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1.
J Clin Nurs ; 29(1-2): 60-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31495000

RESUMO

AIMS AND OBJECTIVES: To explore the perceptions and experiences of perioperative nurses and Certified Registered Nurse Anaesthetists (CRNAs) in robotic-assisted laparoscopic surgery (RALS). The objective was to identify the factors that affect nursing care of patients who undergo robotic-assisted laparoscopic surgery (RALS). BACKGROUND: The rapid introduction of technological innovations into the healthcare system has created new challenges for perioperative nurses. RALS affects the physical and interpersonal context of the surgical team's work and subsequent patient outcomes. Despite significant changes to the workflow for perioperative nurses and CRNAs, there is little research focusing on the nurses' experience and their challenges with RALS. DESIGN: A qualitative descriptive study. METHOD: Semi-structured interview questions guided data collection. A total of seventeen participants including six preoperative and postoperative nurses, seven intraoperative nurses, and four CRNAs in the United States were interviewed. The interviews were conducted between 26 April-24 June 2018. Data were analysed using thematic analysis, and the COREQ checklist was used to report data collection, analysis and the results. RESULTS: Three major themes and two categories within each theme were identified: (a) surgical innovation: nurse perception and workflow; (b) interprofessional practice: teamwork and standards; and (c) outcome: patient outcomes and system outcomes. CONCLUSIONS: The findings indicate that RALS has the potential to improve patient outcomes when performed in a timely fashion by skilled surgeons, and efficient, well-trained surgical teams. For patients to experience full benefits of RALS, patient characteristics, the underlying reason for surgery, and cost must be considered. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the necessity of promoting factors that improve the surgical team training and practice for RALS and will ultimately impact patient outcomes.


Assuntos
Enfermeiras Anestesistas/psicologia , Enfermagem Perioperatória/organização & administração , Procedimentos Cirúrgicos Robóticos/enfermagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Anestesistas/organização & administração , Papel do Profissional de Enfermagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Enfermagem Perioperatória/métodos , Pesquisa Qualitativa
2.
J Clin Nurs ; 28(23-24): 4367-4378, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410897

RESUMO

AIMS AND OBJECTIVES: To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis 'Risk for perioperative positioning injury'. BACKGROUND: Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. DESIGN: Longitudinal concept validation cohort study. METHODS: Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. RESULTS: A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes-Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation-and 13 clinical indicators. CONCLUSIONS: Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at 'Risk for perioperative positioning injury' are sensitive to patient states during the perioperative period. RELEVANCE TO CLINICAL PRACTICE: Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.


Assuntos
Diagnóstico de Enfermagem/normas , Posicionamento do Paciente/efeitos adversos , Enfermagem Perioperatória/métodos , Adulto , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Vocabulário Controlado
3.
J Clin Nurs ; 28(17-18): 3242-3251, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31013378

RESUMO

AIMS AND OBJECTIVES: To explore the perceptions and experiences of surgical nurses before and after introducing the Medications and Oral Restrictions Policy (the Policy). BACKGROUND: The Policy was developed following extensive consultation, and evidence-based strategies were considered for its implementation. However, it is possible uptake did not meet expectations. DESIGN: Focus group interviews. METHODS: Three focus groups were conducted in November 2015 around 'what worked, what didn't and why, before and after hospital-wide implementation of the Policy.' Data were coded and analysed using an inductive-deductive thematic analysis approach. The COREQ checklist guided reporting. RESULTS: The three groups consisted of 16, 14 and six surgical nurses. Before the Policy, there was confusion, lack of clarity and guidance, and lack of experience and confidence in managing medications when patients had oral restrictions. After the Policy rollout, there was a sense of 'knowing what to do' because of improved clarity and decision support; but there were also problems with: not everyone knowing about the policy, particularly due to staff movement and turnover; and, individual interpretation of the policy including use of its signs outside of context, and decision-making processes. CONCLUSION: Exploration of nurses' perceptions of a medication-related policy change found that while the Policy provided clarity and decision support for some, it made little difference for others. Limited reach of the policy was an issue despite an effort to address this at the outset, as well as variations in interpretation of the policy and subsequent decision-making. RELEVANCE TO CLINICAL PRACTICE: How individuals interpret information and their understanding of the context behind the policy or guideline may affect implementation and should be considered alongside other barriers when implementing medication-related initiatives. Furthermore, implementation strategies that are independent of ongoing resources and/or key champions to sustain should be prioritised for all initiatives.


