Bakgrund: Allt fler operationer utförs på patienter i vaket tillstånd och tidigarestudier har visat att majoriteten av patienterna upplever ångest och oro inför ochunder det kirurgiska ingreppet. I operationssjuksköterskans roll ingår det att skapalugn och trygghet för patienten. Genom att belysa operationssjuksköterskans mötemed vakna patienter intraoperativt kan patienters upplevelse under operationförbättras.Syfte: Studiens syfte var att beskriva operationssjuksköterskors erfarenheter avoperation på vaken patient. Metod: En kvalitativ intervjustudie med semistrukturerade individuella intervjuer. Totalt inkluderades tolv intervjuer från ett sjukhus i södra Sverige. Intervjuernaanalyserades utifrån kvalitativ innehållsanalys. Resultat: Resultatet presenteras i tre kategorier: Att upprätthålla ett professionelltförhållningssätt, Att minska oro hos den vakna patienten, Att involvera den vaknapatienten. Operationssjuksköterskornas beskrev att kommunikationen med patientenoch inom operationsteamet skiljer sig från operation på sövd patient. Det framkomatt det var extra viktigt att operationsteamet tänkte på ordvalet och ageradeprofessionellt. Patientens orosnivå kunde bero på flera orsaker och genom strategierkunde operationssjuksköterskan lugna patienten. Lyhördhet och delaktighet lyftesfram som viktiga aspekter i mötet med den vakna patienten.Slutsats: Ett professionellt förhållningssätt och hänsynsfull kommunikation visadesig vara avgörande för patientens trygghet och välbefinnande. Genom attoperationssjuksköterskor och andra yrkeskategorier i operationsteamet blirmedvetna om sitt agerande kan patientens intraoperativa upplevelse förbättras. / Background: An increasing number of surgeries are performed on patients in thewaking state and previous studies have shown that the majority of patientsexperience anxiety and worry before and during surgery. The role of the operatingtheatre nurse includes creating calm and security for the patient. By highlighting theoperating theatre nurse's encounter with awake patients intraoperatively, patients'experience during surgery can be improved. Aim: The aim of the study was to describe operating theatre nurses' experiences ofsurgery on an awake patient. Method: A qualitative interview study with semi-structured individual interviews.A total of twelve interviews from a hospital in southern Sweden were included. Theinterviews were analyzed based on qualitative content analysis. Results: The results are presented in three categories: To maintain a professionalapproach, To reduce anxiety in the awake patient, To involve the awake patient. Theoperating theatre nurses described that the communication with the patient andwithin the surgical team differs from surgery on an anesthetized patient. Theyhighlighted that it was particularly important that the surgical team thought aboutthe choice of words and acted professionally. The patient's level of anxiety could bedue to several reasons and through strategies the operating theatre nurse could calmthe patient. Responsiveness and participation were highlighted as important aspectsin the meeting with the awake patient. Conclusions: A professional approach and considerate communication proved to becrucial for the patient's safety and well-being. By making operating room nurses andthe other members of the surgical team aware of their actions, the patient'sintraoperative experience can be improved.

