Introduktion:  Operationssjuksköterskors  arbete  är  svårdefinierat  och  komplext  där  huvudansvaret  ligger  på patientens perioperativa omvårdnad, medicintekniska produkter och instrumentvård. Operationssjuksköterskor är skyldiga att utföra patientsäker vård i samråd med patienten. Preoperativa samtal kan vara ett redskap för att inhämta patientcentrerad information. Syfte: Att beskriva hur operationssjuksköterskor inhämtar information om patienten avseende säker vård samt undersöka operationssjuksköterskors erfarenheter av den perioperativa dialogen. Metod: En deskriptiv kvalitativ intervjustudie genomfördes. Semistrukturerade intervjuer genomfördes med tio operationssjuksköterskor från tre sjukhus. Intervjuerna transkriberades och texterna analyserades genom kvalitativ innehållsanalys med induktiv ansats. Resultat: Tre huvudkategorier framkom: ”Olika sätt att erhålla information”, ”Olika sätt att arbeta patientsäkert”, ”Möjligheter och hinder att genom den perioperativa dialogen erhålla information”. Operationssjuksköterskorna prioriterade inte samtal med patienten för att inhämta information. Tidsbrist, vårdorganisation och operationssjuksköterskornas attityder ansågs vara hinder för patientsamtal. De använde sig istället av operationsanmälan, journal och andrahandsinformation från kollegor. Operationssjuksköterskorna ansåg vården vara patientsäker även utan preoperativa samtal. Konklusion: Studien visar att operationssjuksköterskorna anser sig kunna utföra patientsäker vård och kan inhämta den information de behöver om sin patient utan att ha kommunicerat med patienten. Operationssjuksköterskorna har ett ansvar att hävda sin roll som patientens advokat för att kunna utföra en individanpassad vård. För att operationssjuksköterskan ska kunna utöva en mer patientcentrerad vård behövs kanske en förändring av operationssjuksköterskornas attityder och om så ska ske är det viktigt med ett organisatoriskt erkännande av hela deras arbetsfält.

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Highly skilled nurses amongst the OR team, are needed in the operating room (OR) to ensure optimal patient safety. Shortages in experienced OR nurses and a stressful working environment prove to have a negative influence on effective safe patient care as well as a negative effect on nurses’ own well-being. The research focused on the effectiveness of sensory stimulation therapy (SST) to strengthen the well-being of nurses in the OR of a private hospital in the North-West Province. SST, better known as Snoezelen™, is a blend of sight, sounds, textures, aromas and motion providing stimulation to the primary senses (Collier, McPherson, et al., 2010:698). The five primary senses are gently stimulated without any intellectual activity needed. A particular aim with SST is to improve the well-being of individuals by setting them at ease. The well-being of OR nurses was studied from a resilience viewpoint assuming that, if exposure to stressors was limited and the individual did have an opportunity to recover, stressors may have a positive, toughening effect. Well-being and resilience was used interchangeably in the study. The objectives of the study were to explore and describe OR nurses‟ needs for SST, to explore and describe OR nurses’ suggestions with regard to the implementation of SST in an OR and to explore and describe the effectiveness of a SST intervention to strengthen the well- being of OR nurses in a private hospital in the North-West Province. An explorative, descriptive quasi-experimental design within a quantitative approach was used. Seventy two participants from two private hospitals in the North-West Province voluntarily participated in the research. A pre-/post-test design was used. One pilot group, one intervention group and one comparison group were identified. Participants from all three the participating groups completed a self administered resilience scale questionnaire before and after the implementation of a SST intervention. Before the intervention 100% participants from the pilot group, 100% participants from the intervention group and 96% participants from the comparison group completed the self administered resilience scale questionnaire. Participants of the intervention group also completed a self report questionnaire from which their needs could be determined and suggestions were made on the implementation of a SST intervention. A 98% response rate was obtained for these self report questionnaires. After the intervention the intervention group’s participants were invited to write narratives regarding their experiences after visiting the SST room. The intervention was implemented for a period of two consecutive months in the OR of one of the private hospitals. After the intervention an 88% response rate from the pilot group, 100% response rate from the intervention group and a 63% response rate from the comparison group, completing self administered resilience scale questionnaires, were obtained. Data was analysed with the assistance of a statistical consultant at the North-West University in Potchefstroom by using