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Backstage in the theatre.

Observations undertaken in the operating theatre suggested that the social environment, and certain forms of staff behaviour could be explained using the space analysis developed by Erving Goffman (1969) in The Presentation of Self in Everyday Life. In the study reported in this paper the theatre department was found to be a strongly 'backstage' area. However, it was also found that there were limits to this analysis, and these are explained within this article. Some practical suggestions as to how this analysis might be helpful in the management of health care institutions and the education of health care professionals are made.

Attitude of Health Personnel↗

The use of predictive modeling to test nursing practice outcomes.

A middle range, multivariate practice model was constructed to test the impact of a perioperative teaching program on multiple patient outcomes: coping, anxiety, recovery pattern, pain, and patient satisfaction. In addition, the influence of such a program on nursing staff was examined. A quasi-experimental, causal modeling approach was used. The operative trajectory of 88 patients and their operating room nursing staff was traced from two pre-operative points through the intra-operative stage to two points post-operatively. The experimental patients (n = 54) evidenced higher satisfaction with their care, a tendency to experience less post-operative vomiting, but also tended to recover more slowly and cope less well than the control patients (n = 34). Multiple regression analysis of the practice model suggested the perioperative teaching program affected patient outcomes, indirectly, through the functioning of the staff nurses intra-operatively.

Adolescent↗

[Gadamer: grounding a proposal for the study of stress in the surgical center].

This article makes a reflection on philosophical foundation to support the methodology in order to study the stress of professionals who work in the operating theater. The qualitative research allows a comprehensive access to the world of each subject, revealing the individual perception of whom experiences the phenomenon. Gadamer understands that the language reveals and is suitable to evaluate properly, through hermeneutics, the symbolic dimension of the subject's speech. Hermeneutics is not only just a theory of the comprehension and interpretation art but much more than that, it is close to the practical philosophy, having to respond for the methodological feature of things whose understanding it provides.

General Surgery↗

Development and definition of the role of the operating department nurse: a review.

In the current cost-conscious National Health Service (NHS), the role of the nurse during anaesthesia and surgery is one that has interested health service managers keen to know what happens behind the closed doors of the operating department. It is clear that if nurses working within this specialized setting are to secure a future in providing care for surgical patients, then it is important to clarify and articulate exactly what it is that their role involves. The aim of this paper is to examine the role of the operating department nurse. First, it will illustrate how the role of the nurse has evolved alongside medical and technical advances in surgery, particularly in the last century. Second, it will highlight that while definition of the role has received attention in the North American literature, references in the British literature as to what it is that operating department nurses do, are scant. Finally, it will address the evolving role of the contemporary perioperative nurse highlighting the changes and challenges that nurses who work within this setting are currently facing. It is suggested here that nurses need to engage in role definition in order to be clear about their direction for the future, particularly within the fast changing, technologically driven environment of the operating department.

Forecasting↗

Safety in intraoperative trauma care.

Care of patients with penetrating trauma is risky because of increased prevalence of blood borne disease. Perioperative nurses have constant exposure to body fluids so they are at an increased risk of exposure. Personal safety has emerged as one of the primary workplace concerns of nurses. This report reviews intraoperative safety, Association of Operating Room Nurses and Occupational Safety and Health Administration standards, and universal precautions in practice.

Humans↗

The sensitivity to chlorhexidine and cetyl pyridinium chloride of staphylococci on the hands of dental students and theatre staff exposed to these disinfectants.

The aim of this investigation was to study the possible emergence of resistant isolates of the genus Staphylococcus on the hands of dental personnel who use 'Hibiscrub' (chlorhexidine-detergent preparation) and cetyl pyridinium-coated gloves. Resistance was determined by a rate-of-kill technique. In four dental student groups (first, second, third and fourth years) no microorganisms survived 30 min exposure to cetyl pyridinium chloride (CPC) or to chlorhexidine diacetate (CDA). In a theatre staff group, no microorganisms survived 30 s exposure to CPC; and only one of 23 isolates survived 30 min exposure to CDA, but was killed after 60 min exposure. It is concluded that staphylococci resistant to either of these disinfectants do not present a problem in dental students or theatre staff.

Aerosols↗

My copilot is a nurse--using crew resource management in the OR.

Crew resource management (CRM) has been used for more than 20 years in the aviation industry to teach individual error countermeasures by developing nontechnical (ie, cognitive, social) skills based on the observed traits of successful individuals and crews. The health care industry began to investigate aviation CRM after the Institute of Medicine's report, To Err is Human: Building a Safer Health System, recommended that medicine adopt aviation's approach to safety and error management. Initial results of implementing CRM in health care arenas have demonstrated reduced adverse outcomes, reduced errors, reduced length of stay, improved nurse retention, and changed attitudes and behaviors toward teamwork.

Accidents, Aviation↗

Systems approach to resolving conduct issues among staff members.

This article describes the outcomes of a foundation grant directed toward strengthening hospital nursing groups to improve patient care. The OR director and the grant-sponsored group facilitator at MeritCare Hospital, Fargo, ND, describe a systems approach to resolving pervasive conduct issues (eg, verbal abuse) in the surgical suite, thereby cultivating a positive work environment for perioperative staff members.

Humans↗