Assuntos
Tratamento Farmacológico/enfermagem , Jejum , Enfermagem Perioperatória/métodos , Políticas , Tomada de Decisões , Feminino , Grupos Focais , Humanos , Pesquisa Qualitativa
4.
Int J Med Robot ; 15(4): e1996, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30884169

RESUMO

BACKGROUND: This study aimed to reveal the experiences of nurses in robotic surgery and their adaptation to this method. METHODS: This research was planned within the framework of qualitative research methods. The study population consisted of robotic surgery nurses in Turkey. Focus group interviews were conducted after the flow process was developed, and the interviews were supported using a semistructured interview form. Two focus interviews were conducted with 15 participants. RESULTS: As a result of the content analysis, 11 themes were created in four categories. The categories of the study were designed as follows: (1) Training in Robotic Surgery Nursing, (2) Adaptation to Technology in Robotic Surgery Nursing, (3) Changing Roles and Adaptation Process in Robotic Surgery Nursing, and (4) Future of Robotic Surgery. CONCLUSIONS: The lack of clarity regarding the roles and responsibilities of robotic surgery nurses and the lack of arrangements for working conditions are thought to cause professional dissatisfaction and disengagement from work.


Assuntos
Enfermagem Perioperatória/educação , Enfermagem Perioperatória/métodos , Enfermagem Perioperatória/tendências , Procedimentos Cirúrgicos Robóticos/enfermagem , Procedimentos Cirúrgicos Robóticos/tendências , Adaptação Psicológica , Adulto , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Humanos , Masculino , Papel Profissional , Pesquisa Qualitativa , Turquia , Adulto Jovem
5.
J Nurs Manag ; 27(5): 918-929, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30856288

RESUMO

AIM: To describe the nurse manager's role in perioperative settings. BACKGROUND: The nurse manager's role is complex and its content unclear. Research in this area is scarce. We need to better understand what this role is to support the nurse manager's work and decision-making with information systems. EVALUATION: An integrative literature review was conducted in May 2018. Databases CINAHL, Cochrane, PubMed and Web of Science were used together with a manual search. The review followed a framework especially designed for integrative reviews. Quality of the literature was analysed with an assessment tool. Nine studies published between 2001 and 2016 were included in the final review. KEY ISSUE: The findings from the review indicate that the nurse manager's role requires education and experience, and manifests in skills and tasks. A bachelor's degree with perioperative specialisation is the minimum educational requirement for a nurse manager. CONCLUSION: Research lacks a clear description of the nurse manager's role in perioperative settings. However, the role evolves by education. More education provides advanced skills and, thereby, more demanding tasks. Information technology could provide useful support for task management. IMPLICATIONS FOR NURSING MANAGEMENT: These findings can be used to better answer the current and future demands of the nurse manager's work.


Assuntos
Enfermeiras Administradoras/classificação , Papel do Profissional de Enfermagem , Enfermagem Perioperatória/métodos , Humanos , Enfermeiras Administradoras/tendências , Enfermagem Perioperatória/normas
6.
J Clin Nurs ; 28(9-10): 1708-1718, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30653776

RESUMO

AIMS AND OBJECTIVES: To describe patient-reported extremity symptoms after robot-assisted laparoscopic cystectomy in patients with bladder cancer. BACKGROUND: Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well-known after prolonged surgery, especially in robot-assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient-related and operative risk factors. METHODS: A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study-specific questionnaire 7-10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. RESULTS: Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7-10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. CONCLUSION: A large proportion of the patients report postoperative extremity symptoms after robot-assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow-ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. RELEVANCE TO CLINICAL PRACTICE: This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow-ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence-based positioning guidelines in the operating theatre for optimal positioning.