STATISTICA (version 10) and SPSS (version 20, release 20.0.0) (StatSoft Inc., 2011, SPSS Inc., 211). Results indicated that there was no statistical difference between the three participating groups regarding their resilience before the intervention. However, after the intervention, the intervention group demonstrated a statistical increase in their resilience levels. Based on these results, as well as on conclusions of relevant literature and the feedback from participants in their written narratives, recommendations were formulated with regard to nursing education, nursing practice and further research. Briefly it means that there should be more consideration for OR nurses’ well-being by means of a SST program providing for their needs. Recommendations included the benefits of a SST room in a hospital environment as well as complete instructions on how to create and to furnish such a room. Attributes of resilience, factors influencing resilience levels and methods to increase resilience levels in the workplace should be included in a regular in-service training program. For future research the researcher recommended further studies in order to determine the resilience levels in various departments of private hospitals. This could mean the successful implementation of a SST room in other departments as well which will eventually lead to the improved well-being of all nursing staff. The researcher is willing to act as a consultant if the need arises for the comparison groups to implement a SST intervention in their different departments. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Highly skilled nurses amongst the OR team, are needed in the operating room (OR) to ensure optimal patient safety. Shortages in experienced OR nurses and a stressful working environment prove to have a negative influence on effective safe patient care as well as a negative effect on nurses’ own well-being. The research focused on the effectiveness of sensory stimulation therapy (SST) to strengthen the well-being of nurses in the OR of a private hospital in the North-West Province. SST, better known as Snoezelen™, is a blend of sight, sounds, textures, aromas and motion providing stimulation to the primary senses (Collier, McPherson, et al., 2010:698). The five primary senses are gently stimulated without any intellectual activity needed. A particular aim with SST is to improve the well-being of individuals by setting them at ease. The well-being of OR nurses was studied from a resilience viewpoint assuming that, if exposure to stressors was limited and the individual did have an opportunity to recover, stressors may have a positive, toughening effect. Well-being and resilience was used interchangeably in the study. The objectives of the study were to explore and describe OR nurses‟ needs for SST, to explore and describe OR nurses’ suggestions with regard to the implementation of SST in an OR and to explore and describe the effectiveness of a SST intervention to strengthen the well- being of OR nurses in a private hospital in the North-West Province. An explorative, descriptive quasi-experimental design within a quantitative approach was used. Seventy two participants from two private hospitals in the North-West Province voluntarily participated in the research. A pre-/post-test design was used. One pilot group, one intervention group and one comparison group were identified. Participants from all three the participating groups completed a self administered resilience scale questionnaire before and after the implementation of a SST intervention. Before the intervention 100% participants from the pilot group, 100% participants from the intervention group and 96% participants from the comparison group completed the self administered resilience scale questionnaire. Participants of the intervention group also completed a self report questionnaire from which their needs could be determined and suggestions were made on the implementation of a SST intervention. A 98% response rate was obtained for these self report questionnaires. After the intervention the intervention group’s participants were invited to write narratives regarding their experiences after visiting the SST room. The intervention was implemented for a period of two consecutive months in the OR of one of the private hospitals. After the intervention an 88% response rate from the pilot group, 100% response rate from the intervention group and a 63% response rate from the comparison group, completing self administered resilience scale questionnaires, were obtained. Data was analysed with the assistance of a statistical consultant at the North-West University in Potchefstroom by using STATISTICA (version 10) and SPSS (version 20, release 20.0.0) (StatSoft Inc., 2011, SPSS Inc., 211). Results indicated that there was no statistical difference between the three participating groups regarding their resilience before the intervention. However, after the intervention, the intervention group demonstrated a statistical increase in their resilience levels. Based on these results, as well as on