Now that the nursing process, along with good-quality nursing documentation, is being introduced into all areas of patient care, the need arises to document work of perioperative nurses in the operating theatre. Perioperative documentation is entirely different from nursing documentation, not only in terms of processing but also in terms of scope.This thesis consists of two parts: Theoretical and Empirical. The Theoretical focuses on the general issue of medical documentation used at the various hospital departments. The aim of the work was to (1) map current situation in the area of perioperative documentation at selected hospitals; (2) ascertain which components perioperative documentation is composed of; (3) find the opinion of nurses on the use of perioperative documentation; and (4) set up perioperative documentation. The research part of the thesis was a combination of quantitative and qualitative survey. For the quantitative survey, questionnaires were prepared and distributed to perioperative nurses working in operating theatres of hospitals throughout the Czech Republic. Two hypotheses were proposed. 1. Perioperative documentation is maintained at operating theatres. 2. Nurses consider perioperative documentation useful. Qualitative examination consisted in comparative analysis of perioperative documentation folders. The research set consisted of six perioperative documentation folders obtained from hospitals throughout the Czech Republic. Answers to the following three questions were sought: (1) Is perioperative documentation used at operating theatres? (2) Which parts is perioperative documentation composed of? (3) Does perioperative documentation comply with applicable legislation? The results were analyzed and processed into tables and graphs. The results show that nurses use perioperative documentation at operating theatres. From the research it follows that the processing of the perioperative folders is not fully compliant with applicable legislation. Although mandatory data are included in the vast majority of perioperative folders, the nursing process, as the information which is most important for nursing care, is missing from all of the perioperative folders analyzed. Despite this, nurses consider perioperative documentation useful, not only from the medical aspect but also from the legal, financial and informative aspects. The results of this research may stimulate creation of a unified model of perioperative documentation. This work may also serve as information material for students of medical disciplines.

The aim of the work: The aim of this thesis is to provide detailed information about organization and operation of today's operating rooms from nurse´s point of view. Operational treatment requires high demands on technical and material equipment, special staff training, perfect adherence to asepse, antisepsis, sterility as well as work organization. The thesis should also introduce the most urgent problems of the current situation of the operating rooms management. The most recent discoveries and proven methods are summarized in a simple and comprehensible form that will serve as a guide for perioperative nurses. Method: Qualitative research methods in the form of a semi-structured interview have been used. This thesis will use the qualitative survey method in the form of a semistructured interview along with snowball sampling. The research consists of respondents with finished specialization in instrumentation for the operating room who are still active in the given field. Current status: The organization and operation room management consists of two functional models. These are so called "sideline sterilization" versus central operating rooms. Both ways have their advantages and disadvantages related to workload, general nursing education, and operating rooms management. However, the least preferred option is a combination of both perioperative operations. Results: The results of the research focused on the centralization and operating rooms management show that "sideline sterilization" is considered an obsolete model of tool sterilization for operating rooms. The results also show that the model of central operating rooms with the combination of central sterilization is more modern and efficient both in terms of expenses and effort, not just for nurses but for all healthcare professionals. Conclusion: In accordance with the aim of this work the issue of centralization of operating rooms is pointed out, considering both the construction with the necessity to follow all known procedures in compliance with aseptic conditions, as well as the need of good management or nurse education. The results can be used for further research and as a further source of information for non-medical fields, mainly perioperative care.

