Investigation of related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy.

OBJECTIVE: The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy. METHODS: A descriptive and cross-sectional design was used. The study was conducted between March and September 2023. Data were collected with an online questionnaire created on Google Forms, consisting of a Nurse Information Form, a Surgery-related Pressure Injury Awareness Form, and the Attitude towards Pressure Ulcer Prevention Instrument. RESULTS: The sample of the study consisted of 258 operating room nurses working in Turkey, Croatia, and Italy. It was found that the majority of the participants (70.90 %) did not use a risk scale, had not received education on pressure injury prevention and treatment (58.10 %) but wanted to receive it (86 %). Mean attitude scores of operating room nurses by country were at an adequate level in Turkey (42.48 ± 4.30) but not at the desired level in Croatia (37.48 ± 3.44) and Italy (36.20 ± 4.02). While there was a significant positive relationship between the awareness and attitudes of operating room nurses in Turkey (p = 0.002) and Croatia (p < 0.001), no relationship was found between these variables of nurses in Italy (p = 0.109). A statistically significant difference was found between nurses' consideration of themselves sufficient and their attitudes and awareness in all three countries (p < 0.05). It was also determined that reading articles affected nurses' awareness in all countries. CONCLUSIONS: While operating room nurses' attitudes towards preventing pressure injuries were adequate in Turkey, it was determined that those of the nurses in Croatia and Italy were not at the desired level. Nurses should receive regular training on surgical pressure injuries to increase their awareness and to support them in implementing the recommendations of pressure injury guidelines in accordance with institutional policy.

Inadvertent Hypothermia in the Perspective of Operating Room Nurses: A Phenomenological Qualitative Study.

PURPOSE: The aim of the study was to reveal the awareness and perceptions of operating room nurses concerning inadvertent hypothermia, as well as their experiences and recommendations for its prevention. DESIGN: The study employed a phenomenological qualitative approach. METHODS: This study was conducted with 17 nurses working in the operating room of a university hospital in Konya, Turkey. Data were collected face to face between 15 August and 30 September 2022 using the in-depth individual interview method. The data were subjected to inductive content analysis. Written permission was obtained from the hospital, the ethics committee, and the participants to conduct the study. FINDINGS: The mean age of the nurses was 28.4 years and the majority were female. The nurses were graduates of a four-year health vocational high school, a two-year nursing associate degree program, or a four-year nursing bachelors' degree program. Their operating room experience ranged from 1 to 22 years. All the nurses were aware of inadvertent hypothermia, and all but one encountered hypothermia and applied preventive measures. The data analysis revealed 263 codes, 12 categories, and 4 themes on the awareness and perceptions of operating room nurses about inadvertent hypothermia and their experiences and recommendations for its prevention. CONCLUSIONS: The findings showed that the majority of the participants were aware of inadvertent hypothermia and its risk factors, and frequently encountered inadvertent hypothermia despite implementing preventive measures.

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.

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.

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.

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.

A Novel Approach to Surgical Instructions for Scrub Nurses by Using See-Through-Type Head-Mounted Display.

In order to facilitate assists in surgical procedure, it is important for scrub nurses to understand the operation procedure and to share the operation status with attending surgeons. The potential utility of head-mounted display as a new imaging monitor has been proposed in the medical field. This study prospectively evaluated the usefulness of see-through-type head-mounted display as a novel intraoperative instructional tool for scrub nurses. From January to March 2014, scrub nurses who attended gasless laparoendoscopic single-port radical nephrectomy and radical prostatectomy wore the monocular see-through-type head-mounted display (AiRScouter; Brother Industries Ltd, Nagoya, Japan) displaying the instruction of the operation procedure through a crystal panel in front of the eye. Following the operation, the participants completed an anonymous questionnaire, which evaluated the image quality of the head-mounted display, the helpfulness of the head-mounted display to understand the operation procedure, and adverse effects caused by the head-mounted display. Fifteen nurses were eligible for the analysis. The intraoperative use of the head-mounted display could help scrub nurses to understand the surgical procedure and to hand out the instruments for the operation with no major head-mounted-display wear-related adverse event. This novel approach to support scrub nurses will help facilitate technical and nontechnical skills during surgery.

Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators.

PURPOSE: To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. DESIGN: We used a prospective cohort study to investigate the research question. SUBJECTS AND SETTINGS: The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion. METHODS: Patients who provided informed consent for study participation were assessed for pressure ulcers, using the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Guidelines, before entering the operating room and again in the post-anesthetic care unit (PACU). Research nurses and all PACU nurses were trained in skin assessment and in pressure ulcer staging. Patients were not assessed again after their discharge from the PACU. RESULTS: Seven patients (1.3%) had existing pressure injuries (ulcers) and a further 6 (1.3%) developed a surgery-related pressure ulcer. Risk factors associated with surgery-related pressure injuries were similar to non-surgically related risks and included older age, skin condition, and being admitted from a location other than one's own home. Length of surgery was not associated with pressure ulcer development in this cohort. CONCLUSION: Perioperative nurses play an important role in identifying existing or new pressure injuries. However, many of these nurses are unfamiliar with pressure ulcer classification, so education in this area is essential. Although the incidence of surgically acquired pressure ulcers was low in this cohort, careful skin inspection before and after surgery provides an opportunity for early treatment and may prevent existing lesions progressing to higher stages.

