Psychological Safety and Hierarchy in Operating Room Debriefing: Reflexive Thematic Analysis.

INTRODUCTION: Debriefing is a team discussion in a constructive, supportive environment. Barriers exist to consistent, effective team debriefing in the clinical setting, especially in operating theaters. The purpose of this study was to gain insights from frontline workers on how to set up an effective debriefing policy for our operating room. METHODS: This was a qualitative study in which we interviewed operating room workers in a tertiary children's hospital. Interviews were audio-recorded, transcribed, and coded. Data were analysed using the reflexive thematic analysis technique within a critical realism paradigm. RESULTS: Interviews were analysed from 40 operating room staff: 14 nurses, seven anesthetic technicians, seven anaesthetists, and 12 surgeons; 25 (65%) were female. The three key themes were (1) "commitment to learning"-healthcare workers are committed to teamwork and quality improvement; (2) "it is a safe space"-psychological safety is a prerequisite for, and is enhanced by, debriefing; and (3) "natural leader"-the value of leadership, but also constructs around leadership that maintain hierarchies. CONCLUSIONS: Psychological safety is both a prerequisite for and a product of debriefing. Leadership, if viewed as a collective responsibility, could help break down power structures. Given the results of this study and evidence in the literature, it is likely that routine debriefing, if well done, will improve psychological safety, facilitate team learning, reduce errors, and improve patient safety.

Development of an Aboriginal Resilience and Recovery Questionnaire - a collaboration between practitioners and help-seeking clients of a Victorian Aboriginal community controlled health service.

BACKGROUND: Indigenous experiences and perspectives of resilience, healing and recovery from trauma is gaining increasing attention, with a growing qualitative literature that spans multiple indigenous cultural groups. However, few quantitative measures are available. In this article, development of a preliminary version of the Aboriginal Resilience and Recovery Questionnaire is described. AIM: The first aim of this study was to describe findings from two focus groups that provided theoretical knowledge and development of items for a draft version of an Aboriginal Resilience Recovery Questionnaire. The second aim of the study was to conduct a preliminary psychometric analysis of the properties of the measure. DESIGN: Multi-method research design grounded in indigenous research methodologies. MEASURES: Aboriginal Resilience and Recovery Questionnaire, Australian Aboriginal Version of the Harvard Trauma Questionnaire Trauma symptom subscale, Growth and Empowerment Measure. RESULTS: (1) Two focus groups with six counselling staff from an Aboriginal health service were run that explored Victorian Aboriginal understandings of resilience, healing, and recovery from trauma. Sixty different protective factors viewed as potentially important to resilience, healing and recovery from trauma were identified by participants. (2) Following a review of the resilience literature, 75 items were reviewed and revised, with additional items developed by the focus group. (3) The final outcome was 60 items selected for a preliminary version of the Aboriginal Resilience Recovery Questionnaire, 50 of which made up 19 different subscales in addition to 10 single items. (4) Structured interviews were conducted with 81 help seeking Aboriginal clients recruited from the same health service. Preliminary psychometric assessment of the Aboriginal Resilience Recovery Questionnaire was undertaken using Principal Components Analysis. Two component subscales were extracted with adequate internal consistency and good convergent and discriminant validity. For both subscales there were moderate to strong positive associations with empowerment, and moderate to strong negative associations with trauma symptom severity. CONCLUSION: The preliminary results are promising for a strength-based resilience measure developed from the knowledge of Aboriginal practitioners and staff of a counselling service. Further research to address some psychometric limitations in the measure is required. A larger sample size will allow for a common factor analysis to be conducted. The Aboriginal Resilience Recovery Questionnaire has potential to assist Aboriginal Community Controlled Health Organisations and other organisations to evaluate whether services and programs can effectively support community members to strengthen individual, relational, community and cultural resilience resources.

Student Perceptions about the Influence of a Perioperative Nursing Elective on Career Preferences.

It has been suggested that offering perioperative nursing courses will increase the number of nurses and new graduates who enter the perioperative area. There is little research to support that students' career choices are influenced by immersion in perioperative content. The purpose of this qualitative study was to describe student perceptions of perioperative nursing as a career option following completion of an elective in perioperative nursing. Two focus groups were held involving students (N=19) who completed the course. One hour sessions were audio taped as students described their perceptions about perioperative nursing. Tapes were transcribed verbatim and analysed for themes. Four themes were identified: 1) opening their eyes: career advantages, 2) being captive: career disadvantages, 3) paradox unrecognized, and 4) I'll be a better nurse. Although students were not persuaded to alter their primary employment intentions, they acknowledged the possibility of a future career in the perioperative area.

Surgical smoke: how an issue in healthcare fits a planetary health framework.

AIM: The smoke generated from electrocautery machines may be harmful to health. Healthcare in general, and surgery in particular, has a large environmental footprint. The aims of this study were to discover what healthcare workers thought about the problem of electrocautery smoke, the idea of a surgical smoke-free policy, and to formulate ideas on how the matter could be approached in an environmentally and socially responsible way. METHOD: Operating room personnel in a tertiary referral hospital were invited to complete a survey about electrocautery smoke: perceived risks, current exposure, and measures to minimise exposure. Quantitative data were analysed in a generalised linear model, and qualitative data by reflexive thematic analysis within a constructivist theoretical framework. RESULTS: The survey response rate was 463/1234 (38%). Most supported a smoke-free policy (89%). Support for a policy was positively correlated with the perceived risk of electrocautery smoke (p<0.001. Support was lower amongst males (p<0.05). Themes from the qualitative analysis developed around nature, society and technology. A framework was developed consisting of earth and its ecosystems, human health, governance, economics, society, and the interconnected of these systems. CONCLUSION: Although smoke-free policies form part of the solution to electrocautery smoke, they are not the whole solution. Healthcare issues, in this case the issue of electrocautery smoke, could be tackled within a planetary health healthcare framework, promoting a systems approach. Applicability of the framework requires confirmation by further research.

Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation.

CONTEXT/OBJECTIVES: We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs. METHODS: Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services. RESULTS: Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would be beneficial, by reducing costs, adding interpreters, meeting population growth, and improving communication. CONCLUSIONS: Most NJ hospitals have no full-time interpreters, interpreter services department, or staff training on working with interpreters, and deficiencies exist in hospital signage and translation services. Most NJ hospitals stated third-party reimbursement for interpreter services would be beneficial.