Medicine and Health Sciences Commons^™

Barriers To And Facilitators Of Using Cognitive Aids In Perioperative Emergencies: An Integrative Review, Simon Almoite, Paula Foran

Journal of Perioperative Nursing

Problem identification: Perioperative emergencies, although infrequent, may lead to significant morbidity and mortality associated with anaesthesia and/or surgery. Human factor errors account for between 43 to 65 per cent of sentinel events in the perioperative environment. Cognitive aids were introduced to reduce a user’s cognitive workload and assist in adherence to key interventions during emergencies. Despite the availability of these aids, implementation of their use remains low. This integrative literature review will identify the barriers to and facilitators of the implementation of cognitive aids during perioperative emergencies.

Literature search: An electronic database search of EBSCO databases (CINAHL Complete, Health Source: …

The New Era Of Aspiration Risk: The Dilemma Of Glp-1 Receptor Agonists, Jack D. Madden Fanzca, Andrew K. Goyen

Journal of Perioperative Nursing

There is a new wave of aspiration risk heading towards our operating theatres in the coming years. The popular weight loss drugs, glucagon-like peptide (GLP-1) receptor agonists, are providing us with new dilemmas in fasting guidelines and airway management. What does the anaesthetic team need to know?

Evaluation Of Nursing Approach To Assessment Of Post-Operative Respiratory Depression Using A Simulation Model, Natalia Tarasova, Usha Asirvatham, Robin D. Goetz, Mariela Riveria, Juraj Sprung, Toby N. Weingarten

Journal of Perioperative Nursing

Introduction: Assessments of post-operative patients that have been carried out by health care providers before critical opioid-induced respiratory events often do not detect respiratory depression. We hypothesise that opioidinduced respiratory patterns present during sleep may not be properly recognised as providers typically awaken patients for vital sign checks, and awake state assessment is recorded. We used a simulation manikin model to test this hypothesis.

Methods: Nurses who work on a standard post-operative hospital ward volunteered to participate in a study designed to record vital signs on an adult male manikin. None of the nurses had formal critical care or postoperative …

Peripheral Nerve Catheter Securement: A Narrative Literature Review, Joshua M. Wiesel, Bernadette R. Findlay, Li Ching Ooi, Jennifer A. Stevens, Renata Hadzic

Journal of Perioperative Nursing

Peripheral nerve catheters are commonly used to provide analgaesia and improve patient outcomes. Catheter dislodgment, displacement or leakage can result in premature cessation of analgaesic effect. There are currently no published guidelines for how to secure peripheral nerve catheters.

This narrative review explores and integrates the available research into the efficacy of peripheral nerve catheter securement products and techniques to reduce catheter dislodgement and displacement.

All studies looking at peripheral nerve catheter securement methods were included from inception until 19 October 2022 across PUBMED, Scopus, Ovid, Google Scholar, EMBASE and The Cochrane Library. The Jadad scale and Newcastle–Ottawa scale were …

Effectiveness Of Virtual Reality Interventions To Reduce Pre-Operative Anxiety In Adult Surgical Patients In The Pre-Operative Period: Systematic Review And Meta-Analysis, Agnes Mulundu Mbewe, Zaneta Smith

Journal of Perioperative Nursing

Aims: To synthesise and evaluate the effectiveness of virtual reality (VR) interventions compared to standard care to reduce pre-operative anxiety in adult surgical patients during the pre-operative period.

Design: Systematic review of effectiveness and meta-analysis.

Data sources: MEDLINE, EMBASE, JBI EBP, PUBMED, CINAHL, SCOPUS, PsycINFO, Cochrane Library, EMCARE, World Health Organisation, WEB OF SCIENCE, Grey Literature, National Institute of Health & Care Excellence were searched with limits between 2010 to 2022.

Review methods: The review followed the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) guidelines. …

One Step Forward Or Two Steps Back?, Toni G. Hains

Journal of Perioperative Nursing

The Surgical Assistant Working Group (SAWG) draft report has been released, which proposes to allow nurses in the surgical assistant role to access a patient rebate from the Medicare Benefits Schedule (MBS). This will address some of the issues affecting access to surgery in Australia. While an initial read of the report has buoyed the spirits of those closely involved, it is with circumspection that we venture forward.

