project topics in perioperative nursing

A Five-Step Evidence-Based Practice Primer for Perioperative RNs

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• AORN journal 112(5):506-515
• 112(5):506-515

• Landstuhl Regional Medical Center

• University of Utah
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Article Contents

Introduction, significance of the problem and current practice, pico question and project formulation, project setting, data analysis, acknowledgments, institutional review board (human subjects), conflict of interest statement.

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Periop 101: Improving Perioperative Nursing Knowledge and Competence in Labor and Delivery Nurses Through an Evidence-Based Education and Training Program

The findings presented in this manuscript have not been previously published or presented. The views expressed are solely those of the authors and do not reflect the official policy or position of the TriService Nursing Research Program, the AORN Foundation, U.S. Army, U.S. Air Force, U.S. Navy, the Department of Defense, or the U.S. Government.

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Christopher H Stucky, Albert R Knight, Rebeccah A Dindinger, Shannon Maio, Sherita House, Joshua A Wymer, Amber J Barker, Periop 101: Improving Perioperative Nursing Knowledge and Competence in Labor and Delivery Nurses Through an Evidence-Based Education and Training Program, Military Medicine , Volume 189, Issue Supplement_1, January/February 2024, Pages 24–30, https://doi.org/10.1093/milmed/usad287

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To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience.

The purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence. Our population, intervention, comparative, and outcome question was, “For labor and delivery nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)?” We implemented Periop 101: A Core Curriculum—Cesarean Section training for 17 L&D nurses, measured knowledge using product-provided testing, and assessed competence using the Perceived Perioperative Competence Scale-Revised.

We found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses demonstrated the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. Nurses reported significantly greater perceived competence across all six domains of the Perioperative Competence Scale-Revised, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency.

We recommend that health care leaders develop policies to standardize perioperative education, training, and utilization for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.

The operating room (OR) is one of the most complex work settings in health care, with frequent unpredictable surgical events requiring a rapid and competent response from trained perioperative registered nurses. 1 Developing expertise in the perioperative nursing specialty requires a broad knowledge base of nursing science, an understanding of surgical anatomy and intraoperative risk factors, competence in collaborating with interprofessional team members and patients, and awareness of physiologic alterations that threaten optimal surgical outcomes and patient health. 2 , 3 This knowledge, guided by nursing education and clinical experience, enables the perioperative nurse to anticipate patient and surgical team needs and provides the clinical acumen to evaluate and act on potential safety threats. Perioperative nurses meet the challenges inherent in the surgical setting after completing a rigorous training program to gain the requisite knowledge and skills required to perform the role. The role-specific training enables the perioperative nurse to proactively safeguard surgical patient rights and the capacity to serve as the primary patient advocate during times of extreme vulnerability.

The most common surgical operation performed worldwide is a cesarean delivery, a major surgery with inherent risks to mothers and babies. 4 Supporting improved maternal outcomes, cesarean deliveries account for nearly 1 in every 14 surgeries performed globally. 4 In the United States, approximately 1.2 million women undergo a cesarean delivery annually, comprising over 32.1% of all deliveries in 2021. 5 Surgeons also perform additional urgent and emergent surgeries in the labor and delivery (L&D) OR suite based on patient condition and urgency of care. Surgery is not without consequence, as complications may arise during surgery requiring specialized surgical knowledge from all team members.

In military and civilian hospitals, either L&D or perioperative nurses provide skilled surgical nursing care for cesarean deliveries in the L&D unit surgical suites. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience. Nevertheless, L&D nurses are expected to manage surgical patients and supervise the care provided by the surgical technologist in the L&D surgical suite with the same standard of care and level of proficiency as that of trained, experienced, and skilled perioperative nurses. The purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence.

The education, training, and utilization of L&D nurses vary across health care settings and within the Military Health System (MHS). Across the MHS, the utilization of L&D nurses to support cesarean deliveries relies on institutional historical precedent, the vision of hospital leadership, and the branch of service. Some Army hospitals require L&D nurses to provide intraoperative surgical care for cesarean deliveries, whereas others do not. Likewise, Air Force L&D nurses only provide intraoperative surgical support when working at jointly staffed, Army commanded hospitals. This non-congruence of policies and practices leads to varying levels of expertise and capabilities across the enterprise.

In contrast, military perioperative nurses attend a rigorous 16-week perioperative nursing course as part of their initial entry into the role. Army, Air Force, and Navy nurses attend perioperative nursing courses with comparable training curricula at various locations. The perioperative nursing course provides foundational instruction for nurses to meet the scope of practice requirements necessary to provide safe patient care across perioperative phases (i.e., preoperative, intraoperative, and postoperative) and in a multitude of physical locations, garrison and operational.

The Army and Air Force training course for L&D nurses focuses on providing patient care during pregnancy, labor, and childbirth and does not provide an extensive intraoperative surgical care practicum or comprehensively instruct nurses on the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice. L&D nurses receive cesarean delivery training in several ways, either a minimal version of didactic and clinical in a formal course or as part of their initial orientation, often a blend of clinical experiences and mentorship from others in their unit. This orientation varies in quality, as the L&D preceptors learned their role from others who did not receive the appropriate underlying education and training. This training approach perpetuates a non-standardized perioperative knowledge base that greatly differs depending on the military treatment facility. Additionally, a core perioperative nursing duty is supervising the care provided by surgical technologists and other allied health professionals. Inadequate training potentially leaves L&D nurses unprepared to comprehend the full breadth of their role, especially when supervising allied health professionals performing complicated tasks.

Thus, we formed a multidisciplinary team of nurse scientists and perioperative and perinatal clinical nurse specialists to identify and target potential weaknesses in health care quality for evidence-based practice (EBP) initiatives. We analyzed formal course training and reviewed the data from medical case reviews and patient safety reports, which indicated that L&D nurses have potential knowledge deficits in intraoperative surgical care and exhibit role ambiguity when caring for surgical patients. The team conducted a risk assessment of L&D nursing practices and identified marked variances in staff member perioperative nursing education and training.

For L&D nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)? We used the population, intervention, comparative, and outcome (PICO) question to guide a systematic, efficient, and thorough literature search.

The literature reviewed pertained to education and training modalities, including traditional didactic and simulation. 6 , 7 Researchers concluded that traditional training methods and simulation were both effective in increasing learner performance and skill. 7 , 8 However, investigators found that simulation was potentially more effective than traditional methods and advocated for a blended or multimodal approach. 6–9 Very little research on perioperative skills education exists in maternity environments. 10 Previous investigators found a lack of knowledge among L&D nurses in basic perioperative practices and unequal levels of competence and confidence, leading to recommendations of standardized training programs to ameliorate these inadequacies across specialties. 10

During the literature search, the team identified “Periop 101: A Core Curriculum—Cesarean Section” as an appropriate evidence-based training program. 11 Previous investigators found that implementing Periop 101 reduced cesarean birth-related incident reports while simultaneously improving nursing perioperative cesarean birth knowledge and self-efficacy. 12 Of note, the implementation occurred at a military hospital with many of the same site-specific role and training challenges. 12

We chose the Periop 101: A Core Curriculum—Cesarean Section after carefully reviewing the curriculum and format to ensure that the training program would provide an optimal learning experience that maximizes perioperative subject comprehension and knowledge retention. The Periop 101 program of study uses a blended learning model incorporating didactic online instruction, video instruction, simulation, skills-based labs, and clinical preceptorship. 11 The program’s foundational evidence is based on recommendations from the “AORN Guidelines for Perioperative Practice” to improve patient and workplace safety. Many civilian hospital leaders now require the course for basic entry into the L&D setting as part of their onboarding process. 11

The project site is a 100-bed, jointly staffed (Army and Air Force) regional military medical center located in Southern Germany. The L&D section supports over 750 annual deliveries and is the only American referral center for high-risk obstetric patients serving eligible beneficiaries throughout Europe, Western Asia, and Africa, with an active Storknest program for expectant mothers in remote locations. The L&D unit has six private birthing rooms and supports cesarean deliveries in two surgical suites. At the project site, L&D nurses from Air Force, Army, and Defense Health Agency civilians provide scheduled, urgent, and emergent surgical care and supervise surgical technologists who typically work in the main OR. All L&D nurses working in the project hospital undergo an orientation process lasting from 4 to 10 weeks, depending on individual competency levels, and shadow an experienced preceptor in the L&D surgical suite.

