Nursing in a technological environment: Nursing care in the operating room

[Intervention-related demands: Criteria for an operating room-specific patient classification. A qualitative focus group study]

Intervention-related demands: Criteria for an operating room-specific patient classification. A qualitative focus group study Abstract: Background: Optimal workforce deployment in the operating room-setting has gained high priority in the context of an economized health care system and the development of skill-grade mix. Therefore, mapping intervention-related demands on perioperative nurses as precisely as possible is a frequently discussed need. A surgery-specific patient classification might be helpful. Aim: This paper aims to present core elements of perioperative nursing care in the Swiss-German context and to establish a link to the Perioperative Nursing Data Set (PNDS). Methods: Three focus group interviews with perioperative nurses took place at a university hospital in the German-speaking part of Switzerland. Data analysis was performed in analogy to qualitative content analysis according to Mayring. The content structuring of the categories was based on the relevant PNDS taxonomies. Results: Intervention-related requirements can be divided into three areas: "patient safety", "nursing and caring", and "environmental factors". The conjunction with the PNDS taxonomy serves as a theoretical foundation. Conclusions: Elements of the PNDS taxonomies can describe the demands on perioperative nurses in the Swiss-German context. The identified definition of intervention-related demands can contribute to the visibility of perioperative nursing and promote professionalization as well as practice development in the operating room-setting.

'I've just got to take that risk and have faith . . .': The challenge of gaining and maintaining trust in patients undergoing knee surgery with a regional anaesthetic

Traditionally, the focus of the operating theatre has been on conducting safe, efficient surgery with unconscious patients. However, the care of awake patients is now a prominent feature of modern perioperative practise as the volume of surgery performed under regional anaesthesia increases. The aim of this novel study was to understand the experience of being a conscious patient during regional anaesthesia and knee surgery in the perioperative environment. Data were gathered through observation and ethnographic interview and analysis followed a constant comparative grounded theory approach. The concepts of Trust and Faith are identified as recurrent themes highlighted in the data. This article identifies the need to understand patients' expectations regarding the clinical encounter and how subsequent treatment will develop, so that, reasons for any deviation can be discussed openly and an explanation provided. Each clinical encounter takes place within a relationship based upon an uneven distribution of power, enacted through the interaction itself, with the health care professional in a dominant role. It is the responsibility of health care staff to recognise and negate this power imbalance and reinforce trusting relationships so information and treatment options are not presented as a 'fait accompli' but negotiated through jargon free easy to understand language.

Continuous training based on the needs of operating room nurses using web application: a new approach to improve their knowledge

INTRODUCTION

Since university education and intensive and limited pre-service training do not provide an acceptable level of performing the duties of operating room nurses, and considering the limitations of traditional training methods in the field of operating room; This study was conducted with the aim of determining the effect of using the electronic education approach based on web application, leveled, personalized and based on the needs of nurses on their level of knowledge and satisfaction.

MATERIALS AND METHODS

This research is a quasi-experimental type of single-group multi-center pre-test-post-test, which during that, four stages of educational needs assessment, educational content design, web application design for training and evaluation of operating room nurses and determining the effectiveness of this method are included. Based on their knowledge and satisfaction, during this period, 36 nurses from the operating rooms that met the study criteria were included in the study by stratified random sampling based on the determined sample size. The data collection includes a four-choice test to measure the knowledge of operating room nurses in heart anatomy (score range 0-20), the principles of movement, transferring and positioning of the patient in the operating room (score range 0-15), the principles of ergonomics in the operating room (score range score 0-10) and satisfaction questionnaire (score range 0-28). Data collected using descriptive statistical tests (percentage of frequency and frequency, mean and standard deviation) and analytical tests (paired sample t-test, independent samples t-test, ANOVA, Pearson correlation, chi-square) with the software SPSS version 16 was analyzed.