Bakgrund: Operationssjuksköterskan är ansvarig för patientens säkerhet i operationssalen tillsammans med det övriga teamet. Vikten av god kommunikation och teamarbete är avgörande för arbetet i operationssalen. Förekomsten av hierarkier i teamet kan skapa tveksamheter i kommunikationen vilket påverkar teamet negativt. Även stress påverkar kommunikationen och samarbetet i teamet.   Syfte: Studiens syfte är att undersöka kommunikationens betydelse mellan operationssjuksköterskan och operatören i den intraoperativa fasen.  Metod: Semi-strukturerad observationsstudie med induktiv ansats och kvalitativ design. Datainsamlingen har skett vid totalt 10 observationer på ett sjukhus i södra Sverige. Studien är en icke-deltagande observationsstudie.   Resultat: Det framkommer under observationerna att kommunikationen är ett viktigt verktyg för att undvika missförstånd och bibehålla patientsäkerheten. En tydlig kommunikation bidrar även till ett bra arbetsflöde och en trevlig arbetsmiljö för professionerna på operationssalen. I observationerna framkom inga tydliga hierarkier utan professionerna hade respekt för varandras arbete och kunskap.   Slutsats: En god kommunikation är nyckeln för en lyckad arbetsmiljö. I kombination av ett gott samspel, en god atmosfär samt respekt för varandras professioner kan det bidra till att patientsäkerheten bibehållas genom hela operationen. / Background: The operating room nurse is responsible for the patient´s safety in the operating room together with the rest of the team. The importance of good communication and teamwork is crucial for the work in the operating room. The presence of hierarchies in the team can create uncertainties in communication, which negatively affects the team. Stress also affects communication and collaboration within the team. Purpose: The purpose of the study is to investigate the importance of communication between the operating room nurse and the operator during the intraoperative phase.  Method: Semi-structured observational study with inductive approach and qualitative design. Data collection was conducted during a total of 10 observations at a hospital in southern Sweden. The study is a non-participatory observational study. Results: It emerges during the observations that communication is an important tool to avoid misunderstandings and maintain patient safety. Clear communication also contributes to a good work flow and a pleasant working environment for the professionals in the operating room. During the observations no clear hierarchies were observed, and the professionals showed respect for each other´s work and knowledge.  Conclusion: Good communication is the key to a successful work environment. In combination with good teamwork, a positive atmosphere, and respect for each other's professions, it can contribute to maintain patient safety throughout the entire operation.

Thesis (MBA (Business Management))--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: Given the increase in the cost of health care, economic considerations have drawn more and more interest over the last decade. Facilities are faced with the challenge to reduce costs while maintaining productivity. The Operating Room (OR) represents a significant opportunity to reduce expenses and improve efficiency. With the development of ambulatory or day surgery, minimally invasive procedures and the decline in admissions to hospitals the management of the OR suite needs re-evaluation. The Battlefords Union Hospital has a four room OR suite that performs a mixture of both inhospital and day surgeries. The current OR suite efficiency is determined by its adherence to the annual budget. A literature study was conducted with the focus on OR efficiency and in particular Patient Outcome and OR Management. Other issues included Perioperative Information systems and OR design. A survey was conducted in the OR suite and responses obtained from OR staff were evaluated. The survey included questions on patient experiences, procedural times, case scheduling, support, communication, quality measures and OR efficiency. The goals of this project was not to do an extensive statistical analysis of OR data. A limited study of OR suite data was presented to highlight relevant OR efficiency indicators. A summary of the findings and recommendations for improvement of the Battlefords Union Hospital OR suite’s efficiency, concludes the report. / AFIKAANSE OPSOMMING: Na aanleiding van die verhoging in koste van gesondheidsorg die laaste dekade, is ekonomiese aspekte meer op die voorgrond. Inrigtings word deur uitdagings in die gesig gestaar om kostes te verminder, terwyl produktiwiteit gehandhaaf moet word. Die operasie suite bied ‘n aansienlike geleentheid om kostes te verminder en effektiwiteit te verhoog. Met die ontwikkeling van dagchirurgie, “minimal invasive” prosedures en die afname in hospitaal opnames, behoort die bestuur van operasie suites herevalueer te word. Die Battlefords Union Hospitaal het ‘n vier teater operasie suite waar ‘n verskeidenheid van dagchirurgie en in-hospitaal prosedures uitgevoer word. Die operasie suite se effektiwiteit word huidiglik slegs gemeet aan die mate van hoe dit binne die jaarlikse begroting bly. ‘n Literatuurstudie is uitgevoer met die fokus op operasie suite effektiwiteit, met die klem op pasient uitkoms en operasie suite bestuur. Ander items wat ook ondersoek is, sluit in perioperatiewe informasie stelsels en teater ontwerp. ‘n Empiriese studie, gebaseer op ‘n vraelys, is uitgevoer onder die staflede van die operasie suite by die Battlefords Union Hopitaal. Die vraelys het vrae ingesluit oor pasient ervarings, prosedure tye, geval skedulering, kommunikasie, kwaliteitsversekering en operasie suite effektiwiteit. Die doel van die projek was nie om ‘n uitgebreide statistiese analise van die operasie suite data te doen nie. 'n Beperkte studie van die beskikbare data is gedoen en relevante effektiwiteits indikators is uitgewys. Die verslag word afgeëindig deur bevindinge, gevolgtrekkings en aanbevelings oor hoe die Battlefords Union Hospitaal die operasie suite se effektiwiteit moontlik kan verhoog.

