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PubMed2005

Rethinking theatre in modern operating rooms.

Metaphor is a means through which a widely accepted meaning of a word is used in a different context to add understanding that would otherwise be difficult to conceive. Through etymological and metaphorical associations, we contend that aspects of "theatre" are still relevant in the modern operating rooms and that the use of dramaturgical metaphors can add another layer of understanding about the social reality in this setting. We begin by exploring the historical roots and derivation of the word theatre as it applied to anatomical dissection and surgery. Briefly, we touch on the work of Erving Goffman and examine how his work has been used by others to explore aspects of operating room nursing. Then, drawing on data from a postmodern ethnographic study that has been used to examine communication in operating room nursing, four dramaturgical metaphors are used to illustrate the argument. They are drama, the script and learning the lines, the show must go on, and changing between back stage and front stage. To conclude, the small amount of previously published literature on this topic is compared and contrasted, and the relevance of using dramaturgical metaphors to understand modern operating rooms is discussed. Being able to distinguish between the inherent drama in operating room work and the dramatic realisation of individuals who work within, can help operating room nurses to think differently about, and perhaps re-evaluate their social situation and how they function within it.

Anthropology, Cultural↗

PubMed1995

The novice perioperative educator: perspectives and comments from mentors.

Fulfilling the role of the perioperative educator can be a complex and overwhelming task. Complexity and anxieties are enhanced when the responsibilities of the perioperative educator are performed as an additional duty. This is especially true for the beginning educator. Developing a pool of resources and identifying mentors in the education arena can provide invaluable insight and support in performing the tasks of the position. This article investigates the feelings associated with performance of the duties of the peroperative educator from the perspective of a novice. Discussions with two mentors regarding the aspects of orientation, competency assessment, in-service training, and where to find additional information are summarized.

Inservice Training↗

PubMed1992

Laser education: current standards and recommendations.

Laser technology has made a significant impact on the nursing profession. Technology challenges traditional practices, and presents an array of new clinical therapies and associated hazards for both patients and medical personnel. Educational opportunities must be objectively evaluated if consumers are to obtain credible, valid, and effective training that will prepare them to comply with current standards and recommended practices.

Curriculum↗

PubMed1995

Perioperative management of patients with vascular disease.

Peripheral artery occlusive disease affects approximately 12% of the population. The evolution of vascular surgery and technologic advances has provided relatively safe and effective treatment regimens for patients with peripheral artery occlusive disease. Vascular surgeries, including carotid endarterectomy, repair of abdominal aortic aneurysm, femoral artery surgeries, thromboembolectomy, and amputation are common surgical interventions performed routinely in many operating rooms. Technologic advances have provided for the success of surgery on occluded arteries. Perioperative nursing care of the patient involves a thorough understanding of the progressive nature of the disease, surgical intervention as palliative, available technology to assist with assessment, and patient and family coping mechanisms. The role of the nurse in caring for patients with peripheral artery occlusive disease spans the health-care continuum from acute care to chronic care. Perioperative, postanesthesia, and intensive care nurses focus on acute care associated with surgical intervention. Practitioners in the rehabilitative and home care arenas must find innovative methods to educate patients and families to become independent and active participants in their care.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Comparison of two methods of measuring gastric pH.

OBJECTIVE: To assess the agreement between two methods of measuring gastric pH in critically ill patients (multiple band litmus paper-tested aspirations versus a meter-read probe located in the tip of a nasogastric tube) and to compare nurse satisfaction with both methods of measuring pH. DESIGN: Prospective, correlational, nonprobability sample. SETTING: Mid-Atlantic, semirural Veterans Affairs Medical Center. SUBJECTS: 39 male, surgical, critical care patients, who were nasogastrically intubated in the operating room and received nothing by mouth. NURSES: Twenty-seven registered nurses on the medical-surgical intensive care staff. OUTCOME MEASURES: Differences in pH units as determined by two methods of measurement and nurse satisfaction scores. INSTRUMENTATION: Litmus paper-tested aspirations versus a meter-read probe located in the tip of the nasogastric tube, measured every 2 hours for 48 hours. A nurse satisfaction assessment form for both measurement methods at entry, 6 months, and 12 months. RESULTS: All measures of association, Pearson's r (0.79), the concordance coefficient (0.74), and eta (0.88), were high. The concordance coefficient measures indicated sufficient agreement between the two methods at the initial and 24 hour measurement times (Cb) = 0.97, 0.97, and 0.94), but not at 48 hours. The meter method indicated prophylaxis was needed when the paper did not, more often than did the paper method (9.3% vs 5.2%). A significant difference between methods was found only at the last reading at 48 hours (z = -2.24, p < .0249). MANOVA revealed that nurses' preference for the meter method was significant (F = 139.48, df = 1.18) and increased over time (F = 4.77, df = 2,36). CONCLUSIONS: The gastric probe method of measuring pH is an accurate substitution up to 48 hours for the litmus-paper aspiration method in the postoperative patient who is receiving nothing by mouth. Nurses prefer the gastric probe method of measuring pH over the litmus-paper method because they judge it to be safer, faster, and more accurate.