RESULTS

Generally, the average knowledge scores of operating room nurses before and after the intervention were 5.96 ± 3.96 vs. 13.6 ± 3.77, in the course of principles of moving, transferring and positioning the patient in the operating room were 6.3 ± 3.42 vs. 13.3 ± 1.32, respectively 8.7 ± 3.97 vs. 18.1 ± 1.07 (in heart anatomy), 1.57 ± 2.6 vs. 0.73 ± 9.1 (in the principles of ergonomics in the operating room) and the average Knowledge scores after the intervention were significantly higher than before the intervention (P<0.001). Also, the average satisfaction score of nurses was 21.3 ± 5.83 and 22 nurses (64.7%) were satisfied with the e-learning course.

CONCLUSION

The use of the electronic education approach based on the web application, leveled, personalized and based on the needs of the nurses, led to the improvement of the level of knowledge and satisfaction of the operating room nurses. E-learning can be used as a complementary educational tool and method for continuous training of operating room nurses in other specialized fields of operating room and surgery.

HIGHLIGHTS

• Educational content in the form of educational videos taught by professors of medical sciences universities on each of the topics of heart anatomy (28 episodes of 5-10 minutes), principles of ergonomics in the operating room (7 episodes of 5-25 minutes) and movement principles. The transfer and positioning of the patient in the operating room (16 episodes of 10-20 minutes) were designed in three primary, intermediate and advanced levels. • The results of this study showed that the use of an electronic education approach based on the web application, levelled, personalized and based on the needs of nurses, led to the improvement of the knowledge of operating room nurses. Also, operating room nurses were delighted with electronic training courses. E-learning can be used as a complementary educational tool and method for continuous training of operating room nurses in other specialized fields of operating room and surgery. • Based on the results of this study, the use of an electronic education approach based on the needs of operating room nurses can be used as a complementary tool to conventional continuous education. Since this method allows interactive, personalized education is levelled, and asynchronous. It can be used at any time and place on a laptop, tablet or mobile phone; a wide range of operating room nurses in the hospitals of the Islamic Republic of Iran can use it for educational justice to Many borders should be established in the country. However, there are studies to evaluate the generalizability and the effect of using the e-learning approach on the clinical skills of operating room nurses and to compare the effect of e-learning with other methods and educational tools on the knowledge and skills of the learners and the extent of consolidating the learned material in their memory.

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.

Operating theatre nurses' with managerial responsibility: Self-reported clinical competence and need of competence development in perioperative nursing

Aim

The aim of this study was to investigate operating theatre nurses (OTNs) with managerial responsibility, and their self‐rated clinical competence and need for competence development in perioperative nursing.

Design

A cross‐sectional study was applied using a modified version of Professional Nurse Self‐Assessment Scale of Clinical Core Competence I.

Method

Data were collected from 303 OTNs in Sweden, 80 of whom indicated that they had managerial responsibility. Statistics analysis was used to identify the relationships between background variables to compare OTNs with and without managerial responsibility and their need for competence development.

Results

OTNs with an academic degree and managerial responsibility self‐rated their clinical competence higher compared with OTNs without an academic degree. It also turned out that OTNs with RN education and 1‐year advanced nursing in theatre care, and master's 60 credits had a lower need for competence development in cooperation and consultation, professional development and critical thinking.

A qualitative study of the operating room experience of patients who underwent surgery under spinal anesthesia: "It was like an adventure"

This study aimed to explore the experiences of the people who underwent orthopedic surgery under spinal anesthesia and to report their feelings and thoughts. The study was carried out using a qualitative approach. Twenty-one patients were interviewed who underwent orthopedic surgery on the first or second postoperative day. Content analysis was performed after the collection of raw data. NVIVO 12 Pro software was used for data analysis. The frequency count (f) and participant codes (P) were used for the presentation of the findings. The themes and frequency counts obtained by analyzing the interviews with the patients were as follows: "Time passed like watching a movie" (f = 213), "Like an adventure" (f = 587), and "See, feel, look" (f = 405). Five of 21 participants (23.8%) stated that they would not recommend spinal anesthesia. The findings generally indicated the anxiety caused by the unknown, fear in the preanesthetic period, operation experienced like an adventure, and a process generally completed with satisfaction.

Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: A discursive paper

Aim

To discuss specialist operating theatre nurses' competence in relation to the general six core competencies and patient safety.