A manutenção da integridade cutânea é um cuidado a ser prestado individualmente a cada paciente de forma integralizada com outros cuidados do intra-operatório, aplicando o conhecimento técnico e científico. Os cuidados de enfermagem promovidos ao paciente no período intra-operatório refletirão no pós-operatório3. Muitas lesões de pele têm seu início na sala de operação e segue se agravando no pós-operatório cirúrgico22. Esta pesquisa justifica-se pela escassez de estudos referentes às lesões de pele de pacientes desenvolvidas e observadas no período intra-operatório. Neste estudo exploratório, descritivo e de coorte o objetivo principal é verificar a incidência de pacientes submetidos à cirurgia cardíaca que desenvolveram lesões de pele no período intra-operatório, caracterizar as lesões e identificar os fatores de risco. A coleta de dados foi realizada no Centro Cirúrgico (CC) de um hospital público de ensino, de atenção terciária à saúde, predominantemente cirúrgico, especializado em cardiologia no município de São Paulo, a amostra do estudo foi de 182 pacientes. O estudo foi feito com um p significativo ( 0,05) frente aos testes estatísticos não-paramétricos. A maioria dos pacientes estudados foi do sexo feminino (67%), com idade mediana de 63 (53 70) anos. A raça branca foi predominante (63,2%). Os pacientes obtiveram a mediana do IMC de 26,15 (23,3 29) e os dias de internação apresentaram mediana de 6 (2 11). Quanto ao perfil clínico dos pacientes 49,5% apresentavam insuficiência coronariana, 18,7% insuficiência da valava mitral; 83,5% dos pacientes apresentavam hipertensão arterial, 22,5% tinham diabete insulino não dependente e 9,3% diabete insulino dependente; 20,9 faziam uso de álcool e 13,2 faziam uso de tabaco. Com relação à avaliação clínica da pele houve predominância da pele de coloração rósea claro com 76,4%, textura normal 56%, turgor normal 67% e 61,5% dos pacientes tinham umidade normal. Quanto à incidência de pacientes submetidos à cirurgia cardíaca que desenvolveram lesões de pele em decorrência do período intra-operatório obteve-se incidência de 20,9% (38). Tivemos que 35 (19,2%) lesões apresentaram-se como UP no estágio I, 02 (1,1%) lesões caracterizaram-se como abrasão, 02 (1,1%) feridas incisas, 01 (0,5%) laceração, 01(0,5%) queimadura elétrica superficial e 01(0,5%) UP no estágio II. Quanto aos fatores de risco para lesão de pele no período intra-operatório de cirurgia cardíaca, na análise estatística, considerando p< 0,05 apresentou-se com estatisticamente significante: a idade elevada (63 anos) p= 0,053; pele pálida apresentou p= 0,015; umidade normal da pele revelou p= 0,042; o tempo total de procedimento anestésico cirúrgico apresentou p= 0,035. Os pacientes que utilizaram o equipamento Eco Trans Esofágico teve significância estatística com p= 0,031 e para os que utilizaram o equipamento Desfibrilador Externo p= 0,01. Muito se tem estudado sobre a integridade da pele, relacionando a prevenção de UPs, porem ainda são escassos os trabalhos referentes sobre lesões de pele. O paciente cirúrgico traz consigo fatores de risco que colaboram com o desenvolvimento de lesões, portanto a enfermagem perioperatória deve estar atenta a todos os riscos para realizar um planejamento de assistência e cuidado individualizado para os pacientes / The maintenance of skin integrity is an individual care given to each patient that is integrated to other intraoperative cares, applying both technical and scientific knowledge. Nursing care provided to the patient in the intraoperative stage will reflect in the post-operative one3. Many skin lesions start in the operating room and worsen in the post-operative stage22. This research is justified by the scarceness of studies referring to skin lesions on patients that developed and were observed during the intraoperative stage. In this exploratory, descriptive and cohort study, the main objective was to verify the incidence of patients that underwent heart surgery who developed skin lesion in the intraoperative stage, to characterize lesions and to identify risk factors. The collection of data occurred in an Operating Room (OR) of a public teaching hospital, with tertiary health care, predominantly surgical, and specialized in cardiology in the Municipality of São Paulo, and the study sample was taken from 182 patients. The study was performed with a significant p ( 0,05) compared to the non-parametric statistics tests. Most of the patients studied were females (67%), with an average age of 63 year (53 70). Caucasians were predominant (63,2%). Patients had a BMI medium of 26,15 (23,3 29) and the average of hospitalization days was 6 (2 11). As for the patients clinical profile 49,5% presented heart failure, 18,7% mitral valve failure; 83,5% of the patients presented high blood pressure, 22,5% had non-insulin dependent diabetes and 9,3% had insulin dependent diabetes; 20,9 used alcoholic beverages and 13,2 were smokers. Concerning the clinical skin evaluation, we found a predominance of light pink skin coloration in 76,4%, 56% normal texture, 67% normal turgor, and 61,5% of the patients had normal skin moister. As for the incidence of patients that underwent heart surgery, which developed skin lesions due to the intraoperative stage, an incidence of 20,9% was obtained.(38). We found that 35 (19,2%) lesions presented Stage I PU, 02 (1,1%), lesions were characterized as abrasions, 02 (1,1%) incise wounds, 01 (0,5%) laceration, 01(0,5%) superficial electric burn and 01(0,5%) Stage II PU. As for risk factors for skin lesions in the intraoperative stage of heart surgery, during the statistics analysis, considering p< 0,05, showed as statistically significant: the increased age (63 years) p= 0,053; the presentation of pale skin p= 0,015; normal skin moister of p= 0,042; the total time of the anesthesia procedure with p= 0,035. Patients that used Esophagic Trans Echo equipment had statistical significance with p= 0,031, e the ones that used the External Defibrillator equipment p= 0,01. The integrity of the skin referring to PUs prevention has been well studied however there are still few works about skin lesions. The surgery patient is followed by risk factors that co-operate with the development of lesions; hence perioperative nursing must be aware of all risks to elaborate an individual care and assistance plan for patients

