Thesis (M. Ed.)--York University, 2003. Graduate Programme in Education. / Typescript. Includes bibliographical references (leaves 109-112). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ82927.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (Ed. D.)--Texas Tech University, 1976. / Bibliography: leaves 88-93.

Thesis (Ed. D.)--Texas Tech University, 1976. / Includes bibliographical references (leaves 88-93).

The purpose of this study was to determine if obese patients have a different sensory regression time from subarachnoid block than non-obese patients using hyperbaric 0.75% bupivacaine. A quasi-experimental design was used. Twenty patients were separated into two groups; one group was classified as obese, and the other group was classified as non-obese. The data consisting of age, height, weight, sex, and surgical procedure were recorded preoperatively. All the patients received hyperbaric 0.75% bupivacaine via subarachnoid puncture. The levels of spinal anesthesia were recorded at the highest level achieved. The injection time was also recorded. When the surgery was completed, the patient was transferred to the recovery room and levels of sensory blockade were checked by pin-prick with an 18-gauge needle every 10 minutes until complete recovery from the spinal anesthesia had been achieved. The hypothesis, there will be no difference in sensory regression time from SAB with hyperbaric 0.75% bupivacaine between obese and non-obese patients, failed to be rejected. No statistically significant difference, using linear regression analysis, was found in mean regression time between groups (obese versus non-obese).

Seven orthopedic surgery patients requiring the use of a tourniquet were studied. The hypothesis stated that tourniquet application does not affect coagulation. A total of 5 blood samples were drawn perioperatively (preoperative, 5 minutes after induction of anesthesia, 30 minutes after tourniquet inflation, 2 - 5 minutes after tourniquet deflation, and 30 minutes after tourniquet deflation. For each sample, TEG parameters (R, R + k, MA and α) were measured. The value for each TEG parameter was compared by analysis of variance (ANOVA), then the samples were contrasted and examined by repeated measures ANOVA. None of the TEG parameters showed a statistically significant difference in the blood samples before, during or after tourniquet application. The hypothesis could not be rejected at the α = .05 level of significance. A t test was used to examine the effect of anesthesia on coagulation. The TEG parameters indicated a significant relationship between the TEG values R and R + k, and a near significant relationship between TEG values MA and a and the administration of anesthesia. It was concluded that tourniquet use does not effect coagulation when applied 2 hours or less. However, anesthesia had a significant effect on TEG parameters R and R + k. The clinical significance of this effect was questionable since the type of anesthesia varied in some patients, and none of the patients in the study demonstrated symptoms of coagulopathy.

The operating room (OR) is an area of particularly high risk for patients, due to technical and non-technical issues. Research in other high-risk industries has shown that leadership can impact safety and performance of work teams. As the leader of the surgical team, surgeons must demonstrate leadership along with technical excellence, to optimize performance and maximize patient safety in the OR. This thesis investigated surgeons’ leadership in the intraoperative period. A review of the surgical literature revealed ten empirical articles examining surgeon leadership. Of these, two articles linked leadership was an outcome measure. A preliminary taxonomy that included seven elements of leadership was developed based on definitions of leadership from the literature. To further investigate intraoperative leadership, observations (<i>n</i>=29) were conducted in three hospitals in Scotland across different types of surgery. Leadership was described in detail according to the leadership elements. Surgeons engaged in significantly more leadership during more complex operations. Ten focus groups with different members of the OR team were conducted to finalize the taxonomy. The final taxonomy, the Surgeons’ Leadership Inventory (SLI), was revised to include eight elements: maintaining standards making decisions, managing resources, directing, training, communicating, supporting others, and coping with pressure. The SLI was used with adequate reliability to code videos (<i>n</i>=29) of live operations. Elements of surgeons’ leadership differed before and after the surgical point of no return. Analysis revealed differences in training and supporting others behaviours in cases with an unexpected event. The element coping with pressure was significantly related to intraoperative blood loss. Surgeons’ intraoperative leadership was found to be reactive, situation based, and often transactional in nature. This thesis provides a first step in identifying the important behaviours and a basis on which improving surgeons’ intraoperative leadership may be made.

Health Sciences Centre (HSC) in Winnipeg is the major healthcare facility serving Manitoba, Northwestern Ontario, and Nunavut. An evaluation of HSC’s adult surgical patient flow revealed that one major barrier to smooth flow was their Operating Room (OR) scheduling system. This thesis presents a new two-stage elective OR scheduling system for HSC, which generates weekly OR schedules that reduce artificial variability in order to facilitate smooth patient flow. The first stage reduces day-to-day variability while the second stage reduces variability occurring within a day. The scheduling processes in both stages are mathematically modelled as multi-objective optimization problems. An attempt was made to solve both models using lexicographic goal programming. However, this proved to be an unacceptable method for the second stage, so a new multi-objective genetic algorithm, Nondominated Sorting Genetic Algorithm II – Operating Room (NSGAII-OR), was developed. Results indicate that if the system is implemented at HSC, their surgical patient flow will likely improve. / October 2008

Health Sciences Centre (HSC) in Winnipeg is the major healthcare facility serving Manitoba, Northwestern Ontario, and Nunavut. An evaluation of HSC’s adult surgical patient flow revealed that one major barrier to smooth flow was their Operating Room (OR) scheduling system. This thesis presents a new two-stage elective OR scheduling system for HSC, which generates weekly OR schedules that reduce artificial variability in order to facilitate smooth patient flow. The first stage reduces day-to-day variability while the second stage reduces variability occurring within a day. The scheduling processes in both stages are mathematically modelled as multi-objective optimization problems. An attempt was made to solve both models using lexicographic goal programming. However, this proved to be an unacceptable method for the second stage, so a new multi-objective genetic algorithm, Nondominated Sorting Genetic Algorithm II – Operating Room (NSGAII-OR), was developed. Results indicate that if the system is implemented at HSC, their surgical patient flow will likely improve.

Caring is emerging as an important concept for the nursing profession especially within the perioperative arena (Bickler, 1994; McNamara, 1995; Rawnsley, 1990). The purposes of this study were to investigate: (a) the relationship between perioperative nurse associates' values and caring behaviors; and (b) the relationship between perioperative nurse associates' perceptions of own demonstrated caring behaviors to demonstrated caring behaviors of nurse managers.The study was based upon Watson's (1985) model of Human Caring. The instruments used were Staub's (1989) Values Questionnaire and Nkongho's (1990) Caring Ability Inventory. A demographic profile of study participants was obtained. The population included all nurses (48,000) who were members of the Association of Operating Room Nurses (AORN). The sample consisted of 300 randomly selected non-managerial perioperative nurse associates obtained from the membership list of AORN.A cover letter explaining the study along with a demographic questionnaire and three survey instruments were mailed to the 300 perioperative associates at their home address. The surveys were returned to the investigator by mail in a furnished self-addressed stamped envelope (n=96). Procedures for human subject protection were followed.A descriptive correlation design and descriptive statistics were used for data analysis. Perioperative nurses identified three recurring themes as suggestions for incorporating caring behaviors by nurse managers; (a) improved communication skills; (b) increased accessibility; and (c) empowerment of nurses. Findings showed a moderately positive and significant relationship between values and caring behaviors supporting Watson's Theory of Human Care (1985). Results showed no relationship of caring behaviors between nurse associates and nurse managers. However, the data did reveal that nurse associates perceived themselves as more caring than the nurse managers. / School of Nursing