The operating room (OR) is an area of particularly high risk for patients, due to technical and non-technical issues. Research in other high-risk industries has shown that leadership can impact safety and performance of work teams. As the leader of the surgical team, surgeons must demonstrate leadership along with technical excellence, to optimize performance and maximize patient safety in the OR. This thesis investigated surgeons’ leadership in the intraoperative period. A review of the surgical literature revealed ten empirical articles examining surgeon leadership. Of these, two articles linked leadership was an outcome measure. A preliminary taxonomy that included seven elements of leadership was developed based on definitions of leadership from the literature. To further investigate intraoperative leadership, observations (<i>n</i>=29) were conducted in three hospitals in Scotland across different types of surgery. Leadership was described in detail according to the leadership elements. Surgeons engaged in significantly more leadership during more complex operations. Ten focus groups with different members of the OR team were conducted to finalize the taxonomy. The final taxonomy, the Surgeons’ Leadership Inventory (SLI), was revised to include eight elements: maintaining standards making decisions, managing resources, directing, training, communicating, supporting others, and coping with pressure. The SLI was used with adequate reliability to code videos (<i>n</i>=29) of live operations. Elements of surgeons’ leadership differed before and after the surgical point of no return. Analysis revealed differences in training and supporting others behaviours in cases with an unexpected event. The element coping with pressure was significantly related to intraoperative blood loss. Surgeons’ intraoperative leadership was found to be reactive, situation based, and often transactional in nature. This thesis provides a first step in identifying the important behaviours and a basis on which improving surgeons’ intraoperative leadership may be made.

Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

Sharps injuries can transmit fatal blood-borne infections to injured health care workers. These blood-borne infections have serious consequences, including long-term illness, disability and death. The operating room is a fast-paced, hazardous working environment, where personnel are constantly exposed to sharps injuries. The psychological aspects of these injuries have received little attention. The emotional impact of a sharps injury can be severe and long lasting, even when a serious infection is not transmitted. Furthermore, according to literature, the mean rates of underreporting sharps injuries vary between twenty two and seventy five percent. The research objectives of this qualitative, explorative and descriptive study were to explore and describe the experiences of operating room personnel in the southern district of the North-West province in South Africa after sharps injuries, to explore and describe the reasons why they do not always report these incidents, to explore and describe what could be done to increase reporting of sharps incidents in operating rooms by personnel and to propose guidelines to support operating room personnel after a sharps injury. In order to achieve these objectives, the researcher gathered data by conducting semi-structured interviews with operating room personnel who had experienced sharps injuries in hospitals of the southern districts of the North-West in South Africa. Ethical considerations were adhered to by the researcher. Permission to conduct research was negotiated by the researcher with management of the hospitals in the target area. Voluntary, informed consent in writing was obtained from all participants before interviews were conducted. Data saturation was reached after 17 interviews were conducted with participants. Data were analysed with the help of an experienced co-coder. The researcher and co-coder reached consensus during a meeting organised for the purpose. Then the data were related to relevant literature. Seven categories emerged from the data analysis: Mechanisms of sharps injuries in the operating room, practical measures taken after a sharps injury, reasons for not reporting all sharps injuries, emotions experienced after a sharps injury, impact of sharps injuries on relationships, the support received by participants after a sharps injury and their coping mechanisms after a sharps injury. Several conclusions were drawn by the researcher from the data. Although all hospitals in this study had a reporting system in place, operating room personnel participating in this study did not report all their sharps injuries. They received no or insufficient support from hospital management after a sharps injury. No or insufficient communication existed between hospital management and participants in this study after these incidents. From these findings the researcher proposed guidelines for support to operating room personnel after sharps injuries and to increase the reporting of these incidents. The researcher also compiled recommendations for nursing practice, nursing education and nursing research in the operating room. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

Sharps injuries can transmit fatal blood-borne infections to injured health care workers. These blood-borne infections have serious consequences, including long-term illness, disability and death. The operating room is a fast-paced, hazardous working environment, where personnel are constantly exposed to sharps injuries. The psychological aspects of these injuries have received little attention. The emotional impact of a sharps injury can be severe and long lasting, even when a serious infection is not transmitted. Furthermore, according to literature, the mean rates of underreporting sharps injuries vary between twenty two and seventy five percent. The research objectives of this qualitative, explorative and descriptive study were to explore and describe the experiences of operating room personnel in the southern district of the North-West province in South Africa after sharps injuries, to explore and describe the reasons why they do not always report these incidents, to explore and describe what could be done to increase reporting of sharps incidents in operating rooms by personnel and to propose guidelines to support operating room personnel after a sharps injury. In order to achieve these objectives, the researcher gathered data by conducting semi-structured interviews with operating room personnel who had experienced sharps injuries in hospitals of the southern districts of the North-West in South Africa. Ethical considerations were adhered to by the researcher. Permission to conduct research was negotiated by the researcher with management of the hospitals in the target area. Voluntary, informed consent in writing was obtained from all participants before interviews were conducted. Data saturation was reached after 17 interviews were conducted with participants. Data were analysed with the help of an experienced co-coder. The researcher and co-coder reached consensus during a meeting organised for the purpose. Then the data were related to relevant literature. Seven categories emerged from the data analysis: Mechanisms of sharps injuries in the operating room, practical measures taken after a sharps injury, reasons for not reporting all sharps injuries, emotions experienced after a sharps injury, impact of sharps injuries on relationships, the support received by participants after a sharps injury and their coping mechanisms after a sharps injury. Several conclusions were drawn by the researcher from the data. Although all hospitals in this study had a reporting system in place, operating room personnel participating in this study did not report all their sharps injuries. They received no or insufficient support from hospital management after a sharps injury. No or insufficient communication existed between hospital management and participants in this study after these incidents. From these findings the researcher proposed guidelines for support to operating room personnel after sharps injuries and to increase the reporting of these incidents. The researcher also compiled recommendations for nursing practice, nursing education and nursing research in the operating room. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

