Abstract: Gore, Amanda; Osborne, Sonya Posthumous organ procurement is a critical procedure in which perioperative nurses contribute significantly to the conduct of the procedure and viability of organs and tissues for later transplant. The rate of organ donation has increased over 70 per cent in recent years, which saw, in 2016, a record 1440 Australians receiving transplants as a result of 503 deceased organ donors'. However the rate of donation in Australia is still relatively low compared to other nations, and occurs so sporadically in most operating rooms that it is difficult to acquire expertise as a perioperative nurse.
Abstract: Sutherland-Fraser, Sally Perioperative nurse, Sally Sutherland-Fraser, has also studied fine arts. In this column, she draws on both disciplines to reveal the history behind an intriguing photograph of surgery from World War One.
Abstract: Gilbert, Julia; Gillespie, Brigid M At law, all individuals are presumed to have the legal capacity to provide consent or refusal of treatment unless there are clinical indications of cognitive impairment. Once concerns are raised regarding the ability of an individual to provide valid consent for a surgical procedure, the use of a substitute decision-maker may be necessary. In this paper, we present an analysis of a clinical case study to illustrate the principles of valid consent. As part of the analysis, we discuss the issues relating to obtaining valid consent for an operative surgical procedure from an elderly client with obvious cognitive impairment. We also explore the role of a substitute decision-maker to obtain the requisite valid consent.
Abstract: Gill, Arron; Randell, Rebecca Effective teamwork in the operating theatre is important for safe patient care. In robotic surgery, the surgeon is physically separated from the operating theatre team, which could potentially have an impact on teamwork. With robotic surgery increasing internationally, this article reviews relevant published literature on teamwork in the operating theatre and reflects on how this might be impacted by robotic surgery. We conclude by describing a research study we are currently undertaking on this topic.
Abstract: Mangham, Mandy Safe, patient-centred care is a large part of our trust values at the Royal Wolverhampton NHS Trust. Robotic assisted laparoscopic surgery (RALS) is still in its infancy within our trust, and we decided to look at what we have learned so far regarding patient positioning during robotic surgery for gynae-oncology and uro-gynae procedures. We also considered what we believe needs to be achieved in order to deliver high standards of care in positioning patients during robotic surgery, not only now, but also for the future of robotic surgery.
Abstract: Kynoch, Kate; Crowe, Linda; McArdle, Annie; Munday, Judy; Cabilan, CJ; Hines, Sonia Perioperative nurses recognise that family members experience increased levels of anxiety during the wait for a relative undergoing a surgical procedure. It is often during this time that little or no meaningful communication occurs between family members and health professionals. It has been suggested that a structured information intervention has the potential to increase communication between families and health care professionals as well as decrease family members' anxiety.
Abstract: Freeling, Michelle; Parker, Steve; Breaden, Katrina While the new graduate nurse journey has been well documented, little research exists from the perspective of the experienced nurse, particularly in the perioperative environment. Barriers to graduate nurse support need to be understood, as job satisfaction, nurse wellbeing and quality of patient care can be negatively affected.
Abstract: Davies, Menna; Sutherland-Fraser, Sally; Mamea, Natasha; Raddie, Nerrie; Taoi, Mabel Hazelman This article is the second in a series that describes the a collaborative project between Australia and the Pacific Island countries (PICs) to develop and implement a set of infection prevention standards which are context-specific to 'limited resource settings', such as those found in PICs.
Abstract: Greene-Golden, Sharon In January 2014, 18 patients in a North Carolina hospital were exposed to surgical instruments used on a patient who was later confirmed as having Creutzfeldt-Jakob disease (CJD), a rare, degenerative, rapidly progressing, fatal neurological disorder that affects approximately one in every one million people worldwide per year.
Abstract: Spruce, Lisa A surgical site infection (SSI) is an unintended and oftentimes preventable consequence of surgery. There is a significant amount of literature related to preventing SSIs, and it is up to practitioners in each care setting to review the evidence and work together to implement SSI prevention measures, such as nasal decolonisation, antibiotic prophylaxis, preoperative showers, preoperative oxygen supplementation, and antimicrobial sutures. In addition, practitioners can follow several recommendations to reduce the risk of SSIs, including following proper hand hygiene practices; wearing clean, facility-laundered scrub attire; following a surgical safety checklist and speaking up when a break in sterile technique is witnessed. The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives.
Abstract: Levada, Lilliana A few months ago, in May 2016 at our recent conference in Hobart, I had the satisfaction of presenting about leading the review process for several ACORN standards including the Post Anaesthesia Car Unit (PACU) nurse role document.