Esta pesquisa avaliou a segurança microbiológica da esterilização a vapor do instrumental laparoscópico reutilizável montado. Foram selecionados dois tipos de instrumental laparoscópico reutilizável: trocarte e pinça de dissecção de 5mm. Considerando a eficácia da limpeza como pré-requisito essencial para o processo de esterilização, a PRIMEIRA ETAPA da pesquisa, avaliou 66 instrumentos laparoscópicos, sendo 33 pinças e 33trocartes, submetidos a diferentes métodos de limpeza, avaliando como desfecho os resíduos orgânicos de proteína, hemoglobina e carboidrato, após contaminação intencional com sangue de placenta humana. Os métodos de limpeza testados foram: (1) limpeza manual com enxágue em água potável; (2) limpeza manual com enxágue em água potável, seguida de limpeza ultrassônica sem enxágue; (3) limpeza manual com enxágue em água potável, seguida de limpeza ultrassônica com enxágue em água potável e (4) limpeza manual com enxágue em água potável, seguida de limpeza ultrassônica com enxágue em água potável e último enxágue em água destilada esterilizada. Os experimentos foram acompanhados pelos grupos controle Positivo (sem limpeza) e Negativo, composto por instrumental laparoscópico novos sem contaminação intencional, avaliados após os procedimentos de limpeza (1) e (4). Para avaliação dos resíduos orgânicos, utilizou-se o kit Quantipro BCA para dosagem de proteínas, TMB One para hemoglobina, fenol 5% e ácido sulfúrico para carboidrato, todos com leitura por espectrofotometria. O grupo controle Positivo evidenciou níveis médios de 332µg/cm2 proteína, 30µg/cm2 carboidrato e 417µg/cm2 hemoglobina. Conforme esperado, o método de limpeza (4) apresentou desempenho superior quando comparado com o método (1), reduzindo 92% a mais de µg/proteína/pinça e 60% a mais de µg/carboidrato/pinça e por trocarte, embora esta superioridade não tenha sido observada de uma forma uniforme em todo o experimento. No grupo controle Negativo, os níveis máximos de proteína detectados foram 1,70µg/cm2 e de carboidrato de 1,07µg/cm2, não sendo detectada hemoglobina. A SEGUNDA ETAPA, avaliou a esterilização do instrumental laparoscópico reutilizável montado com contaminação desafio de três vezes 106 esporos Geobacillus stearothermophillus ATCC 7953, impregnados em suporte de papel filtro extraídos do indicador biológico comercialmente disponível para monitoramento da autoclavação. Os experimentos microbiológicos foram acompanhados dos grupos controle Positivo (suporte do indicador biológico não submetido à esterilização) e controle Negativo (instrumentos laparoscópicos esterilizados desmontados com contaminação desafio). Como grupo Experimental, foram analisados 370 instrumentos laparoscópicos esterilizados montados, sendo 185 pinças e 185 trocartes. Três suportes de papel impregnados com os esporos foram introduzidos no interior de cada instrumento laparoscópico, precedidos de limpeza tipo (4), embalados em papel grau cirúrgico e submetidos à esterilização a vapor saturado sob pressão (134oC por 5 minutos). Com técnica asséptica, cada suporte de papel foi inoculado em meio de cultura de Tryptic Soy Broth (TSB), incubado a 56oC por 21 dias. Não sendo observado crescimento, as amostras foram submetidas a um choque térmico a 80oC, por 20 minutos, para estimular a germinação, com reincubação por mais 72 horas. Não houve crescimento microbiano algum nas amostras do grupo Experimental. Os resultados dos grupos controles foram satisfatórios. O controle Positivo confirmou o desafio imposto aos experimentos e o controle Negativo apresentou resultados esperados de ausência de crescimento. Este estudo forneceu fortes evidências científicas para os Centros de Material e