Measuring Surgical Patient Engagement: A Scoping Review, Rebecca Law, Dawn Wong Lit Wan, Sonja Cleary, Wanda Stelmach, Krinal Mori, Zhen Zheng

Journal of Perioperative Nursing

Background

Patient engagement is a patient’s capacity and willingness to participate and collaborate in their own health care. This scoping review aimed to identify tools used to measure engagement among surgical patients, the levels of engagement and the association between engagement and surgical outcomes. We hypothesise that highly engaged patients are more likely to achieve better surgical outcomes.

Review methods

MEDLINE/PubMed, CINAHL, SCOPUS and Embase were searched for studies that assessed adult perioperative patients for engagement. Analysis from charting the data identified the measurement tools, levels of capacity to engage and relationships between engagement and surgical outcomes.

Results

Twelve studies …

Improving Perioperative Communication: Can Labelled Theatre Caps Play A Role?, Maree Yates, Paula Foran

Journal of Perioperative Nursing

Studies have shown that approximately one third of operating room communications fail. This has a negative impact on patient safety, with half of all adverse events being attributed to communication failures. However, human factors have the capacity to protect patients. Aviation’s human factors strategies provide guidance for staff and are beneficial in the operating room. Currently, no intervention is universally applied to improve operating room communication and team performance. Closed loop communication, though poorly utilised, has been demonstrated to counteract communication errors, therefore protecting patient safety. In 2018, calls were made to take advantage of theatre caps to display staff …

Qualifying Thirst Distress In The Acute Hospital Setting – Validation Of A Patient-Reported Outcome Measure., Sharon Carey, Jacob Waller, Lucy Yueming Wang, Suzie Ferrie

Journal of Perioperative Nursing

Objective: This study aims to examine validity and sensitivity of two visual analogue scales (VASs), measuring thirst intensity and thirst distress, and compare them with a validated thirst discomfort scale (TDS).

Methods: This is a non-interventional, prospective and cross-sectional study. Researchers recruited 161 patients from an acute surgical hospital, who were identified at time of interaction as fasting. Data was collected using a questionnaire, which included the TDS. Criterion validity and construct validity was tested for the two VASs. Sensitivity was assessed based on the amount of time fasting from solid foods or fluids.

Results: Results showed the VAS for …

Variations In Covid-19 Airway Management And Preparedness Among Victorian Hospitals, Kaylee A. Jordan, Teresa M. Sindoni, Reny Segal, Keat Lee, Roni B. Krieser, Paul Mezzavia, Yinwei Chen, Irene Ng

Journal of Perioperative Nursing

The COVID-19 pandemic presents significant concerns surrounding the risk of transmission to health care workers involved in airway management of patients with suspected or known infection. Limited evidence has been available to guide the preparation of staff, intubation environments, team structure and personal protective equipment. Our study invited Victorian hospitals to complete a survey on their airway management practices and protocols, in order to assess the degree of variability in practice and preparedness. Twenty hospitals responded in September 2020, during Victoria’s second wave of COVID-19. Forty percent had dedicated COVID-19 intubation teams, all including consultant anaesthetists. Seventy-five percent had negatively …

The First Three Procedures That Marked The Dawn Of Surgery, Lois Hamlin

Journal of Perioperative Nursing

Archeological studies reveal that humans splinted fractures and operated on skulls. Other than dealing with wounds or fractures, early surgeons carried out three types of operative procedures – circumcision, trephination and lithotomy. The first two procedures are the most ancient, for it is hypothesised they were undertaken between 10 000 and 15 000 years ago. Circumcision was a religious, fertility or initiation rite or ritual and trephination was done for mystical as well as therapeutic purposes. In contrast, lithotomy commenced much later, between the 4th and 5th centuries BCE and therefore did not occur prehistorically. However, it is the first …

Post-Operative Use Of Hme Filter‑Protected Open Tracheostomy Circuit During The Covid-19 Pandemic, Way Siong Koh, Irene Ng, Megan Downing

Journal of Perioperative Nursing

Introduction

In the era of the COVID-19 pandemic, the avoidance of aerosol generating procedures (AGPs) is paramount to reduce the risk of viral transmission to staff and other patients. Perioperative management of a new tracheostomy is challenging as routine care, such as suctioning, frequently involves AGPs.