Anesthetic management and implications of pediatric patients with a diagnosis of anti-N-methyl-D-aspartate receptor encephalitis: two case reports.

This article discusses the anesthetic management and implications of 2 pediatric patients with a diagnosis of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis. Anti-NMDA receptor encephalitis has been described as an immune-meditated syndrome that triggers the production of antibodies to the NMDA receptor: a site of action for many commonly used anesthetic agents. Symptoms of this disease can be autonomic, neurologic, and psychological in nature. This disease process can pose a challenge to the anesthesia provider during all stages of the anesthetic. Thus, the anesthesia provider must incorporate an understanding of the administered anesthetic agent's potential pharmacologic effect on the affected NMDA receptor when formulating the patient's anesthetic plan.

Development and Effectiveness of a Standardized Hand-Off Program Using the SWITCH Tool for OR Nurses: A Randomized Controlled Trial.

The purpose of this study was to develop a standardized hand-off program based on the SWITCH tool (surgical procedure, wet, instruments, tissue, counts, have you any questions?) and to examine its effectiveness in terms of self-reported perceptions of hand-off satisfaction, self-efficacy, surgical nursing performance, and communication competence among OR staff members. This randomized controlled trial used a nonsynchronized control group with a pretest and posttest design. The nurses in the experimental group received one educational session and used the standardized hand-off tool for four weeks. The control group performed hand offs using the usual method rather than a tool. After the intervention, self-reported hand-off satisfaction (P = .001), self-efficacy (P = .005), and surgical nursing performance (P < .001) scores were significantly higher in the experimental group than in the control group. A standardized hand-off tool can improve nurse perceptions of satisfaction, self-efficacy, and surgical nursing performance.

The bedside assistant in robotic surgery--keys to success.

Taking on the position of bedside assistant for a surgical robotic team can be a daunting task. Keys to success include preparation, proper operation set up, effective use of instruments to augment the actions of the console surgeon, and readiness for surgical emergencies. Effective communication, repetitive execution, and readiness facilitate the efforts of the surgical team.

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.

Care of the patient undergoing surgical excision of a carotid body chemodectoma.

The carotid body is a small mass of tissue inside the carotid bifurcation that reacts to the body's level of oxygen. In rare cases, the carotid body may develop a tumor known as a chemodectoma or paraganglioma. These tumors can vary in size and, typically, they are benign. Although carotid body tumors usually are painless and slow growing, they may cause a compression syndrome that results in symptoms such as dysphagia. The treatment of choice for many carotid body tumors is surgical removal, but there are risks involved with resecting these tumors because of their close location to the carotid vessels and cranial nerves. The use of newer imaging modalities to allow earlier detection of carotid body tumors and careful surgical technique can decrease the complications associated with this challenging surgical procedure.

Surgical vacuum drains: types, uses, and complications.

High- and low-pressure vacuum drains are commonly used after surgical procedures. High-pressure vacuum drains (ie, sealed, closed-circuit systems) are efficient and allow for easy monitoring and safe disposal of the drainage. Low-pressure vacuum drains use gentle pressure to evacuate excess fluid and air, and are easy for patients to manage at home because it is easy to reinstate the vacuum pressure. Perioperative nurses should be able to identify the various types of commonly used drains and their surgical applications. Nurses should know how to care for drains, how to reinstate the vacuum pressure when necessary, and the potential complications that could result from surgical drain use.

Managing a chest tube and drainage system.

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes.

The role of the operating room nurse manager in the successful implementation of preoperative briefings and postoperative debriefings in the VHA Medical Team Training Program.

To improve communication within surgical teams, Veterans Health Administration (VHA) implemented a Medical Team Training Program (MTT) based on the principles of crew resource management. One hundred two VHA facilities were analyzed. Nursing leadership participation in the planning stages of the program was compared with outcomes at follow-up. Nurse manager participation in planning was associated with higher rates of implementation of preoperative briefing and postoperative debriefing. Nurse managers are a critical component in the planning phase of team training programs focused on OR clinical staff.

[Ambulatory anaesthesia, beneficial for children]. / L'anesthésie ambulatoire, un bénéfice pour l'enfant.

The advantages of ambulatory surgery and anaesthesia are widely recognised. Apart from their interest in terms of reducing hospital costs, they are overwhelmingly preferred by patients. Of all patients, it is children who can benefit the most.

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.

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.

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.