Hospital-acquired pressure ulcers (HAPUs) and deep tissue injuries (DTIs), while considered to be preventable in most cases continue to affect many patients in acute care facilities. Surgical patients have an especially high risk of developing HAPUs for several reasons, including immobility during the intraoperative and immediate postoperative periods. HAPUs are responsible for significant patient harm in the form of pain, increased susceptibility to infection, and delayed recovery. Perioperative nurses must take a proactive and comprehensive approach to protecting their patients from pressure injuries, including HAPUS and DTIs.
BACKGROUND:Perioperative nurses are expected to demonstrate strict adherence with asepsis principles to prevent surgical site infections (SSIs) as breaching of these principles poses a serious risk of infection to surgical patients.METHODS:A descriptive survey was conducted with a convenience sample of 87 perioperative personnel to describe self-reported compliance with the principles of asepsis during surgery.PURPOSE:The purpose of this study was to examine the practices of perioperative scrub personnel with surgical asepsis.RESULTS:A sizable percentage of participants indicated that they never or rarely observe breaches in the sterile field during surgery with regards to open suction drain systems (46.6%; n = 41), closed suction drain systems (46.6%; n = 41), suture material (39.7%; n = 35), use of surgical instruments (37.5%; n = 33), and prosthetic implants (56.8%; n = 50). Perioperative scrub RNs were less likely to wear shoe covers during surgical procedures than ORTs (M = 3.42 and 4.17; mdn = 3.00 and 5.00 respectively; p = .026).CONCLUSIONS:The findings showed areas of compliance and noncompliance with the principles of asepsis. Given that the role of the perioperative nurse is paramount in maintaining surgical integrity, and enhancing positive patient outcomes, strict adherence to surgical asepsis is vital to prevent SSIs and other complications.
Safety standards for patients with cochlear implants are difficult to find. Safety standards are, in fact, constantly evolving as more information becomes available. This article provides an overview of current philosophies and guidelines for most medical/surgical interventions, with emphasis on the operating room environment, as indicated by the three manufacturers authorized to market cochlear implants in Canada.
The current traditional apprenticeship model in healthcare is no longer meeting the needs of our learners. This model requires learners to master various core skills, carry out a procedure under supervision, and relate simultaneously to other staff in the complex operating room. The approach of "see one, do one, teach one" is considered, by some, to no longer be acceptable. Perioperative nursing educators are, as a result, now faced with the challenge of finding education modalities that will facilitate the learner's journey to competence and the delivery of safe patient care. The purpose of this paper is to discuss team training simulation in the competence development of perioperative nursing learners at the Registered Nurses Professional Development Centre (RNPDC) in Halifax, Nova Scotia.
Initial purchase and replacement costs for surgical instrumentation are significant components in today's operating room budgets. OR staff and medical device reprocessing personnel work together as a team to ensure effective management of this valuable commodity. The purpose of this article is to discuss the composition of stainless steel surgical instruments, to identify processes to minimize damage to instruments caused by staining, corrosion, and pitting, and to utilize that information to describe effective measures to manage instrumentation in both the OR and reprocessing areas.
The Canadian Nurses Association (CNA) values learning from nursing history to provide a contextual perspective in understanding how past events have shaped current nursing practice. Until the publication of operating room nursing journals, Canada's national nursing journal, The Canadian Nurse, served as an educational and professional resource for those nurses working in the operating room and for nurses whose work was related to, or connected with, the operating room. A historical review of early issues of The Canadian Nurse (first published in 1905) reveals a substantial amount of content related to operating room nursing in the twenty year period, beginning in the 1940s, that predated the existence of OR specialty journals. The content was, for the time, both detailed and informative. It was through this journal that operating room nurses, indeed all Canadian nurses, learned about new advances, employment opportunities, educational programs, professional associations, and the achievements of those in the profession. Operating Room Nursing, as an isolated and quickly emerging specialty, was introduced to other nurses via items in The Canadian Nurse journal.
Conflict is partial to no one. It ranges from within an individual and spirals in a ripple effect to others. Conflict among Registered Nurses (RNs) and Operating Room Technicians (ORTs) and between fellow RNs is prevalent in the operation room. The OR environment is filled with a number of personalities, each possessing varying methods for the implementation of patient care. Effective communication is key to preventing, and resolving, conflict situations.
Academic writing can fill pre- and post-registration students with fear and dread. Students often construct written work around re-worded passages from their sources. This results in poor quality work, low marks and frustration. The aim of this article is to inform students embarking on courses in higher education about what academic writing is--and equally importantly what it is not.