Methods

We developed and implemented an apparatus called the heat and moisture exchanger (HME) filter-protected open circuit. This enabled closed suctioning to be performed and allowed spontaneously breathing patients to be managed with an open circuit in a shared environment while reducing the risk of viral aerosolisation. We performed a prospective observational study of …

Undertaking The Surgical Count: An Observational Study, Victoria Ruth Warwick, Brigid M. Gillespie, Anne Mcmurray, Karen G. Clark-Burg

Journal of Perioperative Nursing

Objective

To systematically measure and describe perioperative nurses’ surgical count practices using the Surgical Count Observational Tool, to measure conformity with standardised processes and identify barriers and enablers influencing nurses’ practices.

Sample and setting

A large public tertiary hospital in Western Australia.

Methods

The Surgical Count Observational Tool (SCOT) was developed using the Content Validity Index over two Delphi panel rounds and then pilot tested. Individual observations were analysed according to 14 criteria based on the 2016 Australian College of Perioperative Nurses (ACORN) standard ‘Management of accountable items used during surgery and procedures’¹. Count processes were observed over …

Handover Using Isbar Principles In Two Perioperative Sites – A Quality Improvement Project, Patricia Kitney, Raymond Tam, David Bramley, Koen Simons

Journal of Perioperative Nursing

Background

ISBAR is a structured approach to communication between health care providers, particularly for the purpose of transferring patient clinical care. The ISBAR acronym refers to Identification, Situation, Background, Assessment and Request or Recommendation.

This paper provides the final report on a quality improvement project (QIP) that was carried out in the perioperative unit at two campuses of a large Melbourne metropolitan hospital. The final phase of this project addressed the concluding audits measuring compliance with ISBAR handover principles at selected handover episodes during the patient care journey through the perioperative suite. The previous two phases established baseline data for …

Will Robots Make Good Perioperative Nurses?, Jed Duff

Journal of Perioperative Nursing

New technology is always being introduced into health care and nursing as a profession has had to adapt. Technological advances have changed the practice of nursing from the introduction of the stethoscope to the electronic health record, and now robots and artificial intelligence (AI). With technological advancements occurring at an ever-increasing rate, more and more perioperative tasks will be delegated to robots and AI. The main question for perioperative nurses is, how can we remain relevant in the high-tech operating room of the future?

Type 1 Diabetes Perioperative Care: Preventing Harm To Patients, Rebecca Munt

Journal of Perioperative Nursing

Imagine you lived with a chronic condition that required you to make over 100 selfmanagement decisions every day. Imagine you have been admitted to hospital for a day surgery procedure and the health professionals have refused your request for access to a medication you need for survival. Imagine that as a result of missing this medication you have ended up in an intensive care unit (ICU) with a life-threatening condition. The life-threatening condition is diabetic ketoacidosis (DKA) and the medication you needed is insulin, because you have type 1 diabetes (T1D).

What Is The Scope Of Practice Of The Nurse Practitioner As A Surgical Assistant In Australia?, Toni G. Hains, Catherine L. Smith

Journal of Perioperative Nursing

Discussion around the scope of practice of all nurse practitioners (NPs) in Australia was a component of the recent review of NPs’ eligibility to have broader access to the Medical Benefits Schedule (MBS). This review process has been prolonged and, while the MBS review officially concluded on the 30 June 2020, no information regarding decisions about expanded NP access to the MBS for patient rebates had been disclosed at the time of publication. It is anticipated that the MBS review will contribute little change to NP access to the MBS.

