National Association of Theatre Nurses: small beginnings.
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This inquiry was to determine the feasibility of creating a nursing role for first assisting in the cardiac operating room in Newfoundland and Labrador. A committee was struck to review the role as it existed in the United States and Canada. Following this, the committee gained approval from appropriate professional associations and began developing the program. The result is that three nurses are currently working as RNFA's in Cardiac Surgery and two nurses are piloting a RNFA Program for General Surgery.
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The twofold purpose of this study was to assess the prevalence of latex sensitivity in a large group of operating room nurses and to evaluate the relationship between questionnaire responses and skin tests. Of the total target population of 268 operating room nurses, 248 (93%) answered the questionnaire and 197 had skin prick tests to latex (1/10 wt/vol solution). Symptoms associated with glove wearing were acknowledged by 41.1% of nurses. Skin tests to latex were positive in 21 nurses (10.7%), 4.4 times more often in atopic nurses. Among nurses complaining of local symptoms, only 18.6% had positive skin tests. Itching of the hands during glove wearing correlated poorly with latex sensitivity, but correlation with local urticaria was better. Atopic nurses complaining of urticaria had latex allergy in 70% of cases. Thus latex allergy is common in nurses, especially atopic nurses. A questionnaire is unreliable in predicting latex sensitivity and must be supported by latex skin test. More data will be needed to assess the risk of anaphylactic perioperative reactions in operating room nurses.
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Retaining self-determination about medical care is a basic patient right. Advance directives (e.g., living wills, powers of attorney, health care proxies) are becoming more common in today's health care settings, including the OR. Perioperative personnel should be aware of and respect these documents and the patient's wishes--without compromising their own morals or ethics.
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Many nurse executives have never worked in the operating room (OR) and are often told they "don't understand" by the surgical services director. Often, nurse executives do not have the surgical background required to make informed decisions about problems associated with surgical services. The authors provide insight into issues that exist in the OR environment and present strategies for improving nurse executives' relationships with the OR staff, management, and surgeons.
CONTEXT: Morbidity and mortality rates in intensive care units (ICUs) vary widely among institutions, but whether ICU structure and care processes affect these outcomes is unknown. OBJECTIVE: To determine whether organizational characteristics of ICUs are related to clinical and economic outcomes for abdominal aortic surgery patients who typically receive care in an ICU. DESIGN: Observational study, with patient data collected retrospectively and ICU data collected prospectively. SETTING: All Maryland hospitals that performed abdominal aortic surgery from 1994 to 1996. PATIENTS AND PARTICIPANTS: We analyzed hospital discharge data for patients in non-federal acute care hospitals in Maryland who had a principal procedure code for abdominal aortic surgery from January 1994 through December 1996 (n = 2987). We obtained information about ICU organizational characteristics by surveying ICU medical directors at the 46 Maryland hospitals that performed abdominal aortic surgery. Thirty-nine (85%) of the ICU directors completed this survey. MAIN OUTCOME MEASURES: In-hospital mortality and hospital and ICU length of stay. RESULTS: For patients undergoing abdominal aortic surgery, in-hospital mortality varied among hospitals from 0% to 66%. In multivariate analysis adjusted for patient demographics, comorbid disease, severity of illness, hospital and surgeon volume, and hospital characteristics, not having daily rounds by an ICU physician was associated with a 3-fold increase in in-hospital mortality (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.9-4.9). Furthermore, not having daily rounds by an ICU physician was associated with an increased risk of cardiac arrest (OR, 2.9; 95% CI, 1.2-7.0), acute renal failure (OR, 2.2; 95% CI, 1.3-3.9), septicemia (OR, 1.8; 95% CI, 1.2-2.6), platelet transfusion (OR, 6.4; 95% CI, 3.2-12.4), and reintubation (OR, 2.0; 95% CI, 1.0-4.1). Not having daily rounds by an ICU physician, having an ICU nurse-patient ratio of less than 1:2, not having monthly review of morbidity and mortality, and extubating patients in the operating room were associated with increased resource use. CONCLUSIONS: Organizational characteristics of ICUs are related to differences among hospitals in outcomes of abdominal aortic surgery. Clinicians and hospital leaders should consider the potential impact of ICU organizational characteristics on outcomes of patients having high-risk operations.
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