Factores laborales y nivel de estrés en enfermeras de centro quirúrgico / Work Factors and Stress Level in Nurses in a Surgical Center

Introducción: El estrés laboral es una reacción frente a exigencias y presiones en el trabajo que afecta la salud psicológica y física de la enfermera y repercute en la calidad del cuidado que brinda a los pacientes. Objetivo: Describir los factores laborales y su relación con el nivel de estrés laboral de las enfermeras de centro quirúrgico. Métodos: Investigación descriptiva-correlacional, en el Hospital Guillermo Almenara Irigoyen durante 2017. Población de 92 enfermeras del centro quirúrgico y la muestra de 70. Instrumentos: cuestionario adaptado de Fornés y la escala de estrés de enfermería, válidas y confiables para evaluar factores laborales y nivel de estrés laboral respectivamente, previo consentimiento informado. Los datos fueron procesados con software IBM SPSS versión 25; para el análisis se utilizó estadística descriptiva y el método de chi2 cuadrado de Pearson. Resultados: De la muestra, 100,00 por ciento pertenecía al sexo femenino, 41,42 % más de 50 años, 60,00 por ciento eran contratadas y 47,14 por ciento contaban con más de 20 años laborando. Los factores laborales relacionados al estrés estaban presentes en 52,85 por ciento, ambientales: temperatura inadecuada (67,10 por ciento), organizativos: sobrecarga de trabajo (78,60 por ciento) y clima organizacional poco saludable (64,30 por ciento), sobre factores de presión, exigencia y contenido: supervisión y control excesivo de las tareas (74,30 por ciento) y ritmo de trabajo exigente (54,30 por ciento). La prueba de chi cuadrado (X2) dio como resultado 4,14. Conclusiones: Existe relación significativa solo entre factores laborales de presión, exigencia y contenido del trabajo con el nivel de estrés de las enfermeras(AU)

Introduction: Work stress is a reaction to demands and pressures at work, affecting the psychological and physical health of the nurse and, the quality of care provided to patients. Objective: To describe the work factors and their relationship with the level of work stress of nurses in a surgical center. Methods: This is a descriptive-correlational research of nurses from the Surgical Center at Guillermo Almenara Irigoyen Hospital during 2017. The sample was 70 nurses out a population of 92. A questionnaire from Fornes was adapted and the nursing stress scale was used, since it is valid and reliable to evaluate work factors and level of work stress respectively, with prior informed consent. The data were processed with IBM SPSS version 25 software; descriptive statistics and Pearson's chi2 square method were used for the analysis. Results: Out of the sample, 100.00 percent were female, 41.42 percent were over 50 years old, 60.00 percent were hired and 47.14 percent had more than 20 years working. Work factors related to stress were present in 52.85 percent. Inadequate temperature was the significant environmental factor in 67.10 percent, work overload as organizational factor highlighted in 78.60 percent and unhealthy organizational climate resulted in 64.30 percent. Concerning factors such as pressure, demand and content, 74.30 percent reported excessive supervision and control of tasks and 54.30 percent reported demanding work place. The chi square test (X2) gave the result 4.14. Conclusions: There is significant relationship only between work pressure factors, demand and work content with the stress level of the nurses(AU)

Surgical counts in open abdominal and pelvic surgeries in a university hospital: a best practice implementation project.