The MBS is the primary funding process for private-sector medical …

The Impact Of Distractions And Interruptions In The Operating Room On Patient Safety And The Operating Room Team: An Integrative Review, Sonia Mackenzie, Paula Foran

Journal of Perioperative Nursing

Problem identification: In the operating room (OR), distractions and interruptions are frequent, impacting patient safety, coordination and efficiency and causing errors and patient harm. The OR team is impacted while attempting to perform critical work. This review explores the impact of distractions and interruptions in the OR on patient safety and the OR team.

Literature search: Inclusion and exclusion criteria were determined. Six databases were searched with the search criteria for inclusion being in English, peer-reviewed and published between 2014 and 2019. In total 296 papers were identified.

Data evaluation synthesis: Duplicates were removed, and 195 papers were screened …

A Daily Measure Of Job Satisfaction In The Operating Room: Investigating Its Value And Viability, Miriam S. James-Scotter, Lixin Jiang, Cameron Walker, Stephen Jacobs

Journal of Perioperative Nursing

Objectives: This study aims to explore the value, validity and viability of implementing a daily job satisfaction tool in the operating room setting (OR).

Sample and setting: A daily one-minute survey was developed and trialled with 269 OR staff members (123 nurses) over a three-week period within one New Zealand hospital.

Method: A feedback and validation survey was then administered to staff one week following the trial.

Results: The trial resulted in 569 tool submissions. A daily average of 71% of participants (69% nurses) reported feeling ‘pretty good’ or ‘great’ about their jobs, with ‘relationships and communication with colleagues’ …

Perioperative Nurses’ Engagement With The Surgical Safety Checklist: A Focused Ethnography, Julie A. Rogers, Paul Mcleish, Jan Alderman

Journal of Perioperative Nursing

Purpose

To gain greater insight into how nurses engage with the multidisciplinary team during the surgical safety checklist process.

Participants and setting

Participants were a purposeful sample of eight operating room nurses. The study was conducted in the operating room department of a major tertiary teaching hospital in South Australia.

Methods

Phase 1 employed participant observations while phase 2 employed semi-structured interviews.

Findings

Participants supported the use of the surgical safety checklist and valued its role to enhance patient safety. Multidisciplinary team culture played a significant role in how the checklist was conducted and heavily influenced the level of nurse …

Covid-19 And Perioperative Nursing – Inside The Nsw State Emergency Operation Centre, Sarah-Jane Waller

Journal of Perioperative Nursing

This article is a guest editorial describing how it was to work inside the NSW State Emergency Operation Centre, the COVID-19 response coordinating hub for the Australian state of New South Wales, in the early days of the pandemic.

The Imperative To Build Research Capacity And Promote Evidence-Based Practice In Australian Perioperative Nurses, Jed Duff

Journal of Perioperative Nursing

Evidence-based practice is considered the gold standard of care, and as such it is now an expectation of our patients, regulatory agencies and health care funders. Unfortunately, much of what we do in perioperative nursing continues to be based on tradition and history rather than robust clinical evidence. Even when evidence is available to use, it is often not fully applied in practice. If we want to maintain our standing as a leading nursing specialty, then we need to address this issue by engaging with research and growing our evidence base. To do this, we need to conduct and disseminate …

Pandemics: A Covid-19 Perspective, Lyn Bowen

Journal of Perioperative Nursing

The world is currently gripped by a pandemic, a term that is on everyone’s lips. However, six months ago, many would have found it difficult to define the terms pandemic, epidemic and outbreak, or explain the difference.

The emergence of a novel coronavirus, commonly referred to as COVID-19, has significantly changed our awareness. It has heightened our anxiety, like a primordial fear, leaving us feeling vulnerable, similar to how past generations reacted to pandemics.

Ecg For All Patients In The Pacu: Some Say, Why? I Say, Why Not?, Paula Foran

Journal of Perioperative Nursing

Currently in many Australian hospitals, electrocardiogram (ECG) leads are removed after the operative process and, despite the machines being freely available in the Post Anaesthesia Care Unit (PACU), they are not connected to all patients.