In this EBP project, we implemented the Periop 101: A Core Curriculum—Cesarean Section program in a voluntary group of L&D nurses to standardize and strengthen their training while assessing for changes in their perioperative knowledge and competence. As the framework to augment the implementation of this project from initiation to conclusion, we employed a methodological EBP approach described in greater detail in Stucky et al. 13 and the Iowa Model of Evidence-Based Practice. 14 We obtained a grant from two external funding agencies to purchase Periop 101 and two textbooks: “Alexander’s Care of the Patient in Surgery” and “AORN’s Guidelines for Perioperative Practice.” The project was reviewed and determined to not meet the criteria for human subject research by the institutional human research protection program.

We obtained administrative scheduling approval from L&D unit leaders and enrolled all 17 clinical nurses as instructional learners into the program at various dedicated time intervals. To deliver the course content, a team of perioperative and perinatal experts functioned as clinical preceptors, educators, and program administrators. Upon enrollment into the program, course administrators informed learners of the 3-month learning curriculum timeline and administered baseline knowledge and perceived perioperative competence assessments. Post-training, learners completed an additional perceived competence assessment and provided feedback to the team to refine future learning.

Periop 101: A Core Curriculum—Cesarean Section

Periop 101: A Core Curriculum—Cesarean Section contains 25 highly interactive modules combining didactic learning, hands-on skills labs, group activities, clinical practicums, and video demonstrations that provide 35.6 contact hours after successful completion. The practicum included 120 hours of clinical perioperative nursing experience in the main OR, which provided L&D nurses exposure to a wide range of surgical cases. Additionally, learners spent clinical time bolstering their perioperative knowledge base in the preoperative, post-anesthesia, and sterile processing departments.

Nursing leaders assigned learners to the Periop 101 program administrators through training completion, enabling them to complete the program as their assigned duty. All 25 self-paced modules have an electronic posttest that learners must pass with a minimum score of 80% before proceeding to the next module. Additionally, the course instruction includes a final comprehensive exam that nurses must pass with a minimum score of 80% to receive continuing education credit. The EBP team refined the skills lab checklists to meet organizational and institutional policies and practices.

Project Outcomes

Perioperative knowledge.

We measured perioperative knowledge using the results from the product-provided testing materials. Upon program enrollment, course administrators had learners complete a pretest comprising 222 product-provided posttest questions from the 25 learning modules (5–11 questions per module). Thus, we established a baseline of perioperative knowledge with pretest scores to compare to posttest scores after learners completed their self-paced modules. We administered the pretest via paper and pencil format and compared it to the posttest electronic results from the product-provided software.

Perioperative Nursing Competence

Competence is a fundamental aspect of safe and efficient clinical practice. 15 We administered the Perceived Perioperative Competence Scale-Revised (PPCS-R) 16 to all project participants upon enrollment into the program and after completing the clinical practicum, modules, and the final exam. The PPCS-R is a rigorous and psychometrically validated self-assessment tool for perioperative nursing competence. 16 Investigators use the PPCS-R to identify individual nurse areas of strengths and limitations in six general areas of perioperative nursing practice: Foundational skills and knowledge; leadership; collaboration; empathy; proficiency; and professional development. The 40-item PPCS-R uses a 5-point Likert scale ranging from never (1) to always (5). The PPCS-R author provided permission to use the scale and agreed with the applicability in the setting and sample.

Comparing Pretest and Posttest Perioperative Knowledge Scores

We generated descriptive statistics to summarize pretest and posttest scores for the 25 learning modules. Given the nonnormal distribution of the data, we used a nonparametric Wilcoxon signed-rank test to determine whether there were statistically significant differences between nurses’ pretest and posttest scores for each learning module.

Comparing Pretest and Posttest PPCS-R Competence Scores

We calculated the nurses’ pretest and posttest scores on the six perioperative competence subscales by summing the item scores within each subscale. Then, we summed the scores on the six subscales to generate a total perioperative competence score for each nurse. Higher scores corresponded to greater perceived perioperative competence. Descriptive statistics were generated to summarize the pretest and posttest scores for the six subscales and the total score. The difference between pretest and posttest competence scores was analyzed using a Wilcoxon signed-rank test. To confirm the instrument was reliable for the group of nurses, we estimated the reliability of the six PPCS-R subscales on both testing occasions using Cronbach’s alpha. We used STATA version 15.1 for all statistical analyses, and statistical significance was determined by a P -value ≤.05.

All 17 L&D nurses enrolled in the project completed the Periop 101 program, the corresponding knowledge testing, and the PPCS-R. Most nurses were between 25 and 34 years of age ( n  = 11, 64.7%), and 16 (94.1%) of the 17 nurses were female. Most nurses ( n  = 13, 76.5%) had a bachelor’s degree in nursing, and four nurses (23.5%) had a master’s degree in nursing. Perioperative-specific nursing experience ranged from less than 2 years to more than 20 years, with most nurses ( n  = 13, 76.5%) reporting 5 or fewer years of experience circulating/providing perioperative nursing care for cesarean deliveries. Of the 11 (64.7%) nurses who reported holding a specialty nursing certification, eight nurses reported the Inpatient Obstetric Nursing (RNC-OB) certification, two reported having the RNC-OB certification and another certification not specified in the survey, and one nurse did not report the nursing certification they held. Learners finished the Periop 101 course of instruction with completion times ranging from 2 weeks to 3 months.

At the start of the Periop 101 course, the group of nurses lacked knowledge of multiple topics covered in the course modules. As shown in  Table I , the median pretest score for 19 of the 25 modules was less than 70%. Following the completion of each module, the nurses’ scores noticeably improved. Results of the Wilcoxon signed-rank test revealed that these differences were statistically significant, such that nurses’ perioperative knowledge scores significantly increased after the completion of each module. Among the 25 module topics, nurses showed the greatest improvement in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. The nurses’ comprehension of the program topics was corroborated by their final exam scores, which were all passing scores of 80% and above. Results also reveal that perioperative nursing knowledge was less varied across the group of nurses after completing the course, as the average SD of knowledge scores decreased from 14.57 before module training to 6.21 after module training.

Comparison of Perioperative Knowledge Scores on the Periop 101 Module Tests Before and After Completing Module Training

Perioperative Competence

Table II summarizes perioperative competence scores from before and after the Periop 101 training program and presents the results of the Wilcoxon signed-rank test. At the start of the Periop 101 training program, median self-reported competence scores across the six domains of the PPCS-R were moderate compared to the highest possible score. After the nurses completed the Periop 101 program, their perceived competence considerably improved. Based on the Wilcoxon signed-rank test results, nurses reported significantly greater perceived competence across all six domains of the PPCS-R after completing the program. Of the six competence domains, nurses showed the greatest improvement in foundational skills and knowledge, leadership, and proficiency, as the increase in median scores was 47.8%, 41.7%, and 41.2%, respectively.

Comparison of Perioperative Competence Scores on the PPCS-R Before and After Completing the Periop 101 Course

The Cronbach’s alpha reliability estimates for the six PPCS-R subscales ranged from 0.88 (collaboration) to 0.95 (leadership) for the pretest and 0.89 (professional development) to 0.96 (empathy) for the posttest. These reliability estimates indicate that the PPCS-R was sufficiently reliable for this group of nurses.

