and literature from PubMed were reviewed to find existing terms for the C-arm movement. A focus group of orthopaedic surgeons and radiologic technologists was formed and a standardized nomenclature of the C-arm terminology was developed using the Delphi method. Results: The survey response rate was 71%. The mean percentage of agreement on terms to describe movement was 47% (range, 13% to 83%). Agreement on terms to describe direction was 46% (range, 23% to 73%), and multiple frames of reference were described. No consensus was found by searching the product manuals. Using the Delphi method, we arrived at a standardized nomenclature for the C-arm movement that is reproducible and familiar. Discussion: A standardized terminology for the C-arm movement is described that will help fill a void in OR communication, combat confusion, and provide reproducible results during orthopaedic cases.

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.

"Take a look at this!". Video annotation as a means to foster evidence-based and reflective external and self-given feedback: A preliminary study in operati on room technician training.

Receiving and giving oneself formative feedback is essential to professionals' development of reflective attitudes towards their practices. In the healthcare professions, debriefing sessions are often used to provide feedback. Such sessions often incorporate videos to support the debriefing process. However, this usually occurs with reference to simulations and not to actual practice; furthermore, the potential of using video-annotation software to analyse practice has not been fully exploited in nursing education. To explore this still under-investigated potential, the current pilot study was conducted in the domain of operation room technicians to investigate whether the use of videos of actual practice and video-annotation software affected the quality of feedback given during the debriefing sessions. The pilot experience seems to confirm that this approach is feasible in actual practice. More particularly, the results suggest that video support enables more supportive feedback about work processes and more evidence- and situation-based feedback than regular debriefing without video. The use of video annotation also tends to support more student-driven and dialogical feedback as well as tending to increase student acceptance of feedback. Additional research is needed to further investigate the feasibility of this approach within hospitals.

Perceived barriers to multiprofessional team briefings in operating theatres: a qualitative study.

OBJECTIVES: This study investigates perceived barriers towards the implementation of multiprofessional team briefings (MPTB) in operating theatres, as well as ways to overcome these perceived barriers. Previous research shows that MPTB can enhance teamwork and communication, but are underused in operating theatres. By adopting a multilevel systems perspective, this study examines perceived barriers and solutions for MPTB implementation. DESIGN: Participants completed open-ended survey questions. Responses were coded via qualitative content analysis. The analysis focused on themes in the responses and the systems level at which each barrier and solution operates. SETTING: Four tertiary hospitals in Australia. PARTICIPANTS: 103 operating theatre staff, including nurses, surgeons, anaesthetists, technicians and administrators. RESULTS: Participants identified barriers and solutions at the organisational (15.81% of barriers; 74.10% of solutions), work group (61.39% of barriers; 25.09% of solutions) and individual level (22.33% of barriers; 0% of solutions). Of all the perceived barriers to MPTB occurrence, a key one is getting everyone into the room at the same time . Matching of perceived barriers and solutions shows that higher systems-level solutions can address lower level barriers, thereby showing the relevance of implementing such wider reaching solutions to MPTB occurrence (including work practices at occupational level and above) as well as addressing more local issues. CONCLUSIONS: Successful MPTB implementation requires changes at various systems levels. Practitioners can strategically prepare and plan for systems-based strategies to overcome barriers to MPTB implementation. Future research can build on this study's findings by directly examining higher systems-level barriers and solutions via detailed case analyses.