Aged↗

PubMed1995

Neuroendoscopic laser-assisted ventriculostomy of the third ventricle.

Hydrocephalus is caused by an imbalance between the production and absorption of cerebrospinal fluid. Ventriculostomy of the third ventricle now is an acceptable treatment alternative for this problem. This procedure reduces costs over the course of the illness because the patient does not require subsequent shunt revisions throughout his or her life. The specialized care and the fear associated with the dependency on mechanical hardware also are eliminated if shunt placement is avoided. Postoperative complications may include increased intracranial pressure, bleeding, infection, and pain.

Child↗

PubMed1998

Morbid obesity and spinal cord injury: a case study.

With obesity on the rise in the United States, most nurses will probably encounter the unique challenges that result from the pathophysiological changes in this population. The combination of morbid obesity and any other disease process or injury create complex medical management issues for caregivers during hospitalization and after discharge. Complications of spinal cord injury are intensified with obesity. Prevention and treatment of secondary complications require nursing practice to go above and beyond the standards of care. This paper clearly illustrates the nursing challenges by focusing on the experience of caring for a morbidly obese person who sustained a C5-6 spinal cord injury. Complications unique to this patient, as well as adjustments in care, will be discussed with a main focus on the acute rehabilitation phase. Ms. Z. is a 24-year-old female who worked as a home health aide. One cold winter day, as she was driving to a client's house, she lost control of her truck and struck another vehicle. The result of Ms. Z.'s accident was a C5-6 complete spinal cord injury (SCI), which would be complicated by her weight of more than 400 pounds. When the accident occurred, Ms. Z. was not wearing a seatbelt and had not worn one since age 12 because they did not fit. In fact, it is reported that obesity is associated with decreased seat belt use (Lichtenstein, Bolton & Wade, 1989). It took an hour to extricate Ms. Z. from the truck. She was then flown via Mayo One life support helicopter to our Type I Emergency Trauma Unit/Center. There she received methylprednisolone 4.8 gm i.v./1 hour followed by 22 cc/hr or 5.4 mg/kg over 23 hours. After medical personnel made assessments, they sent her to the operating room for cervical fusion. Ms. Z.'s obesity complicated positioning, X-ray, draping, and all facets of the operative procedure. Ms. Z. was in the intensive care unit (ICU) for six weeks, where she faced more complications that included: prolonged ventilator dependence; right upper lobe collapse; three episodes of asystole after being turned; a midback adipose fold wound; and urinary tract infections. Members of the rehabilitation team (physicians, nurses, physical therapists, occupational therapists, and a psychologist) became involved in her care at the beginning of her ICU stay. Early intervention by the rehabilitation team was essential to provide Ms. Z. with collaborative care and to eventually ensure an adequately prepared transition to the rehabilitation unit while maintaining continuity of care. Innovative planning for Ms. Z.'s transition to rehabilitation and mobilization included careful selection of beds, wheelchairs, and lifts to accommodate her weight and body size.

Adult↗

PubMed2003

Using a personal digital assistant to streamline the OR workload.

PERSONAL DIGITAL ASSISTANTS (PDAs), are handheld minicomputers used for tasks such as referencing, documentation, and data storage and retrieval. THESE DEVICES can help perioperative nurses solve problems associated with updating, maintaining, and retrieving surgical preference cards and accessing treatment and medication references. CHOOSING A PDA and accessories, finding basic software, and writing a perioperative nursing program can be painless, even for a novice. NURSING DOCUMENTATION can be accelerated and streamlined with the use of PDAs, which leaves perioperative nurses more time for quality patient care.

Computers, Handheld↗

PubMed1997

Hysteroscopic fluid management.

Many of the technical difficulties and hazards associated with operative hysteroscopy revolve around management of the liquid distending medium. For the nurse, this involves vigilance in determining when the reservoir bag needs to be changed and when the return canister is full, and the task of calculating inflow-outflow deficits. The last is made more difficult by the fact that 3-L bags of dilute sorbitol or glycine most often used in hysteroscopy are not filled precisely, and readings of residual reservoir volume and canister levels are often made in darkened operating rooms. For the surgeon, the first issue is to achieve satisfactory intrauterine visualization that relates to the pressure and the flow of medium. Both surgeon and patient are understandably concerned about problems of excessive absorption of water from the electrolyte-free medium causing potentially life-threatening hyponatremia and hypervolemia. A system to manage hysteroscopic fluid was developed that addresses these concerns.