Title of the thesis: Specifics of the nursing care of patients with MRSA in the operating room from an anesthesiology nurse perspective. The aim of this thesis was to identify the specifics of nursing care of a patient with the MRSA in the operating room from the perspective of nurses working in the operating room. In the theoretical part focus is given to nursing care and its specifics for a patient with MRSA. Chapters relating to the regime measures, barrier nursing procedures and the use of specific aids, instruments and tools are treated in detail. The nursing care provided by anesthesia nurses and perioperative nurses in the operating room is defined. To reach the goals the quantitative research through questionnaires was chosen. The research sample consisted of anesthesia nurses and perioperative care nurses. Two types of standardized questionnaires were used, consisted of closed questions where respondents chose an appropriate answer, and from semi-open questions where respondents could specify their answers, and in one case open questions. Both questionnaires were completed by 12 test questions, where respondents had the choice of three possible answers, where one answer was correct. The results of the investigation are summarized in two types of graphs. Bar charts were used in questions where more answers were possible to mark, and for a better clarity the results were supplemented by tables. Results to other questions, where options were limited by one answer, are shown in percentages in pie graphs. Our thesis is very narrowly focused, because we concentrated on specifics of nursing care in a patient with MRSA in the operating room. We have determined the specifics of barrier nursing, nursing problems in a patient with MRSA in the operating room. We have discovered barrier nursing procedures in a patient with MRSA in the operating room. We have also succeeded in assessing the knowledge of nurses working in the operating room. The goal was met. An interesting finding was that most of anesthetic nurses and perioperative nurses had responded that the structural and technical arrangement in the operating room was not satisfactory in terms of barrier nursing of a patient with MRSA. This problem was expected, owing to the author´s experience in operating theaters. Thus Hypothesis 1 is confirmed. In total five hypotheses were stated, four of which were confirmed and one was disproved. The aim of the thesis was to draw attention to problems in the operating room during nursing a patient with MRSA. In the course of the research work there were no problems, however, it is necessary to mention the lack of literature on MRSA with regard to nursing care in operating theaters. The theoretical section of this thesis could be recommended as a resource for the education plan created on the basis of information collected and the results of this research. The results of the research survey may serve for general public, anesthesia and perioperative nurses who could benefit from the educational plan in practice while providing nursing care for a patient with MRSA.

Bakgrund: Informationsöverföring sker kontinuerligt i den perioperativa vården. Det anses vara ett riskmoment när patient och information överförs till ny personal och vårdenhet. Kontinuitet, kvalitet, effektivitet och patientsäkerhet uppnås genom att operationssjuksköterskan initierar och genomför adekvat informationsöverföring i samband med patientens kirurgiska ingrepp. Syfte: Var att belysa den perioperativa sjuksköterskans upplevelser av informationsöverföring, pre- och postoperativt. Metod: En litteraturstudie med systematiskt tillvägagångssätt i enlighet med Bettany-Saltikov och McSherry (2016). Resultatet baseras på analysen av tolv kvalitativa vetenskapliga artiklar. Resultat: Resultatet påvisade att det fanns flertalet brister i den perioperativa informationsöverföringen och att den upplevdes som komplex. Resultatet redovisades i tre huvudkategorier; Utspridd och bristfällig information, Förutsättningar för informationsöverföring samt Människans inverkan på informationsöverföring. Slutsats: Många faktorer påverkar informationsöverföringen pre- och postoperativt utifrån den perioperativa sjuksköterskans upplevelser. Då medlemmar av det kirurgiska teamet inte alltid medverkar vid den postoperativa patientöverlämningen  finns en risk för att kirurgisk information kan gå förlorad. När  informationsöverföringen brister kan det ge upphov till negativa konsekvenser för patienten. / Background: The transfer of information within perioperative care, is a continuous process. When a patient, together with the relevant patient-information is transferred to a new carer and care unit, there is considered to be an element of risk involved. Continuity, quality, efficiency and patient safety will be achieved when the operating theatre nurse initiates and implements an adequate transfer of information, in connection with the patient’s surgical procedure. Aim: To illustrate how perioperative nurses experience the pre and postoperative transfer of information. Method: A systematic literature review in accordance with  Bettany-Saltikov and McSherry (2016).  The result is based on an analysis of twelve qualitative, scientific articles. Results: The study results demonstrate that there are several deficiencies during the transfer of perioperative information, and that it is perceived as complex. The results are presented in three main categories; Scattered and inadequate information, Prerequisites for information transfer and The human influence on information transfer. Conclusion: Based on the experiences of the perioperative nurses, there are many factors which influence the pre and postoperative transfer of information. As members of the surgical team do not always participate in the postoperative patient handover, there is a risk that surgical information may be lost. There can be negative consequences for the patient when the transfer of information is inadequate.

Preoperative safety procedure is a departmental safety goal laid down by the Ministry of Health of the Czech Republic. The providers of health care directly controlled by the Ministry of Health of the Czech Republic are obliged to putpreoperative safety procedure and its documentation into practice, other health care organizations are recommended this implementation. However, the Ministry does not specify the formof this procedure nor its process in the operating room, there is no uniform documentation prescribed and last but not least, it is not clearly laid down which person of the operational team is responsible for the correct implementation of this procedure. The goal of the research is to map the preoperative safety procedure in the operating theatres in selected hospitals, to compare the process of the preoperative safety procedures in the operating theatres among the addressed hospitals, to describe the competencies of perioperative nurses during the preoperative safety procedures in the operating theatres in the selected hospitals and to find out the attitude of the perioperative nurses to the preoperative safety procedure. In the selected hospitals the safety procedure is introduced and implemented in different ways. The preoperative safety procedure in the operating theatres is introduced as an administrative act, but not as a practical tool to improve patient safety. The competences of perioperative nurses in preoperative safety procedures are not clearly specified in all of the respondent hospitals. The perioperative nurses adopt entirely positive approach to that, in most cases they believe it is important for ensuring the safety of the patient.