INTRODUCTION: Counting of accountable items used during surgery, frequently called 'the count', is a fundamental practice to ensure that items such as surgical instruments, sponges and sharps are not forgotten within patients. Although inadvertently leaving behind a sponge or instrument at the end of an operation is a rare event, it is an error that may have serious implications. OBJECTIVES: The aim of this evidence implementation project was to contribute to promoting evidence-based practice in surgical counts in open abdominal and pelvic surgeries and thereby improving the outcomes of the surgical patients at a surgical centre of a university hospital. METHODS: The current evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. The JBI Practical Application of Clinical Evidence System and GRiP framework for promoting evidence-based healthcare involves three phases of activity: first, establishing a project team and undertaking a baseline audit based on evidence-informed criteria; second, reflecting on the results of the baseline audit and designing and implementing strategies to address non-compliance found in the baseline audit informed by the JBI GRiP framework; third, conducting a follow-up audit to assess the outcomes of the interventions implemented to improve practice, and identify future practice issues to be addressed in subsequent audits. These three phases were performed over a period of 6 months, from August 2017 to March 2018. RESULTS: The baseline audit revealed deficits between old and best practice in all criteria. Barriers for implementation of a protocol for surgical counts were identified, and strategies were implemented. The postimplementation (follow-up) audit showed improvement in compliance with best practice in six of the audit criteria selected except two, a multidisciplinary team approach to decrease retained surgical items, and limited staff hand-offs during surgical procedures to ensure the same team is present in all counting episodes. CONCLUSION: The main achievements of the study included substantial increases in compliance with best practice. However, registration and report and commitment of all members of surgical team to apply the entire protocol, avoiding to skip any step, persist as challenges.

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden.

BACKGROUND: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons. METHODS: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden. RESULTS: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres. CONCLUSIONS: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.

Using Virtual Reality to Compare Design Alternatives Using Subjective and Objective Evaluation Methods.

OBJECTIVE: This study sought to develop a method that supports a more evidence-based approach to evaluating multiple design options in virtual reality (VR), combining subjective insights gathered using traditional approaches and objective feedback gathered using the VR platform. Additionally, this study sought to understand how objective data garnered from the VR platform could be used to compliment traditional evaluation strategies. BACKGROUND: VR can be a viable research platform for supporting evidence-based design practices. Prior studies have predominately utilized experiential user feedback. While able to provide valuable subjective insights, these approaches are less effective in making objective comparisons between multiple designs alternatives. METHOD: A repeated measures study was conducted with nursing faculty. User feedback was captured through surveys, interviews, and the VR platform. RESULTS: The survey, interview, and the objective VR data converged in terms of identifying the highest performing design option. Survey data showed that Room 2 performed best in terms of perceived physical access to supplies, unobstructed movement, and availability of space to accommodate additional equipment. VR data showed that participants in Room 2 had significantly higher visibility to both patient and care partners throughout their simulated interaction. CONCLUSION: Simulation-based evaluations in VR that use a combination of users' subjective insights and objective data obtained from VR can be an effective tool for helping designers evaluate multiple design options. The use of scenario-based simulations provided a structured and clinically relevant approach to comparing three preoperative rooms, supporting a more robust assessment of users' physical response to a simulated healthcare environment.

Lived experiences of international operating room nurses in organ procurement surgery: A phenomenological study.

International operating room nurses come from different regions of the world with diverse social and cultural backgrounds, religions, personal beliefs, and education. They are likely to form unique attitudes toward multi-organ procurement that potentially might affect their opinions and clinical practices. The aim of this phenomenological study was to explore the lived experiences of international operating room nurses participating in deceased organ procurement procedures in Australia. Semistructured interviews were conducted with 18 international operating room nurses. van Manen's phenomenological data analysis method was adopted to uncover and interpret meanings from these nurses' descriptions. Four essential themes emerged and evolved to signify the meanings of participants' experiences in organ procurement procedures: the surreality of death, personal and professional challenges, becoming stronger, and personal beliefs and wishes. The present study highlights the importance of cultural awareness in dealing with death, organ procurement, and interprofessional collaboration in the multi-cultural perioperative context. It is essential to provide clinical education and support around culture and practice transition for international operating room nurses to increase and maintain their professional confidence, career satisfaction, health, and well-being during organ procurement surgery.

The Elephant in the Room: Nurses' Views of Communication Failure and Recommendations for Improvement in Perioperative Care.

Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees' interpersonal skills is essential to preventing communication issues.

Especialidad de Enfermería Médico-Quirúrgica, una asignatura pendiente después de 14 años / Specialty of Medical Surgical Nursing, a subject still pending after 14 years

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Development and Evaluation of a Quick Response Code-Based Nursing Education Program for Operating and Recovery Room Nurses.