Female↗

PubMed1975

[A hospital epidemic due to Achromobacter calcoaceticus].

35 patients were secondarily infected in our hospital with a strain of A. calcoaceticus resistant to the usual antibiotics and sulfonamides, but sensitive to colimycin. The epidemic lasted 118 days and is not yet finished. Each of the infected patients had a severe surgical or medical illness, underwent operations, trachetomy, etc. and was treated with antibiotics. A. calcoaceticus persisted alone or was associated with other bacteria from 1 to 46 days, in specimens (sputum, etc. or in blood) sometimes until death. It is not pathogenic for rabbits and mice; its pathogenicity in man is discussed in the text. The epidemic strain was not harboured by 15 doctors, students or nurses, nor present on 147 objects in the vicinity of the patients, but was found in a bottle of aqueous 1% eosin solution in the room of an infected child. Experiments show that A. calcoaceticus is not killed by a 1% eosin solution, and freely multiplies in broth containing 0,5% eosin. It is easy to identify the first case and chronology of the epidemic, but it is less easy to identify each time the means of propagation. Usually, infected patients seem to be the source of further infection. Does eosin paly more than an occasional role? Were the germs transported by dust? This not very disturbing epidemic suggests that less pathogenic germs may still cause unsuspected hospital epidemics.

Acinetobacter↗

PubMed1999

Who goes to the ICU postoperatively?

OBJECTIVE: To describe changes in ICU postoperative management strategies utilized for patients undergoing cardiac surgery. The treatment of these patients serves as a useful illustration of the changing patterns of ICU utilization and care associated with contemporary surgery. DESIGN: Evidence-based review of the clinical literature following a MEDLINE search, direct observation of rapid recovery programs following surgery, and informal inquiry of others utilizing similar approaches to postoperative cardiac surgery care. SETTING AND PATIENTS: The reports reviewed are from a diverse set of hospitals providing cardiac surgery services in both Europe and the United States. Most reports focus efforts on patients undergoing coronary artery revascularization. MEASUREMENTS: Outcome measures used to gauge the effectiveness of postoperative ICU care typically include time to extubation, ICU and hospital length of stay, postoperative complications including reintubation and ICU readmission, patient satisfaction, and health resource savings. MAIN RESULTS: The literature regarding current practice for postoperative ICU management in cardiac surgery consists primarily of grade 2 and 3 literature. CONCLUSIONS: Despite the paucity of controlled data, rapid recovery, extubation, and discharge from the ICU following cardiac surgery is an approach to care that is growing in acceptance. The goals include reduction in the utilization of resources and costs associated with cardiac surgery and maintenance of quality of care and patient satisfaction. Assessment of outcomes requires a program to monitor outcomes. Success does not appear to be linked to preoperative risk for most patients but does relate directly to the anesthetic management delivered in the operating room. Few adverse consequences from this approach have been reported. Experience to date suggests that programs designed to truncate ICU admission following cardiac surgery can be implemented with the cooperation between the health delivery team including surgeon, anesthesiologist, intensivist where available, nursing, respiratory care, and patient and family. These programs can serve as useful models for reassessing the utilization and role of the ICU in the postoperative treatment of routine surgical patients.

Cardiac Surgical Procedures↗

PubMed1998

Prevalence of inadvertent hypothermia during the perioperative period: a quality assurance and performance improvement study.

The inadvertent hypothermia that is often seen after anesthesia in a cool environment has been associated with delays in recovery from anesthesia and longer stays in the PACU. This quality assurance/performance improvement study was undertaken to determine the following: (1) the effectiveness of current interventions for preventing intraoperative hypothermia, (2) whether there were any apparent differences in effectiveness among the current methods for preventing intraoperative hypothermia, and (3) was intraoperative hypothermia associated with delays in discharge from the PACU. Data were completed on 502 patients. Despite longer surgical procedures, those patients treated intraoperatively with the Bair Hugger (Augustine Medical Inc, Eden Prairie, MN) were less likely to arrive in the PACU hypothermic than those who did not receive this treatment. Patients who arrived in the PACU hypothermic had longer PACU stays than patients who arrived normothermic. As a result of these findings, changes in nursing practice in the PACU and in the availability of the Bair Hugger in the operating rooms were made.

Adolescent↗

PubMed1993

Monitoring i.v. conscious sedation, the legal scope of practice.