Our results show that implementing an evidence-based training program for L&D nurses can improve their perioperative nursing competence and knowledge. Nurses were very receptive to the training and provided positive feedback on the course content, skills checklists, and clinical practicums. Through clinical experiences in the main OR, L&D nurses provided care for a broader range of surgical cases and appreciated the standardized approach to many critical OR patient life safety functions, including fire protection, briefing and debriefing, and surgical timeouts. Importantly, improvements in competence and knowledge should ideally lead to improvements in operative efficiency and safety for patients and staff. 17

We found that perioperative nursing knowledge significantly improved and was less varied among the nurses after completing the training program. Across all 25 modules, nurses showed significant improvement in knowledge, indicating that Periop 101: A Core Curriculum—Cesarean Section is an appropriate educational intervention and tool to improve knowledge in L&D nurses. Nurses showed the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. The increase in sterilization and disinfection scores is logical, as none of the nurses in our project had prior clinical exposure to working in a sterile processing department. The substantial decrease in the overall variation of knowledge scores after the Periop 101 course indicates that the course helped to alleviate some of the inconsistencies often seen in nursing specialty knowledge. The nurses reported that this experience was beneficial in understanding how different instruments and supplies are cleaned, prepared, processed, stored, and issued for patient care. The knowledge domain scores also provided reliable data for our clinical nurse specialists to target future staff member educational improvement initiatives.

Although we recommend implementing Periop 101 in the same structured format as presented here, nurse educators may immediately utilize the findings of our pretest scores to tailor training initiatives. Our L&D nurse sample exhibited the lowest pretest median scores for perianesthesia nursing; perioperative safety equipment focus; wound closure; surgical instruments; and the scrubbing, gowning, and gloving modules. Although the educational needs of L&D nurses potentially differ among settings, nurse educators can consider these findings to build training curricula while waiting for Periop 101 adoption in their institutions.

Improving nurse competence has many second- and third-order effects, including improving patient and job satisfaction. 18 Nurses reported significantly greater perceived competence across all six domains of the PPCS-R. The largest competence improvements were in foundational skills and knowledge, leadership, and proficiency, all key facets to providing safe surgical care. Although the increases in collaboration and empathy were statistically significant, the magnitude of these changes was the smallest of the six domains. However, we would not necessarily expect empathy and collaboration to drastically change after this type of training for a population of nurses with collaboration experience who are renowned for their empathetic approach when caring for mothers and babies.

Across the MHS, the inconsistencies in L&D nurse education, training, and utilization act as barriers to achieving the highest levels of health care quality and safety. Decreasing inconsistencies and variations in clinical practice is vital to reduce costs, enhance efficiency, and improve overall patient satisfaction. 19 Gee and colleagues 10 recommended including perioperative nurses in the education of perinatal nurses for emergency cesarean deliveries, which is a clever idea. There should ideally be more interaction between both specialties to enhance clinical knowledge. L&D nurses currently provide expert preoperative and post-anesthesia patient care by virtue of their current training and role. By enhancing their intraoperative skillsets, L&D nurses would improve the surgical care they provide and expand their role. With an expanded role, these multitalented nurses could bolster perioperative nurse staffing in the main OR and potentially provide intraoperative surgical care for humanitarian missions 20 or in tactical environments. Our sustainment plan comprises onboarding new L&D nurses with Periop 101, continuing the perioperative skills training program for those already trained, annually validating L&D nurse perioperative competencies, and using their new skillsets to support perioperative nurse staffing in the main OR.

Implications

Although the cesarean birth rate (24.7%) 21 in the MHS is lower than the national average (32.1%), 5 the inherent risks associated with cesarean deliveries likely impact military readiness. 22 As the percentage of women serving in the military steadily increases, 23 efforts to enhance their care are vital to building a resilient and healthy force. Enhancing the competence of nurses providing perinatal patient care is a critical step toward improving care for female warfighters.

Senior MHS leaders should standardize perioperative education, training, and utilization to reduce clinician role ambiguity, decrease inefficiencies, and potentially enhance care. We recommend that leaders initiate Periop 101: A Core Curriculum—Cesarean Section, or other comprehensive training programs, for L&D nurses to improve their perioperative nursing skills and develop policies to define role expectations for clinicians providing direct intraoperative care in L&D units. Although the Periop 101 product developers do not specify how frequently retraining should occur, skills and knowledge deteriorate with time. 24 We propose that nurse leaders conduct periodic knowledge assessments with their L&D nurses to ensure knowledge retention and consider retraining when appropriate.

Ideally, L&D nurses must have the clinical expertise to provide patient care for all deliveries in their units across the enterprise, not just vaginal births. The ultimate goal is to build the perioperative nursing competency base of L&D nurses, enabling safe and standardized intraoperative care for cesarean deliveries at every facility where women give birth across the MHS.

Limitations

There are several limitations to this project. First, we collected only clinician-centric data. Although maternal care can be a high-risk area for morbidity, adverse events, and surgical site infections, 25 the project site did not have enough surgical volume within the project timeline to assess for variations in patient outcomes. An expanded and more precise analysis would include clinician education and competence outcome measures paired with patient characteristics and indicators of health care quality. Second, our knowledge assessment results potentially indicated reduced variation in posttest scores because of manufacturer software constraints requiring students to attain at least an 80% passing rate. A more exact metric for gauging knowledge improvement would not include this restriction. Thus, we recommend that future investigators develop study-specific knowledge testing to depict improvements more accurately. Lastly, our results relied on the self-report of perceived competence using a validated scale. Future investigators should build upon this limitation by visually testing for increased clinician competency with a wide array of pertinent clinical skills testing.

To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. We found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses showed the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection. Nurses reported significantly greater perceived competence across all six domains of the PPCS-R, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency. We recommend that health care leaders develop policies to standardize perioperative education, training, and utilization across the enterprise for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.

The authors would like to thank Colonel William Brown, Ms. Rachael BowersEmard, and Ms. Jacklyn Conniff for their assistance in the project. This supplement is sponsored by The Geneva Foundation.

The TriService Nursing Research Program (#N22-02) and the AORN Foundation provided funding for this project.

This evidence-based practice project was reviewed and determined to not meet the criteria for human subject research by the Landstuhl Regional Medical Center Human Subject Protections Office.

None declared.

Stucky   CH , De Jong   MJ , Kabo   FW : The paradox of network inequality: differential impacts of status and influence on surgical team communication . Med J (Ft Sam Houst Tex)   2022 ; 56 – 63 .

Google Scholar

Benze   C , Spruce   L , Groah   L : Perioperative nursing: scope and standards of practice . Denver, CO : AORN, Inc. ; 2021 .

Stucky   CH , Wymer   JA , House   SL : Nurse leaders: transforming interprofessional relationships to bridge healthcare quality and safety . Nurse Leader   2022 ; 20 ( 4 ): 375 – 80 .doi: 10.1016/j.mnl.2021.12.003 .

Weiser   TG , Haynes   AB , Molina   G , et al. : Size and distribution of the global volume of surgery in 2012 . Bull World Health Organ   2016 ; 94 ( 3 ): 201 – 209F .doi: 10.2471/BLT.15.159293 .

Hamilton   BE , Martin   JA , Osterman   MJ : Births: provisional Data for 2021 . National Center for Health Statistics (NCHS); 2022 .

Alamrani   MH , Alammar   KA , Alqahtani   SS , Salem   OA : Comparing the effects of simulation-based and traditional teaching methods on the critical thinking abilities and self-confidence of nursing students . J Nurs Res   2018 ; 26 ( 3 ): 152 – 7 .doi: 10.1097/jnr.0000000000000231 .

