Surgical counting interruptions in operating rooms.

BACKGROUND: Operating rooms are complex working environments with high workloads and high levels of cognitive demand. The first surgical count which occurs during the chaotic preoperative stage and is considered a critical phase, is a routine task in ORs. Interruptions often occur during the first surgical count; however, little is known about the first surgical counting interruptions. This study aimed to observe and analyse the sources, outcomes, frequency of the first surgical counting interruptions and responses to interruptions. METHODS: A retrospective observational study was carried out to examine the occurrence of the first surgical counting interruptions between 1st August 2023 and 30th September 2023. The data were collected using the "Surgical Counting Interruption Event Form", which was developed by the researchers specifically for this study. RESULTS: A total of 66 circulating nurses (CNs) and scrub nurses (SNs) were observed across 1015 surgeries, with 4927.8 min of surgical count. The mean duration of the first surgical count was 4.85 min, with a range of 1.03 min to 9.51 min. In addition, 697 interruptions were identified, with full-term interruptions occurring an average of 8.7 times per hour. The most frequent source of interruption during the first surgical counts was instruments (N = 144, 20.7%). The first surgical counting interruptions mostly affected the CN (336 times; 48.2%), followed by the ORNs (including CNs and SNs) (243 times; 34.9%) and the SN (118 times; 16.9%). Most of the outcomes of interruptions were negative, and the majority of the nurses responded immediately to interruptions. CONCLUSIONS: The frequency of the first surgical counting interruption is high. Managers should develop interventions for interruptions based on different surgical specialties and different nursing roles.

Effects of operating room nursing intervention on wound infection in patients undergoing ovarian cysts surgery: A meta-analysis.

We conducted this study aimed to explore the effect of operating room nursing intervention on wound infection in patients undergoing ovarian cysts surgery. A computer system was used to search PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure databases, from database inception to October 2023, for randomised controlled trials (RCTs) on the application of operating room nursing intervention to ovarian cyst surgery. Literature that met the requirements was independently screened by two researchers, and data were extracted and assessed for literature quality. RevMan 5.4 software was applied for data analysis. Fifteen RCTs involving 1187 patients were finally included. The analyses revealed that, compared with routine nursing, the implementation of operating room nursing intervention had a significant advantage in reducing the incidence of wound infections (1.17% vs. 5.44%, odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.15-0.58, p = 0.0004) and postoperative complications (6.34% vs. 25.17%, OR: 0.20, 95%CI: 0.13-0.29, p < 0.00001), as well as being able to shorten the operative time (standardised mean difference [SMD]: -3.93, 95%CI: -5.67 to -2.20, p < 0.00001), hospital length of stay (SMD: -2.54, 95%CI: -3.19 to -1.89, p < 0.00001) and gastrointestinal recovery time (SMD: -1.61, 95%CI: -2.24 to -0.98, p < 0.00001) in patients undergoing ovarian cysts surgery. This study confirmed by meta-analysis that the operating room nursing intervention can significantly reduce the incidence of wound infection and complications, shorten the operative time, gastrointestinal recovery time, and hospital length of stay after ovarian cyst surgery.

The impact of a dedicated operating room team on robotic transplant program growth and fellowship training.

INTRODUCTION: Despite considerable interest in robotic surgery, successful incorporation of robotics into transplant programs has been challenging. Lack of a dedicated OR team with expertise in both robotics and transplant is felt to be a major barrier. This paper assesses the impact of a dedicated robotic transplant team (DART) on program growth and fellowship training at one of the largest robotic transplant programs in North America. METHODS: This is a single center, retrospective review of all robotic operations performed on the transplant surgery service from October 2017 to October 2022. DART was incorporated in February 2020 and included transplant first assists (RFAs), scrub technologists and circulating nurses who received robotic training. Robotic experience before and after DART was compared to assess its impact on program growth and training. RESULTS: Four hundred and two robotic cases were performed by five transplant surgeons: 63 pre-DART and 339 post-DART. 40% of cases were transplant-related and 59.5%, HPB. There was a significant increase in case volume (2.5-10.6 cases/month, p < .0001) and complexity (36.5% vs. 70.3% high complexity cases, p < .0001) post-DART. RFA case coverage increased from 17% to 95%, and participation of transplant fellows as primary surgeons increased from 17% to 95% post-DART period (both p < .05). Conversion rates (9.5% vs. 4.1%) and room turn-around-times (TAT) (58.4 vs. 40.3 min) were lower post-DART (p < .05). There were no emergent conversions, conversions in transplant patients, or robot-related complications in either group. CONCLUSION: OR teams with expertise in robotics and transplant surgery can accelerate growth of robotic transplant programs while maintaining patient safety.

