The operating room (OR) is accountable for most hospital admissions and is one of the most cost and work intensive areas in the hospital. From recent trends, we discover an unexpected parallel increase in expenditure and waiting time. Therefore, improving OR planning has become obligatory, particularly regarding utilization, and service level. Significant challenges in OR planning are the high variations in demand, processing times of surgical specialties, the trade-off between the objectives, and control of OR performance in long-term. Our model provides OR configurations at a strategical level of OR planning to minimize the tradeoff between the utilization and service level accounting for variation in both demand and processing times of surgical specialties. An adaptive control scheme is proposed to aid OR managers to maintain the OR performance within the prescribed controllable limits. Our model is validated using a simulation of demand and processing time data of surgical services at University of Kentucky Health Care.

"September 2002" Includes bibliographical references (leaves 301-318)

"September 2002" / Includes bibliographical references (leaves 301-318) / viii, 318 leaves : ill. (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003

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.

Die Befragung „Ist-Stand der OP-Textilienversorgung in deutschen Krankenhäusern“, die eingebettet ist in das Forschungsvorhaben „Evaluierung von OP-Textilien nach hygienischen, ökologischen und ökonomischen Kriterien“, hat zum Ziel, den gegenwärtigen Stand der OP-Textilienversorgung zu erfassen. Für die Befragung, die sowohl web-basiert als auch postalisch im Zeitraum 11/2008 bis 02/2009 durchgeführt worden ist, wurden vorab alle Krankenhäuser und Kliniken in Deutschland kontaktiert, um den jeweiligen Ansprechpartner für die Beschaffung von OP-Textilien zu erhalten. Der Fragebogen gliedert sich in drei Teile: Abschnitt A: OP-Textilien mit den Unterabschnitten Allgemeines, Ausschreibung von OP-Textilien, OP-Mäntel, OP-Abdeckungen, OP-Kit-Packs, Ökonomische Analyse der OP-Textilienversorgung und Ökologische Bewertung der OP-Textilienversorgung; Abschnitt B: Umweltschutz im Krankenhaus und Abschnitt C: Angaben zum Krankenhaus. Zu den zentralen Ergebnissen der Befragung zählen, dass das Kriterium Versorgungssicherheit das wichtigste Kriterium bei der Ausschreibung ist, gefolgt von Zuverlässigkeit und Reinigungsqualität; dass sowohl Einweg-OP-Mäntel als auch -OP-Abdeckungen häufiger angewendet werden als Mehrweg-Textilien; dass der Tragekomfort der Mehrweg-Mäntel als deutlich besser eingestuft wird als der der Einweg-Mäntel. Ein ähnliches Ergebnis zeigt sich bei der Umweltfreundlichkeit von OP-Mänteln und OP-Abdeckungen. Weiterhin zeigte die Untersuchung, dass eine ökonomische Bewertung bisher häufiger vorgenommen wurde als eine ökologische Bewertung. Bei ökonomischen Analysen, die in den meisten Fällen durch ein krankenhausinternes Team durchgeführt wurden, wurden weitestgehend die Anschaffungskosten/ Miet- bzw. Leasingrate als Kriterium herangezogen. Im Rahmen der ökologischen Bewertung sind vor allem Kriterien wie schadstoffarmer Abfall, geringe Umweltbelastung und wenig schädliche Stoffe von Bedeutung. Insgesamt wird der Umweltschutz tendenziell als wichtig eingeschätzt, wobei die am häufigsten vertretenen Umweltschutzmaßnahmen die Beachtung von Umweltkriterien bei der Beschaffung, die/der Umweltbeauftragte/r und die Zertifizierung nach ISO 14001 sind.