Bakgrund: Operationsteamet består av ett komplext samspel mellan olika professioner som tillsammans ska arbeta kring patienten vid kirurgiska ingrepp. Kirurgisk säkerhetschecklista [KSC] är ett redskap som ska bistå med hjälp för samarbetet och kommunikationen inom operationsteamet. Det finns en stor mängd forskning som bevisar hur KSC förbättrar mortalitet, morbiditet och patientsäkerheten, trots detta har operationsteamet bristande följsamhet gentemot KSC. Syfte: Syftet med denna litteraturöversikt var att beskriva operationsteamets uppfattningar av att använda KSC. Metod: Litteraturöversikten baserades på 14 vetenskapliga artiklar av kvalitativ, kvantitativ och mixad ansats. Artiklarna kvalitetsgranskades, analyserades, sönderdelades, tematiserades och sammanfogades till denna översikts resultat. Resultat: KSC kunde bidra till förbättrat teamarbete, kommunikation, och arbetsmiljö på operationssalen, samtidigt uppmärksammades olika hinder med samarbetet kring KSC. Personliga attityder, ställningstaganden och övertygelser hos de olika professionerna var faktorer som påverkade teamarbetet. Hur operationsteamet var lett påverkade även samarbetet kring KSC. Upplevelsen av tidsbrist och svårigheter med timing försvårade genomgången av KSC. Slutsats: Det är essentiellt att förstå den komplicerade arbetsmiljön på operationssalarna och hur KSC kan underlätta arbetet i operationssalen men även vilka faktorer som försvårar för operationsteamet att arbeta säkert. För att bilda en djupare uppfattning om operationsteamets komplexitet och arbete med KSC krävs vidare forskning. Resultatet av denna litteraturöversikt skulle kunna bistå med hjälp för klinikerna i sitt arbete kring säkerheten och samarbetet på operationssalarna. / Background: The surgical team consists of a complex interaction between different professionals who work together around the patient during surgical procedures. Surgical Safety Checklist [SSC] is a tool that should assist the interaction and communication within the surgical team. There is a great deal of research that proves how SSC improves mortality, morbidity and patient safety. The surgical team has despite that a lack of compliance with SSC. Aim: The aim of this litterateur review was to describe the surgical team’s perceptions of using the SSC. Method: The literature review was based on 14 scientific articles of qualitative, quantitative and mixed approaches. The articles were quality checked, analysed, broken down, thematized and merged into the result of this overview. Result: SSC was able to contribute to improved teamwork, communication, and work environment in the operating room, while at the same time various obstacles were highlighted with the collaboration around SSC. Personal attitudes, standpoints and beliefs within the various professions were factors that influenced teamwork. How the surgical team was led also affected the collaboration around SSC. The experience of lack of time and difficulties with timing made the performance of SSC more difficult. Conclusion: It is essential to understand the complicated work environment in the operating rooms and how SSC can facilitate the work in the operating room, also what factors hinder the operating team to work safely. In order to form a deeper understanding of the complexity of the operation team and their work with SSC, further research is needed. The result of this literature review could be of assistance to clinics in their work to improve safety and collaboration in the operating rooms.

A quantitative, descriptive and contextual research study was conducted to establish the impact of the South African Nursing Council regulation number 212 on the training of theatre nurses in the Northern are of the Eastern Cape Province. A survey was conducted, using a questionnaire as research instrument. Convenience sampling was used to select the required sample of registered theatre nurses employed in the area. The data analysis revealed that the way theatre nurses are utilized in the area does not yet show an impact in terms of the aim of this course namely to develop their knowledge, skills and attitudes in order to be effective practitioners. However, the respondents felt positive about the curriculum. / Health Studies / MA (Health Studies)

A quantitative, descriptive and contextual research study was conducted to establish the impact of the South African Nursing Council regulation number 212 on the training of theatre nurses in the Northern are of the Eastern Cape Province. A survey was conducted, using a questionnaire as research instrument. Convenience sampling was used to select the required sample of registered theatre nurses employed in the area. The data analysis revealed that the way theatre nurses are utilized in the area does not yet show an impact in terms of the aim of this course namely to develop their knowledge, skills and attitudes in order to be effective practitioners. However, the respondents felt positive about the curriculum. / Health Studies / MA (Health Studies)

Knowledge of The Joint Commission's National Patient Safety Goals and an effective provider cooperative practice involving communication and teamwork are essential for the delivery of safe and compliant patient care in the surgical setting. The purpose of this study was to assess the impact of an educational intervention for physicians and nurses designed to increase documentation of compliance with national patient safety standards. As events of noncompliance have impacted patient safety at the hospital where this project was conducted, measures were needed to assess barriers to compliance with standards of practice and to focus educational session plans on identified knowledge-base needs. The goal of this project involved bringing all surgical team members together for educational sessions on safety standards. Pre-intervention and post-intervention assessments of knowledge were administered to study participants. Additionally, random chart documentation audits were conducted before and after the intervention to assess the effectiveness of the education sessions on documentation compliance with the targeted standards. Outcomes of this study included improved knowledge of, and compliance with, national patient safety goals. Results may improve safe patient care at this hospital, reduce costs, and create mutual respect and teamwork, all contributing to the successful achievement of the organization's quality improvement goals.