Application of a new nano-TiO2 composite antibacterial agent in nursing management of operating room: Based on real-time information push assistant system.

With the maturity of the hospital real-time information management system at this stage, the main nursing informatics of the hospital has also been fully developed. Based on the analysis of the application status of medical information technology and Internet technology, the real-time information management system is applied to mobile medical and its development status. This paper realizes the auxiliary system of real-time information push. Several 5 nm thick two-dimensional TiO2 ultra-thin nanosheets were prepared by low-cost liquid phase method, and the application of new nano-TiO2 composite antibacterial agent in the nursing management of the operating room was systematically studied. In the nursing management of the operating room, the patients in the control group were dissatisfied with 18%, basically satisfied with 40%, and very satisfied with 42%, while the patients in the experimental group were dissatisfied with 6%, basically satisfied with 42%, and very satisfied with 52%. However, in the control group, the dissatisfaction rate of nurses' nursing care accounted for 14%, accounting for 34% of the basic satisfaction rate, 52% of the very satisfied rate. In the experimental group, the dissatisfaction rate was 4%, the basic satisfaction rate was 28%, and the very satisfied degree was 68%. The real-time information management system provides a wide range of medical potential space, and can help hospitals realize intelligent medical management, so as to have a great understanding of the digitalization of medical information, scientific medical operation process, human communication and services, and can provide more comprehensive nursing services for patients.

Experiences of operating room nurses in disaster preparedness of a great disaster in Iran: a qualitative study.

BACKGROUND: In recent years, Iran has encountered a growing frequency of earthquake disasters. Given that nurses constitute the largest group of healthcare providers, it is imperative that they possess adequate disaster preparedness skills, irrespective of the location or time. Despite the operating room nurses' roles in disasters, their experiences and challenges in disaster preparedness have been overlooked. Consequently, this study aimed to investigate the experiences, challenges, perspectives, and factors influencing the disaster preparedness of operating room nurses during the 2017 earthquake in Kermanshah, Iran. METHODS: The present qualitative research was carried out in Iran In 2022 utilizing conventional content analysis. The study involved conducting semi-structured interviews with 16 operating room nurses who had participated in disaster preparedness during the Kermanshah earthquake. The participants were selected using a purposive sampling approach that aimed to achieve maximum diversity. The interviews were continued until the point of data saturation was reached, and the verbatim transcripts were analyzed using conventional content analysis in MAXQDA software. To ensure the rigor of the research, Guba and Lincoln's criteria were employed. RESULTS: The study conducted data analysis to identify the main theme as "insufficient disaster preparedness due to a faded preparedness", along with six major categories and eighteen subcategories related to earthquake disaster preparedness. The major categories included: knowledge and perception of preparedness for disasters; educational and training programs for disaster preparedness; equipment preparedness for disasters; managerial-organizational preparedness for disasters; clinical skills for responding to disasters; and resilient ability in disaster response situations. CONCLUSION: The findings of the study provide valuable insights into the dimensions of disaster preparedness in earthquake disasters among operating room nurses. Nursing managers can utilize these findings to develop effective strategies and provide support in areas such as improving knowledge and educational level, equipment preparedness, strengthening plans and managerial structures, enhancing skills, and explaining resilience strategies to improve the disaster preparedness of operating room nurses and medical organizations' disaster response teams.

Expanding the non-technical skills vocabulary of operating room nurses: a qualitative study.

BACKGROUND: Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession's dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses' descriptions of their practices in search for non-technical skills not included in the crew resource management framework. METHODS: This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). RESULTS: The inductive thematic analysis developed two themes, 'Ethical competence' and 'Professional accountability', that encompass operating room nurses' novel descriptions of their non-technical skills. The participants take pride in having the patients' best interest as their main objective even if this may threaten their position in the team. CONCLUSIONS: This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.

Assessment of the risk factors for intraoperative pressure injuries in patients.

