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PubMed2003

Horizontal violence among nurses in the operating room.

MANY NURSES report that sabotage is a common event in the OR, and the level of sabotage present in the OR may have an effect on overall job satisfaction among perioperative nurses. THIS STUDY looked at the relationship between the presence of sabotage in the OR and job satisfaction levels reported by a group of perioperative nurses in New Jersey. STUDY RESULTS found that although sabotage is reported as common in the OR, the presence of sabotage is not significantly associated with reported job satisfaction.

Adult↗
PubMedDate not supplied

The new code of ethics: implications for perioperative nurses.

This article will look briefly at the historical development of the Code of Ethics for Nurses and then critique the New Code of Ethics. From there, aspects of the Code will be applied to perioperative nursing. The Canadian Nurses Association (CNA) revised its Code of Ethics of Nursing to all its members in November, 1992. Nurses can be guided by this document in ethical issues which they must face in their work. Perioperative nurses encounter specific situations daily, for which the Code of Ethics can be a guide.

Canada↗
PubMed1994

Thyroplasty type I for unilateral vocal cord paralysis.

Unilateral vocal cord paralysis may occur with trauma, neoplasms, mechanical or central nervous system dysfunction, or following extensive aortic and mediastinal vascular surgery or thyroidectomy. Thyroplasty type I is a form of laryngeal framework surgery (ie, phonosurgery) used to treat unilateral vocal cord paralysis. A silicone implant is placed inside a surgically created window in the thyroid cartilage and pushes the paralyzed cord medially, allowing the moving cord to touch the paralyzed cord and close the opening. The procedure is performed under monitored local anesthesia with sedation so the patient can phonate during the procedure. Airway compromise is the main complication associated with this procedure.

Contraindications↗
PubMed2000

Process analysis in outpatient knee surgery: effects of regional and general anesthesia on anesthesia-controlled time.

BACKGROUND: The performance of anesthetic procedures before operating room entry (e.g., with either general or regional anesthesia [RA] induction rooms) should decrease anesthesia-controlled time in the operating room. The authors retrospectively studied the associations between anesthesia techniques and anesthesia-controlled time, evaluating one surgeon performing a single procedure over a 3-yr period. The authors hypothesized that, using the anesthesia care team model, RA would be associated with reduced anesthesia-controlled time compared with general anesthesia (GA) alone or combined general-regional anesthesia (GA-RA). METHODS: The authors queried an institutional database for 369 consecutive patients undergoing the same procedure (anterior cruciate ligament reconstruction) performed by one surgeon over a 3-yr period (July 1995 through June 1998). Throughout the period of study, anesthesia staffing consisted of an attending anesthesiologist medically directing two nurse anesthetists in two operating rooms. Anesthesia-controlled time values were compared based on anesthesia techniques (GA, RA, or GA-RA) using one-way analysis of variance, general linear modeling using time-series and seasonal adjustments, and chi-square tests when appropriate. P < 0. 05 was considered significant. RESULTS: RA was associated with the lowest anesthesia-controlled time (11.4 +/- 1.3 min, mean +/- 2 SEM). GA-RA (15.7 +/- 1.0 min) was associated with lower anesthesia-controlled time than GA used alone (20.3 +/- 1.2 min). CONCLUSIONS: When compared with GA without an induction room for outpatients undergoing anterior cruciate ligament reconstruction, RA with an induction room was associated with the lowest anesthesia- controlled time. Managers must weigh the costs and time required for anesthesiologists and additional personnel to place nerve blocks or induce GA preoperatively in such a staffing model.

Adult↗
PubMed1983

Reducing lost drug charges by monitoring computer-generated interdepartmental transfers.

