Perioperative Nursing Research Articles

Guidelines in Practice: Processing Flexible Endoscopes.

Flexible endoscopes allow surgeons and proceduralists to view patients' internal organs through small incisions or natural orifices. These devices may be difficult to clean and dry adequately, and the formation of biofilm can further complicate effective cleaning. The updated AORN "Guideline for processing flexible endoscopes" provides perioperative personnel with evidence-based best practice recommendations on a variety of concepts associated with this topic. This article provides an overview of the guideline and discusses recommendations for point-of-use treatment, transport, cleaning (including verification and drying), and storage of flexible endoscopes. It also includes a scenario that illustrates the importance of adequately drying and storing flexible endoscopes. When processing flexible endoscopes, personnel should adhere to the endoscope and processing equipment manufacturers' instructions for use. Perioperative nurses should review the guideline in its entirety and implement recommendations in practice settings where flexible endoscopes are used.

Investigating the relationship between patient safety culture and self-efficacy of operating room: A cross-sectional study on 228 perioperative nurses in Iran

BackgroundHospitals should implement structural changes as well as a culture of patient safety among their staff in order to increase the quality and safety of healthcare. One of the traits that can have an impact on mental health and the provision of high-quality services and care for these people is self-efficacy. The goal of the current study was to link operating room nurses' self-efficacy to the culture of patient safety. MethodsThis cross-sectional study was done in 2022 on a group of 228 operating room nurses who were employed by hospitals in the province of East Azerbaijan. In this research, 228 operating room nurses were included in the study by random sampling method. Data collection tools included demographic questionnaire, patient safety culture questionnaire and general self-efficacy questionnaire Sherer. Software SPSS version 27 was used to examine the data that had been gathered. P value less than 0.05 is regarded as significant. ResultsThe results of data analysis showed that the average score of patient safety culture in operating room nurses is 131.2 ± 14.5, which is in the middle level. Also, the average self-efficacy score is 51.7 ± 5.5, which is in the middle level. The self-efficacy of operating room nurses and patient safety culture are directly and significantly correlated (P<0.001). Therefore, increasing the self-efficacy of operating room nurses leads to the promotion of patient safety culture. ConclusionBased on the results of the study, the more self-efficacy operating room nurses have, the higher the level of patient safety culture will be. Considering the critical responsibility of operating room nurses in providing safe and quality services to patients, people with higher self-efficacy provide better safe services and patients in hospitals with a more positive safety culture experience fewer injuries.

Perioperative nurses’ activities in the brazilian scenario: a scoping review

Objective: To map perioperative nurses’ main activities in the Brazilian scenario, explained in the current literature. Methods: This is a scoping review prepared in accordance with current JBI guidelines, using the checklist for conducting and reporting the study. The search was carried out by two independent researchers, between August and December 2021, in six databases in the health area, using the descriptors nurses, nurse role, intraoperative period, perioperative nursing, surgical centers. Articles published between January 2011 and October 2022, in English, Portuguese or Spanish, were part of the sample. The information was extracted, classified, synthesized and presented descriptively. Results: Eighteen were included in the research synthesis. The analysis of results made it possible to highlight the implementation of surgical safety measures as prevalent activities in care (50%); in management, material, input and equipment (72%) and room preparation (39%) management; in teaching, permanent nursing education (50%). No studies related to researcher activity were identified. Conclusion: In the Brazilian scenario, perioperative nurses’ activities range from management to assistance with a smaller proportion in teaching, highlighting their strategic position in mobilizing actions that promote safety and quality in perioperative processes. Protocol registration on the Open Science Framework platform: https://osf.io/8jmq6/

The Perioperative Nurse Manager's Role in Quality Improvement and the Barriers and Facilitators Impacting their Engagement: A Mixed Methods Approach

The Perioperative Nurse Manager's Role in Quality Improvement and the Barriers and Facilitators Impacting their Engagement: A Mixed Methods Approach

Perioperative nursing of a patient undergoing total parathyroidectomy with subcutaneous autotransplantation for secondary hyperparathyroidism

Perioperative nursing of a patient undergoing total parathyroidectomy with subcutaneous autotransplantation for secondary hyperparathyroidism

Guidelines in Practice: Hand Hygiene.