Introduktion: Den perioperativa omvårdnaden där operationssjuksköterskan ingår innefattar faserna före, under och efter operation och kan ses som ett arbetssätt. Perioperativ omvårdnad har utarbetats under 1990-talet. Arbetssättet har inte efterlevts i någon stor grad trots positiva effekter för patienter och personal. Operationssjuksköterskans arbete är fortfarande övervägande traditionellt, med fokus på tiden då patienten är sövd och opereras. Vårdenhetschefers och sektionsledares uppfattningar om den perioperativa omvårdnaden har betydelse för hur arbetet bedrivs på operationsavdelningar. Syfte: Att beskriva vårdenhetschefers och sektionsledares uppfattningar om operationssjuksköterskans perioperativa omvårdnadsarbete samt om införandet av perioperativ omvårdnad. Metod:Datainsamling skedde genom öppna intervjuer med fyra vårdenhetschefer och fyra sektionsledare inom operationssjukvården på två länssjukhus och två universitetssjukhus i Sverige. Insamlad data har analyserats kvalitativt med manifest innehållsanalys. Huvudresultat: Perioperativ omvårdnad som arbetssätt hade enligt vårdenhetschefer och sektionsledare inom operationssjukvård ett värde genom att förnya operationssjuksköterskans arbetssätt vilket anses förbättra patientens omvårdnad. För att införa perioperativ omvårdnad krävdes att olika behov tillgodoses, som tydliggörande av patientnyttan, stöd som skapar rätt förutsättningar, samt att det behövs motivation hos operationssjuksköterskor. Slutsats: Perioperativt omvårdnadsarbete är, trots dess värde, inte möjligt att genomföra utan långtgående förändringar i synsätt och organisation. / Introduction: Perioperative care in which the operating room nurse takes part includes the phases before, during and after operation and can be seen as a way of working in parallel with the care process. This approach has however not been applied to any great extent in pratice despite several studies having shown the positive effects for both patients and staff. The common view of the operating room nurse’s role is still a traditional one with the focus on the time when the patient is anaesthetized and during the actual surgery. Unit managers and section leaders perceptions of perioperative care are important since it affects how the approach is applied in practice. Aim: To describe the unit managers and section leaders perceptions of the operating nurse’s perioperative care work together with how the process is applied in practice. Method: Data were collected by semi-structured interviews with four unit managers and four section leaders within the operating room unit of two provincial hospitals and two university hospitals in Sweden. Data have been analysed with a qualitative content analysis. Main results: Perioperative care as an approach has, according to the unit managers and section leaders in the operating room unit, a value as it revitalises the operating room nurse’s method of working which in turn is thought to improve patient care. It is maintained that in order to introduce perioperative care certain requirements need to be fulfilled, such as clarification of the benefit to patients, support in order to create the right conditions, as well as the need for motivated operating room nurses. Conclusion: Perioperative nursing care is, despite its value, not possible to implement without farreaching changes to how operating room nursing is approached as well as organisational changes.

Dieser Beitrag gibt, basierend auf einem BMBF-Verbundvorhaben, Einblicke in die umfassende Bewertung von OPTextilien. Ziel des Vorhabens ist es, Entscheidern in Krankenhäusern Anregungen und Know-how für ihren Berufsalltag und Produzenten von OP-Textilien Impulse für die Gestaltung ihrer Produkte zu geben. Es werden die hygienischen Anforderungen zur Vermeidung nosokomialer Infektionen, die die Schutzwirkung der Textilien garantierenden textiltechnologischen Voraussetzungen sowie die zur Erfüllung der Wirtschaftlichkeit und Umweltfreundlichkeit notwendigen Anforderungen an OP-Textilien dargestellt. Der Beitrag verdeutlicht, dass die Beachtung all dieser Kriterien und deren Zusammenführung für eine bewusste Entscheidung zum Einsatz von OP-Textilien notwendig ist. / This article describes a holistic assessment approach for operating room (OR) textiles, based on a joint research project funded by the German Ministry of Education and Research. The objective of the project is to ease decision processes for decision makers in hospitals and OR textile manufacturers. The hygienic demands for protection against nosocominal infections, the technological requirements to guarantee textiles their protective properties, as well as the bases for an economically and environmentally optimum decision, are discussed. To permit a holistic procurement decision regarding OR textiles, it is necessary to consider all these criteria and their integration, as proposed in this article.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Bakgrund: Organdonation från avlidna är idag vanligt förekommande för att ge liv och hälsa åt svårt sjuka patienter. Operations- och intensivvårdssjuksköterskor är två av de yrkeskategorier som arbetar mest intimt med donatorvård, ett arbete som befunnits kunna ge såväl etiska som psykologiska efterverkningar. Syfte: Att sammanställa kunskap kring hur dessa yrkesgrupper upplever och hanterar arbetet med att vårda avlidna donatorer, med fokus på de strategier som används för att patienten ska behandlas med respekt och värdighet. Metod: Litteraturstudie med kvalitativ ansats. En litteratursökning i databaserna PubMed och CINAHL resulterande i 15 artiklar som inkluderades i resultatet. Resultat: Analysen genererade tre teman; ”Att vårda de döda” samlar utsagor och företeelser förknippade med denna vård. Här framkom synen på arbetet som stressigt och mentalt mycket tungt. Bristande förmåga att ta till sig hjärndödhetsbegreppet var vanligt och gjorde arbetet än svårare och mer etiskt utmanande. ”Att möjliggöra ett värdigt slut” beskriver en värdig behandling och strävan mot ett värdigt slut för donatorerna som de mest centrala förhållningssätten i vården av avlidna donatorer. I ”Att själv finna mening” beskrivs hur respondenterna, framför allt, genom att stötta varandra och genom vetskapen om det goda som kom ut av organdonation, både för de anhöriga och för organmottagarna. Ändå fann arbetet meningsfullt och givande. Slutsats: Denna studies resultat visar upp en bred problematik på en rad områden gällande vård av avlidna donatorer. Samtidigt som värdighet och respekt för de avlidna ansågs både viktigt och tillfredsställande. Att se sig själv och det goda som uppnåddes med arbetet, i ett större perspektiv gjorde arbetet positivt och tillfredsställande, trots de negativa aspekterna. / Background: Organ donation from deceased donors has become a common procedure that enables health and prolonged life for critically ill patients. Two of the professions most intimately involved with the care of the donors are operating room and intensive care nurses. This care has been found to cause adverse effects, ethical and psychological. Aim: To gather knowledge regarding how these two professions perceive, and cope with, the care of deceased donors. Focusing on strategies used to preserve and maintain respect and dignity for the donors. Method: Literature review with a qualitative approach. Results: Three themes emerged; ”Caring for the dead” collects statements and phenomena associated with the care. This was perceived as mentally exhausting and very stressful. Lack of understanding for the concept of brain death was common, which made the work harder and more ethically challenging. ”Facilitating a dignified end” established that very concept as the main purpose of the actions during donor care. ”To find a purpose” describes how the respondents, mainly, through support for each other and through the knowledge of the positive outcomes of organ donation, both for the donors’ families and for the organ recipients, still found meaningfulness and satisfaction in their work. Conclusion: This study displays a broad spectrum of adversities associated with donor care, in several areas. Dignity and respect for the deceased was deemed both highly important and personally satisfying. To see oneself and the good things achieved through ones labor, in a larger perspective, made donor care both positive and satisfying.