Design

A discursive analysis of legal statutes and scientific articles.

Methods

Swedish legal statutes and an overview of scientific articles on operating theatre nursing were deductively analysed and classified into healthcare providers' general six core competencies.

Results

All healthcare professionals should possess the general core competencies, regardless of their discipline. The specific content within these competencies differs between disciplines. The specialized operating theatre nurse is the only healthcare professional having the competence to be responsible for asepsis, instrumentation, infection and complication, control and management of biological specimens during the surgical procedure. Besides operating theatre nurses, no other healthcare profession has the formal education, competence or skills to perform operating theatre nursing care in the theatre during the surgical procedure. Operating theatre nurse competence is therefore indispensable to ensure patient safety during surgery.

Newly trained operating room nurses' experiences of nursing care in the operating room

There is limited research on nurses' experiences of nursing care in the operating room. The operating room nurses' responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses' experiences of nursing care in an operating room. Semi-structured interviews were performed with ten operating room nurses with a maximum three years' work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses' searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses' experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients' well-being and working in teams for the patients' best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.

Operating theatre nurses' self-reported clinical competence in perioperative nursing: A mixed method study

AIMS

The aim of this study was to investigate how operating theatre nurses (OTNs) self-rated their clinical competence and describe their experience of important factors for the development of clinical competence in perioperative nursing.

DESIGN

A cross-sectional study with a mixed-method approach was chosen. Data were collected through a modified version of the questionnaire Professional Nurse Self-Assessment Scale of Clinical Core Competence I, which was supplemented with an open-ended question.

METHODS

Data were collected from 303 operating theatre nurses in Sweden. Statistics analysis was used to identify the relationship between the participants' background variables. The open-ended question was analysed by using a qualitative conventional content analysis.

RESULTS

Academic degree and professional experience of perioperative nursing were significant for the development of clinical competence. Academic degree appeared to affect operating theatre nurses' leadership and cooperation in the surgical team, as well as how consultations took place with other professionals.

Dead on the table: A theoretical expansion of the vicarious trauma that operating room clinicians experience when their patients die

The practice of operating room (OR) clinicians - nurses, surgeons, and anesthetists - is fundamentally about preserving life. Some patients, however, die in the OR. Clinicians are therefore vulnerable to moral and emotional trauma. In this paper, we discuss three forces that shape clinicians' moral and emotional experiences in OR care: biomedical values, normative death discourse, and socially (un)sanctioned grief. We suggest how each of these forces increases clinicians' vulnerability to feel traumatized when their patients die. We hope this discussion will stimulate clinicians and researchers to engage with social and cultural determinants of clinicians' experiences when patients die.

Operating Room Nurses' Perceptions of the Clinical Learning Environment: A Survey Study

BACKGROUND

Authors commonly agree that the clinical learning environment significantly affects student learning. Studies of how operating room nurses perceive the clinical learning environment during their specialist studies are sparse.

METHOD

This study aimed to examine newly graduated operating room nurses' perceptions of the clinical learning environment during their specialist education. Fifty newly graduated operating room nurses answered a questionnaire gaging their perceptions of clinical education.

RESULTS

Most participants perceived the clinical learning environment as good and highly associated with the supervisor's ability to supervise, enjoy supervision, and show interest in the participants' degree project. The management at the clinical setting, which was perceived to emphasize the importance of supervision, time allocated especially for supervision, and perceived cooperation between the University and hospital, also had an impact.

CONCLUSION

Social interactions and structures within the operating room affect how the clinical learning environment is perceived. J Contin Educ Nurs. 2018;49(9):416-423.

Responsibility for patient care in perioperative practice

AIM

To obtain an understanding of operating theatre nurses' experiences of responsibility for patient care and safety in perioperative practice.

DESIGN

A hermeneutic design were used.

METHOD

Data were collected during 2012 from 15 operating theatre nurses who participated in individual interviews. The text was analyzed by hermeneutical text interpretation.