AIM: This study was conducted to assess the risk factors for pressure injuries in patients during surgery. METHODS: In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS). RESULTS: The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05). CONCLUSIONS: According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.

Experiences of Operating Room Nurses During the COVID-19 Pandemic: A Qualitative Study.

PURPOSE: The study was conducted to examine the experiences of operating room nurses during the COVID-19 pandemic. DESIGN: This study was designed as a phenomenological qualitative research method. METHODS: This study was conducted with 10 volunteer operating room nurses who met the criteria for participation in the study between February 2021 and March 2021 in a public hospital. Data were collected using a personal information form and a semistructured interview from using the in-depth interview technique. Two researchers and one expert created the themes and codes using the thematic analysis method. FINDINGS: As a result of the analysis, four themes and 29 codes were identified. The following codes were created for the theme "Changing systems and practices in the operating room": Personal protective equipment and sterility, workload/time, lack of communication between patient and nurse, decrease in the number of cases, change in the use of emergencies and elective procedures, flexible working methods. On the theme of the impact of the pandemic, anxiety/anxiety, psychological distress, difficulty with personal protective equipment, lack of nurses, longing/distance from family, sleep disturbances, family problems, and difficulty working in another department were noted. On the theme of coping strategies for the pandemic, the codes found were; communication with family, breathing/sporting exercises, spirituality, regular/healthy diet, online shopping, watching TV series/movies, and acceptance of the process. On the theme of "learning from the pandemic," the codes of the importance of life/health, the importance of family, worthlessness of the caring profession, financial injustice, gaining work experience, the importance of personal protection, lack of union support, and job satisfaction were produced. CONCLUSIONS: The study found that the nursing in the operating room has changed due to the COVID-19 pandemic, that nurses have experienced many positive/negative impacts, and that they have gained many benefits from the pandemic through various coping methods.

Effects of refined nursing interventions in the operating room on surgical-site wound infection in patients with lung cancer: A meta-analysis.

In this study, a meta-analysis was conducted to assess the effect of refined nursing interventions in the operating room on the incidence of surgical-site wound infections in patients undergoing lung cancer surgery to provide an evidence base for the prevention and management of nosocomial infections. A computerised literature search was used to identify randomised controlled trials (RCTs) on the application of refined nursing interventions in the operating room in patients undergoing lung cancer surgery published in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP and Wanfang databases from their inception until July 2023. The literature screening, data extraction and quality assessment of the included studies were performed independently by two researchers. RevMan 5.4 software was used for the meta-analysis. Twenty-eight studies were included in the analysis, with a total of 2406 patients, including 1210 patients in the refined nursing intervention group and 1196 patients in the control group. The results of the meta-analysis showed that the refined nursing interventions in the operating room significantly reduced the incidence of surgical-site wound infections in patients undergoing lung cancer surgery, compared with the control group (1.82% vs. 6.52%, odds ratio: 0.30, 95% CI: 0.19-0.47, p < 0.001), and shortened the length of hospital stay (standardised mean difference: -1.51 days, 95% CI: -1.92 to -1.11 days, p < 0.001). Current evidence suggests that the application of refined nursing interventions in the operating room is effective at reducing the incidence of surgical-site wound infections and shortening the length of hospital stay in patients undergoing lung cancer surgery. However, owing to the small number and low quality of the studies, more high-quality RCTs with large sample sizes are needed to confirm these results.

Effectiveness of nursing intervention in the operating room to prevent pressure ulcer and wound infection in patients undergoing intertrochanteric fracture: A meta-analysis.

In this study, a meta-analysis was conducted to comprehensively assess the effectiveness of nursing intervention in the operating room to prevent pressure ulcers and wound infections in patients with intertrochanteric fractures. A computerised search of PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Database of Chinese Technical Periodicals, and Wanfang databases was performed to identify randomised controlled studies (RCTs) on the effectiveness of nursing intervention in the operating room for patients undergoing intertrochanteric fractures from the time of construction of the respective databases to June 2023. Two researchers independently searched and screened the literature, extracted information and performed quality assessments of the included literature. The meta-analysis was performed using RevMan 5.4 software. Eighteen studies were finally included, including 1517 patients, with 757 in the intervention group and 760 in the control group. The results showed that nursing intervention in the operating room significantly reduced the incidence of postoperative pressure ulcers in patients with intertrochanteric femoral fractures compared to the control group (1.69% vs. 6.01%, odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.18-0.57, p < 0.001) and reduced the incidence of surgical site wound infection (1.00% vs. 6.15%, OR: 0.23, 95% CI: 0.11-0.50, p < 0.001). Current evidence suggests that nursing intervention in the operating room is superior to routine care in reducing the incidence of pressure ulcers and wound infections in patients with intertrochanteric fractures and that such interventions should be promoted for clinical use.