Vural Dogru   B , Zengin Aydin   L : The effects of training with simulation on knowledge, skill and anxiety levels of the nursing students in terms of cardiac auscultation: a randomized controlled study . Nurse Educ Today   2020 ; 84 : 104216.doi: 10.1016/j.nedt.2019.104216 .

Suseel   A , Panchu   P , Abraham   SV , Varghese   S , George   T , Joy   L : An analysis of the efficacy of different teaching modalities in imparting adult cardiopulmonary resuscitation skills among first-year medical students: a pilot study . Indian J Crit Care Med   2019 ; 23 ( 11 ): 509 – 12 .doi: 10.5005/jp-journals-10071-23284 .

Zarifsanaiey   N , Amini   M , Saadat   F : A comparison of educational strategies for the acquisition of nursing student’s performance and critical thinking: simulation-based training vs. integrated training (simulation and critical thinking strategies) . BMC Med Educ   2016 ; 16 ( 1 ): 294.doi: 10.1186/s12909-016-0812-0 .

Gee   LL , Behling   DJ , Sweeney   NL : Nurses’ knowledge of and confidence in perioperative skills for emergency cesarean birth . Nurs Womens Health   2021 ; 25 ( 6 ): 422 – 9 .doi: 10.1016/j.nwh.2021.09.005 .

Association of periOperative Registered Nurses : Periop 101: A Core Curriculum Cesarean Section—AORN . Available at https://www.aorn.org/education/periop-courses/periop-101-a-core-curriculum/periop-101-a-core-curriculum-cesarean-section ; accessed February 12, 2023 .

Melendez   CT , March   AL , Cunningham   C : Improving perioperative knowledge, self-efficacy, and performance in labor and delivery nurses: a quality improvement project . J Nurses Prof Dev   2019 ; 35 ( 4 ): E9 – E14 .doi: 10.1097/NND.0000000000000559 .

Stucky   CH , De Jong   MJ , Rodriguez   JA : A five-step evidence-based practice primer for perioperative RNs . AORN J   2020 ; 112 ( 5 ): 506 – 15 .doi: 10.1002/aorn.13220 .

Buckwalter   KC , Cullen   L , Hanrahan   K , et al. : Iowa model of evidence-based practice: revisions and validation . Worldviews Evid Based Nurs   2017 ; 14 ( 3 ): 175 – 82 .doi: 10.1111/wvn.12223 .

Stucky   CH , Wymer   JA : Progressing toward specialty certification as the National Standard for Nursing . Nurs Forum   2020 ; 55 ( 3 ): 531 – 4 .doi: 10.1111/nuf.12459 .

Gillespie   BM , Polit   DF , Hamlin   L , Chaboyer   W : Developing a model of competence in the operating theatre: psychometric validation of the perceived perioperative competence scale-revised . Int J Nurs Stud   2012 ; 49 ( 1 ): 90 – 101 .doi: 10.1016/j.ijnurstu.2011.08.001 .

Stucky   CH , De Jong   MJ , Liu   Y : Military surgical team performance: the impact of familiarity, team size, and nurse anesthesia students . J Perianesth Nurs   2022 ; 37 ( 1 ): 86 – 93 .doi: 10.1016/j.jopan.2021.04.008 .

Rahmah   NM , Hariyati   TS , Sahar   J : Nurses’ efforts to maintain competence: a qualitative study . J Public Health Res   2021 ; 11 ( 2 ): 2736.doi: 10.4081/jphr.2021.2736 .

Sutherland   K , Levesque   JF : Unwarranted clinical variation in health care: definitions and proposal of an analytic framework . J Eval Clin Pract   2020 ; 26 ( 3 ): 687 – 96 .doi: 10.1111/jep.13181 .

Stucky   CH , Brown   WJ , Knight   AR , Hover   AJ , De Jong   MJ : Operation Allies Refuge and Operation Allies Welcome: military perioperative and perianesthesia nursing support to the Afghan evacuation mission . J Perianesth Nurs   2021 ; 37 ( 3 ): 298 – 307 .doi: 10.1016/j.jopan.2021.12.003 .

Stahlman   S , Witkop   CT , Clark   LL , Taubman   SB : Pregnancies and live births, active component service women, US Armed Forces, 2012-2016 . Msmr   2017 ; 24 ( 11 ): 2 – 9 .

Iobst   SE , Phillips   AK , Wilson   C : Shared decision-making during labor and birth among low-risk, active duty women in the U.S. Military . Mil Med   2022 ; 187 ( 5-6 ): e747 – 56 .doi: 10.1093/milmed/usab486 .

Moore   E : Women in combat: five-year status update . Center New Am Secur . 2020 ; 31. Available at https://www.cnas.org/publications/commentary/women-in-combat-five-year-status-update .

Ameh   CA , White   S , Dickinson   F , Mdegela   M , Madaj   B , van den Broek   N : Retention of knowledge and skills after emergency obstetric care training: a multi-country longitudinal study . PLoS One   2018 ; 13 ( 10 ): e0203606.doi: 10.1371/journal.pone.0203606 .

Collier   AY , Molina   RL : Maternal mortality in the United States: updates on trends, causes, and solutions . Neoreviews   2019 ; 20 ( 10 ): e561 – 74 .doi: 10.1542/neo.20-10-e561 .

Author notes

• cesarean section
• obstetric delivery
• intraoperative care
• perioperative care
• perioperative nursing
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Getting Back to Basics in the OR Through Evidence-Based Practice

Patient Safety Awareness Week, being celebrated March 8-14, 2015, is an excellent time to review current practice and identify weaknesses that need to be addressed. Nowhere is this more important than in the operating room (OR), where perioperative professionals and infection preventionists can collaborate to determine knowledge gaps and ways to mitigate and eliminate risk of infection and adverse events.

Addressing Sterile Processing Instrument Errors With Advanced Technology and Data Insights

Surgical instrument errors, often linked to visualization failures during sterile processing, pose significant risks to patient safety and OR efficiency. Advanced technologies, including AI, are essential for reducing these errors and improving overall outcomes in sterile processing departments.

CLABSI Prevention in the Post-COVID-19 Era

Read this informative article on mitigating central line-associated bloodstream infections (CLABSIs) in acute care settings, which is crucial for enhancing patient safety.

Closing the Gap: Maximizing the Potential of UV-C Technology to Reduce Health Care-Associated Infections

Effective implementation of UV-C disinfection is crucial to reducing HAIs. The Providence Holy Cross Medical Center achieved a 19% reduction in multidrug-resistant HAIs and saved $1.2 million through strategic deployment, highlighting the importance of collaboration and innovative management.

Back to the Future—Focus on Oral Care for Preventing Pneumonia

Pneumonia, a leading cause of death from health care-acquired infections, can be prevented through oral care, especially in nonventilator hospital-acquired pneumonia (NV-HAP) cases.

About the Infection Control Today's Educator of the Year Award

Infection Control Today® speaks with the 2023 Infection Control Today’s Educator of the Year Award™ winner, Sharon Ward-Fore, MS, MT,(ASCP), CIC, FAPIC

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Perioperative Nursing Research Topics: Navigating the Surgical Journey

• Carla Johnson
• August 25, 2023
• Essay Topics and Ideas

Perioperative nursing is pivotal in ensuring patients’ safety, well-being, and successful surgical procedure outcomes. This specialized nursing field encompasses various phases, from preoperative assessment to intraoperative care and postoperative recovery. For nursing students seeking a comprehensive understanding of perioperative nursing , this article presents a range of PICOT questions and provides project and research topic ideas to enhance your learning experience.

What You'll Learn

Understanding Perioperative Nursing

Perioperative nursing involves the care of patients throughout the surgical process, encompassing three primary phases: preoperative, intraoperative, and postoperative . In the preoperative phase, nurses conduct thorough assessments, review medical histories, and address patients’ concerns, working closely with the healthcare team to ensure readiness for surgery. During surgery, the intraoperative phase demands meticulous attention to infection control, sterile techniques, and patient safety. Finally, in the postoperative phase, nurses manage pain , monitor recovery, and educate patients about self-care upon discharge.