FINDINGS

The texts revealed two main themes: A formal external responsibility and personal ethical value. Responsibility that the patient was not exposed to risks, protecting the patient's body, systematically planning and organizing work in the surgical team. The personal ethical value meant confirming the patient as a person, caring for the patient and preserving the patient's dignity. A new understanding emerged that the operating theatre nurse always have the patient in mind.

Nurse anaesthetist students' experiences of patient dignity in perioperative practice-a hermeneutic study

Aim

The aim of the study was to describe how nurse anaesthetist students experienced patient dignity in perioperative practice.

Design

A hermeneutical design and the critical incident technique were used to obtain experiences from practice.

Method

In the Autumn of 2015, after participating in a mandatory lecture on ethics, 23 nurse anaesthetist students reported their experiences and interpretation concerning violation and preservation of patients' dignity in the operating theatre. The text, which was a compilation of descriptions of 35 incidents, was analysed by using hermeneutical text interpretation.

Findings

The text revealed three main themes preserving patients' dignity: allocating time to the patient, inviting the patient to participate and shielding the patient's body. Furthermore, three main themes of dignity violation were identified: alienation, backbiting and violation of intimate sphere.

Conclusion

Discussion and reflection based on the personal experience of the students during their practice are ways to strengthen ethical awareness and promote an ethical and dignified caring culture.

Perioperative nursing in public university hospitals: an ethnography

BACKGROUND

In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly specialized operating rooms in public university hospitals?

METHODS

An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark.

RESULTS

Patients were addressed as either human beings or objects. Likewise, the participants' technical skills were observed and described as either technical flair or a lack of technical skills/technophobia. The different ways in which the technical skills were handled and the different ways in which the patients were viewed contributed to the development of three levels of interaction between technology and nursing care: the interaction, declining interaction, and failing interaction levels.

CONCLUSION

Nursing practice at the interaction level is characterized by flexibility and excellence, while practice at the declining interaction level is characterized by inflexibility and rigidity. Nursing practice at the failing interaction level is characterized by staff members working in isolation with limited collaboration with other staff members in operating rooms. Considering that the declining and failing interaction levels are characterized by inflexibility, rigidity, and isolation in nursing practice, nurses at these two levels must develop and improve their qualifications to reach a level of flexible, excellent interaction. Nurse leaders must therefore refocus their skills on proficiency in perioperative nursing.

Linking theory to practice in introductory practice learning experiences

Nurse educators internationally are challenged with finding a sufficient number of suitable practice learning experiences for student nurses. This paper reports on a study which aimed to evaluate the utilisation of specialised and highly technical environments ("new" environments) as first practice learning experiences for adult nursing students in the UK. A survey was conducted on 158 first year student nurses who were allocated to either "new" or "old" (those that have been traditionally used) environments. Data analysis was conducted using Mann-Whitney U test and exploratory factor analysis was performed. Results have demonstrated that all environments afford novice nurses the opportunity to observe or practice the essential skills of nursing. In addition, the "new" environments have revealed greater opportunity to observe and practice aspects of practice related to governance of care. This paper concludes that a nursing curriculum which makes clear association between the essential nature of nursing and practice based learning outcomes will help the student to appreciate contemporary nursing practice and to link nursing theory with practice. Further research is required to explain the observation that aspects of practice related to governance are more visible within highly technical areas of practice.

Making the invisible visible--operating theatre nurses' perceptions of caring in perioperative practice

The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret.

Student nurses' experiences of preserved dignity in perioperative practice - Part I

BACKGROUND

In recent years, operating theatre nurse students' education focussed on ethical value issues and how the patient's dignity is respected in the perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery.

OBJECTIVE

The objective of this study was to present what operating theatre nurse students experienced and interpreted as preserved dignity in perioperative practice.

RESEARCH DESIGN

The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique.

PARTICIPANTS AND RESEARCH CONTEXT

Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation.

ETHICAL CONSIDERATIONS

The study was conducted accordance with the Declaration of Helsinki and approved by a local University Ethics Research Committee.

FINDINGS

The findings revealed that students experienced that operating theatre nurses perserved patient's dignity in perioperative practice by being present for each other and making themselves known to the patient. Operating theatre nurses caring for the patient by being compassionate and preserved the patient privacy. The new understanding that emerged was that the operating theatre nurse students understood that the operating theatre nurse wanted to care for the patient like a human being.