Esterilização sustentarem a segurança microbiológica da prática de esterilização do instrumental laparoscópico montado / This study evaluated the microbiological safety of steam sterilization, the reusable laparoscopic instrument assembled. We selected two types of reusable laparoscopic instrument: trocar and dissecting forceps 5mm. Considering the efficacy of cleaning as an essential prerequisite for the sterilization process, the FIRST STEP evaluated 66 laparoscopic instruments, 33 trocars and 33 dissecting forceps, subjected to different cleaning methods evaluating outcome as organic waste protein, hemoglobin and carbohydrate after intentional contamination with blood from human placenta. Cleaning methods were tested: (1) manual cleaning rinse with potable water, (2) manual cleaning with rinsing in clean water, then cleaning ultrasonic without rinsing, (3) manual cleaning with rinsing in clean water, then cleaning ultrasonic rinse with potable water and (4) manual cleaning rinse with potable water, followed by ultrasonic cleaning with potable water rinse and final rinse in sterile distilled water. The experiments were accompanied by positive control groups (without cleaning) and negative, composed of laparoscopic instruments again without intentional contamination, assessed after the cleaning procedures (1) and (4). For evaluation of organic waste is used Quantipro BCA kit for the determination of protein, TMB One to hemoglobin, 5% phenol and sulfuric acid of carbohydrate with any read by spectrophotometry. The positive control group showed average levels of 332µg/cm2 protein, carbohydrate 30µg/cm2 and 417µg/cm2 hemoglobin. As expected, the cleaning method (4) superior performance when compared with the method (1), reducing 92% more µg/protein/forceps and more than 60% µg/carbohydrate/forceps and trocar, although this superiority has not been observed in a uniform manner throughout the experiment. In the negative control group maximum levels of protein detected were 1.70 µg/cm2 and 1.07 µg/cm2carbohydrate was not detected hemoglobin. The SECOND STEP evaluated the sterilization of reusable laparoscopic instruments assembled with contamination challenge 3 times 10 Geobacillusstearothermophillus spores ATCC 7953, impregnated strips filter paper extracted from commercially available biological indicator for monitoring steam sterilization. The experiments were accompanied microbiological positive control groups (biological indicator spore strips non-sterile) and negative (laparoscopic instruments sterilized contamination disassembled challenge). As experimental group were analyzed 370 laparoscopic instruments sterilized assembled, 185 dissecting forceps and 185 trocars. Three spore strips of paper impregnated were introduced in laparoscopic instrument within each preceded by cleaning type (4), packed in surgical paper and subjected to saturated steam sterilization under pressure (134oC for 5 minutes). With aseptic technique, each paper spore strip was inoculated into culture medium Tryptic Soy Broth (TSB) and incubated at 56oC for 21 days. No growth was observed, they were subjected to heat shock at 80oC for 20 minutes to stimulate germination, with more reincubation for 72 hours. There was no microbial growth in some samples of the experimental group. The results of the control groups were satisfactory. The Positive Control confirmed the challenge posed to experiments and the negative control presented results expected from the absence of growth. This study provides strong scientific evidence for the Centers for Material and Sterilization sustain the microbiological safety of the practice of sterilization of laparoscopic instruments assembled.

