The aim of this thesis was to examine the contribution of nurses to interprofessional collaboration (IPC) in the operating room (OR) guided by the Interprofessional Education Collaborative Patient Care Practice (IECPCP) framework. First, a secondary analysis of interviews with 19 registered nurses was conducted. Twenty emergent themes were identified. The most prevalent of the four dimensions (internalization; shared goals and vision; governance; and formalization) consisted of the internalization dimension relating to human interaction and sense of belonging within the interprofessional team. A scoping review then identified 20 studies evaluating four interventions (briefings, checklists, team training, and debriefings) used to improve IPC in the OR. Despite weak study designs, these interventions showed improvements in communication, teamwork, and safety outcomes. OR nurses contribute mainly through interactional processes and they require organizational support to foster their efforts in IPC. Nurse are involved in all IPC interventions and their contribution is important to support IPC in the OR.

This project represents the ever-changing methods surrounding Enhanced Recovery after Surgery and the protocols that compose it. The purpose of this study is to expand education of ERAS guidelines and improve patient outcomes through furthering staff education. Enhanced Recovery After Surgery has been a part of perioperative departments worldwide after being introduced in the 1990s by Northern European general surgeons and has been adapted and modified since its introduction (ERAS Society History, 2022). The preoperative and postoperative process is ever-changing and is difficult for staff to keep up with. Many staff members find it difficult to stay on top of the most recent protocols. From clerical staff to nurses to surgeons there is a breakdown in the process of ensuring patients receive the optimal benefits if ERAS. This presentation will serve to both educate viewers on the latest ERAS recommendations as well as help develop and define a workflow for ensuring staff members have the most updated guidelines available to streamline the process and provide the best recovery experience for patients.

No description available.

It is widely acknowledged that elevated levels of noise are commonplace in the healthcare environment, particularly in high acuity areas such as the operating room (OR). Excessive ambient noise may pose a threat to patient safety by adversely impacting provider performance and interfering with communication among perioperative care team members. With respect to the certified registered nurse anesthetist (CRNA), increased ambient OR noise may engender distractibility, diminish situation awareness and cause untoward health effects, thereby increasing the possibility for the occurrence of error and patient injury. This research project analytically examines the perceived impact of ambient noise in the operating room by CRNAs. Findings from this study reveal that CRNAs perceive elevated noise to be regularly present in the OR, specifically during the critical emergence phase of the anesthetic. However, CRNAs feel that increased noise only occasionally limits their ability to perform procedures, concentrate and communicate with the perioperative team. OR noise rarely interferes with memory retrieval. CRNAs perceive that noise is sometimes a threat to patient safety but infrequently engenders adverse patient outcomes. CRNAs do not perceive noise in the OR to be detrimental to their health but strongly agree that excessive noise can and should be controlled. Increased ambient OR noise is a veritable reality that may pose a potential threat to patient safety. Further research to identify elevations in noise during critical phases of the anesthetic and delineation of significant contributors to its genesis is warranted.

Occupational exposures of healthcare workers tend to occur because of inconsistent compliance with standard precautions. Also, incidence of occupational exposure is underreported among operating room personnel. The purpose of this project was to develop national estimates for compliance with standard precautions and occupational exposure reporting practices among operating room nurses in Australia. Data was obtained utilizing a 96-item self-report survey. The Standard Precautions and Occupational Exposure Reporting survey was distributed anonymously to 500 members of the Australian College of Operating Room Nurses. The Health Belief Model was the theoretical framework used to guide the analysis of data. Data was analysed to examine relationships between specific constructs of the Health Belief Model to identify factors that might influence the operating room nurse to undertake particular health behaviours to comply with standard precautions and occupational exposure reporting. Results of the study revealed compliance rates of 55.6% with double gloving, 59.1% with announcing sharps transfers, 71.9% with using a hands-free sharps pass technique, 81.9% with no needle recapping and 92.0% with adequate eye protection. Although 31.6% of respondents indicated receiving an occupational exposure in the past 12 months, only 82.6% of them reported their exposures. The results of this study provide national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses in Australia. These estimates can now be used as support for the development and implementation of measures to improve practices in order to reduce occupational exposures and, ultimately, disease transmission rates among this high-risk group.