The purpose of this study was to develop and evaluate the effectiveness of a quick response code-based nursing education program to improve the competence of operation and recovery room nurses. An experimental methodological design was used to develop a quick response code-based nursing educational program and analyze its effects and nurses' satisfaction with its use. The quick response code-based nursing education program was developed in five steps based on the ADDIE model: analysis, design, development, implementation, and evaluation. The program was built on smartphones, and a Web site was linked to it. After testing the program for 40 days, nurses' attitudes toward various medical devices were significantly less negative. Nurses were able to use a large number of medical devices and were highly satisfied and willing to engage with the quick response code-based nursing educational program. In the context of nursing education, introducing educational content using quick response codes helps to improve nurses' knowledge and competence in providing high-quality nursing care and medical services.

Learning procedural skills with a virtual reality simulator: An acceptability study.

BACKGROUND: Virtual Reality (VR) simulation has recently been developed and has improved surgical training. Most VR simulators focus on learning technical skills and few on procedural skills. Studies that evaluated VR simulators focused on feasibility, reliability or easiness of use, but few of them used a specific acceptability measurement tool. OBJECTIVES: The aim of the study was to assess acceptability and usability of a new VR simulator for procedural skill training among scrub nurses, based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. PARTICIPANTS: The simulator training system was tested with a convenience sample of 16 non-expert users and 13 expert scrub nurses from the neurosurgery department of a French University Hospital. METHODS: The scenario was designed to train scrub nurses in the preparation of the instrumentation table for a craniotomy in the operating room (OR). RESULTS: Acceptability of the VR simulator was demonstrated with no significant difference between expert scrub nurses and non-experts. There was no effect of age, gender or expertise. Workload, immersion and simulator sickness were also rated equally by all participants. Most participants stressed its pedagogical interest, fun and realism, but some of them also regretted its lack of visual comfort. CONCLUSION: This VR simulator designed to teach surgical procedures can be widely used as a tool in initial or vocational training.

A pilot study of non-routine events in gynecological surgery: Type, impact, and effect.

OBJECTIVE: Quantifying non-routine events (NREs) assists with identify underlying sociotechnical factors that could lead to adverse events. NREs are considered any event that is unusual or atypical during surgical procedures. This study aimed to use prospective observations to characterize the occurrence of non-routine events in gynecological surgeries. METHODS: Observational data were collected prospectively within one surgical gynecology department over a five month period. Researchers captured NREs in real time using a validated tablet PC-based tool according to the NRE type, impact, whom was affected, and duration. Researchers also noted what surgical approach (i.e. open, laparoscopic, robotic) was used. RESULTS: Across 45 surgical cases, 554 non-routine events (M = 12.31 NREs per case, SD = 9.81) were identified. The majority of non-routine events were external interruptions (40.3%), teamwork (26.7%), or equipment (21.3%). The circulating nurse was most frequently affected by NREs (43.2%) followed by the entire surgical team (13.7%). There was no statistically significant difference in non-routine events based on surgical approach. CONCLUSION: Non-routine events are prevalent in the gynecological surgical setting. Identifying the sociotechnical factors that influence non-routine events are important in determining interventions that will combat the associated risks. Interventions focusing on teamwork, managing external interruptions, and coordinating equipment may have the greatest impact to reduce or eliminate NREs in gynecological surgeries.

Effect of problem and scripting-based learning combining wearable technology on orthopedic operating room nurses' learning outcomes.