Assuntos
Cistectomia/efeitos adversos , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/enfermagem , Enfermagem Perioperatória/métodos , Complicações Pós-Operatórias/enfermagem , Adulto , Idoso , Cistectomia/enfermagem , Extremidades/lesões , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/enfermagem , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/enfermagem , Neoplasias da Bexiga Urinária/enfermagem , Neoplasias da Bexiga Urinária/cirurgia
7.
Int J Med Robot ; 15(1): e1954, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30133127

RESUMO

BACKGROUND: The availability of an increasing number of medical devices in the digital operating room has led to increased interaction demands of the surgical staff. To counteract the risk of bacterial contamination induced by device interactions, touchless interaction techniques are required. Support systems based on eye tracking enable interaction while maintaining sterility and freeing the hands to manipulate surgical instruments. METHODS: A system using eye tracking glasses was developed. In an evaluation, participants completed tasks using gaze gestures. Three use cases were evaluated in an intraoperative setup. System performance, user acceptance, and workload were measured. RESULTS: The system was evaluated in a laboratory environment with 26 participants. The precision of the gaze gesture recognition is 97.9%, and the true positive rate is 98.5%. The participants rated the system useful and were satisfied. CONCLUSIONS: Touchless interaction ensures sterility, although the increasing availability of medical devices in the operating room.


Assuntos
Fixação Ocular , Gestos , Enfermagem Perioperatória/métodos , Instrumentos Cirúrgicos , Interface Usuário-Computador , Calibragem , Processamento Eletrônico de Dados , Desenho de Equipamento , Equipamentos e Provisões , Movimentos Oculares , Reações Falso-Positivas , Humanos , Salas Cirúrgicas , Reprodutibilidade dos Testes , Robótica , Software , Inquéritos e Questionários , Análise e Desempenho de Tarefas
8.
Int. j. gynecol. cancer ; 29: 651-668, 2019.
Artigo em Inglês | BIGG | ID: biblio-1026214

RESUMO

Enhanced Recovery After Surgery (ERAS) is now firmly established as a global surgical quality improvement initiative that results in both clinical improvements1 and cost benefits to the healthcare system.2 ERAS guidelines are based on the highest quality evidence available and as such require updating on a regular basis.3 The ERAS Gynecologic/Oncology guidelines4 5 were first published in February 2016. This article represents the joint efforts of the ERAS® Society (www.erassociety.org) and authors from the international ERAS Gynecology chapters to present an updated consensus review of perioperative care for gynecologic/oncology surgery based on best current evidence.


Assuntos
Humanos , Feminino , Procedimentos Cirúrgicos em Ginecologia/normas , Enfermagem Perioperatória/métodos , Assistência Perioperatória/normas , Procedimentos Cirúrgicos em Ginecologia/métodos
9.
J Perianesth Nurs ; 33(6): 880-886, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30449436

RESUMO

Placing a peripheral intravenous catheter is a painful procedure and produces much anxiety for the pediatric patient, as well as for their parents and nursing staff. There is a heightened need for having effective pain control during this process, which will lead to increased cooperation and decreased anxiety for the patient, making the placement of a peripheral intravenous catheter successful. Topical analgesics and distraction are powerful tools that can make inserting a peripheral intravenous catheter easier for the patient, and also easier for a nurse with limited pediatric experience. The purpose of this article is to educate nursing staff of the importance of using topical analgesics such as LMX4 and EMLA, needle free lidocaine injections, as well as different methods of distraction to successfully place a peripheral intravenous catheter in a pediatric patient on first attempt.


Assuntos
Anestésicos Locais/administração & dosagem , Cateterismo Periférico/métodos , Dor/tratamento farmacológico , Ansiedade/prevenção & controle , Cateterismo Periférico/efeitos adversos , Criança , Humanos , Recursos Humanos de Enfermagem no Hospital/educação , Dor/etiologia , Enfermagem Perioperatória/métodos
10.
Metas enferm ; 21(8): 60-66, oct. 2018. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-172716