Exploring PICOT Questions in Perioperative Nursing

• P: Adult patients undergoing orthopedic surgery; I: Implementation of multimodal pain management; C: Traditional pain management methods; O: Reduced postoperative opioid consumption; T: 3 months. In this study, researchers aim to determine if implementing a multimodal pain management approach for adult orthopedic surgery patients reduces postoperative opioid consumption compared to traditional methods.
• P: Pediatric population requiring day surgeries; I: Introduction of preoperative education through play therapy; C: Standard preoperative education; O: Decreased preoperative anxiety; T: 6 weeks. This investigation seeks to evaluate whether preoperative education delivered via play therapy reduces preoperative anxiety in pediatric patients undergoing day surgeries compared to standard educational methods.
• P: Older adults undergoing cardiac surgery; I: Implementation of a mobility protocol postoperatively; C: Conventional postoperative care; O: Improved postoperative physical function; T: 1 year. The objective of this study is to ascertain whether the implementation of a postoperative mobility protocol enhances the physical function of older adults who have undergone cardiac surgery, compared to standard care practices.
• P: Bariatric surgery patients; I: Adoption of enhanced postoperative monitoring; C: Routine postoperative monitoring; O: Early detection of complications; T: 6 months. This inquiry aims to determine whether the use of enhanced postoperative monitoring for bariatric surgery patients leads to early identification of complications compared to routine monitoring procedures.
• P: Cancer patients undergoing radical surgeries; I: Integration of mindfulness meditation in the preoperative phase; C: Standard preoperative care; O: Reduced stress and improved coping; T: 3 months. Researchers in this study seek to establish whether incorporating mindfulness meditation into the preoperative care of cancer patients undergoing radical surgeries reduces stress levels and improves coping mechanisms.
• P: Patients undergoing emergency surgeries; I: Implementation of a checklist-based communication system; C: Conventional communication methods; O: Enhanced teamwork and reduced errors; T: 1 year. This investigation aims to determine whether adopting a checklist-based communication system during emergency surgeries enhances teamwork and reduces communication errors, compared to traditional communication practices.
• P: Geriatric patients undergoing hip replacement surgery; I: Preoperative nutritional optimization; C: Standard preoperative nutrition care; O: Improved postoperative wound healing; T: 4 months. This study aims to evaluate whether preoperative nutritional optimization in geriatric patients undergoing hip replacement surgery leads to improved wound healing outcomes compared to standard preoperative nutrition care.
• P: Obstetric patients undergoing cesarean sections; I: Skin-to-skin contact during the intraoperative period; C: Delayed skin-to-skin contact postoperatively; O: Enhanced maternal-infant bonding; T: 2 weeks. In this study, researchers aim to determine whether facilitating immediate skin-to-skin contact between mothers and infants during cesarean sections contributes to enhanced maternal-infant bonding compared to delayed contact.
• P: Patients undergoing laparoscopic procedures; I: Utilization of virtual reality distraction; C: Standard preoperative anxiety reduction techniques; O: Decreased preoperative anxiety levels; T: 1 month. This investigation seeks to evaluate whether employing virtual reality distraction techniques before laparoscopic procedures results in decreased preoperative anxiety levels compared to conventional anxiety reduction methods.
• P: Surgical staff in an ambulatory surgery center; I: Implementation of a structured handoff protocol; C: Informal handoff practices; O: Enhanced communication and reduced errors; T: 6 months. This study aims to ascertain whether implementing a structured handoff protocol among surgical staff in an ambulatory surgery center leads to enhanced communication and reduced errors during patient transfers.

EBP Project Ideas on Preoperative Nursing

• Development of a comprehensive preoperative patient education pamphlet.
• Evaluation of the effectiveness of postoperative pain management strategies.
• Implementation of infection prevention protocols in the perioperative setting.
• Assessment of the impact of nurse-led intraoperative communication on patient outcomes.
• Investigation of the use of technology in enhancing patient safety during surgery.

Nursing Capstone Project Ideas

• Design and execution of a perioperative care improvement program in a local healthcare facility.
• Analysis of the psychological impact of prolonged stays in the post-anesthesia care unit (PACU).
• Creation of a perioperative simulation training module for nursing education.
• Evaluation of patient satisfaction with perioperative nursing care in different surgical specialties.
• Exploration of the ethical challenges in perioperative nursing decision-making.

Research Paper Topics on Preoperative Nursing

• Strategies for preventing surgical site infections in the perioperative setting.
• The role of perioperative nurses in ensuring patient safety during robotic surgeries.
• Impact of cultural competence in perioperative nursing care.
• Barriers and facilitators to effective communication among the surgical team.
• Patient advocacy in perioperative nursing: Challenges and opportunities.

Perioperative Nursing Research Questions

• How does the implementation of a standardized checklist improve patient outcomes in the perioperative phase?
• What are the best practices for managing postoperative pain without excessive opioid use ?
• How does patient anxiety influence recovery outcomes following surgery, and how can it be effectively managed?
• What role does nurse-led education play in preparing patients for surgery and reducing perioperative complications?
• What are the key factors contributing to the successful implementation of perioperative infection control protocols?

Essay Topic Ideas & Examples

• The Evolution of Perioperative Nursing: From Florence Nightingale to Modern Practices.
• Exploring the Emotional and Psychological Aspects of Preoperative Anxiety.
• The Crucial Role of Communication in the Perioperative Team.
• Technology’s Impact on Patient Safety and Surgical Outcomes.
• Ethical Dilemmas in Perioperative Nursing: Balancing Patient Autonomy and Best Practices.

As you embark on your journey into the realm of perioperative nursing, remember that knowledge and curiosity are your greatest allies. Engage with the questions, topics, and ideas presented here, and consider how you can contribute meaningfully to this vital healthcare field. Whether you’re delving into EBP projects, crafting thought-provoking essays, or pursuing research opportunities,  we encourage you to explore our writing services ‘ valuable resources. Together, we can elevate the standard of care and make a lasting impact on patients’ lives.

FAQs about Perioperative Nursing

• What are the 4 categories of perioperative nursing? Perioperative nursing can be categorized into four main roles: the circulating nurse, scrub nurse, anesthesia nurse, and recovery room nurse. Each role plays a distinct part in ensuring the smooth flow of surgical procedures and patient care.
• What are the 3 phases of perioperative nursing? The three phases of perioperative nursing are the preoperative phase (before surgery), the intraoperative phase (during surgery), and the postoperative phase (after surgery). These phases encompass comprehensive patient care throughout the surgical process.
• What are the types of perioperative nursing? Perioperative nursing includes various specialities, such as scrub nurses who maintain sterile fields, circulating nurses who manage the operating room environment, and anesthesia nurses who focus on patient sedation and safety. Additionally, some nurses specialize in post-anesthesia care and recovery.
• What are the components of perioperative nursing? Perioperative nursing involves several crucial components, including preoperative assessments, patient education, infection control measures, sterile techniques during surgery, monitoring patients’ vital signs, managing pain and recovery, and ensuring effective communication among the surgical team. These components collectively contribute to optimal patient outcomes throughout the surgical journey.

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• Indian J Anaesth
• v.65(9); 2021 Sep

Adopting newer strategies of perioperative quality improvement: The bandwagon moves on….

Sukhminder jit singh bajwa.

Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India

Lalit Mehdiratta

1 Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India

‘Quality improvement management’ is commonly done by business organisations to improve the process of production output. In the healthcare industry too, since the last few years, quality improvement has been receiving a lot of attention.[ 1 ] It has always been believed that ‘Change’ is inevitable and is essential for improving the quality and for better adjustments in our lives. Quality improvement in healthcare includes improving patient outcomes by adopting changes and making rapid adaptations.[ 2 ] Perioperative care including anaesthesia services are domains in which quality assurance is of utmost importance. Quality assurance in this arena aims at ensuring high standards of perioperative care. Ensuring patient safety, resorting to means that can improve clinical decisions in the operation theatre, and adopting modern strategies aimed at minimising perioperative complications can definitely improve the perioperative healthcare delivery system.

Perioperative care has always been challenging since time immemorial; nonetheless, the modern surgical environment is highly multifaceted because of the complexity of surgeries, presence of highly variable co-morbidities in the patients, and the high-tech environment where such surgeries are carried out. It is very likely that patient-safety-related adverse events including patient/surgical site misidentification, clinical and therapeutic misadventures, medication errors, errors in clinical decision-making and omissions can occur in this composite environment.[ 3 ] Efforts to ensure patient safety have always been followed globally in a progressive manner. The evidence from various articles published on preoperative evaluation and risk assessment, perioperative monitoring, patient satisfaction and various clinical guidelines and advisories that have been published from time to time undoubtedly shows the intensity of the efforts aimed at ensuring good perioperative outcomes.[ 4 , 5 , 6 , 7 , 8 , 9 , 10 ] In spite of these efforts and advancements, how can we be assured that the existing strategies are good enough to improve patient outcomes? Quality improvement initiatives are certainly challenging.[ 11 ] Following on the principles of “Change”, is it not the time for us to embrace and adopt more robust strategies to improve and strengthen our perioperative care and anaesthesia services?

APPLICATION OF SPECIALISED E-TECHNOLOGY IN PERIOPERATIVE CARE

Healthcare technology in perioperative care includes Healthcare information technology (HIT) and Clinical information technology (CIT).[ 3 ] The use of this e-technology can help reduce human errors, improve clinical outcomes, help coordination of care and track data over time.

HIT includes Computerised physician order entry (CPOE), Clinical decision support systems (CDSSs), Electronic medical record (EMR), electronic ‘Sign out’ and ‘Hand-off’ tools, Bar code medication administration (BCMA), Patient data management systems, telemedicine, Electronic incident reporting and so on.[ 12 ]

CIT is highly sophisticated and focuses on specific clinical tasks. It includes Picture archive and communication systems, clinical imaging technologies, robotic surgical systems, perfusion and infusion pumps, anaesthesia delivery systems, mechanical ventilators and automated medication cabinets.[ 3 ] This technology is already being widely used; nevertheless, improvement in perioperative technology including perioperative monitoring, airway devices and intravenous infusion systems has certainly enhanced the quality of perioperative care and has also made the modern perioperative experience very pleasant and safe.[ 13 ] However, a lot more needs to be incorporated routinely into modern perioperative care.

CPOE involves the use of computers to enter physician medication orders, electronic ordering of tests, procedures and consultations.[ 12 ] This could be used in perioperative care especially during preanaesthetic evaluation including ordering of preoperative investigations, preoperative ordering of medications and postoperative pain and fluid management.

CDSSs are nowadays becoming popular and are being used to support the use of clinical data science in daily clinical practice.[ 14 ] A CDS tool provides clinicians, administrative staff, patients and members of the care team with information that is filtered to a specific person or situation.[ 15 ] There are non-computerised CDS tools like clinical guidelines or digital clinical decision support resources such as Clinical Key® or Up ToDate®.[ 16 ] The merits of these resources are that they are effective in reducing diagnostic errors, improve the quality of patient care and are trusted as evidence-based clinical information resources.[ 17 ] There are basic or simple CDSSs like lab info systems that highlight critical care values and pharmacy info systems that present alerts in ordering a new drug/when there is a possibility of drug interaction. Old CDSSs like decision tree models use a tree-like model of decisions consisting of multiple steps. Medication-related CDSSs help in checking drug allergies, drug doses and drug interaction, thereby potentially minimising the morbidity and mortality.[ 14 ]

Several hospitals today have integrated Electronic health records (EHRs) and CPOEs with CDSSs and have found this to have reduced hospital readmissions, ordering of unnecessary radiological/laboratory investigations and mortality rates.[ 15 , 18 ] Many CDSSs have been incorporated into modern perioperative care, anaesthesia and intensive care services to complete drug-dosing calculations, access drug formulary guidelines, use time-triggered reminders for drug delivery and access filtered educational information. DSSs are not novel and are used widely in the developed world. They have been devised for practically every step of the perioperative process, namely DSS for artificial ventilation and weaning (SmartCare™), a complex DSS conceived to assist anaesthesiologists during surgery (Diagnesia) that uses inputs from the anaesthesia panel and gives diagnoses in the descending order, a simple DSS that detects ‘light’ anaesthesia using the changes in mean arterial pressure as input, a DSS for antibiotic prophylaxis (Smart Anaesthesia Messenger), a DSS for assisting physicians in selecting the right preoperative clinically relevant test [System for preoperative test selection (SPOTS)], a DSS for providing reminders for the prophylaxis of postoperative nausea and vomiting and so on. CDSSs using computerised surveillance algorithms and real time analytics can help alert new diagnosis of sepsis and thus contribute to its early detection. They can give alerts regarding worsening of vital signs in the intensive care unit (ICU) and also generate hourly predictions about ICU patients, thereby proving the merits of admixing clinical anticipation with technology.[ 15 ] It is well known that risk assessment and scoring in ICU patients can improve patient outcomes. In a retrospective observational study on coronavirus disease (COVID)-19 patients on mechanical ventilation published in this issue of the Indian Journal of Anaesthesia (IJA), the applicability of nutrition risk in critically ill (NUTRIC) score was assessed. The study concludes that COVID-19 patients with acute respiratory distress syndrome and on mechanical ventilation were at nutritional risk and that a high NUTRIC score was associated with higher mortality[ 19 ]; nevertheless, it is likely that in the near future, CDSSs based on the NUTRIC score will be used to deliver real-time nutritional risk alerts to the intensivist caring for the critically ill COVID -19 patient, thus improving the quality of COVID-19 patient care and resultant outcomes. A scoping review found that CDSSs have positive impacts like improving work efficiency, providing more personal care, increasing confidence in making decisions and decreasing the number of ordered laboratory and medical imaging tests.[ 20 ]

Though we are harping on the advantages of CDSSs, these systems do have some disadvantages including several challenges and barriers to their design and implementation.[ 20 ] There are sporadic reports of unintended adverse clinical consequences from institutions that have implemented CDSSs.[ 21 ] In the perioperative arena, this could equivalate to a wrong CDSS alert given to a Postanaesthesia care unit (PACU) doctor to start a drug that the anaesthesiologist has not mentioned in the postoperative instructions leading to undesirable clinical consequences. Delay in data feeding, omission of data, wrong data entry and latency in data management can impact the decision-making.[ 22 ] Alert and alarm fatigue, clinical burnout and malfunction leading to stopping of alerts during monitoring, firing of spurious alerts and inappropriate drug alerts are other problems with CDSSs, which can probably enhance the morbidity and mortality particularly in critically ill patients[ 23 ]; nonetheless, more research on assessing the benefits and problems of CDSSs is needed.