Impacto de un programa de prevención de infecciones en la conducta de cirujanos y anestesistas en un hospital público / Impact of an infection prevention program on the behavior of surgeons and anesthetists in a public hospital

Introducción: El control de las infecciones de sitio quirúrgico (ISQ) es importante en los programas de vigilancia y control de infecciones nosocomiales. Hay evidencias de que hasta un 60% podrían evitarse. Nuestro objetivo fue determinar si el porcentaje de cumplimiento de las medidas de prevención de ISQ fue mayor luego de la implementación de un programa en un hospital público.Material y métodos: Estudio comparativo inter-sujeto, observacional, retrospectivo y transversal. Se analizaron fichas de registro de cumplimiento de medidas de prevención pre y post instrumentación del programa, que consistió en entrega de ropa quirúrgica al ingreso al quirófano, difusión de las recomendaciones de prevención de ISQ y auditoría diaria. Variables: categoría profesional, uso adecuado de barbijo, de ambo y de camisolín, higiene de manos quirúrgica, cambio de ropa cuando se mancha, y manejo de efectos personales dentro del quirófano. Los datos fueron analizados empleando VCCstat3.0. Se estimaron intervalos de confianza del 95%.Resultados: En el control de la categoría "Profesional" hubo diferencias significativas en todas las variables auditadas entre cirujanos y anestesistas. Por lo tanto, se realizó un análisis de las poblaciones por separado. Cirujanos y anestesistas mejoraron el cumplimiento de ambo adecuado, cambio de ropa cuando se mancha y manejo de efectos personales dentro del quirófano. Los anestesistas, además, presentaron mejoras significativas en el uso adecuado de barbijo e higiene de manos quirúrgica. Conclusiones: La instrumentación del programa fue exitosa. Es importante continuar con los esfuerzos de la mejora. El efecto en las tasas de ISQ es un dato a medir.

Introduction: Surgical site infections (SSI) occupy a prominent place in nosocomial infection surveillance and control programs. There is evidence that up to 60% could be avoided. Our objective was to determine if the percentage of compliance with surgical infection prevention measures is higher after the implementation of a program in a public hospital.Methods: Intersubject, observational, retrospective and cross-sectional comparative study. Record of compliance with prevention measures before and after instrumentation of the Program were analyzed. The Program consisted of: delivery of surgical clothing upon admission to the operating room, dissemination of SSI prevention recommendations, daily audit. Variables: professional category, proper use of surgical mask, scrubs, and surgical gowns, surgical hand hygiene, change of clothes when stained, and handling of personal effects within the operating room. The data were analyzed using VCCstat 3.0. 95% confidence intervals were estimated.Results: In the control "Professional Category" variable, there were significant differences in all audited variables between surgeons and anesthetists, therefore, a separate population analysis was performed.Surgeons and anesthetists improved the compliance of both adequate, change of clothes when stained and handling of personal effects within the operating room. The anesthetists also presented significant improvements in proper use of chinstrap and surgical hand hygiene.Discussion: Program implementation was successful. Continuous efforts in the continuation of improvement is important. The effect on ISQ rates is a fact to be measured

Instrumentación quirúrgica: de la formación de grado a las competencias requeridas en puestos jerárquicos en la Ciudad Autónoma de Buenos Aires, Argentina / Surgical instrumentation: from undergraduate education to required competences in hierarchical positions in the Autonomous City of Buenos Aires, Argentina

La Licenciatura en Instrumentación Quirúrgica se ha propuesto desarrollar las competencias propias del profesional que actúa en un ámbito de gestión, sin descuidar las que sostiene el instrumentador en su práctica asistencial. El objetivo de esta investigación es articular los contenidos que se brindan en instituciones educativas de formación de grado para instrumentadores quirúrgicos, con las competencias que se requieren para desempeñarse en diferentes puestos jerárquicos. Se realizó un estudio cualitativo, descriptivo, de corte transversal, en el cual se procedió a entrevistar a siete profesionales de la salud que ocupan un cargo jerárquico, utilizando una guía de preguntas abiertas cuyos resultados se trabajaron mediante el análisis de contenido. También se compararon los listados de las asignaturas que se brindan en la Licenciatura para Instrumentadores Quirúrgicos en distintas universidades, cotejando los resultados con los de las entrevistas. Estas evidenciaron que los licenciados ocupan cargos jerárquicos de importancia en las instituciones para las que se desempeñan, donde necesitan poner en juego competencias como la comunicación, la gestión y el liderazgo, entre otras. En las licenciaturas ofrecidas a instrumentadores quirúrgicos se dictan asignaturas que brindan a los profesionales conocimientos generales acerca de gestión, administración, investigación y educación, concluyendo que la formación de grado sirve como base a la hora de adentrarse en el mundo laboral; no obstante, el contenido de las asignaturas varía según cada institución; por lo tanto, el nivel de formación de los licenciados resulta dispar y muchos deben realizar otros cursos o capacitaciones para complementarla. (AU)