A vídeo-laparoscopia é uma inovação tecnológica que trouxe indiscutíveis vantagens e também novos desafios, incluindo nestes, as diretrizes para o reprocessamento adequado dos instrumentais e seus acessórios. A autoclavação dos instrumentais laparoscópicos desmontados é mais segura, uma vez que a condução térmica é facilitada. No entanto, são artigos complexos, compostos por múltiplas peças e a sua remontagem no momento da cirurgia traz transtornos às equipes cirúrgicas, correndo o risco do não funcionamento ou de danos às peças pela montagem inadequada. Existe um arraigado conceito, entre os profissionais da saúde, que para o sucesso da esterilização ser alcançado, é necessário o contato direto do vapor com todas as superfícies dos materiais submetidos à autoclavação sem considerar também o raciocínio do calor latente. A destruição microbiana por meio da esterilização pelo vapor está essencialmente relacionada ao calor latente, gerado pela condensação deste em contato com a superfície fria do material, promovendo a termocoagulação das proteínas microbianas. É uma prática comum nos hospitais brasileiros a realização da autoclavação de instrumentos previamente montados, apesar de não haver comprovação científica consistente dessa prática. Isto posto, esta investigação teve o objetivo de avaliar a eficácia do processo de esterilização a vapor dos instrumentais laparoscópicos previamente montados, comparando os seus resultados com os desmontados, considerada neste estudo a melhor prática. Tratou-se de uma pesquisa experimental, laboratorial, com abordagem quantitativa. Foram selecionados dois modelos de maior complexidade dentre os instrumentos laparoscópicos para realização do estudo, sendo eles: trocarte com válvula tipo janela rosqueada de 5mm, composto por cinco peças desmontáveis e pinça para dissecção de 5mm, composta por quatro peças desmontáveis. Cada peça dos instrumentais foi considerada como uma unidade amostral na análise microbiológica. Este estudo teve então como Grupo Montado: instrumentais laparoscópicos montados; Grupo Desmontado: instrumentais laparoscópicos desmontados; Grupo Contagem Microbiana: instrumentais laparoscópicos submetidos aos procedimentos de contaminação desafio, encaminhados diretamente para o teste de contagem microbiana. O inóculo para a contaminação desafio constitui-se de suspensão do Geobacillus stearothermophilus, na forma esporulada, acrescido de sangue de carneiro desfibrinado esterilizado. Todos os instrumentais foram contaminados desmontados com o inóculo desafio. Os grupos Montado e Desmontado foram submetidos aos processos de limpeza manual, complementada pela limpeza automatizada em lavadora ultra-sônica com retrofluxo, enxágüe em água corrente e sob pressão. Por fim, foi realizado o enxágüe com água destilada esterilizada e secagem com ar comprimido medicinal. Na seqüência, foi realizado sorteio para composição dos Grupos Montado e Desmontado. Os instrumentais foram embalados individualmente em papel grau cirúrgico e submetidos à esterilização a vapor em autoclave com pré-vácuo. Após a esterilização, os instrumentais foram avaliados quanto à eficácia da esterilização, por meio dos resultados dos testes de cultura microbiológica, utilizando o método de inoculação direta. No Grupo Montado foram recuperados os microrganismos teste em três peças de uma mesma pinça (3/48) e em três peças de um mesmo trocarte (3/60), enquanto que no Grupo Desmontado o microrganismo teste não foi recuperado nas unidades amostrais estudadas. Nas condições desse experimento, os resultados obtidos refutaram a hipótese inicial da pesquisa quanto à segurança da autoclavação das pinças e dos trocartes utilizados em cirurgia laparoscópica previamente montados / The video laparoscopy is a technological innovation that brought unquestionable advantages and, also, new challenges, like: the policies for the adequate reprocessing of the instruments and its permanent accessories. The steam sterilization of disassembled laparoscopic instruments is much safer, once that the thermal conduction is facilitated. However, laparoscopic instruments are quite complex articles; they are composed by many parts and the reassemblage in site at the moment of the surgery brings many inconveniences to the surgical team, like the possibility of the instrument’s malfunctioning or non functioning at all, or even damages to the instruments due to inadequate assembling. There is a strong belief among the Healthcare Professionals about the necessity of the direct contact of the steam with all the surface of the materials submitted to the steam sterilization, which is correct, however it doesn´t consider the latent heat assumption as well. The destruction of the microbiological material throughout the steam sterilization is essentially related to the latent heat, created by the vapor condensation when in contact with the instrument´s cold surface, promoting the thermal-coagulation of microbiological proteins. Many hospitals use the steam sterilization of previously mounted instruments, although there´s not any consistent scientific evidence about the efficiency of this practice. Once stated this point, this investigation´s aim was: evaluate the effectiveness of the steam sterilization process of the previously mounted, permanent laparoscopic instruments. It was an experimental laboratorial research, using a quantitative approach. Two models of permanent laparoscopic instruments of major complexity were chosen for the experiments: a trocar with a 5mm screw window valve, composed by five dismountable parts and a 5mm dissection clamp, composed by four dismountable parts. Each part of the instruments was considered as a sample unit on the microbiological analysis. This study it had