The use of EHRs in the perioperative environment can facilitate accessibility of information of all patients in one location, improve communication of information among all personnel involved in the perioperative care, help adapt nursing interventions to the patients’ needs and thereby enhance the quality of patient care in the operation theatre.[ 24 ] Electronic ‘Sign out’ and ‘Hand-off ’ tools related to e-application (either stand-alone/integrated with EMRs) can be used to pass the surgical patient-specific information from one team of caregivers to the other team, for example from the preoperative room care group to the operating room group and later to the PACU/surgical ICU group.[ 12 , 24 ] The use of BCMA systems that integrate electronic medication administration records with barcode technology can prevent perioperative medication errors. Smart intravenous infusion pumps that are equipped with medication error-prevention software can also be used perioperatively to decrease medication errors. Anaesthesiologists can voluntarily report safety related incidents through the electronic perioperative incident reporting system.[ 12 ] Tagging and collocation of blood products with Radio-frequency identification chips is an upcoming technology that can help to check whether the blood product matches the blood type of the patient who is located within a predefined distance of the blood product. In case of mismatch, an alarm sounds and thus patient safety in perioperative blood transfusions can be enhanced.

In the current scenario of the COVID-19 pandemic, telemedicine has emerged as a new physician–patient interaction interface and can be used to facilitate patient–anaesthesiologist/surgeon communication both pre and postoperatively, monitor patients and track them efficiently. The preanaesthesia evaluation clinic, pain clinic, ICU and PACU are some areas wherein anaesthesiologists need to participate in multidisciplinary discussions. Synchronous telemedicine including real-time, two-way audio/video communication can prove useful in these areas. Tele-monitoring can help in ICU management in remote areas and this has already been used during the COVID-19 pandemic.[ 13 , 25 ]

Without a proper communication and feedback system, the utilisation of the technological advancements cannot be achieved optimally. Patient experience through e-feedback on the waiting time before surgery, preanaesthetic evaluation experience, intraoperative and postoperative experience and care can motivate and improve the perioperative care-givers’ performance.[ 1 ]

PERIOPERATIVE PATIENT SIMULATIONS

Simulation training is now no longer a novel technique and cannot be put in the same cohort as the newer health technological advancements. However, it is now an integral part of the regular undergraduate and postgraduate medical training in our country. Simulation training of perioperative team members in the management of perioperative life-threatening scenarios and multidisciplinary simulation training can improve communication, team work behaviour and attitudes, and this can definitely improve patient safety and the quality of perioperative care.[ 26 ]

ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOLS

Similar to perioperative patient simulations, ERAS protocols are no longer novel, but their implementation is clouded by challenges. Perioperative ERAS protocols have been found to reduce the length of hospital stay and incidence of complications, thereby producing improved clinical outcomes in almost all surgical specialities.[ 27 , 28 ] Randomised controlled trials (RCTs) have shown that the use of surgical safety checklist and ERAS produce a significant reduction in perioperative morbidity and mortality.[ 29 ] However, the implementation of these tools in perioperative care is marred by barriers to their acceptance, adoption and implementation, especially in countries like ours. Nevertheless, a previous editorial in the IJA has questioned whether ERAS will remain a distant speck on the horizon![ 28 ] Another editorial, a national survey and a retrospective study on ERAS published in previous issues of the IJA have predicted that ERAS will soon create a paradigm shift in perioperative care.[ 27 , 29 , 30 , 31 ]

E-TECHNOLOGY IN PERIOPERATIVE CLINICAL RESEARCH

EHRs have a potential to improve the efficiency of clinical trials. EHRs are currently accepted in clinical research for hypothesis generation, feasibility assessments, performance improvement and guideline adherence. Their role in patient recruitment, comparative effectiveness, health technology assessments, pragmatic trials and point- of- care randomisation is now emerging. They are widely used to assess health and drug utilisation, epidemiology and risk factors in observational studies and in postmarketing surveillance.[ 32 ] It has been forecasted that in the future, EHR data might become the standard resource for clinical research and that research studies using EHR data may equal or surpass prospective cohorts and RCTs as the primary resource for advancing evidence-based medicine.[ 33 ] In a multicentre pilot study published in this issue of the IJA, the authors have tried to assess the feasibility for planning a larger multicentric study at national level to find out the incidence and outcome of major neurological complications following central neuraxial block (CNB). They have concluded that a larger study is feasible.[ 34 ] This study throws up a volley of ideas. Could advanced e-tools like EMRs, Patient data management systems be used in this planned larger study to make data collection easier and complete? Would the routine use of CDSSs and Electronic incident reporting system by the anaesthesiologists of Aurangabad city have altered the incidence of the neurological complications following CNB? Will their use alter the nationwide incidence of post-CNB neurological complications?

This issue of the IJA has several articles related to postoperative complications and perioperative and intensive care outcomes.[ 19 , 34 , 35 , 36 ] These articles speak for themselves and strongly advocate for the implementation of newer strategies to enhance the quality of perioperative care and research. Countries like the United Kingdom have established initiatives like the Perioperative Quality Improvement Programme, which is multidisciplinary. It collects and analyses data on the perioperative care of patients undergoing major non-cardiac surgery and measures complication rates, failure to rescue and patient reported outcomes.[ 37 ] It is time for us in India too, to take up such initiatives; nevertheless, developments are occurring at a good pace in the HIT landscape in our country. Different types of healthcare software are now emerging: healthcare management software, healthcare analytics software, medical diagnosis software, imaging and visualisation software, medical database software and medical research software. Indian companies are in tune with the production of this software (e.g., e-Sushrut, e-Swasthya, Megh- Sushrut, Srishti).[ 38 ] It is time for us to adapt this technology in modern perioperative care. Nonetheless, the perioperative quality improvement bandwagon is here, and it certainly promises to usher in a new era of high-quality perioperative care in our country.

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Research in peri-operative nursing care

Affiliation.

• 1 Department of Surgery, Turku University Hospital, Finland.
• PMID: 10401345
• DOI: 10.1046/j.1365-2702.1999.00239.x

This review analyses 97 research reports dealing with peri-operative care which included patients. The literature review was done as the basis of a development project to measure the quality of intra-operative nursing care from the patient's perspective. The pre-operative phase provides information about the teaching, anxiety and stress of patients. Few sources dealt with the intra-operative phase; there were a small amount of reports concerning concrete nursing activities (e.g. surgical position and warming the patient). The most information was available on the post-operative phase, such as recovery, adaptation and the treatment of pain. Peri-operative research is mainly concerned with the quality of nursing care, control of life and ambulatory surgery. The main defects of analysed studies can be characterized as follows: small samples and a single hospital, lack of definition of terms, theoretical ambiguity, short follow-up times, anaesthetic or other drugs used during the care not mentioned in the report (especially in studies on pain and quality). Previously developed research tools had usually been well tested, but there was great variety in the testing of investigator-constructed tools. There were also discrepancies in the evaluation of validity and reliability. Future research should especially deal with treatment of pain and anxiety, information and guidance given to patients, and the costs of surgical care; there is also a need for studies dealing with intra-operative care from the patient's perspective. Although information is already available on the above mentioned topics, more detailed and comprehensive facts are still needed.

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Perioperative Nurses: Topics to Watch in 2017 and Beyond

New protocols, new equipment, new research — it can be challenging to keep up with the rapidly changing dynamics of a perioperative nursing job . Despite your best effort to stay on top of it all, the sheer volume of changes in healthcare and surgical center careers can make new, trending, or even quirky topics relevant to your profession easy to miss.

Here are a few recent developments that may have skirted your radar:

Who Wears It Better?

It’s called the curious case of caps — a clash between professional healthcare associations that have made head gear, of all things, a hot topic in surgical settings.

A mini feud erupted in August 2016 when the American College of Surgeons (ACS) replied to a guideline update on safe surgical attire issued by the American Association of periOperative Registered Nurses (AORN). The nursing association’s guidelines support full covering of “head, hair, ears and facial hair” for professionals in semi-restricted and restricted operating room  areas and favor use of the so-called bouffant cap, a fashion-defying but often-used head covering, closely resembling a shower cap. Nope, said the surgeon group in publishing its own guidelines (the first time the organization addressed dress code in the OR). According to the ACS, the traditional surgeon’s cap, also called a skullcap, represents the better route because it symbolizes the surgical profession and preserves “professionalism, common sense, decorum, and the available evidence.”