RESUMO

Objetivo: validar los procedimientos de lavado manual y automático de instrumental quirúrgico previo a su esterilización en una unidad de esterilización de un complejo hospitalario universitario. Método: estudio descriptivo, prospectivo y longitudinal realizado entre enero de 2015 y septiembre de 2017 en la central de esterilización del Complejo Asistencial Universitario de Salamanca. La selección del instrumental quirúrgico para cada tipo de lavado se hizo en función de las características del mismo. La validación del lavado automático se llevó a cabo mediante los test de contaminación residual Load Check de Browne y CliniChek USW de Clinichem, y del lavado manual mediante los test de proteínas Resi-test de Browne. Resultados: se realizaron 134 controles de test residual en el lavado automático. El 56% fue válido, mientras que el 44% de los controles contenía restos visibles de contaminación residual, principalmente debido a problemas mecánicos en el procedimiento. En el estudio de validación del lavado manual se analizaron un total de 85 test de proteínas. No se detectó presencia de proteínas en el material previo a su esterilización en el 88,3% de los casos. Conclusiones: la incorporación de las nuevas técnicas, como los test de proteínas o de contaminación residual, permite realizar una validación del proceso de lavado, tanto automático como manual, controlando desde el inicio el tratamiento del material quirúrgico, así como plantear las medidas correctoras oportunas para conseguir la excelencia en la esterilidad del instrumental


Objective: to validate the manual and automated cleaning process of surgical instruments before their sterilization at the Sterilization Unit of a University Hospital. Method: a descriptive, prospective and cross-sectional study conducted between January, 2015 and September, 2017 at the Central Sterilization Unit of the Complejo Asistencial Universitario de Salamanca. The selection of surgical instruments for each type of cleaning was conducted according to their characteristics. The validation of automated cleaning was conducted through the Load Check by Browne and CliniChek USW by Clinichem residual contamination tests; and the manual cleaning was evaluated through the Resi-test protein test by Browne. Results: there were 134 residual control tests conducted in the automated wash: 56% were valid, while 44% of the controls contained visible rests of residual contamination, mainly due to mechanical problems during the procedure. For the manual cleaning validation, 85 protein tests were analyzed in total. There was no presence of proteins detected in the material before sterilization in 88.3% of cases. Conclusions: the incorporation of new techniques, such as protein or residual contamination tests, allow to conduct a validation of the cleaning process, both automatic and manual, controlling from the start the treatment of surgical materials, as well as to implement any adequate correcting measures in order to achieve the excellent sterilization of instruments


Assuntos
Humanos , Desinfecção das Mãos/normas , Esterilização/normas , Instrumentos Cirúrgicos/normas , Subprodutos da Desinfecção/políticas , Cuidados de Enfermagem/métodos , Desinfetantes/uso terapêutico , Enfermagem Perioperatória/métodos , Estudos Prospectivos
11.
J Perianesth Nurs ; 33(5): 590-600, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30236565

RESUMO

Historically, the use of cuffed endotracheal tubes (ETTs) was reserved for children aged 8 years or older to minimize the risks of postextubation laryngeal edema. However, since publication of a 1997 study, researchers have consistently presented evidence that appropriately used cuffed ETTs are as safe as uncuffed ETTs. Because of the advantages of cuffed ETTs in the perianesthesia setting, the transition to cuffed ETTs in children is now complete. However, risks related to using cuffed ETTs in young children increase when guidelines for safe and appropriate use are not followed. Perianesthesia practitioners caring for children must understand the implications related to ETT type, correct ETT sizing, and the monitoring and control of ETT cuff pressure. The purpose of this educational module is to present evidence-based guidelines for the appropriate use of cuffed ETTs in children less than 8 years of age in the perianesthesia setting.


Assuntos
Intubação Intratraqueal/instrumentação , Guias de Prática Clínica como Assunto , Fatores Etários , Criança , Desenho de Equipamento , Medicina Baseada em Evidências , Humanos , Intubação Intratraqueal/efeitos adversos , Enfermagem Perioperatória/métodos
14.
Crit Care Nurs Clin North Am ; 30(3): 399-406, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30098743

RESUMO

Perioperative care of the septic patient presents unique challenges for the nurse. Understanding the physiology of sepsis is important for the nurse to anticipate the physiologic changes associated with the disorder and to prioritize the patient's needs. Ensuring adequate intravenous access by peripheral or central venous access as well as anticipating potential invasive monitoring lines allows the nurse to quickly administer antibiotic therapy, initiate fluid resuscitation, and prepare for potential vasopressor use.