Effective hand hygiene is an important part of infection prevention, especially in perioperative areas. The revised AORN "Guideline for hand hygiene" provides perioperative personnel with evidence-based practice recommendations for hand hygiene. This article presents an overview of the guideline and discusses specific recommendations for maintaining appropriate fingernail and hand condition; wearing or removing hand and wrist jewelry; performing general hand hygiene; performing surgical hand antisepsis with a traditional hand scrub or surgical hand rub; selecting sinks, faucets, and drains to avoid hand contamination; and implementing quality activities to enhance hand hygiene compliance. It also includes a scenario illustrating how nurses can use the guideline to mitigate hand dermatitis associated with surgical hand antisepsis. Perioperative nurses should review the revised guideline in its entirety and apply the recommendations as applicable for their practice.

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.

Evidence-based practice in perioperative nursing: Barriers and facilitators to compliance

Evidence-based practice in perioperative nursing: Barriers and facilitators to compliance

IMPACT OF THE PERIOPERATIVE NURSE ON SURGICAL PATIENT SAFETY

Background: The inadvertent retention of quantifiable items (RIIQ) continues to be an occurrence in surgical realities, which entails catastrophic consequences for the patient. IIRQ prevention translates into a collective effort where all members of the surgical team must take responsibility and adopt preventive strategies. Objective: To determine what promotes surgical count (SC) practices that ensure surgical patient safety. Methodology: The literature search was carried out in the CINAHL and Pubmed databases. It included all studies published in English or Portuguese from 2016 to 2020. Results: 6 articles were obtained. Most episodes of IIRQ occur in general surgery surgeries and where CC has been performed. The achievement of the reported CC is 77.4% and 86.5%. There is a statistically significant correlation between instrumentalist nurses and CC. Factors such as emergent, long-term surgeries, inexperienced nurses, complacency in surgical counts, different surgical teams for the same procedure, and communication failures contribute to IIRQ. There is a relationship between body mass index (BMI) and the occurrence of IIIQ. Discussion: IIIQ is a sentinel event that has a direct negative impact on patient safety and health. The risk of IIIQ is not unique to abdominal surgery, and minimally invasive surgery is not risk-free. IIRQ occurs due to several factors, although CC alone does not prevent IIRQ, it is necessary to keep in mind that it is a surgical error and, like all errors, it is preventable. Conclusion: The correct practice of CC by perioperative nurses should be a priority in all surgical interventions. This practice contributes to the prevention of IIRQ, increasing the safety of the surgical patient.

Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study.

(1) Background: The COVID-19 pandemic has led to an increase in the complexity of caregiving, resulting in challenging situations for perioperative nurses. These situations have prompted nurses to assess their personal and professional lives. The aim of this study was to explore the experiences of perioperative nurses during the first wave of the COVID-19 pandemic, with a specific focus on analyzing moral breakdowns and ethical dilemmas triggered by this situation. (2) Methods: A qualitative design guided by a hermeneutical approach was employed. Semi-structured interviews were conducted with 24 perioperative nurses. The interviews were transcribed and thematically analysed following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. (3) Results: The findings revealed three main categories and ten subcategories. These categories included the context in which moral breakdowns emerged, the ethical dilemmas triggered by these breakdowns, and the consequences of facing these dilemmas. (4) Conclusions: During the first wave of COVID-19, perioperative nurses encountered moral and ethical challenges, referred to as moral breakdowns, in critical settings. These challenges presented significant obstacles and negatively impacted professional responsibility and well-being. Future studies should focus on identifying ethical dilemmas during critical periods and developing strategies to enhance collaboration among colleagues and provide comprehensive support.

Design of a Nursing Intervention Program to Prevent Adolescents' Perioperative Anxiety