Health Canada recommends that hospitals should have procedures in place to ensure Reusable Medical Devices (RMD) are cleaned, disinfected and sterilized according to the manufacturer's instructions. For the purpose of this paper, reusable medical devices will be referred to as RMDs and include all instrumentation and devices that the Central Processing Department (CPD) resterilizes for use in the hospital. Patient safety in surgery begins in CPD. Manufacturer recommendations for the decontamination and sterilization of surgical instrumentation are of utmost importance to Operating Room (OR) and CPD staff. With recommendations that are unclear, nonspecific or unattainable there was a need to define what it means institutionally to meet standards and provide safe patient care while continuing to support the advancement of surgical technology. The purpose of this paper is to describe the challenges faced by one multisite organization (The University Health Network) in managing the sterilization of surgical instrumentation. The development of The Guidance Matrix by the network's inter-professional Reusable Medical Device (RMD) Committee, will be discussed along with information about the elements of this tool and an illustration of how it is used. The key benefits of The Guidance Matrix, including how its use has facilitated transparent decision-making, communication and collaboration regarding sterilization issues across the sites, will be described. Sterilization processes in Central Processing Departments (CPD) include chemical indicators, dated load indicators, and tamperproof locks and filters. The lack of an indicator of sterilization can be a frustrating experience for an OR Nurse. But do we really understand the critical importance of all these indicators? The foundation of sterilizing reusable medical devices (RMDs) begins with proper processes, standards and subsequent scientific validation from the vendors. According to AORN, patient safety is vital and it begins with proper cleaning and processing of the surgical instruments. Surgical site infections can increase the length of stay and the cost of the patients' hospitalization, as well as increased risk, morbidity and even mortality. 1 Today's patients are far more informed than they were in the past. They can gather information from the internet as well as from television, radio, and print media. This knowledge empowers the patient to expect that their healthcare providers are practicing due diligence. It is the ethical duty and responsibility of nurses to provide safe, competent care while protecting the rights of the patient and being accountable to the professional governing bodies. In other words, we are advocates for both our patients and the healthcare system.2 Using both new and innovative instruments in the OR was, in the past, as simple as a surgeon requesting an instrument, the perioperative nurse ordering the instrument and CPD processing it for use in the OR. That is no longer the case. With a wide range of more complex instrumentation and an increasing focus on sterilization strategies, healthcare facilities have had to adopt a more rigorous approach. There are many challenges in the world of sterile processing. A common one, faced on a regular basis, is the provision of vague, inaccurate reprocessing recommendations from the medical device manufacturer. Canadian centres are not able to meet European standards for reprocessing. European cycles, often referred to as "Fractionated Steam Cycles", are different than the pre-vacuum steam cycles run in Canada.
Current nursing shortages along with unsuccessful nursing orientation programs have been a major concern for the past decade because they result in poor retention, reduced quality of patient care, decreased job satisfaction and high financial costs to the organization. Specialty areas, such as the Operating Room (OR), are even more vulnerable due to the stressful working environment and critical care skill set. It has been estimated that approximately 35-65% of new graduates will leave their work place within the first year of employment, lending to the 55% nursing turnover rate. The cost of orientating a new nurse to the perioperative role is estimated to cost between $50,000 and $59,000 U.S. Thus, it is imperative to improve the orientation experience for both new and senior perioperative nurses. Matching preceptor/preceptee learning styles is one way to enhance job satisfaction levels. This paper revisits the literature on preceptorship and provides suggestions on how to enhance existing orientation programs.
Cardiac arrest may occur intraoperatively at any time. The purpose of this article is to help the reader recognize and assist in the management of an intraoperative cardiac arrest. Patients who are at risk for cardiac arrest in the OR are identified and different types of pulseless arrythmias are identified. Roles of perioperative personnel are suggested and documentation during the code is discussed.
Meeting benchmarks of Ontario's Wait Time Strategy and the expansion of The Ottawa Hospital are key issues driving the recruitment of perioperative nurses in Ottawa and Eastern Ontario. Added pressures resulting from Canada's aging population and a nationwide nursing shortage mean perioperative nurses are overworked and understaffed. Preceptoring new members of staff raises valid concerns as many of the new recruits have little or no operating room experience. The Dreyfus Model of Skill Acquisition demonstrates the importance of time and patience in supporting the learning process. Mentoring is a valuable strategy in an effort to teach and guide new nurses, to increase nursing retention, and to promote professional growth and recognition. Building successful mentorship programs, through the creation of healthy organizational cultures, transformational leadership and staff development programs, will strengthen support for nurses in stressful times. The stress of meeting the province-wide benchmarks outlined in Ontario's Wait Time Strategy and the expansion of perioperative services at The Ottawa Hospital in Ontario are two key issues driving the need for the recruitment of nurses into the specialty of perioperative nursing. As a result of Canada's aging population and a nationwide nursing shortage, perioperative nurses are over-worked and under-staffed while being faced with the pressure to preceptor new staff members while struggling to meet the daily demands of the wait list strategy. This article discusses current trends in healthcare and the career path changes being made by many nurses in response to the demand for specialty trained nurses. It is followed by a brief explanation of the Dreyfus Model of Skill Acquisition. Mentoring is presented as an effective strategy in the guidance and teaching of new nurses with a discussion of the benefits and suggestions on how to build a successful mentorship program to support nurses in these stressful times.
ABSTRACTPOSITIONING THE PATIENT for surgery is an important part of perioperative nursing care that should not be underemphasized. The combined factors of time, mechanical pressure, and immobility increase the risk of tissue damage.THE OBJECTIVES of perioperative positioning activities are to balance optimal surgical exposure with the prevention of any injury related to position and to maintain normal body alignment without excess flexion, extension, or rotation.GENERAL PRINCIPLES OF POSITIONING and specific considerations with surgical rationale are presented in this article for each of the commonly used neurosurgical positions (eg, supine, knee‐chest, prone, lateral, park‐bench, sitting). AORN J 87 (June 2008) 1156‐1168. © AORN, Inc, 2008.