conclusions of relevant literature and the feedback from participants in their written narratives, recommendations were formulated with regard to nursing education, nursing practice and further research. Briefly it means that there should be more consideration for OR nurses’ well-being by means of a SST program providing for their needs. Recommendations included the benefits of a SST room in a hospital environment as well as complete instructions on how to create and to furnish such a room. Attributes of resilience, factors influencing resilience levels and methods to increase resilience levels in the workplace should be included in a regular in-service training program. For future research the researcher recommended further studies in order to determine the resilience levels in various departments of private hospitals. This could mean the successful implementation of a SST room in other departments as well which will eventually lead to the improved well-being of all nursing staff. The researcher is willing to act as a consultant if the need arises for the comparison groups to implement a SST intervention in their different departments. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Introduktion Patientsäkerhet är en viktig del i arbetet med att upprätthålla en god kvalitet inom hälso- och sjukvården och inte minst inom riskfyllda områden som anestesi- och operationssjukvård. Operationsprocessen kan stödjas genom användandet av ett kliniskt informationssystem, ett så kallat operationsplaneringssystem. Vad som dock inte finns väl beskrivet är hur ett sådant här informationssystem skulle kunna bidra till en säkrare vård. Syfte: Syftet med studien var att beskriva processen och vilken betydelse ett operationsplaneringssystem hade för patientsäkerheten på en operationsavdelning utifrån personalens perspektiv. Metod: En empirisk studie med kvalitativ ansats genomfördes och analyserades med riktad innehållsanalys enligt Hsieh & Shannon. Tjugosex intervjuer genomfördes utifrån nio olika befattningar relaterade till operationsprocessen på tre olika sjukhus i mellersta och södra Sverige Resultat: Processen av kirurgska ingrepp bestod av tre olika faser; planering, genomförande och uppföljning. Extern planering hanterades av kirurgisk avdelning eller mottagning. Den interna planeringen hanterades av operationsavdelningen och för att kunna fullfölja planeringen genomfördes en interorganisationell planering. Faktorer att ta hänsyn till under den första fasen var ändringar och bristande planering. Den verkställda planeringen utgjorde arbetsunderlaget vid genomförandet av operationerna. Uppföljningen var mestadels produktionsinriktad och patientrelaterad vårduppföljning saknades. Patientsäkerhet handlade om två saker, perspektiv och betydelse. Patientsäkerhetsperspektivet beskrevs utifrån patient-, organisations- och medarbetareperspektiv. Betydelsen av ett operationsplaneringssystem för patientsäkerheten var relaterad till information, kontrollfunktioner, organisation och förändringar. Konklusion: Patientsäkerheten garanterades av den personal som arbetade i operationsprocessen och inte av operationsplaneringssystemen. Utveckling av säkerhetsfunktioner i operationsplaneringssystemen skulle kunna bidra till ökad patientsäkerhet. / Introduction: Patient safety is an important part in the performance of good quality in healthcare and particularly in critical areas like anesthesia and surgery. The process of surgery can be supported by an operating room information system, but there is no adequate description of how a system like this will support a safer care of the patient. Purpose: The aim of the present study is to describe the process and importance of an operating room information system for the patient safety in operating rooms from the perspective of employees. Method: An empirical study with a qualitative onset was implemented and analyzed using directed content analysis according to Hseih & Shannon. Twenty six interviews were performed from nine different positions during the process of surgery in three different hospitals in mid- and southern Sweden. Results: Operating room management included planning, surgery and evaluation. Extern planning was handled by the surgery ward or reception and intern planning by the surgery department. To complete the process there was an inter-department coordination and planning. Changes and insufficient planning had to be taken into account during this process of planning surgery. Executed planning functioned as the working document during the day of surgery. Evaluation was considered as mostly production-oriented and patient-related evaluation was missing. Two areas emerge from patient safety, perspective and significance. The importance of an operating room information system related to patient safety was information, safety controls, organization and changes. Conclusion: Patient safety was guaranteed by employees who worked in the process of surgery and not by the operating room information systems. Development of safety functions in operating room information system may improve patient safety.