Introduktion: Omvårdnad är operationssjuksköterskans huvudområde. Operationssjuksköterskan ska förebygga skador och komplikationer som kan uppstå vid en operation. En sådan komplikation kan vara kompartmentsyndrom. Kompartmentsyndrom är en ovanlig komplikation men kan leda till allvarliga skador. Det är därför viktigt att operationssjuksköterskan beaktar det i sitt arbete. Syfte: Detta arbete syftar till att belysa operationssjuksköterskans erfarenheter av att arbeta med att förebygga kompartmentsyndrom i den perioperativa omvårdnaden. Metod: En kvalitativ ansats tillämpades och data samlades in via intervjuer. Insamlade data analyserades genom kvalitativ innehållsanalys. I arbetet deltog 11 operationssjuksköterskor, tio kvinnor och en man, som arbetade på fyra olika operationsavdelningar vid två olika sjukhus. Resultat: I den kvalitativa innehållsanalysen av texten framkom två kategorier, Att arbeta förebyggande samt Att handla på osäker grund. I den förstnämnda kategorin beskrevs hur operationssjuksköterskorna genomförde en individuell riskbedömning, var noggranna i positioneringen och utförde lägesändring samt massage av patientens ben för att förebygga kompartmentsyndrom. I den andra kategorin, Att handla på osäker grund, beskrevs en osäkerhet i den perioperativa omvårdnaden kring kompartmentsyndrom. Det belystes en osäkerhet runt ämnet, omvårdnadsinterventionerna ifrågasattes och en brist på vetenskaplig evidens framkom. Konklusion: Det fanns brister i riktlinjer och rutiner gällande omvårdnad kring kompartmentsyndrom. Det fanns även en brist i att implementera ny kunskap i operationssjuksköterskans omvårdnad för att kunna arbeta evidensbaserat. / Introduction: Nursing is the main area for the operating room (OR) nurse. The OR nurse will prevent injuries and complications that can occur during surgery. One such complication can be compartment syndrome. Compartment syndrome is a rare complication but can lead to serious injuries. It is therefore important that the OR nurse take this in consideration in their work. Aim: This essay aims to highlight the OR nurse's experiences of working with the prevention of compartment syndrome in the perioperative nursing. Method: A qualitative approach was applied and the data were collected through interviews. Collected data were analyzed by qualitative content analysis. The essay enrolled 11 OR nurses, ten women and one man, who worked in four different surgical wards at two different hospitals. Result: After a qualitative content analysis of the data were conducted two categories emerged, Preventive work and To act on uncertain foundations. The first category described how the OR nurse undertook an individual risk assessment, was accurate in positioning and performed a change in position and massage of the patient’s leg to prevent compartment syndrome. The second category, To act on uncertain foundations, described an uncertainty in the perioperative care regarding compartment syndrome. It highlighted an uncertainty around the topic, nursing interventions were questioned and a lack of scientific evidence emerged. Conclusion: There were a lack of guidelines and recommendations regarding care about compartment syndrome. There was also a lack of implementing new knowledge in nursing to provide an evidence-based practice.