There are many evidence-based reasons why an ECG would be advantageous for perioperative patient safety, including the detection of often asymptomatic conditions such as myocardial injury after non-cardiac surgery (MINS) and new-onset atrial fibrillation, which has been shown to increase the risk of stroke. Advantages may also be seen in saving precious minutes in a cardiac arrest, and the ability for nurses to constantly observe …

Who’S Under The Mask? Colour-Differentiated Identification Labels For Perioperative Staff, Diana Bentley

Journal of Perioperative Nursing

Staff identification in the perioperative environment is difficult when all staff, students and visitors wear the same attire. All attire needs to be laundered to national standards for infection control governance and consequently attire cannot be individualised. In emergency situations it is also difficult to identify the roles of all staff with standard methods of identification.

The aim of the ‘Colour-differentiated identification labels’ project was to improve identification of all staff and visitors in the perioperative environment with the intended result being improved communication and safety among staff, patients and visitors. The project began in February 2018 with project leads …

Organ Procurement Processes In The Operating Room: The Effects Of An Educational Session On Levels Of Confidence And Understanding In Operating Room Registered Nurses And Surgical Technologists, Ann Ross, Janet Reilly, Emily Halla, Kathryn Anderson

Journal of Perioperative Nursing

Objectives: This project aimed to determine the effects an online educational course about organ procurement procedures (OPPs) in the operating room (OR) had on the levels of confidence and understanding among OR registered nurses (RNs) and surgical technologists (STs).

Sample and setting: Data were collected from OR RNs and STs in the United States (US) at a Level II trauma centre with 19 operating rooms that completes eight to ten OPPs per year. A graduate nursing leadership student in this hospital created a Microsoft PowerPoint educational course about OPPs as her capstone project.

Methods and variables: The course was developed …

The Perioperative Nurse Surgical Assitant (Pnsa) Of The Future, Olivia Sonneborn

Journal of Perioperative Nursing

Advanced practice nurse (APN) roles have been implemented across all areas of the Australian health service and have extended into the perioperative environment in the form of the perioperative nurse surgical assistant (PNSA) or non-medical surgical assistant (NMSA). With a growing and ageing population, Australia will see an increased demand for acute care nurses. For the PNSA role to expand to meet this demand, the role requires recognition and regulation in Australia. Education programs also need to meet the increasing demand for acute care nursing and provide quality, accessible and collaborative education programs to meet the needs of all nurses …

Changing Workplace Culture: What Would It Take To Speak Up?, Sandra Millis

Journal of Perioperative Nursing

Bullying in the health care environment historically has been tolerated and, in many cases, expected. The Health and Safety at Work Act 2015 has provided the necessary legislation to stimulate a move toward addressing the bullying culture within New Zealand hospitals. This article takes a reflective look at how speaking up about bullying, although difficult, is important in order to change workplace culture.

Factor V Leiden And Superior Mesenteric Artery Occlusion: A Case Study, Cristina Atayde

Journal of Perioperative Nursing

Factor V Leiden (FVL) is an inherited condition that prolongs the clotting process; this subsequently places individuals at a higher risk of developing a thromboembolism. This case study will discuss a 41-year-old female who developed a superior mesenteric artery occlusion with subsequent small bowel ischaemia on a background of FVL. The discussion will illustrate the rarity of an arterial occlusion, the risk factors that are associated with an ischaemic small bowel, the implications of inheriting FVL and some of the associated social aspects of an ileostomy.

Malignant Hyperthermia In A Regional Facility: A Case Study, Catherine Kleidon

Journal of Perioperative Nursing

Malignant hyperthermia (MH) is a rare hypermetabolic state that may be triggered by both anaesthesia and non-anaesthesia triggers. The main anaesthesia triggers for MH are the depolarising muscle relaxant suxamethonium and volatile anaesthetic gases. MH presents in several ways with not all clinical symptoms being required to make a diagnosis. Safe and efficient patient management of MH requires knowledge and understanding of this inherited disorder. The perioperative team need to be aware of the tasks that are required to manage this emergency. This case study will discuss a suspected episode of MH presenting in a patient late on Christmas Eve …