BACKGROUND: Orthopedic operating room (OR) nurses entail specialized skills and training, which are not part of the regular curricula at most nursing college. Instead, many nursing students' exposure to orthopedic care in the orthopedic range is limited to occasional observational assignments. Additionally, teamwork is an important factor affecting the performance of the orthopedic OR nurses. This results in a knowledge gap in clinical nursing education. Problem and scripting based learning (PSBL) method is a crucial tool of pre-operative prepared improvement. It is easy for surgeon to record surgical video from his own field of vision by wearable technology (WT). Nevertheless, few studies related to combine WT and PSBL been done to investigate features underlying efficiency in training of novice orthopedic OR nurses. OBJECTIVE: This study aimed to evaluate the feasibility of combining WT with PSBL in training of novice orthopedic OR nurses. METHODS: 20 operating room post-graduate-year-1 nurses from the First Hospital of China Medical University were randomly divided into two groups ("conventional training (CT)" group and "WT combining with PSBL" group). Initially the superior orthopedic operating room nurses who immediately followed each procedure filled out a feedback questionnaire of the novice nurses. After finished procedure, novice nurses had a basic understanding of each training method benefits and then filled out the questionnaires. Statistical analysis of the results was performed. RESULTS: Novice nurses of WT&PSBL Group got the better score in most of the preparedness and performance feedback statement. Mean scores of overall total preparedness and performance feedback statement of WT&PSBL Group was higher than CT Group (P ≤ 0.05). Based on summarizing the questionnaires, the novice nurse in WT- PSBL Group also made significantly better total score than "Conventional training" Group (P ≤ 0.05). CONCLUSIONS: WT&PSBL method, as a crucial tool for improving pre-operative preparedness and intra-operative performance, can cultivate novice orthopedic operating room nurses' ability to use prior knowledge and cognitive frameworks flexibly to deal with problems during performance. It plays a crucial role in training confident and safe orthopedic operating room nurses. DESIGN: Randomized controlled trial (RCT).

Intervenciones de enfermería en pacientes con cirugía ambulatoria de enfermedades anorectales / Nursing interventions in patients with anorectal diseases outpatient surgery

RESUMEN Introducción: En la cirugía ambulatoria, el paciente es operado y enviado el mismo día a su hogar, es decir, requiere poco tiempo de estadía hospitalaria después del procedimiento. Una unidad de cirugía ambulatoria en coloproctología precisa, además de cirujanos coloproctólogos expertos, de una atención de enfermería de calidad, con amplio conocimiento de las principales intervenciones que se deben realizar a los pacientes. Objetivo: Sistematizar las principales intervenciones de enfermería en pacientes con cirugía ambulatoria de enfermedades anorectales. Métodos: Revisión bibliográfica sistemática para realizar análisis crítico reflexivo del contenido artículos originales y de revisión publicados entre 1997 y 2015 en español portugués e inglés. La búsqueda fue realizada en las bases de datos Medline y SciELO de enero a marzo de 2016, las palabras clave utilizadas fueron "cirugía ambulatoria", "intervenciones de enfermería". Tras la identificación de los estudios pre-seleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusiones: Se potencializa la responsabilidad profesional implícita en el acto del cuidado y se adquiere conocimiento de las enfermedades anorectales más frecuentes, para realizar con calidad y seguridad las intervenciones de enfermería(AU)

ABSTRACT Introduction: Outpatient surgery the patient is operated on the same day and sent home, ie, requires little time of hospital stay after the procedure. An ambulatory surgery unit in coloproctology accurate, as well as experts colorectal surgeons, a nursing care quality, with extensive knowledge of the main interventions to be performed by patients. Objective: To systematize the main nursing interventions in patients with anorectal diseases outpatient surgery. Methods: Systematic literature review for thoughtful critical analysis of original content and review articles published between 1997 and 2015 in Portuguese and English Spanish. The search was conducted in Medline and SciELO bases January to March 2016 data, the keywords used were "ambulatory surgery", "nursing interventions". Following the identification of pre-selected studies he carried out reading the titles, abstract and keywords, checking the relevance to the study. Conclusions: It potentiates professional liability implicit in the act of care and knowledge of the most common anorectal disease is acquired, for quality and safety of nursing interventions(AU)

The Impact of Operating Room Layout on Circulating Nurse's Work Patterns and Flow Disruptions: A Behavioral Mapping Study.