DISCUSSION

In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act.

CONCLUSION

Preserved dignity is an ethical and caring act. Ethical questions and how to preserve dignity in perioperative practice should be discussed more both in educations of healthcare professionals and in clinical practice.

Student nurses' experiences of undignified caring in perioperative practice - Part II

BACKGROUND

In recent years, operating theatre nurse students' education focused on ethics, basic values and protecting and promoting the patients' dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery.

OBJECTIVE

The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice.

RESEARCH DESIGN

The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique.

PARTICIPANTS AND RESEARCH CONTEXT

Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation.

ETHICAL CONSIDERATIONS

The study was approved by the Karlstad University's Research Ethics Committee.

FINDINGS

The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient's worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient's body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient's dignity in perioperative practice.

DISCUSSION

In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act.

CONCLUSION

The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed.

Caring and technology in an intensive care unit: an ethnographic study

BACKGROUND

Critical care practice is a mixture of caring and technological activities. There is debate about whether the balance between these two elements is correct and a concern that critical care units can dehumanize the patient. This research sought to examine aspects that might affect this balance between the caring and technology within the critical care setting.

AIM

What aspects affect registered health care professionals' ability to care for patients within the technological environment of a critical care unit?

METHODOLOGY

A qualitative approach using ethnography was utilized as this methodology focuses on the cultural elements within a situation. Data collection involved participant observation, document review and semi-structured interviews to triangulate methods as this aids rigour for this approach. A purposeful sample to examine registered health care professionals currently working within the study area was used. A total of 19 participants took part in the study; 8 nurses were observed and 16 health care professionals were interviewed, including nurses, a doctor and 2 physiotherapists. The study took place on a District General Hospital intensive care unit and ethical approval was gained.

FINDINGS

An overarching theme of the 'Crafting process' was developed with sub themes of 'vigilance', 'focus of attention, 'being present' and 'expectations' with the ultimate goal of achieving the best interests for the individual patient.

CONCLUSION

The areas reflected in this study coincide with the care, compassion, competency, commitment, communication and courage ideas detailed by the Department of Health (2012). Thus, further research to detail more specifically how these areas are measured within critical care may be useful.

RELEVANCE TO PRACTICE

Caring is a complex concept that is difficult to outline but this article can inform practitioners about the aspects that help and hinder caring in the technical setting to inform training.

Holding the patient's life in my hands: Swedish registered nurse anaesthetists' perspective of advocacy

BACKGROUND

Anaesthesia often induces a state of unconsciousness that includes inability to communicate and influence the situation. The patient has to rely on the nurse anaesthetist to speak up for her/him as well as maintain her/his dignity and safety. Consequently, the nurse anaesthetist can be likened to the patient's advocate.

AIM

The aim of the study was to describe advocacy in anaesthesia care during the perioperative phase from the perspective of the registered nurse anaesthetist.

METHOD

Data for this qualitative descriptive study were collected during March and April, 2011. Individual interviews were conducted with a purposive sample of 20 nurse anaesthetists from two hospitals in Sweden. The audio-taped interviews were transcribed verbatim and analysed by means of qualitative content analysis.

FINDINGS

The main theme, Holding the patient's life in my hands, described the nurse anaesthetists' perception of advocacy and comprised three subthemes: providing dignified care, providing safe care and a moral commitment.

CONCLUSION

Acting as the patient's advocate includes important health and well-being issues and could be stressful for the nurse anaesthetists'. A work environment where the nurse anaesthetists' can make their voices heard and feel that their opinion regarding the patient's best interests is taken seriously would be desirable, as all health professionals should ideally focus on those in their care.

Operating room nurses' perceptions of the effects of physician-perpetrated abuse

BACKGROUND

Operating room (OR) nurses experience abuse perpetrated by physicians; however, little research has been conducted to examine nurses' perceptions of the effects of such abuse.

AIMS

The aim of this research was to understand participants' perceptions of physician-perpetrated abuse on their health and ability to provide patient care.