Bakgrund Operationspersonal är den yrkesgrupp inom vården som är mest utsatt för risk för blodsmitta genom frekvent hantering av stickande och skärande instrument samt exponering av blod. Bland operations­sjuksköterskor finns en stark önskan att arbeta så säkert som möjligt för att minska risken för smittöverföring. Det finns föreskrifter, metoder och hjälpmedel för att förhindra stick- och skärskador men få skriftliga riktlinjer och rutiner. Syfte Syftet med den här studien är att undersöka operationssjuksköterskans hantering av stickande och skärande instrument i operationssalen. Metod Studiens design är en empirisk tvärsnittsstudie med en kvantitativ ansats. En strukturerad observationsstudie utfördes på Södersjukhuset i Stockholm. 18 operationssjuksköterskor observerades under 50 operationer. Resultat Studiens resultat visar på brister inom samtliga områden som observerats. Beskrivna hjälpmedel och metoder för att förhindra stick- och skärskador användes i liten utsträckning.  Trots detta utfördes viss hantering av vassa instrument på ett säkert sätt. Stundom utfördes arbetet på ett riskfyllt sätt. Slutsats Beskrivna hjälpmedel och metoder för säker hantering av stickande och skärande instrument finns men användes i liten utsträckning vilket resulterar i ett självstyrt säkerhetsarbete i operationssalen. Hjälpmedel bör göras mer tillgängliga, tydliga rutiner och skriftliga riktlinjer för hantering av stickande och skärande instrument behövs. Klinisk betydelse Studien kan fungera som en del av ett utvecklingsarbete på Södersjukhuset gällande hantering av stickande och skärande instrument. Utvecklingsarbetet kan exempelvis leda till en uppdatering av innehållet i kundanpassade operationsset och plocklistor samt att skriftliga riktlinjer tas fram. / Background Operating room personnel are at particularly high risk of injury and blood borne diseases due to handling of sharp items and frequent blood exposure. Operating room nurses aim to perform at a high level of security to reduce the risk of transmission of blood borne diseases. To prevent sharps injuries there are regulations, methods and safety devices but few written guidelines. Aim The aim of this study is to identify how the operating room nurse handles sharps within the operating room. Method A quantitative cross-sectional study was conducted at Södersjukhuset in Stockholm, Sweden. 18 operating room nurses participated in this structured observation study during 50 operations. Results The result indicates shortcomings in obtaining a safe working environment in all observed areas. Safety devices and other methods to prevent sharps injuries were seldom used. Despite this the work with sharps was mainly conducted in a safe way. At times the work was performed in a hazardous manner. Conclusions The safety devices and methods described in the study exist but are seldom used which leads to a subjective work method regarding safety in the operating room. The safety devices need to be made more accessible and explicit guidelines are needed. Clinical significance This study may be part of a quality improvement project at Södersjukhuset regarding handling and routines concerning sharps. The quality improvement effort can result in alterations of the contents in the procedure pack and the development of written guidelines.

Bakgrund: I dagens läge finns det kunskapsluckor om hur den perioperativa omvårdnadsprocessen uppfattas ur operationssjuksköterskans synvinkel. För att operationssjuksköterskan ska kunna ge god vård till patienten utifrån dennes önskningar och behov är det viktigt att operationssjuksköterskan får en bra kontakt med patienten. Får operationssjuksköterskan dela patientens värld d.v.s. om patienten både vill och är förmögen till att dela med sig av sina tankar och önskemål, då blir det lättare att ge en personcentrerad vård. Syfte: Syftet med föreliggande litteraturstudien är att undersöka hur operationssjuksköterskan uppfattar den vårdande relationen ur ett perioperativt synsätt. Metod: Det är en litteraturstudie med elva artiklar som har en kvalitativ ansats och en artikel som har en kvantitativ ansats. Föreliggande studien har en kvalitativ ansats då fokus är att beskriva och tolka operationssjuksköterskans upplevelser av omvårdnadsprocessen. Resultat: Generellt sett hade operationssjuksköterskorna en positiv inställning till den perioperativa processen. Operationssjuksköterskorna upplevde att den perioperativa processen  bidrog till ökad kontinuitet och ökad trygghet hos patienterna men framförallt också hos dem själva. Operationssjuksköterskorna utvecklades i sin yrkesroll men också som individer. De kände att deras arbete var meningsfullt och att det fanns en vårdande relation mellan patienten och operationssjuksköterskan. Slutsats: Föreliggande studie lyfter fram att arbetet för operationssjuksköterskor skulle bli effektivare, säkrare vård, få mer kontinuitet och gynna både sjuksköterskorna och patienterna om den perioperativa processen användes i större utsträckning. Det skulle bli lättare att uppnå välmående och god omvårdnad i slutändan. / Background: At present, there are gaps in the knowledge of how the perioperative process is seen from the point of view of the operating room nurse. When it comes to the operating theater nurse to provide quality care to the patient, it is important that the operating theater nurse gets a good contact with the patient. The operating room nurse has to share the patients’ world. Then, it will be easier to give a patient-centered care. Aim: The purpose of this study is to investigate how the operating theater nurse experienced the perioperative process from her/his point of view. Method: This study is a literature review of eleven articles that have a qualitative approach and one article which has a quantitative approach. This study has a more qualitative approach. Its focus is describing and interpreting the surgery nurses’ experience of the perioperative process. Result: The surgical nurses had, to a large extent, a favorable attitude to the perioperative process. Surgical nurses felt that the perioperative process contributed to increased continuity and increased safety for patients, but above all for themselves. Surgical nurses developed professionally, but also as individuals, they felt that their work was meaningful and that there was a caring relationship between the patient and the surgical nurse. Conclusion: This paper emphasizes that if the perioperative process would be used on a larger scale, the work for operative nurses would be more efficient, provide a more secure care, give more continuity and be very favourable to nurses as well as patients. The result for the patients would be a good care and well-being.