Introduction Adolescents undergoing surgery have expressed a willingness to obtain information about their surgery and to be involved in the decisions about their health care process. Around 80% of adolescents experience anxiety before undergoing surgery. On the basis of the adolescents' shared experiences, areas of possible nursing intervention have been identified to prevent anxiety and the multitude of adverse effects associated with it. The purpose of this study is to present a nursing intervention program to prevent perioperative anxiety in adolescents (3P2A) designed based on the first phase of the complex intervention's framework. Methods The design of this program followed the updated guidance for developing complex interventions issued by the Medical Research Council and the National Institute for Health Research. Five Portuguese nurses, experts in perioperative nursing, and pediatric specialists evaluated and validated the final version of this program. Results The nursing intervention program to prevent perioperative anxiety in adolescents (3P2A) consists of three phases that correspond to the preoperative, intraoperative, and postoperative periods. The first phase includes conducting a preoperative nursing consultation to identify stressors, providing written and verbal information about the surgery, and applying nonpharmacological interventions to reduce anxiety. In the intraoperative period, nonpharmacological interventions are implemented in the anesthetic induction room immediately before the adolescent falls asleep. Finally, the postoperative period comprises a nursing visit to identify postoperative complications and promote the adolescents' well-being. Discussion The program is structured with specific interventions to be implemented in each of the perioperative periods. Because of its flexibility, it may be fully or partially implemented considering the identified needs, priorities, and resources when caring for an adolescent with anxiety during the perioperative period.

Perioperative Nursing Informatics Relevant Data Standard Research in the Context of Medical Big Data: Improving Patients? Health Behavior.

Objectives: Our objective was to determine the progress of perioperative nursing informatics relevant data standard research in the context of medical big data. We also determine the moderating impact of big data in healthcare between standard data and perioperative nursing informatics. Methods: We used Smart PLS for structual equation modeling and reviewed some recent literature and briefly discussed the progress on perioperative nursing standardized data in five aspects. Results: Our findings demonstrate that the direct impact of standard data and big data in healthcare is positively confirmed on perioperative nursing informatics. The moderating impact of big data in healthcare between standard data and perioperative nursing informatics is also confirmed. Conclusions: Our model is novel in the literature. Big data can be used by the healthcare system to the advanced level for patient record-keeping according to their health behavior and improving the methods of treatment.

Guidelines in Practice: Prevention of Perioperative Pressure Injury.

Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.

Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review.

The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps. The process of obtaining consent for planned elective surgery manifests an individual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error. Scoping review. Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) five-step scoping review methodology was used. Fifty-three articles were included; 39 primary and 14 secondary research publications. Three key findings were identified; there is currently low-level evidence about surgical consent processes to inform clinical practice; junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub-optimally; and current knowledge gaps include capacity assessment, decision-making and pre-procedural consent checks. Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision-making, pre-procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident. This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room. The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective.

Psychometric validation of the Perceived Perioperative Competence Scale-Revised Short Form.

To develop a parsimonious, shortened version of the Perceived Perioperative Competence Scale-Revised for perioperative nurses to complete as part of their specialty training while retaining good psychometric properties. A longitudinal online survey was adopted. A national sample of perioperative nurses from Australia completed an online survey at two different time points 6 months apart between February and October 2021. Confirmatory factor analysis was conducted for item reduction and construct validity, while criterion, convergent validity and internal consistency were examined. Usable data for psychometric assessment were obtained from 485 operating room nurses at time 1 and 164 nurses at time 2. The original 40-item revised scale was reduced to an 18-item measure, maintaining its six domains. Cronbach's alpha for the 18-item scale was .92 at time 1 and .90 at time 2. Scale validation demonstrated moderate to weak positive relationships in perceived competence scores relative to general self-efficacy, years of operating room experience, postgraduate education and recency of training. Results suggest the 18-item Perceived Perioperative Competence Scale-Revised Short Form has initial robust psychometric properties and may be implemented in clinical settings as part of perioperative transition-to-practice, orientation programs and yearly professional development reviews. This short-form scale can help prepare perioperative nurses to demonstrate clinical competence in a climate of increasing professional demands using a valid measure of competence required in clinical practice. Short and validated scales of perioperative competence are needed in clinical practice. Assessment of practising operating room nurses' perceived competence is essential in quality care provision, workforce planning and human resource management. This study provides an 18-item measure of the previously validated 40-item Perceived Perioperative Competence Scale-Revised. This scale can help provide an option for future testing of perioperative nurses' competence in clinical or research settings. Perioperative nurses were involved in the design of the study, particularly in the assessment of validation of the tools used in the study.

