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

Unintentional harm due to healthcare is common, especially in the operating theatre. Previous research, aiming to reduce harm to patients in the operating theatre, has not examined the non-technical skills of anaesthetic assistants. The aim of this project was to identify the essential non-technical skills required by anaesthetic assistants for safe and effective practice, and to develop a behavioural marking system to assess these skills. A literature review identified three articles which described anaesthetic assistants' non-technical skills. An interview study with anaesthetic assistants (n=22) and anaesthetists (n=23) described the use of situation awareness, teamwork and task management more commonly than leadership or decision making. This was corroborated by a critical incident database review of the Australian Incident Monitoring System from 2002 to 2008. The material identified in the interview study was considered by focus groups of anaesthetic assistants (n=6,7,3,4) to generate headings. These themes were considered by anaesthetic assistant lecturers (n=6) in a Delphi questionnaire, and positive and negative behavioural markers proposed. The Anaesthetic Non-Technical Skills for Anaesthetic Practitioners (ANTS-AP) behavioural marker system was completed by a research panel. The prototype ANTS-AP system had three categories: 'situation awareness', 'communication and teamwork', and 'task management', each with three elements. The reliability, validity and usability of the ANTS-AP system were evaluated by anaesthetic assistants (n=48) observing videos of simulated theatre work at a 3.5 hour workshop. The system had good internal consistency, and was able to discriminate good, average and poor behaviours. The element 'coping with pressure' was removed due to its poor inter-rater reliability. Future work will assess the inter-rater reliability of the ANTS-AP system, when observers have the opportunity for calibration. This project has provided anaesthetic assistants a means of structuring observation and feedback for training and reflection with the goal of improving patient care.

Bakgrund: Sjukvårdens kostnader ökar, liksom antal vårdtillfällen och vårdtyngd och krav finns därför på att effektivisera vården. Samtidigt som vården skall effektiviseras så skall också kvaliteten på vården tillgodoses. Syfte: Att undersöka och beskriva operationssjuksköterskors upplevelser av arbete på effektivitetssal. Metod: Studien utfördes med en beskrivande kvalitativ ansats och ett ändamålsenligt strategiskt urval har använts. Tio operationssjuksköterskor med erfarenhet av att arbeta på effektivitetssal fick svara på sex i förväg utformade frågor genom enskilda intervjuer som spelades in på ljudband. Datan transkriberades sedan och analyserades genom innehållsanalys, där två huvudkategorier och flera underkategorier framkom. Resultat: Det finns både fördelar och nackdelar med arbetet på effektivitetssal samt också erfarenheter som inte kan tolkas som enbart positiva eller negativa. Fördelar var bland annat att arbetet var stimulerande, det var bättre teamarbete och bättre kommunikation. Nackdelar var bland annat att det av vissa ansågs stressigt och att personalen kunde uppleva sämre kontroll. Slutsats: På effektivitetssalarna tycks det råda ett högre tempo, som av operationssjuksköterskorna kan upplevas som både stimulerande och stressigt och med arbetet finns både för- och nackdelar. Klinisk betydelse: Genom resultatet framkommer vad som redan fungerar bra i arbetet på effektivitetssal och även var möjligheter till förbättringar finns, förbättringar som kan göra arbetet än mer effektivt. / Background: Costs of healthcare are increasing and so is the amount of admissions to the hospitals as well as the burden of care in the wards, and therefore demands for more efficiency in the healthcare system is required. While healthcare needs to become more efficient there is also a demand that the quality on healthcare is met. Aim: To investigate and describe operating room nurses experiences of working in an efficiency OR unit. Method: The study was conducted using a descriptive qualitative approach and a purposeful sampling strategy was used. Ten operating room nurses, with experience of working in an efficiency OR unit, answered six beforehand designed questions through individual interviews that were recorded on audiotape. The data was transcribed and then analyzed by content analysis, where two main categories and several sub-categories emerged. Result: There are advantages and disadvantages of working in an efficiency OR unit and there is also some experience that can’t be interpreted as solely positive or negative. Advantages were that the work was found stimulating, there was better teamwork and better communication. Disadvantages were, among other things, that work could be found stressful by some of the staff and staff could also experience loss of control. Conclusion: It seems to be a faster pace in efficiency OR units, which can be perceived as both stimulating and stressful among operating room nurses and there are also both advantages and disadvantages with the work. Clinical relevancy: The result shows what already works well in the efficiency OR units and also where opportunities for improvement exist, improvements that could make work more efficient.