There are many terms used to describe pressure ulcers: pressure sores, decubitus ulcers, bedsores, and pressure necrosis or ischaemic ulcers. Essentially they all describe damage to the patient's skin and underlying tissue. The nursing literature abounds with information about the risk, grading, prevention and treatment of pressure ulcers. These ulcers are a problem in hospital and long term care facilities, and are a major cause of morbidity. In the hospital setting they contribute to an extended length of stay and by doing so 'block' the bed for use by another patient. The ulcers are difficult to treat, are an ongoing cause for pain and discomfort for the patient and can be a strain on hospital finances. Pressure ulcers are not unique to modern times, as they have been discovered on the remains of an Egyptian mummified body (Armstrong & Bortz 2001). This would suggest that the problem dates back to the Pharoahs, and has continued to be a challenging problem throughout the centuries (Bridel 1992). The escalating costs of treating these ulcers today, has brought about an emphasis on the risk factors, prevention and the appropriate interventions, rather than an acceptance of these ulcers as a tolerable ondition (Bridel 1992). In the operating room, nurses are faced with unique challenges when caring for their patients. This is due to difficulty in caring for patients under the influence of the anaesthesia required for surgery, long periods of forced immobility and the inability of the patient to perceive pain and discomfort from the pressure of the hard surface of the operating room table. These problems are increased by nurses' inability to gain access to the patient because of the sterile drapes required to cover the patient for surgery. Armstrong and Bortz (2001) present information from one study in which it is stated that surgical patients have 90% greater chance of developing pressure ulcers than medical patients. One reason for this may be due to the limited information available in regard to the most effective support surface to place on top of the operating room table. This gap in information is problematic for operating room nurses as it limits their ability to select the most effective item of equipment, and determine if the chosen equipment reduces pressure on tissue intra- operatively. The most effective operating room table mattress used and the skills and knowledge of the operating room nurse about the aetiology and prevention of pressure ulcer prevention, are important aspects of nursing care and can influence patient outcomes. The potential for complications to occur may be dependent on single or combined factors such as the patient's age, disease processes, nutritional status and mobility. Preparatory and supportive nursing interventions for surgical procedures based on best available evidence, nursing experience and patient preference, can reduce the incidence of pressure ulcer development in the perioperative environment. This doctoral portfolio contains four separate sections related and linked together by a common theme - pressure ulcer prevention in the perioperative environment. This first section of the portfolio situates the topic and provides a brief overview of the portfolio. The second section is a critical review of the literature pertaining to the most commonly used operating room table mattresses, and the effectiveness of these mattresses in the prevention of pressure ulcer development. This review highlighted a lack of quality research in this area, and while many evaluations have been undertaken to determine the effectiveness of perating room table mattresses, the results are contradictory concerning the patients, exposures and interventions. Because of issues related to the methodological quality of published research in this area a systematic review using meta- analysis was not possible rather a critical review of the research literature is used. The third section of the portfolio reports on a hermeneutic ethnography of the perceived skills and knowledge of nurses in the prevention of pressure ulcer development in the perioperative environment. This study was designed to determine if pressure ulcer prevention forms an aspect of the everyday practice of perioperative nurses. This review has highlighted the need for operating room nurses to review practices when caring for patients in the perioperative environment particularly in respect of pressure ulcer prevention. The fourth and final section of the portfolio summarises the research and provides recommendations for nursing practice and further research in the area of pressure ulcer prevention in the perioperative environment. / Thesis (D.Nurs.)--Department of Clinical Nursing, 2004.

Thesis (Ph.D.) -- University of Adelaide, Dept. of Clinical Nursing, 2003. / "September 2002" Includes bibliographical references (leaves 301-318).