MATERIALS/METHODS

In this qualitative descriptive study, ten operating room nurses working in Eastern Canada participated in open-ended, individual audiotaped interviews that were transcribed for analysis using Boyatzis' method for code development.

RESULTS

Three categories of factors contributing to abuse were developed. The first, culture of the OR, included environment and hierarchy. The second, catalysts of abuse, included nurses' positions and experience as well as non-nurse factors such as resources and interpersonal relationships among physicians. The third category, perceived effects, included psychological, physical and social health consequences for nurses. Effects on patient care consisted of safety and potential challenges to access.

DISCUSSION

Nursing practice implications included mentoring, support and accountability for action. Educational implications related to interdisciplinary education and increased education on communication, assertiveness, and awareness of abuse. Implications for research included studying perceptions of other health-care providers including physicians, studying recruitment and retention in relation to abuse, and studying other abuse in health care such as horizontal violence.

CONCLUSION

We suggest a proactive approach for empowering OR nurses to address abuse and an increased focus on interdisciplinary roles.

A synthesis of the literature on "competence" as it applies to perioperative nursing

Perioperative competence is an eclectic concept that has been difficult to define and even more difficult to measure. Competence has been described in relation to standards of practice with little emphasis placed on its interpersonal aspects. This article presents a synthesis of the literature focused on perioperative nurse competence. Although specialized knowledge in the form of technical proficiency is important, it is no longer the only indicator of perioperative competence. The findings in this synthesis attest to the increased awareness and emphasis given to human factors--recognition that teamwork, communication, coordination, and leadership also affect human performance. Based on these findings, the next important step would be to develop and test these categories of competence empirically.

Surgical management of traumatic L2-L3 spondyloptosis

Subluxation of a vertebra secondary to an injury (ie, traumatic spondyloptosis) is most commonly seen in the lumbosacral joint. This extremely rare spinal destabilization is caused by congenital defects, degeneration, tumors, infection, or trauma and is accompanied by severe neurologic debilitation. The patient's neurological function can be preserved when surgical team members have knowledge of spinal injuries, surgical interventions, positioning and its implications, and an awareness of the risks to the patient. Appropriate interventions can decrease complications, operative revisions, length of stay, morbidity and mortality, and hospital costs.

Nursing and patient safety in the operating room

AIM

This paper is a report of a study to identify what operating room nurses believe influences patient safety and how they see their role in enhancing patient safety.

BACKGROUND

Research in health care shows that work experience, communication and the organization of work are key factors in patient safety. This study draws on Reason's definitions of active and latent errors to conceptualize the complex issues that affect patient safety in the operating room.

METHOD

The study reported here is part of an action research project at a university hospital in Iceland. Semi-structured interviews were conducted in 2004 with eight nurses, followed by two focus groups of four nurses each in 2005. Data were analysed using interpretive content analysis.

FINDINGS

Securing patient safety and preventing mistakes were described as key elements in operating room nursing by all survey participants. In the interviews, the nurses identified the existing culture of prevention and protection that characterizes operating room nursing as crucial in enhancing safety. The organization of work into specialty teams was considered essential. Increased speed of work in an environment where enhanced productivity is imperative, as well as imbalance in staffing, was identified as the main threats to safety.

CONCLUSION

Operating room nurses have a common understanding of the core of their work, which is to ensure patient safety during operations. The work environment is increasingly characterized by latent error, i.e. system-based threats to patient safety that can materialize at any time. Interventions to enhance patient safety in operating room nursing are needed.

A Comparison of US, UK, and Dutch Perioperative Staffing Practices

American nurses developed the profession of the perioperative RN. Lasting personnel shortages led to the creation of the position of surgical technologist, however, and the necessity of having an RN in the OR has been under scrutiny in the United States and United Kingdom. The Netherlands had a different historical development of perioperative professions, resulting in ORs largely staffed by technicians. The differences in staffing practices have consequences not only for functionality but also for perioperative staff members job satisfaction. An examination of the historical differences in staffing may support the hypothesis that both disciplines may be needed for the OR to function most effectively.