Bakgrund: Arbetsmiljön består av fyra delar: fysiska, psykiska, organisatoriska och psykosociala. Delarna i arbetsmiljön påverkar personalen olika mycket. Den organisatoriska delen är stor på operationsavdelningar, där fokus ligger på planering av operationsprogrammet för att inte behöva stryka patienter och att patienter med mest behov ska få vård först. Det gör att snabba förändringar behöver göras och att operationssjuksköterskan inte alltid hinner med att förbereda sig. Motiv: Föreliggande studie kommer att kunna leda till kunskap om operationssjuksköterskans hantering av förändringar i operationsprogrammet. Den informationen kan vara värdefull för mindre erfarna operationssjuksköterskor. Syfte: Syftet med studien var att beskriva erfarenheter bland operationssjuksköterskor gällande hanteringen av kortsiktiga förändringar i operationsprogrammet. Metod: Studien är kvalitativ där deltagarna var operationssjuksköterskor och arbetade vid ett länssjukhus i Norrland. Semistrukturerade intervjuer användes för att samla in data, med en respondent i taget. Kvalitativ innehållsanalys användes sedan för att analysera materialet. Resultat: För hantering av kortsiktiga förändringar har deltagarna olika sätt att förbereda sig, de beskrev vad som var avgörande för att räcka till och vilket sorts inflytande operationssjuksköterskorna har. Dessa tre delar har delats in i kategorier: att hinna förbereda sig, att räcka till och att ha inflytande. Konklusion: Operationssjuksköterskorna beskrev en förståelse av förändringarna som sker i operationsprogrammet. Irritation och frustration kan däremot uppkomma vid sena ändringar och vid ovana ingrepp. Erfarenhet är en tillgång när det gäller förändringar, då de kan jämföra ingrepp med tidigare operationer. Ovana ingrepp kan annars lösas genom byte med kollega eller förlita sig på övrig personal på salen. Antalet förändringar i operationsprogrammet upplevs ha minskat något över tid. / Background:The work environment consists of four parts: physical, mental, organizational and psychosocial. The parts of the work environment affect the staff differently. The organizational part is large in operating wards, where the focus is on planning the operating program so as not to have to cancel patients and that patients with the most needs should receive care first. This means that rapid changes need to be made and that the operating room nurse sometimes does not have enough time to prepare. Motive: The present study will be able to lead to knowledge about the operating room nurse's handling of changes in the operating program. That information can be valuable for less experienced operating room nurses. Aim: The purpose of this study was to describe experiences among operating room nurses regarding the management of short-term changes in the operating program. Methods: The study has a qualitative approach where the participants were operating room nurses and worked at a county hospital in northern Sweden. Semi-structured interviews were used to collect data, with one respondent at a time. Qualitative content analysis was then used to analyze the material. Result: To manage short-term changes, the participants have different ways of preparing, they described what was crucial to suffice and what kind of influence the operating room nurses have. These three parts have been divided into categories: to have time to prepare, to suffice and to have influence. Conclusion: The operating room nurses described an understanding of the changes that are taking place in the surgical program. Irritation and frustration can, however, occur at late changes and the unfamiliar procedures. Experience is an asset when it comes to changes, as they can compare procedures with previous operations. Unusual interventions can otherwise be solved by changing with a colleague or relying on other staff in the hall. The changes in the operating program are perceived to have decreased.

The Institute of Medicine's report in 2000, To Err Is Human: Building a Safer Health System, highlighted the seriousness of medical errors in the U.S. health care system. The unintentional retention of foreign objects in surgical patients is one of those errors. At the time of this study, there was no standardized counting policy and process across operating rooms in the United States. The purpose of this project was to develop a best practice educational counting program to help prevent the unintentional retention of foreign objects in surgical patients. The Logic Model was used to guide the design of the educational program and expected learning outcomes. A draft of the educational program was distributed to 10 perioperative stakeholders for an initial formative review. Changes were incorporated into the program and it was distributed to 6 perioperative experts for an additional summative assessment and content validation utilizing the AGREE II Instrument. The overall quality evaluation of the educational program was 85%, indicating that it was of high quality. Four of the respondents recommended the educational program for implementation without any changes and 2 recommended it for implementation with some minor modifications related to rewording of one question in the pretest-posttest. There were no recommended modifications in the content of the educational program. As a result, the project was recommended for adoption as a best practices-based educational program to prevent the unintentional retention of foreign objects in surgical patients. The study promotes positive social change by providing suggestions to improve the provision of safe care to surgical patients and decrease health care costs.