the Assembled Group was: mounted laparoscopic instruments; the Disassembled Group was: disassembled laparoscopic instruments; the Microbiological Counting Group was: laparoscopic instruments submitted to the - challenge contamination - procedures, being directed straight to the test of microbiological counting. The inoculants material used for the challenge contamination consisted on the suspension of the Geobacillus stearothermophilus, in its spore form, plus defibrinated and sterilized sheep blood. All the instruments were contaminated, disassembled with the challenge inoculants material. The Assembled and Disassembled groups were submitted to the manual cleaning processes, enhanced by the automatic cleaning in an ultrasonic washer with retro-flux, rinsed in running and under pressure water. At last, a rinsing with distilled water was performed; the drying process was made with medicinal compressed air. Then, a sorting was performed to decide about the composition of the Assembled and Disassembled groups. The instruments were individually packed in surgical paper and submitted to the steam sterilization in a pre-vacuum sterilizer machine. After the sterilization, the instruments were evaluated according to sterilization effectiveness throughout the microbiological culture test´s results, using the straight inoculation method. In the Assembled Group the microorganism´s tests were recovered in three parts of one same clamp (3/48) and in three parts of the same trocar (3/60), in the Disassembled Group the test microorganism wasn´t recovered in any of the sample unities. The results, under the conditions of the experiment, refuted the hypothesis of safety in the usage of the steam sterilization in previously mounted used clamps and trocar in laparoscopy

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications after cardiac surgery. Specific aim one was addressed through a secondary analysis of data collected during the Patient Response to Myocardial Infarction following a Teaching Intervention Offered by Nurses trial to determine whether hostility was a predictor of ACS recurrence and mortality. Hostility was common after ACS and predicted all-cause mortality. Hostility did not predict recurrent ACS. Specific aim 2 was addressed in a secondary analysis of baseline data from a randomized controlled trial in male prisoners. Participants completed the BSI at baseline prior to the intervention. Internal consistency reliability was good for both subscales (Cronbach’s alpha - hostility 0.83, anxiety 0.81). Items from the two dimensions were analyzed together using exploratory factor analysis with varimax rotation. Two dimensions, anxiety and hostility, were identified. Construct validity was supported; those with high anxiety and hostility reported a greater number of days where their self-reported health was rated as fair or poor. Those prisoners with less perceived control had higher levels of anxiety and hostility. Specific aim 3 was addressed through a prospective, descriptive correlational study that measured patient and caregiver anxiety, hostility and depressive symptoms, at baseline to determine whether these predicted quality of life using a multilevel dyadic analysis; and to evaluate the association of baseline anxiety, hostility and depressive symptoms and quality of life with postoperative complications and mortality. Anxiety, hostility, and depressive symptoms were common in both cardiac patients and their caregiver. Psychological state influenced quality of life in both dyad members, but was not associated with complications.

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical. Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity and mortality is on the horizon unless aggressive measures are taken at mitigating risk. Similarly, as the obesity epidemic expands, obesity-related comorbid conditions including obstructive sleep apnea (OSA) are likely to grow. The purpose of this research was to explore the relationship between ambulatory orthopedic patient-reported activities (quality of life metrics) and diagnostic factors (physical and perioperative care data) in the immediate postoperative period that are predictive of arterial oxygen desaturation. Data was obtained using a novel patient journal exploring sleep, pain, nausea, tobacco use, alcohol use, and appetite in conjunction with a valid and reliable portable, wrist-worn pulse oximeter. Additional assessment data was taken from the preanesthetic assessment. All participants were scored according to the STOP-Bang questionnaire, an accepted survey of OSA risk. Patients were recruited from a busy metropolitan ambulatory surgery center in Richmond, Virginia that sees approximately 500 cases monthly, and a 309-bed tertiary care hospital in West Burlington, Iowa. The target sample included 52 individual patients with data collected over the first two post-operative nights following discharge. Two patients were excluded. Negative binomial regression, log10 transformation, and least-squares regression examined the relationships the STOP-Bang questionnaire, quality of life data, and physical perioperative data had on postoperative desaturation events. Results suggested the STOP-Bang score predicted desaturation events and that age and BMI were significant individual predictors. Opiate pain medication treatment, a happy mood, and home CPAP use were associated with decreased events. This study provided a unique perspective in patient safety research, relating human behaviors and experiences with postoperative oxygen desaturation. Future research projects aligned with postoperative monitoring, pulse oximetry, patient safety, and obstructive sleep apnea are potential following the findings of this study.