Effectiveness of nursing intervention in the operating room to prevent wound infections in patients undergoing orthopaedic surgery: A meta-analysis.

Surgical site wound infection is one of the most common postoperative complications in orthopaedic clinical practice. This study employed a meta-analysis approach to comprehensively evaluate the effect of operating room nursing interventions on the prevention of surgical site wound infections in orthopaedic surgical patients. A computer search was conducted using PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang databases from the inception of each database until May 2023 for randomised controlled trials (RCTs) that investigated the application of operating room nursing interventions in orthopaedic surgery. Two reviewers independently screened the literature, extracted data, and assessed study quality. The meta-analysis was conducted using Stata 17.0. A total of 29 studies involving 3567 patients were included, with 1784 patients in the intervention group, and 1783 patients in the control group. The results of the meta-analysis showed that compared with the control group, the use of operating room nursing interventions significantly reduced the incidence of surgical site wound infection after orthopaedic surgery (2.85% vs. 13.24%; odds ratio: 0.18, 95% confidence interval: 0.14-0.25; p < 0.001). Current evidence suggests that operating room nursing interventions reduce the incidence of surgical site wound infections. However, owing to the limited number and low quality of the studies, more high-quality, large-sample RCTs are needed to further verify these findings.

Relationships Between Job Satisfaction of Operating Room Nurses and Hospital's Compliance With Protective Guidelines During the Covid-19 Pandemic: A Cross-Sectional Study, Iran.

PURPOSE: The Covid-19 pandemic is considered the biggest threat to human health in the recent century. During emergency surgeries, the possibility of infection of members of the surgical team with Covid-19 increases due to the direct contact with patients. The present study has been conducted aimed to investigate the relationships between job satisfaction of operating room nurses and the hospital's compliance with protective guidelines (guidance) during Covid-19 pandemic from the perspective of operating room nurses. DESIGN: This was a descriptive and cross-sectional study conducted from September 22, 2020 to April 21, 2021. METHODS: This study was conducted on 926 nurses working in operating rooms in 15 metropolises of Iran. The sampling method in this study was multistage clustering. The questionnaire was sent to the target group through social apps (WhatsApp and Telegram). The collected data were analyzed by SPSS software version 26 using descriptive and analytical statistics. FINDINGS: The mean age and job satisfaction of the participants were 28.81 ± 5.64 years and 51.15 ± 11.45, respectively. Participants (n = 259; 27.97%) reported very good job satisfaction. Also, the mean hospital's compliance with protective guidelines during Covid-19 pandemic from the perspective of operating room nurses was 42.29 ± 7.11. The results of the present study showed a significant relationship between job satisfaction and hospital's compliance with protective guidelines during Covid-19 pandemic (P-value ≤ .001). CONCLUSIONS: Optimization of infrastructure, improvement of management decisions and increasing human resources in a crisis can affect the quality of performance and job satisfaction of operating room nurses. The researchers suggest that health system managers can contribute to the safety and efficiency of the existing human resources by taking measures to increase job satisfaction.

Knowledge, attitude and application towards fast track surgery among operating room paramedics: a cross-sectional study.