The incorporation of a bachelor's degree for surgical-instrumentation practitioners, the academic field aims to develop the competencies required by professionals in management positions while improving the ones of surgical-instrumentation practitioners in an operating room. The following research articulated the academic training provided by different higher education institutions with the competences required to perform in several hierarchical positions. We conducted a qualitative, descriptive and cross-sectional study: we carried out interviews with seven health-professionals who work in different hierarchical roles, using open-ended questions, whose answers were studied through content analysis; and we analyzed the study-plans for Surgical Instrumentation degrees offered by a select group of universities. We also compared the lists of the subjects of the different universities that are offered in the degree for surgical instrumenters, collating the results with the interviews. The interviews revealed that graduates often get middle-level management roles that require not only the competences directly related to their surgical-assistance practice, but also a set of skills regarding human-management, such as administration, communication and leadership among others. Generally, in the analyzed bachelor's degrees curricula, the contents are properly organized and provide students with abilities in management, administration, investigation and education, concluding undergraduate academic education is an added value in graduates' resume for labor insertion. However, it exits a variation in the subject's content between higher education institutions, which creates a disparity in the academic level between graduates from different universities and force some of them to take further courses and trainings to complement their academic background. (AU)

Descripción de las herramientas de comunicación utilizadas en el área quirúrgica y la perspectiva de los instrumentadores quirúrgicos / Description of communication tools practices in the surgical area and the perspective of surgical instrumenters

La comunicación efectiva dentro de las organizaciones es uno de los factores más importantes para lograr un trabajo positivo y eficaz. Se realizó una investigación cuyo objetivo fue identificar y describir las herramientas de comunicación en el área de Quirófano Central del Hospital Italiano de Buenos Aires y las distintas perspectivas de los instrumentadores quirúrgicos respecto de su utilización. Métodos: se realizó un estudio de corte transversal con un componente de observación participativa de los medios de comunicación y una encuesta a los instrumentadores quirúrgicos de la institución. Resultados: se identificaron ocho tipos de herramientas de comunicación en el área quirúrgica. El correo electrónico (e-mail) como herramienta de comunicación es muy utilizado según los instrumentadores quirúrgicos, pero estos sugirieron otras herramientas más directas, como reuniones y capacitaciones solas o en combinación para determinados tipos de información. Conclusiones: los instrumentadores quirúrgicos utilizan una amplia gama de medios de comunicación en el área quirúrgica. La distribución de preferencias según el tipo de información indica que la elección de estos medios debería ser personalizada. (AU)

Effective communication within organizations is one of the most important factors to achieve a positive and effective work. An investigation was carried out and its objective was to identify and describe the communication tools in the surgical area of the Hospital Italiano de Buenos Aires and the different perspectives of the surgical nurses regarding its use. Methods: a cross-sectional study was carried out with a component of participative observation of the communication tools and a survey of the surgical nurses of the institution. Results: eight types of communication tools were identified in the surgical area. The implementation of email as a communication tool is widely used by surgical nurses, but they suggested other more direct tools such as meetings and training sessions alone or in combination for certain types of information. Conclusions: Surgical nurses use a wide range of communication tools in the surgical area. The distribution of preferences according to the type of information indicates that the choice of these tools should be personalized. (AU)

Operating room technician trainees teach medical students - an inter-professional peer teaching approach for infection prevention strategies in the operation room.