The use of computerized interdepartmental transfer records to identify lost drug charges and a program to capture those charges are described. All charges for medications ordered on floor-stock requisitions for the operating room and various intensive-care units in a 400-bed hospital were entered into the pharmacy's computer. Medications ordered on requisitions that were not stamped with a specific patient's name were charged to the patient-care unit using the computer's interdepartmental transfer program. Computer reports itemizing these charges indicated that over $5100 per month was being lost, approximately half of which originated from the operating room. To reduce lost charges, an improved method of drug-inventory control was implemented in the operating room, and two nurses were hired to coordinate the drug-distribution system in this area. In addition, nurses in other intensive-care units were informed about the liabilities associated with failure to charge for medications, and incentive programs were developed to improve compliance with these procedures. During the first six months after implementation of these measures, monthly lost charges were reduced by a mean of 86%. The use of computerized interdepartmental transfer records to identify lost pharmacy charges may help to justify the cost of computer systems.

Computers↗
PubMed2002

An outbreak of Staphylococcus aureus in a pediatric cardiothoracic surgery unit.

OBJECTIVE: To investigate an outbreak of Staphylococcus aureus surgical-site infections. DESIGN: Case-control study. SETTING: Pediatric cardiothoracic surgery service of a tertiary-care university medical center. METHOD: Molecular typing was used to identify healthcare workers who carried the epidemic strain. RESULTS: Three children acquired surgical-site infections caused by a single strain of S. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P = .01). A case-control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not grow S. aureus. CONCLUSIONS: Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.

Carrier State↗
PubMed2003

A specialty organization addresses the nursing shortage.

The Association of periOperative Registered Nurses (AORN) has committed organization resources to address the worsening shortage of qualified professional registered nurses in the operating room. Organizationally, the efforts have addressed assisting members to recruit new staff and provide orientation and educational experiences that prepare competent practitioners for this specialty. As well, the organization has developed educational programs, membership programs, and other services to support AORN members to develop mentoring relationships with students and new staff. Other organizational efforts include legislative activities and collaborative relationships with other organizations.

Curriculum↗
PubMed2001

The registered nurse first assistant classroom that isn't really a classroom.

Faculty and students in the 21st century need to be skilled in the use of computer technology. In this registered nurse first assistant (RNFA) program, distance learning modalities are used to link students and faculty from different locales, expanding the accessibility of RNFA education. Independent study is used to stimulate critical thinking and skill acquisition in a safe, user friendly environment. The strategies described are simple yet powerful and can be similarly developed by faculty in other RNFA programs without the need for large budgetary expenditures or sophisticated technology.

Clinical Competence↗
PubMed2003

[Surgery in children and adolescents].

The authors explain the second phase in surgery procedure which is known as intra-operative, developing a standardized model of nursing care for children and adolescents during the intra-operative phase. This phase commences in the operating room from the moment the child/adolescent arrives after being brought from a hospital ward and lasts until the child/adolescent is transferred to the recovery room. The authors perform a systematic and holistic evaluation, using the Gordon Functional Health Patterns. The authors select the Nursing Diagnoses of NANDA, the North American Nursing Diagnosis Association, which most frequently appear in this intra-operative phase: risk of lesion, risk of infection, risk of hypothermia, and risk of asphyxiation. The authors also mention the potential complications which could appear during an operation according to the age of the child, the type of anesthesia used, the surgical technique used, and the overall health of the patient prior to surgery. Finally, the authors describe the nursing treatments related to the potential complications and the outlined nursing diagnoses.

Adolescent↗
PubMed2005

AORN guidance statement: sharps injury prevention in the perioperative setting.

Occupational exposure to bloodborne pathogens via percutaneous injuries is one of the most serious dangers perioperative team members face on a daily basis. The risk of sustaining a percutaneous injury can be decreased through employee education, clear communication, device engineering, and focused work practice controls. Risk reduction strategies should include specific practices aimed at reducing the unique risks of percutaneous injuries encountered in the perioperative environment. AORN recognizes the various settings in which perioperative RNs practice, and the suggested risk reduction strategies in this guidance statement are intended to be adaptable to any setting where surgical or other invasive procedures are performed.

Blood-Borne Pathogens↗