BACKGROUND: Fast track surgery has shown its effectiveness to accelerate recovery and gained acceptance in many operations. However, data for paramedics using fast track surgery are limited in China. The aims of our study are to evaluate the knowledge, attitude and application status of fast track surgery in paramedics and to provide suggestions for the better application of fast track surgery. METHODS: Two Hundred Ninety-one operating room paramedics were investigated by simple random sampling from October 20 to December 20, 2019 time. A self-reported questionnaire was used to collect data with five dimensions: demographic data, cognitive level, knowledge, attitude and application of fast track surgery. Data were analyzed using qualitative and quantitative methods. RESULTS: 19.93% of participants never heard fast track surgery and only 3.32% of participants were very familiar with it. Gender (0.702, 95% CI 0.109-1.294), technical title (0.342, 95% CI 0.126-0.558) and awareness of the concept of fast track surgery (0.471, 95% CI 0.165-0.776) had a correlation with the knowledge level of paramedics towards fast track surgery. In terms of attitude towards fast track surgery, gender (- 1.944, 95% CI -3.830- -0.058), age (0.303, 95% CI 0.021-0.585) and knowledge score of fast track surgery (0.426, 95% CI 0.014-0.838) are related. Half of the paramedics believe the most difficult problem in the application of fast track surgery was the lack of multi-team communication and cooperation. CONCLUSION: The knowledge of fast track surgery among paramedics in Wuhan is poor, and some paramedics have a negative attitude towards it. As the attitude is positively correlated with the knowledge, it is necessary to improve the knowledge level of fast track surgery among paramedics in Wuhan.

Work-related potential traumatic events and job burnout among operating room nurses: Independent effect, cumulative risk, and latent class approaches.

AIMS: The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches. DESIGN: The study followed a multisite cross-sectional design. METHODS: A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. RESULTS: Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. CONCLUSION: Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. IMPACT: This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Effects of a fixed nurse team in the orthopaedic surgery operating room on work efficiency and patient outcomes: a propensity score-matched historically controlled study.

BACKGROUND: The work value of operating room (OR) nurses is directly reflected in nursing quality. However, evaluating the work value of these nurses has not been sufficiently investigated. This study evaluated the effects of a fixed nurse team (FNT) in an orthopaedic surgery OR on work efficiency and patient outcomes. METHODS: A propensity score-matched historically controlled study conducted from 1 July 2015 to 30 June 2018 was used to investigate the difference in nursing quality between an FNT period and a non-FNT period in the orthopaedic surgery OR at a tertiary care hospital in China. The primary outcome was surgical site infections (SSIs) during in-hospital visits, and as a secondary outcome, other nursing-sensitive quality indicators were assessed with historically controlled data. A multifactor logistic regression model was constructed to examine the primary outcome differences between the FNT and non-FNT periods before and after propensity score matching. RESULTS: In total, 5365 patients and 33 nurses were included in the final analysis. The overall SSI rate was 2.1% (110/5365; the non-FNT period 2.6% [64/2474], the FNT period 1.6% [46/2891]). A lower incidence of SSIs in patients (odds ratio 0.57, 95% CI 0.36 to 0.88, P=0.013), a lower turnover time of the surgical procedure (odds ratio 0.653, 95% CI 0.505 to 0.844, P<0.001), and improvement in surgeon satisfaction (odds ratio 1.543, 95% CI 1.039 to 2.292, P=0.031), were associated with the FNT period compared with the non-FNT period. However, we did not find significant differences between the FNT period and the non-FNT period in terms of the other indicators. CONCLUSIONS: The presence of an FNT in an OR reduces the incidence of SSIs in surgical patients and the turnover time of surgical procedures and improves surgeon satisfaction. Further implementation of an advanced-practice nurse model with nurse specialists is encouraged.

Knowledge and practices of operating room nurses in the prevention of pressure injuries.

BACKGROUND: Operating room (OR) nurses play an important role in preventing the pressure injuries (PIs) that may develop during the perioperative process. This study was conducted to determine OR nurses' level of knowledge about PIs, and how they manage them. METHODS: This is a cross-sectional, quantitative and descriptive study. The sample of the study consisted of 234 OR nurses working in eight different public hospitals in Ankara. The questionnaire applied in this study was prepared in accordance with the guidelines. This questionnaire consisted of three sections: demographic profiling, common preventive practices, and the knowledge of OR nurses about intraoperative PI prevention. FINDINGS: 66.7% of the participants had received education about PIs during their basic nursing training, and 41.5% had received education after graduation. 97.4% of OR nurses did not follow international guidelines about PIs. The mean total score of the OR nurses for the questions about PIs was 52.0 ± 13.7 out of a possible score of 100. The lowest mean score was obtained for the topic of 'staging pressure injuries', and the highest score was obtained from 'interventions to prevent pressure injuries'. In addition, 81.5% of the OR nurses stated that they were not given information about patients with a high PI risk by clinical nurses. 97.9% of the OR nurses did not use a scale to assess intraoperative PI risks. Fewer than half of the nurses said that they assessed the risk of PIs during surgery. 90.8% the nurses did not record risk assessment and interventions to prevent PIs. CONCLUSION: There is a need to incorporate basic operating room PI (ORPI) training into both the basic nursing and in-service training to improve the knowledge of OR nurses about how to prevent and manage ORPIs. In addition, measures to assess PI risk and prevent ORPI should be included in institutional policies and procedures.