Assuntos
Antibacterianos/uso terapêutico , Salas Cirúrgicas/estatística & dados numéricos , Sepse/tratamento farmacológico , Cuidados Críticos , Hidratação/métodos , Humanos , Enfermagem Perioperatória/métodos , Ressuscitação
15.
Enferm. clín. (Ed. impr.) ; 28(4): 266-273, jul.-ago. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-182244

RESUMO

Los programas de recuperación intensificada (PRI) o fast-track tienen por objetivo disminuir el estrés quirúrgico y conllevan una reducción de la carga laboral enfermera, de los costes y la estancia hospitalaria, un mayor empoderamiento del paciente, una recuperación posquirúrgica precoz y una reducción de las tasas de morbimortalidad. Para ello se requiere de la participación coordinada de un equipo multidisciplinar. A partir de una revisión integrativa de la literatura, el presente trabajo pretende ofrecer una definición del concepto de PRI o fast-track, así como mostrar la evidencia existente sobre la implantación de dichos programas en el ámbito de la Enfermería. Los beneficios y escasos perjuicios de los PRI en Enfermería justifican su implementación, que precisa un mayor apoyo y difusión para su desarrollo, así como mayor investigación que aumente la evidencia sobre la eficacia y eficiencia del protocolo


Rapid recovery (RR) or fast-track programmes are aimed at reducing surgical stress, leading to a reduction in nurse workload, costs and hospital stay, greater patient empowerment, early post-surgical recovery and reduced morbidity and mortality. These new protocols require the coordinated participation of a multidisciplinary team. Based on an integrative review of the literature, this paper aims to define the concept of a RR or fast track programme and show the existing evidence on the implementation of these programmes in nursing. The benefits and low incidence of damage of RR programmes in nursing justify their implementation. The programmes require greater support and diffusion in order to develop, as well as more research to increase the evidence on the effectiveness and efficiency of the protocols


Assuntos
Humanos , Enfermagem em Pós-Anestésico/organização & administração , Papel do Profissional de Enfermagem , Enfermagem Perioperatória/métodos , Análise Custo-Eficiência , Fatores de Tempo , Tempo de Internação
16.
AORN J ; 108(1): 13-22, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29953606

RESUMO

Pelvic fractures are traumatic injuries that can be caused by motor vehicle accidents, motorcycle accidents, motor vehicle-related pedestrian injuries, or falls from a significant height. These injuries can be life threatening because of the high vascularity of the pelvis and the difficulty in being able to see bleeding occurring in this area. Traditional approaches to treat pelvic fractures have been pelvic binding, external fixation, and open preperitoneal packing; however, the use of angiography and embolization enables faster pinpointing of the location of the bleeding. Increased use of hybrid ORs for treating traumatic pelvic fractures combines the superior imaging of interventional radiology with an OR that can quickly provide open interventions without needing to move a patient from an interventional radiology suite to another OR. This improvement in technology has combined the resources and knowledge of more diverse disciplines to provide a more centralized approach to improving patient outcomes.


Assuntos
Fraturas Ósseas/cirurgia , Pelve/cirurgia , Fraturas Ósseas/complicações , Hemorragia/etiologia , Hemorragia/cirurgia , Humanos , Pelve/lesões , Pelve/fisiopatologia , Enfermagem Perioperatória/métodos , Fatores de Risco , Ferimentos e Lesões/complicações
17.
AORN J ; 107(6): 705-714, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29851048

RESUMO

Although health care workers feel pressure to reduce adverse events in the perioperative department, a lack of education, communication, and leadership can prevent hospital personnel from reporting good catches. The purpose of this evidence-based quality improvement project was to improve the culture of safety in our perioperative department by implementing the Good Catch Campaign. An interprofessional team led staff member education after implementing a standardized electronic reporting system and debriefing process to occur after good catches. Staff members reported 391 good catches from all perioperative areas during the six-month postimplementation period. Staff members completed the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture before and six months after implementation; scores improved in five areas: communication openness, feedback and communication about error, frequency of event reporting, nonpunitive response to error, and organizational learning and continuous improvement. The campaign was a successful strategy for improving perioperative patient safety.


Assuntos
Segurança do Paciente/normas , Enfermagem Perioperatória/normas , Gestão da Segurança/normas , Atitude do Pessoal de Saúde , Humanos , Cultura Organizacional , Enfermagem Perioperatória/métodos , Desenvolvimento de Programas/métodos , Melhoria de Qualidade , Inquéritos e Questionários
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