Registered nurses who are not CRNAs and are undertaking the administration and/or monitoring of patients receiving IV conscious sedation should consult their state board of nursing, undertake and document the additional education or training to monitor IV conscious sedation patients safety and document the successful achievement of competency in these services, and work with nursing, surgery, and anesthesia staff members to develop written protocols and policies. Written policies must include the provisions, if any, as prescribed by the state's board of nursing. The provisions of other state boards of nursing could be considered for possible inclusion. Policies should reflect nursing practice as described in the professional literature. Professional association position statements, such as those issued by the ANA and endorsed by AORN and other specialty associations and those issued by AANA, should be consulted. AORN's "Recommended practices for monitoring patients receiving intravenous conscious sedation" in the 1993 edition of AORN Standards and Recommended Practices for Perioperative Nursing should be incorporated into the institution policy as appropriate.

Procedural Sedation↗

PubMed1990

Perioperative autotransfusion. Avoiding donated risks.

Because of the risks associated with donated blood, although slight, intraoperative and postoperative autotransfusion is becoming the wave of the future. "Intraoperative autotransfusion," according to Ken Williamson, MD, of the Mayo Clinic, "is now a medically indicated procedure." Cost effectiveness, once raised as an objection to intraoperative autotransfusion, is no longer considered; disease prevention is paramount. Every OR nurse should become familiar with the operation of the autotransfusion machines and be able to set up such a machine and operate it in an emergency. In our institution, one OR nurse can run two machines in different operating rooms because blood loss into the orthopedic wound is usually slow. Inservice training for nurses is readily available from the manufactures' representative or distributors. All in all, nurses-especially OR nurses-must prepare to be part of the autotransfusion team in the 1990s and beyond.

Blood Group Incompatibility↗

PubMed1995

Day surgery: cheap option or challenge to care?

The tendency for surgery and associated nursing care to become short-stay is driven by so many considerations (of both dubious and desirable kinds) that it may be useful to attempt a little stock-taking on previous patterns of day operating and, by consulting a crystal ball, to consider possible implications for nursing and patient aftercare.

Ambulatory Surgical Procedures↗

PubMed1995

An expert system to teach troubleshooting of common problems associated with the automated anesthesia recordkeeper.

Automated anesthesia recordkeepers have been used to monitor patients during surgery in up to 90% of cases at The Ohio State University. The record-keeping devices are complex and can be difficult to troubleshoot. The 1st-CLASS Fusion Program, an expert system "shell-program," has been programmed to allow the resident or nurse anesthetist to solve the two most common types of problems associated with the recordkeeper: printer problems and patient monitor problems. Use of this program allows the resident or nurse anesthetist to troubleshoot the recordkeeper quickly and accurately and promotes in the user a sense of competence and control over the technology.

Anesthesia↗

PubMed2002

Level of awareness about transplantation, brain death and cadaveric organ donation in hospital staff in India.

A questionnaire was distributed in a group of randomly selected hospital staff to ascertain the level and factors associated with awareness regarding organ transplantation, brain death, and cadaveric organ donation. Between October and December 2000, a total of 166 paramedical (nurses, technologists, medical physicists) and 100 nonmedical (administrative, clerical, engineering, social scientists, and miscellaneous) staff of a tertiary referral academic hospital in northern India received this questionnaire. Ninety-seven percent had good to excellent awareness about transplantation, 17.3% of the hospital staff thought that brain death was a reversible process, and 59.4% had misconceptions about the retrieval of cadaveric organs. A significant positive correlation (r = 0.147, P = .01) was observed between the awareness of transplantation, brain death, and organ donation. A significant association was also observed between the workplace (operating room and intensive care unit vs other areas) and awareness of transplantation (P = .048), and brain death and organ donation (P = .030).

Adult↗

PubMed1997

Case costing means, measuring and managing now! The journey traveled by a community hospital.

Funding for health care in Ontario is moving from global funding to equity funding. In the future, hospitals will be reimbursed for how efficiently they care for their various patient populations. The Ontario Case Costing Project (OCCP) was a joint venture by the Ontario Hospital Association and the Ministry of Health. Incentive for participation in this project was based on the need to assess efficiencies in caring for patient populations in surgical suites and to obtain Canadian data. Case Costing has the potential to forecast budgets, identify variances and highlight areas for cost savings. Case Costing can also determine cost per surgeon, cost per service, cost per procedure. The nurses at Markham Stouffville Hospital are empowered to enhance the focus of their practice to include managing human resources, processes and materials. This enhanced focus in the Operating Room maximizes efficiency and effectiveness of processes, and allows the organization to provide better service. This article documents the journey and growth of perioperative nurses toward the destination of case costing. Key to this journey is not only the destination, but the growth and change that occurred and enabled perioperative nurses to effectively champion initiatives such as case costing. Opportunities and Threats, a One Page Plan and our recommended learnings will be shared.

Case Management↗