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed June 5, 2008). Includes bibliographical references (p. 77-87).

Background: Previous studies show that nurse retention is one of the most effective strategies to counteract nursing shortages. Few studies have focused on the crucial resource of registered specialist nurses in operating departments. Aim: The overall aim of this thesis was to gain knowledge on registered specialist nurses’ and assistant nurses’ work in operating departments and on what factors they consider to be important for attractive work. Methods: In Study I, operating room nurses were interviewed regarding their perspective on their work. In Studies II and III, specialist registered nurses and assistant nurses at operating departments in a Swedish county council responded to the Attractive Work Questionnaire. Study IV is a case study with interviews, a review of organisational goal documents and data concerning the number of planned, acute and cancelled operations. Findings: The adaption of the Attractive Work Questionnaire for nurses in operating departments was satisfying. The most important factors for attractive work were: Relationship, Leadership and Status. The factors with the largest discrepancies between their important to work attractiveness and their rating at the nurses’ current work were: Salary, Organisation and Physical Work Environment. It was important for nurses to be able to prepare for and be in control of the different work tasks. However, the daily operating schedule guided the nurses’ work, and changes in the schedule, nurse shortages and the design of the premises constituted obstacles to their work. Conclusion: The Attractive Work Questionnaire provided specific information to management on what to focus on to make work attractive. The majority of the identified attractive factors are already known to be of importance in nurse retention; however, factors requiring more investigation are Equipment, Physical Work Environment and Location (of the workplace). Their work prerequisites did not enable the specialist and assistant nurses to reach what they saw as their daily goals. Regularly occurring activities, such as acute and cancelled operations, were interpreted as obstacles to reaching daily goals.

Esta tese apresenta abordagens apoiadas em métodos de otimização para solucionar problemas relacionados ao planejamento de recursos físicos de um bloco cirúrgico (BC) hospitalar. Na tese, tais abordagens são divididas em cinco artigos que inicialmente identificam os métodos atualmente empregados na literatura em geral e pelo hospital acadêmico utilizado como referência neste estudo, para propor novos métodos de solução para problemas estratégicos, táticos e operacionais de extrema relevância no contexto da gestão eficiente dos recursos físicos de um BC. Os métodos otimizantes apresentados nesta tese se referenciam nos tempos históricos de realização das cirurgias e no tempo esperado de permanência dos pacientes nos leitos da unidade de recuperação pós-anestésica (URPA) para alocar, em nível tático, os blocos de tempo das salas de cirurgia (SC’s) às especialidades cirúrgicas e, em nível operacional, sequenciar as cirurgias para atender a demanda de cirurgias eletivas e maximizar a utilização de capacidade dos recursos físicos do BC. Em nível estratégico, os problemas abordados na tese se referem ao dimensionamento da quantidade requerida de SC’s e de leitos de recuperação da URPA, e do compartilhamento ótimo desses recursos entre as especialidades cirúrgicas, utilizando os blocos de tempo das SC’s como variáveis de decisão para atender a demanda de cirurgias eletivas das especialidades cirúrgicas do BC. / This thesis presents optimising approaches for solving resource planning problems in an operating theatre (OT). The approaches are presented in five articles which start identifying current methods used in the literature as well as in the academic hospital for proposing new optimising solution methods for relevant strategic, tactical and operational problems concerning to efficient OT’s resource utilisation. The methods presented in the thesis take as the reference the historical surgery times of the surgical specialities to calculate their expected number of surgeries per working shift and their expected patient’s length of stay in the recovery beds of the post anesthesia care unit (PACU). Such metrics are essential for allocating the operating room block times, at tactical level, and for sequencing the surgeries in the operating rooms, at operational level, in order to comply with the elective surgeries demand and miximise OT’s resource utilisation. The problems at strategic planning level refer to the dimensioning of the required number of operating rooms and PACU recovery beds to comply with the surgical demand and determining the optimal allocation mix within the surgical specialities, taking the operating room block times as the decision variables of both problems.