Perioperative, Operating Room and Surgical Nursing Commons^™

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

Ischemic Stroke, Rachele Gualtieri

Nursing Student Class Projects (Formerly MSN)

Stroke is one of the leading causes of death in the United States, and a very large percentage of those who suffer a stroke experience an ischemic stroke. It is detrimental that the healthcare providers caring for these patients are proficient in understanding the pathophysiology and treatment of a stroke to preserve maximal function of the brain and promote a full recovery. It is also crucial that providers are aware of risk factors for stroke, events leading up to an ischemic injury, and the events that follow an ischemic injury. This poster discusses the underlying pathophysiology, signs and symptoms, risk …

Academic Center Tiered Operating Room Strategy (Action): Comparing A High Efficiency Or To The Conventional Or, Moaz Bin Yunus Chohan

Electronic Thesis and Dissertation Repository

Canadian healthcare system is under immense economic pressure. In an attempt to resolve the problem, outpatient surgical services were offered to patients presenting with orthopaedic surgical complaints. An observational cohort study was carried out, comparing the conventional surgical setup to the newly designed high-efficiency setup that provided similar care, with a significantly lower operating cost. A total of 200 patients were enrolled in the study. Standardized and unstandardized questionnaires were used to evaluate pre-operative and post-operative patient data that reflected quality of life outcomes. Data was collected at enrolment and during post-operative follow-ups of up to 6 months. Results indicate …

Decreasing Opioid Overprescription Following Outpatient Gynecology Surgery, Monica Kistler

Dissertations

Problem: Opioid abuse may be a result of overprescribing opioids. There are no opioid prescribing recommendations for minor gynecologic surgery. As a result, there is a wide variation in prescribing practices at a privately-owned surgery center where excessive opioid prescription occurs.

Methods: A quality improvement initiative with a descriptive, cohort design. A retrospective review of medical records and telephone surveys over three months resulted in the development of a series of posters describing prescription data for three procedures: hysteroscopy dilation and curettage (HDC), uterine ablation (UA), and laparoscopy (LAP). The trends and changes in opioid prescription practices were displayed throughout …

The Value Of A Perioperative Nurse, Nicholas Ralph

Journal of Perioperative Nursing

No abstract provided.

Australian Perioperative Nurses’ Attitudes, Levels Of Knowledge, Education And Support Needs Related To Organ Donation And Procurement Surgery: A National Survey, Zaneta Smith, Cindy Woods, Kim Usher, Jackie Lea

Journal of Perioperative Nursing

Objectives: The aim of this study was to examine Australian perioperative nurses’ self-reported knowledge, attitudes, levels of education and support in relation to their participation in organ donation and procurement surgery.

Sample and setting: Data was collected from Australian perioperative nurses who are members of the peak national body Australian College of Perioperative Nurses (ACORN).

Methods: An online survey was distributed to ACORN members on behalf of the researchers. The online survey comprised 67 items encompassing open- and closed-ended questions along with graded Likert and ordinal multicategory scales.

Results: Of ACORN’s 4000 Australian members, 452 (11.3 per cent) responded to …

Improving Hand Surgery Pain Management Results Using A Key Phrase And Patient Feedback: A Quality Improvement Project In A United States Ambulatory Surgery Site, Janet E. Reilly, Brenda Tyczkowski, Stacie Murley

Journal of Perioperative Nursing

Objective: The objective of this study was to report changes in patient pain satisfaction and quality indicator scoring of post-operative pain using key phrasing, or standardised scripts, as the nursing intervention.

Sample/setting: Data was collected from an ambulatory surgery clinic in an American non-profit, 185-bed community hospital which is part of a nationally ranked health system.

Method: This study used a before-and-after design in which quality improvement data was collected from the Press Ganey™ ambulatory surgery surveys completed by patients undergoing hand surgery. Changes in outcomes were measured three months before and during the key phrase intervention.