Darbo tikslas: Įvertinti operacinės slaugytojų susižeidimų adatomis ir kitais aštriais instrumentais riziką. Tyrimo objektas - operacinės slaugytojų susižeidimų adatomis ir kitais aštriais instrumentais rizika. Darbo uždaviniai: 1. Įvertinti operacinės slaugytojų susižeidimų adatomis ir kitais aštriais instrumentais dažnumą, pobūdį bei susižeidimų priežastis. 2. Išanalizuoti saugią operacinės darbo aplinką lemiančius veiksnius. 3. Ištirti operacinės slaugytojų požiūrį į susižeidimų adatomis ir kitais aštriais instrumentais pranešimą ir jų registraciją. Tyrimo metodika: Tyrimas atliktas 2013 metų sausio – balandžio mėnesiais Vilniaus ir Kauno miestų tretinio lygio ligoninėse. Tyrimui panaudota vokiečių mokslininkės dr. Sabine Wicker sudarytos anketos: „Atsitiktinis susižeidimas“ (‚,Ein stich stecktan“) ir „Sumažinti pavojų užsikrėsti – vengti adatos dūrio“ (,,Infektionsrisiken senken – Nadelstichverletzungen vermeiden“). Anketos išverstos į lietuvių kalbą. Viso buvo išdalinta 200 anketų, grižo 185 anketos, iš jų nepilnai atsakytos 10. Statistinei analizei buvo naudotos 175 užpildytos anketos. Statistiniam duomenų apdorojimui naudoti SPSS 17.0 ir Microsoft Excel programų paketai. Statistinis duomenų reikšmingumas tikrintas pagal chi kvadrato (χ2) kriterijų ir statistinį reikšmingumą (p). Duomenų skirtumas reikšmingas, kai p<0,05. Tyrime naudotas faktorinės analizės metodas. Rezultatai ir išvados: Analizuojant tyrimo duomenis, nustatyta, kad tarp apklaustųjų nebuvo nei vieno... [toliau žr. visą tekstą] / Research aim: to assess the risk of operating room nurses injuries with needles and other sharp instruments. Research object: operating room nurses injuries with needles and other sharp instruments. Research objectives: 1. To asses frequency, type and reasons of operating room nurses injuries with needles and other sharp instruments. 2. To analyse influencing causes for safe operating room environment. 3. To analyse the operating room nurses attitudes towards registration and reporting of injuries inflicted by needles and other sharp instruments. Research methodology: Research was done in January–April 2013 in Vilnius and Kaunas 3rd level hospitals. For this research two types of questionnaires, written by German scientist Dr. Sabine Wicker, were used: „Incidental Injury“ („Ein stich Stecktan“) and „Minimizing the danger of infection – prevent the needle puncture“ (,,Infektionsrisiken senken – Nadelstichverletzungen vermeiden“). Questionnaires were translated to Lithuanian language. There were 200 questionnaires distributed in total, 185 of them were returned and 10 were not fully answered. 175 fully answered questionnaires were used for statistical analysis. SPSS 17.0 and Microsoft Excel programs were used for statistical data analysis. Statistical data meaningfulness was verified by chi quadrant (χ2) criteria and statistical meaningfulness. Data difference is meaningful when p<0,05. Factor analysis method was used for the research. Results and conclusions: During the... [to full text]

Patient safety is a primary concern of members of the surgical team. Professional nurses working in the operating room play a vital role in the safety of the patients from the moment the patient enters the operating room to the discharge of the patient to the unit. Quality nursing care is of the utmost importance and therefore it is the responsibility of a professional nurse to ensure patient safety during the peri-operative period. Team work and good communication in the operating room are essential in order to ensure patient safety. Nursing care practices related to patient safety should be a key aspect to consider in rendering care to the surgical patient and professional nurses should perform their duties to the best of their ability despite lack of resources and shortage of staff. The main purpose of the study was to explore and describe nursing care practice related to patient safety in the operating room at hospitals in the Nelson Mandela Metropolitan area. Once this was established recommendations on how to enhance nursing care practice related to patient safety in the operating room were made. This study is based on a quantitative, explorative, descriptive and contextual design. Convenient sampling was used in this study. Data were collected by means of a self-administered questionnaire. Descriptive and inferential statistics were used to analyse the data. Ethical considerations were adhered to and the findings of the research will be disseminated appropriately. Recommendations based on the findings that emerge from the data, as well as the literature review, will be offered to enhance nursing care practice related to patient safety in the operating room.