A Delphi study identifying operating room nurses' non-technical skills.

AIM: To identify the non-technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses. DESIGN: A three-round modified online Delphi technique was used for this study. METHODS: Eligible participants (n = 106) with a minimum of 2 years of operating room nursing experience were selected for the expert panel by self-recruitment from a population (N = 1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds. RESULTS: A consensus was obtained to maintain the non-technical skills categories of situation awareness, leadership, decision-making, communication and teamwork. The qualitative data revealed several novel non-technical skills, including independent decision-making and leadership skills. CONCLUSION: The non-technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non-technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared. IMPACT: This study addresses the lack of research on the non-technical skills of operating room nurses. When exploring the non-technical skills of scrub and circulating nurses, a diversity of novel non-technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non-technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non-technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery-related patient safety.

Comparison of interface pressures on three operating table support surfaces during surgery.

AIM OF THE STUDY: To investigate the effect of support surface usage and positions on interface pressure during surgery. MATERIALS AND METHODS: This randomized controlled experimental study was conducted between October 2018 and June 2019. The study included patients who had planned surgery in supine and prone positions. The sample size was 72 patients. Patients were assigned to three groups (gel support surface, viscoelastic support surface and standard operating table) according to the determined randomization table. During the surgery, the pressure in the patients' body was recorded. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data. RESULTS: There was no statistically significant difference between the total body average interface pressure (mmHg) values between the supporting surfaces in the prone position. There was a statistically significant difference between the total body average interface pressure (mmHg) values between the support surfaces in the supine position, and the average interface pressure measured on the viscoelastic foam support surface was significantly lower than the gel support surface and the standard operating table. CONCLUSION: In the study, the use of viscoelastic foam support surface was found to be more effective than the use of a standard operating table and gel support surface. Viscoelastic foam support surface is recommended for patients at risk for pressure injury in the operating room.

Using metaphor method to interpret and understand meanings of international operating room nurses' experiences in organ procurement surgery.

AIMS: To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures. BACKGROUND: International operating room nurses are likely to form unique attitudes towards multi-organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds. DESIGN: Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen. METHODS: A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure. RESULTS: Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four-colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange-"The surreality of experiencing death," Red-"Personal and professional challenges," Green-"Becoming stronger" and Purple-"My beliefs, my wishes." CONCLUSION: Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice. RELEVANCE TO CLINICAL PRACTICE: Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses. Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations.

Evaluation of the Effect of Surgical Drapes on Intraoperative Hypothermia: A Randomized Clinical Trial.

Many patients experience unintended hypothermia in intraoperative processes. This randomized clinical trial aims to investigate the impact of surgical drapes on hypothermia during the intraoperative period. A randomized clinical trial was conducted from April 2019 to November 2020 in the Department of Anesthesiology and Reanimation/Operating Rooms at an education and research hospital. Out of 205 patients assessed for eligibility, 74 underwent elective abdominal surgery and were randomized into two groups: nonwoven surgical drapes and woven surgical drapes. The study had two stages: preoperative and intraoperative. Preoperative data were collected using information and evaluation forms, while intraoperative assessment involved forms for wetness and weight. Tympanic and esophageal temperatures were recorded every 15 minutes, and surgical drapes were weighed with a precision scale before and after surgery. There was no significant difference between the two groups in terms of body mass index, irrigation amount, surgery duration, gender, and preoperative shivering (p > 0.05). A statistically significant difference was found in preoperative body temperature (36°C), type of surgery, and intraoperative hypothermia (p < 0.05). Both types of surgical drapes were wet, but this difference was not statistically significant between the nonwoven group (mean ± SD [1368 ± 607]) and the woven group (mean ± SD [1335 ± 636], p = 0.824). This study demonstrated that neither woven nor nonwoven surgical drapes, nor the wetness of the surgical drapes, had a significant effect on intraoperative hypothermia. However, there is a need for randomized controlled trials involving uniform types of surgery related to the topic.