Results: Data indicated …

Implementing A Surgical Site Infection Care Bundle: Implications For Perioperative Practice, Elaine Michelle Proops

Journal of Perioperative Nursing

Surgical care bundles are made up of a group of evidence-based practice interventions which when performed together can have a positive outcome on patient care. The ACORN Standards for Perioperative Nursing in Australia outline practices that should be adhered to in Australia; however, practices can be further refined clinically to ensure best practice. Surgical site infection is one of the most preventable causes of hospital-acquired infections in Australia. Research suggests that care bundles implemented by the perioperative team can reduce the incidence of such infections while also offering additional benefits.Surgical site infection intervention bundles can support nurses in their evidence-based …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Reducing Ed Re-Admissions In Post-Op Neuro Patients Utilizing A Np Telephone Follow-Up Protocol, Katherine Curran

Doctor of Nursing Practice Final Manuscripts

Reducing ED Re-admissions in Post-Op Neuro Patients utilizing a NP Telephone Follow-up Protocol

Background

Post craniotomy patients discharging from the hospital to home, commonly present to the emergency department (ED) with incisional concerns. Complaints stem from minimal post-op education, poor incision management, and lack of knowledge relational to infection. Unanswered questions prior to discharge lead to unnecessary ED visits, anxious calls after discharge, and poor patient satisfaction. ED admissions lead to fortuitous costs that can be prevented through evidenced based interventions.

Purpose/Aim

Post craniotomy patients at a large hospital system in Southern California will have decreased ED visits correlated to …

Operative Times In Adolescent Idiopathic Scoliosis Surgery. What Do They Mean?, Joanne Abby Marasigan

Research Days

No abstract provided.

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

The Lived Experience Of Recovery Following Transoral Robotic Surgery (Tors) For Head And Neck Cancer, Katharine Mahalik

Electronic Theses and Dissertations

Abstract

Ongoing advances in minimally invasive surgical techniques, such as transoral robotic surgery (TORS), has enabled select patients with head and neck cancer to receive treatment that results in less disfigurement and dysfunction compared with traditional approaches. While TORS research has focused mainly on functional surgical outcomes, a need exists to understand recovery following TORS from the patient perspective. A hermeneutic phenomenological approach was used to recruit patients who had recently undergone TORS at a major academic health system in northeastern US. Data were collected using audio-recorded telephone interviews and field notes and analyzed concurrently. Participants included 17 HNCS (12 …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Implementation Of Crisis Checklists In The Operating Room, Gregory S. Feilner

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Comparing Two Surgical Outcomes: Minithoracotomy Or Full Sternotomy In Coronary Artery Bypass Grafting Surgery, Shirin Badrkhani

Doctoral Projects

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG).

Specifically, there is inadequate data to compare these …

Surgical First Assist: An Educational Program For Advanced Practice Providers, Sandra Walton Mobley

Doctoral Projects

As the number of surgical procedures increase, many Advanced Practice Providers (APPs) are being required to scrub in as a First Assist (FA). Unfortunately, many APPs lack any formal surgical training. The Association of perioperative Registered Nurses (AORN) now requires that all advanced practice providers in the perioperative environment to complete a course that complies with Registered Nurse First Assist (RNFA) standards. The purpose of this project was to evaluate knowledge acquisition of APPs participating in a surgical FA educational program. A surgical FA course was comprised of five days of didactic learning, which included lecture, small groups, skills lab, …

The Effect Of Basal Bolus Insulin Administration Vs. Sliding Scale Insulin On Glycemic Control In Patients With Type 2 Diabetes Mellitus At A Community Hospital, Meriam Signo

Doctoral Projects

Evidence of effective insulin delivery by nurses can help prevent fluctuating plasma glucose levels of Type 2 diabetes mellitus (T2DM) in the hospital setting. Information leading to better diabetes care using either basal bolus insulin administration (BBI) or sliding scale insulin (SSI) is essential for safe blood sugar values. The purpose of this project was to measure patient glycemic control after the implementation of BBI vs. SSI during a patients’ stay in the hospital. This study was a quantitative, retrospective exploratory chart review of T2DM in medical-surgical units at a Northern California community hospital. The data were collected from routine …