AIM: To assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions. BACKGROUND: The CN plays a significant role in promoting patient safety during surgical procedures by observing, monitoring, and managing potential threats at and around the surgical field. Their work requires constant movement to different parts of the OR to support team members. The layout of the OR and crowded and cluttered environment might impact the CN's workflow and cause disruptions during the surgery. METHOD: A convenience sample of 25 surgeries were video recorded and thematically coded for CN's activities, locations, and flow disruptions. The OR layout was categorized into transitional zones and functional zones (workstations, supply zones, support zones, and sterile areas around the surgical table). CN's activities were classified into patient-, equipment-, material-, and information-related activities. Flow disruptions included those related to environmental hazards and layout. RESULTS: The CN traveled through multiple zones during 91% of the activities. The CN's workstation acted as a main hub from which the CN made frequent trips to both sides of the surgical table, the foot of the OR table, supply zones, and support zones. Transitional zones accounted for 58.3% of all flow disruption that the CN was involved in whereas 28% occurred in areas surrounding the OR bed. CONCLUSION: The similarity of the movement and flow disruption patterns, despite variations in OR layout, highlighted the adjacencies required between major zones that CNs regularly visit. These optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.

Evolving safety practices in the setting of modern complex operating room: role of nurses.

Operating room (OR) nursing previously referred to patient care provided during the intra-operative phase and the service provided within the OR itself. With the expansion of responsibilities of nurses, OR nursing now includes pre-operative and post-operative periods, therefore peri-operative nursing is accepted as a nursing process in OR in the contemporary medical literature. Peri-operative nurses provide care to the surgical patients during the entire process of surgery. They have several roles including those of manager or a director, clinical practitioner (scrub nurse, circulating nurse and nurse anesthetist), educator as well as researcher. Although, utmost priority is placed on insuring patient safety and well-being, they are also expected to participate in professional organization, continuing medical education programs and participating in research activities. A Surgical Patient Safety Checklist formulated by the World Health Organization serves as a major guideline to all activities in OR, and peri-operative nurses are key personnel in its implementation. Communication among the various players of a procedure in OR is key to successful patient outcome, and peri-operative nurses have a central role in making it happen. Setting up of OR in military conflict zones or places that suffering a widespread natural disaster poses a unique challenge to nursing. This review discusses all aspects of peri-operative nursing and suggests points of improvement in patient care.

Nursing Care of the Patient Undergoing an Anterior Approach to Total Hip Arthroplasty.

The anterior, anterolateral, direct lateral, transtrochanteric, and posterior techniques have historically been the surgical approach to a total hip arthroplasty; however, a forthcoming technique called the direct anterior approach has been demonstrated to produce many patient and physician quality outcomes. These favorable outcomes can include shorter hospital stay, earlier mobility and functionality, decreased medical costs, and increased patient satisfaction scores. Appropriate nursing care during the preoperative, intraoperative, and postoperative phases is essential. The purpose of this article is to describe the nursing care for a patient undergoing a direct anterior approach to hip arthroplasty.

The effectiveness of sensory stimulation therapy to strengthen the resilience of operating room nurses.

BACKGROUND: Operating room (OR) nurses need to be resilient in order to cope with extreme demands in their workplace. This research focused on the effectiveness of sensory stimulation therapy (SST) to strengthen the resilience of nurses in the OR of a private hospital in the North West Province. PURPOSE: The purpose was to determine the effectiveness of SST as an intervention to strengthen the resilience of OR nurses. DESIGN: A quasi-experimental design was used. METHOD: The population consisted of OR nurses and ICU nurses at private hospitals in the North West Province. All-inclusive sampling was used. Forty-one OR nurses formed the intervention group. A pilot group (8 subjects, OR nurses), as well as a comparison group (23 subjects, ICU nurses), was also sampled. An intervention, namely SST, was implemented with the intervention group. The resilience of the intervention group, pilot group and comparison group was measured before and after the implementation of the SST by means of Wagnild and Young's resilience questionnaire. The intervention group also completed a self-report questionnaire on their needs and suggestions for SST and wrote short narratives on their experience of SST. Data were analysed using descriptive and inferential statistics, and by thematic coding. RESULTS: Results indicated a significant statistical increase in the intervention group's resilience levels. Results from the narratives confirmed that the intervention group's resilience may have been strengthened through SST. CONCLUSION: SST has potential to strengthen the resilience of OR nurses.