Background: Education is a cornerstone strategy to prevent health-associated infections. Trainings benefit from being interactive, simulation-based, team-orientated, and early in professional socialization. We conceived an innovative inter-professional peer-teaching module with operating room technician trainees (ORTT) teaching infection prevention behavior in the operating room (OR) to medical students (MDS). Methods: ORTT delivered a 2-h teaching module to small groups of MDS in a simulated OR setting with 4 posts: 'entering OR'; 'surgical hand disinfection'; 'dressing up for surgery and preparing a surgical field', 'debriefing'. MDS and ORTT evaluated module features and teaching quality through 2 specific questionnaires. Structured field notes by education specialist observers were analyzed thematically. Results: On Likert scales from - 2 to + 2, mean overall satisfaction was + 1.91 (±0.3) for MDS and + 1.66 (±0.6 SD) for ORTT while teaching quality was rated + 1.89 (±0.3) by MDS and self-rated with + 1.34 (±0.5) by ORTT. Students and observers highlighted that the training fostered mutual understanding and provided insight into the corresponding profession. Conclusions: Undergraduate inter-professional teaching among ORTT and MDS in infection prevention and control proved feasible with high educational quality. Inducing early mutual understanding between professional groups might improve professional collaboration and patient safety.

CONTAGEM CIRÚRGICA E SEGURANÇA DO PACIENTE NA PERSPECTIVA DO CIRCULANTE DE SALA OPERATÓRIA / Surgical count and patient safety in the perspective of the operating room circulating nurse / Conteo quirúrgico y seguridad del paciente en perspectiva del circulante de quirófano

Objetivo: Investigar a perspectiva do circulante de sala operatória sobre a contagem cirúrgica para a segurança dos pacientes. Método: Estudo exploratório, qualitativo, realizado em um centro cirúrgico de um hospital de grande porte do Nordeste do Brasil, entre janeiro e março de 2018. Foi realizada Análise de Conteúdo das entrevistas realizadas com 11 circulantes de sala operatória por saturação teórica. Resultados: As falas foram organizadas em duas categorias temáticas ­ "Contagem cirúrgica para a segurança do paciente" e "Falhas no protocolo de contagem cirúrgica" ­ , revelando que a mudança da prática deve ser investida, visto que a maioria entende ou reconhece a importância da contagem cirúrgica para os pacientes. Conclusão: Há o reconhecimento empírico da relevância da contagem cirúrgica, devendo ser reforçada por meio de ações que garantam a compreensão da dimensão e a repercussão dessa prática na segurança dos pacientes.

Objective: To investigate the perspective of the operating room circulating nurse on surgical count for patient safety. Method: Qualitative exploratory study, performed at the surgical center of a large hospital in the Northeast of Brazil, between January and March 2018. We carried out a Content Analysis of the interviews conducted with 11 operating room circulating nurses using theoretical saturation. Results: The responses were organized in two thematic categories ­ "Surgical count for patient safety" and "Flaws in the surgical count protocol" ­, revealing the need to invest in practice change, as most interviewees understood or acknowledged the importance of surgical count for patients. Conclusion: The relevance of surgical count is empirically recognized and must be strengthened through actions that guarantee the understanding of the extent and impact of this practice on patient safety

Objetivo: Investigar la perspectiva del circulante de quirófano sobre el conteo quirúrgico para la seguridad de los pacientes. Método: Estudio exploratorio, cualitativo, realizado en un centro quirúrgico de un hospital de grande porte del Nordeste de Brasil, entre enero y marzo de 2018. Fue realizado Análisis de Contenido de las entrevistas realizadas con 11 circulantes de quirófano por saturación teórica. Resultados: Las conversas fueron organizadas en dos categorías temáticas ­ "Conteo quirúrgico para la seguridad del paciente" y "Fallas en el protocolo de conteo quirúrgico" ­, revelando que el cambio de la práctica debe ser invertida, visto que la mayoría entiende o reconoce la importancia del conteo quirúrgico para los pacientes. Conclusión: Hay el reconocimiento empírico de la relevancia del conteo quirúrgico, debiendo ser reforzada por medio de acciones que garanticen la comprensión de la dimensión y la repercusión de esa práctica en la seguridad de ldos pacientes

Playing the Surgical Technologist Role by Surgery Residents Improves Their Technical and Nontechnical Skills.