Kommunikationskunskaper kan ses likvärdiga till tekniska kunskaper i en högteknologisk vårdmiljö, såsom en operationssal. Många avvikelser i operationssjukvård handlar om brister i kommunikationen. Det finns en begränsad mängd av kvalitativ forskning kring operationssjuksköterskors upplevelser av intraoperativ kommunikation relaterad till patientsäkerhet och därför var det viktigt att utföra denna studie. Studiens syfte var att undersöka operationssjuksköterskors upplevelser av intraoperativ kommunikation relaterad till patientsäkerhet. För att beskriva och analysera deras upplevelser användes en kvalitativ metod i form av av semistruktuerade intervjuer med följfrågor. Studie genomfördes i ett mellanstort sjukhus i södra Sverige i februari 2022 på centraloperationsavdelning och det var tio stycken informater som deltog i studien. Vid analys av intervjuerna framkom tre olika huvudteman: olika sätt att kommunicera, faktorer som främjar intraoperativ kommunikation och faktorer som hindrar intraoperativ kommunikation.

Bakgrund: Postoperativa sårinfektioner orsakar lidande för den drabbade patienten och kostnader för patienten, vården och samhället. Intraoperativ kontamination av operationsinstrumenten är en av källorna till dessa infektioner. Operationssjuksköterskan är ansvarig för aseptiken och operationsinstrumenten.   Syfte: Syftet med denna pilotstudie var att mäta graden av bakteriell kontamination över tid på operationsinstrument som används vid öppen neurokirurgi samt observera utvalda källor till kontamination under samma tid. Metod: Denna studie designades som en kvantitativ icke-experimentell observationsstudie. Datainsamlingen skedde under hösten 2015 och bestod av omhändertagandet av specifika instrument som använts av operatören under operationen efter förutbestämd åtgången knivtid. Bakterieodlingar på dessa instrument skedde sedan på laboratorium enligt en förutbestämd metod och graden av kontamination mättes genom observation av mängden colony forming units (CFU). Resultaten presenteras i form av förändringar av mängden CFU. Resultat: Fem operationer observerades och tio odlingar utfördes på tio instrument. Totalt tio CFU registrerades under samtliga observationer. Ingen signifikant ökning av antal CFU kunde observeras från en till två timmars knivtid (P=0,156). Antal dörröppningar ökade från 3,4 till 9,0 och antal personer på operationssalen ökade från 5,4 till 5,8. Slutsats: Trots det ringa antal observationer som ingick i denna studie tyder resultaten på god aseptik och minimal bakteriell kontamination på operationsinstrumenten under operationens två första timmar. Ytterligare forskning med längre observationer, fler observationer och observationer kring annan typ av kirurgi behövs. / Background: Post-operative surgical site infections (SSI) cause suffering for the afflicted patient and is a great cost for the patient, the health care system and society. Intra-operative contamination of surgical instruments is one of the sources of these infections. The operating room nurse is responsible for preventing infections. Purpose: The purpose of this pilot-study was to measure the degree of bacterial contamination over time on surgical instruments used in open neurosurgery as well as to observe specific sources of contamination during this time. Method: The design was a quantitative nonexperimental observational study. The data collection took place during autumn 2015 and consisted of the sampling of specific instruments used by the surgeon during surgery after preset elapsed operating times. Bacterial culturing on these instruments was then carried out at a laboratory according to a preset routine and the degree of contamination was measured by observing the amount of colony forming units (CFU). The results are presented as changes in CFU. Results: Five operations were observed and ten bacterial culturings were conducted on ten instruments. A total of ten CFU was registered during all observations. No significant increase in the number of CFU could be observed from one to two hours of elapsed surgery (P=0,156). The amount of door openings increased from 3,4 to 9,0 and the number of personnel in the operating room increased from 5,4 to 5,8. Conclusion: Despite the small number of observations included in this study the results indicate good aseptics and minimal bacterial contamination on the surgical instruments during the first two hours of surgery. Further research with longer observations, more observations and observations on other forms of surgery is needed.