Factors affecting compliance to preoperative patient care guidelines among nurses working in surgical wards of a tertiary referral hospital in Nairobi, Kenya

BACKGROUND &#x0D; Worldwide, over 234 million surgical patients are operated on yearly with 3%-16% of them developing complications and other preventable surgical mistakes. To mitigate these negative surgical outcomes, pre-operative patient care guidelines (PPCG) have been developed. However, poor compliance with the guideline may lead to surgical errors. In Kenyatta National Hospital (KNH) 20% of surgical errors and 10% of cancelled surgeries are due to poor compliance with PPCG. Therefore, this study aimed to establish the level of compliance with PPCG and its associated factors among perioperative nurses at KNH. &#x0D; MATERIALS AND METHODS &#x0D; This was an analytical cross-sectional study that was conducted at the KNH surgical wards. The census method was utilized to collect data among 103 nurses and analyzed using SPSS version 22. Bivariate analysis with Fischer’s exact test was used for the correlation between the independent and dependent variables, with a p-value of &lt;0.05 being considered to be statistically significant at a 95% confidence interval. &#x0D; RESULTS &#x0D; Most [59(57.3%)] of the participants had low compliance to PPCG, with nurses’ experience (p=&lt;0.001), gender (p=0.02), level of education (p=&lt;0.001), having post-basic nursing training (p=0.02), not having training in PPCG (p=&lt;0.001) and knowledge on PPCG (p=&lt;0.001) being significantly associated with compliance to PPCG. &#x0D; CONCLUSION &#x0D; Most of the nurses have low compliance levels to PPCG, with nursing experience, nurses of the male gender, not having post-basic nursing training and not having training in PPCG use being the main contributing factors.

RISK OF INJURY DEVELOPMENT DUE TO SURGICAL POSITIONING: AN OBSERVATIONAL STUDY

Objective: To classify the risk of developing injury due to surgical positioning. Method: Observational, longitudinal, prospective study with a quantitative approach carried out in a public hospital, with 135 patients undergoing elective surgery. Instruments containing sociodemographic, clinical, and surgical characteristics and a risk assessment scale for the development of injuries due to surgical positioning were used. Descriptive analysis, Fisher’s exact test or χ2 test and odds ratio association measure were used as appropriate. Results: Most participants were male (51.11%), adults (52.59%) and were classified as having a higher risk for developing injuries due to surgical positioning (51.85%). Elderly, hypertension, diabetes mellitus and urological surgeries were statistically significant (p &lt; 0.05) for a higher risk of developing lesions. The incidence of pressure injuries was 0.74%, with observation only in the sacral region. Conclusion: There was a greater risk of developing lesions due to surgical positioning and low incidence of pressure injury. Perioperative nursing should incorporate validated risk measurement tools into care practice for safe, individualized and quality care for surgical patients.

Evaluation of enhanced recovery after surgery combined with percutaneous acupoint electrical stimulation in perioperative nursing of patients with gastric cancer

Evaluation of enhanced recovery after surgery combined with percutaneous acupoint electrical stimulation in perioperative nursing of patients with gastric cancer

A Perioperative Specialty Elective to Address the Perioperative Nursing Shortage: Student Perspectives and Outcomes.

To help solve the perioperative nursing shortage, it is imperative that health care leaders understand why students choose or do not choose to pursue a career in perioperative nursing. In May 2021, we published the results of a specialty elective course evaluation from a leadership and perioperative services personnel perspective; in the current article, we examine the same program from the students' perspective. We distributed survey links to undergraduate nursing students to evaluate their perioperative knowledge before and after completing the course. Students reported large gains in knowledge, critical thinking, teamwork, and confidence at course completion, but the posttest mean number of students with an interest in pursuing perioperative nursing was lower than the pretest mean. This realization is perceived as a positive outcome of the perioperative elective course because it may lead to a decrease in turnover among newly hired perioperative nurses.

Guidelines in Practice: Positioning the Patient.

Positioning the patient is an important perioperative task; the recently updated AORN "Guideline for positioning the patient" provides perioperative personnel with background information and evidence-based best practices for perioperative patient positioning and focuses on maintaining patient and staff member safety. The revised guideline includes recommendations for placing patients safely in a variety of positions and avoiding positioning injuries, such as postoperative vision loss. This article provides an overview of positioning recommendations for assessing patients' risk for injury, implementing safe positioning practices, placing patients in the Trendelenburg position, and preventing intraocular injuries. It also includes a patient-focused scenario on preventing adverse events associated with the Trendelenburg position that aligns with information discussed in the article. Perioperative nurses should review the guideline in its entirety and implement appropriate recommendations for positioning patients during procedures.