OBJECTIVE: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the operating room (OR) - touting surgical site infections (SSIs) and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature. BACKGROUND DATA: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomy. METHODS: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented SSIs. Articles that satisfied the following criteria were included: (1) studies looking at personal items in the OR, such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, but not just OR equipment; and (2) the primary outcome measure was infection at the surgical site. RESULTS: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for SSIs. Only one article examined the correlation between a personal item near the operative site and SSI, concluding that wedding rings worn in the OR had no impact on SSIs. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to SSI in any of these studies. CONCLUSION: There is no objective evidence to suggest that personal items in the OR increase risk for SSIs.

Approximately 65% of all surgeries are conducted in the outpatient surgery setting involving more than 35 million patients. Thirty-five to fifty percent of these outpatients will experience post discharge nausea and vomiting (PDNV), nausea and vomiting that occurs after discharge from the health care facility after surgery. A dearth of literature details the problems associated with nausea and vomiting experienced by patients after discharge home from outpatient surgery. The purposes of this dissertation were to (1) review the current knowledge in the area of post discharge nausea and vomiting; (2) present results of an integrative review of the research literature to determine best evidence for prevention of PDNV in adults or rescue of patients who suffer from post discharge nausea and vomiting (PDNV); (3) present a critical review and analysis of measurement of nausea and vomiting after discharge from outpatient surgery, and (4) present findings of a prospective research study. The purposes of the research study were to: 1) describe the incidence and severity of PDNV over a 7-day period in a sample of adult surgical patients undergoing outpatient surgeries under general anesthesia, 2) describe the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, 3) compare the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and 4) determine outcomes associated with PDNV. This study was part of a multi-site study that had as a primary objective development of a simplified risk model for predicting patients most likely to suffer PDNV. In this research study we described the incidence and severity of PDNV in adult outpatients after ambulatory surgery, described the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, compared the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and determined outcomes associated with PDNV.

Bakgrund: Att arbeta i en miljö där hälsofarlig rök och risk för smitta förekommer innebär en risk för operationssjuksköterskans hälsa. På universitetssjukhuset finns riktlinjer om när mun- och andningsskydd ska användas. Syfte: Att undersöka om operationssjuksköterskorna på universitetssjukhuset har fullgoda kunskaper om sjukhusets riktlinjer angående mun- och andningsskydd. Att undersöka förutsättningarna för operationssjuksköterskorna att kunna följa riktlinjerna, deras upplevelse av riktlinjernas tillgänglighet samt vilka faktorer som avgör operationssjuksköterskornas val av mun- och andningsskydd. Metod: Studien är en deskriptiv enkätstudie med tvärsnittsdesign och kvantitativ ansats. Enkäter delades ut till operationssjuksköterskor på universitetssjukhuset vilka är verksamma på operationssal. För att bli godkänd i sin kunskap krävdes att respondenten hade 100 % rätta svar på kunskapsfrågorna. Data från enkäterna hanterades deskriptivt och analyserades med Mann Whitney u-test och Chi-två-test. Resultat: Hos 62 % fanns inte fullständiga kunskaper om universitetssjukhuset riktlinjer angående mun- och andningsskydd. Vidare upplevde 60 % att riktlinjerna inte är lättillgängliga. Resultatet visade att 24 % ansåg sig alltid kunna följa riktlinjerna. Slutsats: Resultatet visar att kunskapen gällande riktlinjerna är ofullständig vilket innebär att en stor del av operationssjuksköterskorna i studien riskerar sin hälsa i sitt arbete. För att operationssjuksköterskorna ska kunna uppdatera sina kunskaper bör universitetssjukhuset utforma tydligare riktlinjer angående mun- och andningsskydd i ett samlat dokument. / Background: OR nurses work in a place where there is hazardous smoke and contagion. This represents a risk to their health. The teaching hospital has guidelines for when to use facial protective devices. Aim: To see if the OR nurses at the teaching hospital have complete knowledge about the hospital guidelines regarding facial protective devices, and to study the OR nurses’ ability to follow the guidelines. The study will also determine the nurses’ perception of the availability of the guidelines and which factors determine the OR nurses’ choice of facial protective devices. Method: This is a descriptive questionnaire study with a cross-sectional design and a quantitative approach. The questionnaires were distributed to OR nurses who work in the operating room. In order to pass the test about the guidelines the respondent had to get 100 % correct answers. Data from the questionnaire were described and analyzed using Mann Whitney U test and Chi-square test. Result: Of the OR nurses, 62 % were lacking complete knowledge about the guidelines regarding facial protective devices. Furthermore, 60 % perceived the guidelines as not easily accessible. The result showed that 24 % always considered themselves to be able to follow the guidelines. Conclusion: The result shows a lack of knowledge regarding the guidelines. This means that a big part of the OR nurses in this study risk their health at work. To enable the OR nurses to update their knowledge, the teaching hospital should develop clearer guidelines on facial protective devices in one single document.