Surgical face masks have been designed to protect health care professionals from the splashes of the patients’ blood or body fluids and also to minimise the transmission of oro- and nasopharyngeal bacteria from the surgical team to the patient’s wounds, thereby decreasing the likelihood of postoperative surgical site infections during a surgical procedure. However, there are several ways in which surgical face masks could potentially contribute to contamination of the wound during a surgical procedure in the operating room. The objectives of this study were to explore and describe the effectiveness of surgical face masks as a protective barrier during a surgical procedure in the operating room in the public hospitals in the North West Province, South Africa and to formulate recommendations regarding surgical face masks worn by health care professionals during a surgical procedure in the operating rooms. A systematic review was conducted, followed by a quantitative, explorative, descriptive and contextual approach. The motivation for a systematic review was to search evidence on surgical face mask efficiency. A search strategy was conducted in February and March 2012 and the total initial search was 9,933 research articles. Screening of articles on effectiveness of surgical face masks during a surgical procedure was done. After six months the search was updated and the final sample of six relevant articles (n=6) was obtained. Studies that met the inclusion criteria were critically appraised based on the scores using standardised critical appraisal tools. The findings of this research project were synthesised and evaluated in order to come to conclusions. Conclusions were integrated and synthesised as the basis of developing a clear overview of the best quality empirical evidence about effectiveness of surgical face masks during a surgical procedure in the operating room. Recommendations were formulated for the nursing practice, education and research focussing on wearing a surgical face mask during a surgical procedure in the operating room. Reviewer’s conclusion: From the limited results it is unclear whether wearing surgical face masks during a surgical procedure in the operating room serve as a protective device for both surgical team and the patient. There is a need for further research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Surgical face masks have been designed to protect health care professionals from the splashes of the patients’ blood or body fluids and also to minimise the transmission of oro- and nasopharyngeal bacteria from the surgical team to the patient’s wounds, thereby decreasing the likelihood of postoperative surgical site infections during a surgical procedure. However, there are several ways in which surgical face masks could potentially contribute to contamination of the wound during a surgical procedure in the operating room. The objectives of this study were to explore and describe the effectiveness of surgical face masks as a protective barrier during a surgical procedure in the operating room in the public hospitals in the North West Province, South Africa and to formulate recommendations regarding surgical face masks worn by health care professionals during a surgical procedure in the operating rooms. A systematic review was conducted, followed by a quantitative, explorative, descriptive and contextual approach. The motivation for a systematic review was to search evidence on surgical face mask efficiency. A search strategy was conducted in February and March 2012 and the total initial search was 9,933 research articles. Screening of articles on effectiveness of surgical face masks during a surgical procedure was done. After six months the search was updated and the final sample of six relevant articles (n=6) was obtained. Studies that met the inclusion criteria were critically appraised based on the scores using standardised critical appraisal tools. The findings of this research project were synthesised and evaluated in order to come to conclusions. Conclusions were integrated and synthesised as the basis of developing a clear overview of the best quality empirical evidence about effectiveness of surgical face masks during a surgical procedure in the operating room. Recommendations were formulated for the nursing practice, education and research focussing on wearing a surgical face mask during a surgical procedure in the operating room. Reviewer’s conclusion: From the limited results it is unclear whether wearing surgical face masks during a surgical procedure in the operating room serve as a protective device for both surgical team and the patient. There is a need for further research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.