BACKGROUND: The present study was designed to implement and evaluate an interprofessional surgical technologist-to-surgical resident training program for junior general surgery residents aimed at enhancing their operating room skills. This program would be incorporated into the general surgery educational curriculum. MATERIAL AND METHODS: Under the guidance and supervision of a surgical technologist, first-year and second-year general surgery residents performed the perioperative and intraoperative tasks that are the responsibilities of the surgical technologist for 16 inguinal/umbilical hernia and 15 laparoscopic appendectomy/cholecystectomy operations performed by attending surgeons assisted by other surgical residents from June 01, 2017 until December 31, 2017. A pretraining and post-training survey comprised 25 ranked questions (using a four-point Likert scale), and four Yes/No questions were administered to volunteer general surgery residents. RESULTS: Paired t-test analysis showed that playing the role of the surgical technologist by the junior surgery residents significantly improved (P < 0.0001) their assessment of operating room technical skills (knowledge and skills to prepare for the case and maintain a sterile field, understanding of the operative steps, knowledge of surgical instruments and their handling) as well as their nontechnical skills (situational awareness, understanding the importance of collaboration, teamwork, and communication). The answers to the binary Yes/No questions showed that all participating residents expect to use the experience gained from this training, would recommend this training session to a colleague, and support including this training session in their educational curriculum. CONCLUSIONS: The findings of this study suggest a significant educational benefit of incorporating interprofessional, surgical technologist-to-surgical resident training into the educational curriculum of the junior general surgery residents.

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 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.

Radiation Exposure to the Surgeon, Surgical Assistant, and Scrub Nurse During Closed Intramedullary Nailing of Long Bones-Does It Vary Depending on the Experience of the Surgeon?

OBJECTIVES: To assess radiation exposure (RE) to the surgical team and fluoroscopy time (FT) during closed nailing of long bone fractures performed under fluoroscopic guidance with regard to surgeon's experience. DESIGN: Prospective observational study. SETTING: Level-1 trauma center. PARTICIPANTS: Surgical team, comprising a surgeon, a surgical assistant, and a scrub nurse, for closed nailing procedures performed in 202 consecutive closed tibial and femoral diaphyseal fractures. INTERVENTION: Dosimeter provided to each member of surgical team. Surgeon experience level (trainee, senior registrar, and consultant). MAIN OUTCOME MEASUREMENTS: RE (microsieverts) to the surgical team and FT (minutes) were recorded from the dosimeter and fluoroscopic unit, respectively, and correlated with surgeon's experience. RESULTS: In tibial nailing, mean RE (in µSv) per procedure to surgeon, surgical assistant, and scrub nurse was 15.2, 9.2, and 2.0 for trainees, 14.5, 8.1, and 1.6 for senior registrars, and 13.6, 7.4, and 1.5 for consultants, respectively. In femoral nailing, mean RE per procedure to surgeon, surgical assistant, and scrub nurse was 181.6, 113.6, and 37.1 for trainees, 110.1, 66.7, and 20.4 for senior registrars, and 79.9, 30.9, and 12.5 for consultants, respectively. RE to the surgeon was highest followed by surgical assistant and scrub nurse irrespective of operating surgeon's experience in both tibial and femoral nailing (P < 0.001). In tibial nailing, there was a significant difference in FT only for the stage of guide wire passage (P = 0.041), whereas in femoral nailing, total FT (P < 0.001), nail entry verification (P = 0.02), guide wire passage (P = 0.013), nail introduction (P = 0.006), and distal locking (P < 0.001) showed a significant difference. CONCLUSIONS: RE was maximum for operating surgeon and least for scrub nurse irrespective of operating surgeon's experience in both femoral and tibial nailing. FT and RE to the surgical team decreased with increasing experience of the surgeon in femoral nailing. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.