Weighing in heavily on team bouffant, AORN fired back, criticizing the ACS for prioritizing symbolism over patient safety and promoting etiquette over evidence-based practice. Surgeons, in the meantime, decried bouffant caps as hot, uncomfortable, and never before necessary, as reported by The Boston Globe.

The federal government, via the Centers for Medicare & Medicaid Services, will rely on the AORN guidelines, the Globe reported; but the last say in the great hat debate could come from the Joint Commission, which says it will analyze both sets of guidelines before taking a side.  

Smoking Ban

Even if you’ve never smoked, or you quit the habit, a perioperative nursing job could still put you at risk for respiratory illness from surgical equipment.

The hazards of surgical smoke plume and aerosols —byproducts of the use of lasers, electrocautery and ultrasound devices, and other energy-based equipment in the operating room  — have been known for more than a decade. While the use of electrosurgical devices has risen exponentially with a surge in minimally invasive procedures, progress toward reducing or eliminating the risk of surgical smoke has remained slow.

The Occupational Safety and Health Administration estimates that half a million U.S. surgical center workers are exposed each year to smoke plumes carrying carbon monoxide, polyaromatic hydrocarbons, and other toxic gases. AORN describes the risk to perioperative nurses and other healthcare professionals in the operating room  in a striking way: Exposure to surgical plume, it says, amounts to the equivalent of smoking 27 to 30 unfiltered cigarettes each day . According to the association, perioperative nurses “experience twice the incidence of many respiratory problems as compared to the general population.”

A growing market for smoke evacuation systems — high-flow vacuum sources that capture smoke and gases centrally or at the surgical site — show promise for achieving smokeless ORs. A 2017 market analysis, however, cautions that a current emphasis on cost containment could contribute to lackluster adoption of the systems by healthcare facilities. For its part, AORN has partnered with medical technology giant Medtronics to raise awareness of the dangers of surgical smoke to both healthcare professionals and patients through its Go Clear campaign. The newly launched program provides interprofessional education activities, testing, gap analysis, and monitoring for participating hospitals, ambulatory surgery centers and office-based practices, culminating in recognition with a Go Clear award.

Musical Interlude

Reggae icon Bob Marley once said, “One good thing about music, when it hits you, you feel no pain.”

He might have been onto something, or so researchers from University Hospitals Seidman Cancer Center in Cleveland set out to demonstrate. Two music therapists and a nurse anesthetist tested the value of music therapy in reducing anxiety among women undergoing biopsy for breast cancer. The results of their two-year, randomized study, reported in the September 2016 issue of AORN Journal, showed patients who listened to either live music performed bedside by a music therapist or recorded music shortly before their procedures reported significantly less anxiety than patients who didn’t listen to tunes.

While acknowledging that additional studies are needed, the study’s authors think patients can benefit in anxiety reduction and pain management when surgical centers add music therapists to their rosters.

Fragility Test

There’s good news for the senior set undergoing elective surgery: A new study found that preoperative screening of elderly patients for frailty reduces postoperative mortality.

Researchers at the Veterans Affairs Pittsburg Healthcare System in Pennsylvania implemented a Frailty Screening Initiative based on a 14-point questionnaire performed at intake with elderly patients undergoing elective noncardiac procedures. Patients identified as frail received tailored surgical planning and perioperative care reviewed by surgical, anesthesia, critical care, and palliative care practitioners.

The study’s findings, published in the Nov. 30 edition of JAMA Surgery, showed participating patients’ overall 30-day mortality rate fell from 1.6% to 0.7 % after frailty screening. While mortality decreased among robust patients (from 1.2% to 0.3%), those identified as frail showed the most significant improvement in mortality, with rates falling from 12.2% to just 3.8%. What’s more, at 180 and 365 days postop, mortality rates among patients determined preoperatively to be frail fell from 23.9% to 7.7% and 34.5% to 11.7%, respectively.

The study’s authors believe implementation of preoperative frailty screening could improve outcomes for elderly patients across surgical settings.

And you thought virtual reality gaming was just the latest brouhaha for all the cool kids. From training tools to treatment protocols, new realities — virtual, augmented, and mixed — aren’t just popping in all the right places in healthcare, they’re set to explode.

Nursing schools are moving past patient simulators to incorporate wearable technology, including VR headgear and sensory gloves, into game-based learning for students. Boise (Idaho) State University’s nursing program, for example, won a national award in 2016 when it partnered with game developers to create a VR platform that allows students to address complex patient situations in a hands-on, real-but-not-really-real way. In a 3D environment, students can “touch” objects and patients and practice procedures at their own pace.

VR equipment is also making its way into on-the-job training for perioperative nurses. As a fix for expensive, time-consuming training for nurses new to surgical settings (double scrubbing with experienced colleagues, for example), a Canadian hospital pioneered the integration of VR to help scrub nurses learn to pass instruments and operate equipment before they set foot in the operating room .  VR training, the hospital says, significantly cuts training time and costs for nurse and surgical residents.

Look for VR use with surgical patients, too. A surgeon in Mexico City is testing use of VR as a high-tech distraction that replaces sedation for patients undergoing procedures for which a local anesthetic might suffice.

Get Outta My Operating Room?

Medical device representatives have found a place on the sidelines in many ORs, where they help surgical teams with technical aspects of advanced equipment. But should they be there?

Particularly in neurosurgery and orthopedics, where use of high-tech equipment has rapidly expanded, industry reps’ presence in the operating room  has become commonplace. Device reps do not scrub in, and state laws typically bar them from direct contact with patients; but they’re not medical professionals by any stretch. Yes, they’re experts in the equipment they represent, and yes, they offer valuable technical and troubleshooting expertise during procedures. Still, they’re salespeople employed by equipment manufacturers, not hospitals.

New scrutiny of the role of device reps, some of it resulting from lawsuits and some from provisions of the Affordable Care Act, is causing hospitals to take a second look at their necessity in the operating room . While instances of reps overstepping their bounds have reportedly occurred, a chief concern among hospital administrators revolves around informed consent. Most patients are unaware that a device rep may be present during their surgical procedure.

At Eisenhower Medical Center, we’re committed to helping perioperative nurses stay up-to-date with the information they need to enjoy long, successful careers. We offer education programs, including access to free or low-cost continuing education activities, and Nursing Grand Rounds, among other training opportunities. Apply with us today!

Originally posted on 16/2/2017

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• Perform medical review of ICSRs including (SUSARs, cases from special countries), assessment of Literature cases and authoring of enhanced MAC. • Support safety lead for authoring medical assessment letters based on the bi-annual/six monthly line listing. • Perform literature review of assigned articles (CQC, pre-screening and SICO) and assist safety lead in review of articles for inclusion in PBRER, DSUR, IB etc. • Provide rotating support to the TAs as per the business needs, (i.e. co-authoring safety documents, assisting in providing safety input to regulatory and clinical documents). • Assist the TA Safety Leads in monitoring the safety profile of products including but not limited to the activities such as literature review, medical review of individual cases, including collecting additional follow-up information as necessary, medical evaluation of quality defects. • Together with the Safety Leads, co-author of the PBRER. Provides medical inputs to the sections 9, 15, 16, 17, 18, including analytical input to PBRER for risks defined in the RMP. Perform follow up activities on HA assessment reports. • Co-authors and contributes to the medical sections of Development Safety Update Report (DSUR), Investigator Brochures (IB), labelling documents (e.g. CDS, (SMPC, USPI, Japanese PI), Product Guidance Documents (PGD) and Expert Statements. • Supports the preparation and review of Investigator Notifications (INs). • Provide support signal detection and signal evaluation activities for assigned products. • Provide support for the preparation of Health Authority queries.

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Evidence-Based Practice

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