Abstract: Foran, Paula The month of May saw ACORN hold its biennial national conference in Hobart. While attendees were soaking up the wonderful education, I was busily searching for expert presenters for our education series of webinars.
Abstract: Melville, Ruth The feedback from IFPN and other international delegates regarding the ACORN conference in Hobart was very positive and has motivated many to return again in 2018 for the conference in Adelaide.
Abstract: Williams, Carollyn I am very proud to be delivering the eighth Judith Cornell Oration and join the group of distinguished nurses who have gone before me. I thank the committee of the Victorian Perioperative Nurses Group (VPNG) for believing me worthy of the task and the ACORN board for offering me the honour.
Abstract: Smith, Catherine; Hains, Toni; Mannion, Natasha The Ramsay Health Care facility, Sunshine Coast University Private Hospital (SCUPH), opened on the 4th of November 2013. The facility has six operating theatres offering surgical services in orthopaedics; ear, nose and throat; general; urology; gynaecology and gastroenterology. The private hospital will be co-located on the site of the pending public hospital, Sunshine Coast University Hospital, on the Kawana Health Campus.
Abstract: Sutherland-Fraser, Sally A critical shortage of trained medical officers during World War 1 resulted in nurse volunteers being trained in anaesthetics to support the surgical teams. Whilst the role has spread globally from its early origins in America it has taken almost a century for Australian perioperative nurses once again to extend their scope of practice in anaesthesia with the role of 'nurse sedationist'.
Abstract: Smith, Pete; Gibbs, John Noise in the operating theatre environment has remained a persistent and unresolved problem. The problem currently lacks an effective solution. In order to partially resolve this issue, the authors created a behavioural noise reduction tool called 'Below ten thousand'.
Abstract: Foran, Paula Another busy few months for ACORN education. You will have all enjoyed perioperative nurses' week. Congratulations to all perioperative nurses for all the great work we do.
Abstract: Wilson, Seri With nearly 40 per cent of Australian nurses aged 50 or over, baby boomer nurses' retirement may have significant impact on the nursing workforce. We hear so much about new graduates having trouble getting into the workforce but we rarely hear about nurses thinking of leaving. So what are baby boomer nurses thinking about their retirement plans'
Abstract: Russell, Kylie; Coventry, Tracey A key expectation from the health care industry in Australia is that nurses engaged in postgraduate specialist education need to be able to apply their extended knowledge and skills to the workplace. For this to succeed, health services need to be involved in the development of course content and learning outcomes to ensure authentic engagement. Essential to this is student participation in workplace learning that provides experience, performance feedback and reflection. This promotes graduate success to meet industry expectations.
Abstract: Battie, Renae The American Nurses Association (ANA) code of ethics states that the definition of accountability is 'to be answerable to oneself and others for one's own actions'. As perioperative nurses, we are accountable to our patients and their family members, our colleagues, our workplace and our profession. Because of this, perioperative nurses should hold themselves accountable for patient advocacy, continuity of care and lifelong learning, and to colleagues, the nursing profession and their organisation.
Abstract: Holmes, Stephanie Despite the acknowledgement of the hazards of surgical plume, compliance with smoke evacuation is not routine.
This review examines the current literature on factors influencing compliance with smoke evacuation. Factors identified included the design of the smoke evacuation device, surgeon refusal, education and managerial support. Strong leadership, education and policy enforcement from a local facility level are required to improve surgical plume evacuation compliance. More research in this field would help to further strengthen these findings.
Abstract: Karam, May The operating room! It is a closed world with a large sign posted 'no entry'. For many it is mysterious, secret, hard, cold, hostile.
Abstract: Steward, Coralie Once in a while, something happens to us that makes us question our faith in the caring ethos which is so integral to our role as clinicians.
Abstract: Criscitelli, Theresa Health care is a technologically driven profession that is rapidly evolving. Technology is thought to improve outcomes, but data shows an increase in health care errors, some of which are technology related.
Abstract: Unac, Fiona; Rolls, Suzanne Nurses who assist anaesthetists are being squeezed out of the role, despite a workforce shortage. What's happening'
Abstract: Jensen, Joy In the months leading up to the conclusion of my term as the Honorary Treasurer on 11 November 2016, I wondered what governance meant to our predecessors, those charged with governing ACORN 40 years ago and in the years since. I have concluded that they must have done a sterling job, given that we are financially strong and performing well four decades on. The recent change to the ACORN constitution eliminated the role of Honorary Treasurer and I write this article to provide members with knowledge about how ACORN is governed and confidence that our College remains in good hands.
Abstract: McGarry, Jon R This paper presents the management of a woman undergoing her fifth caesarean section in the presence of a placenta percreta. It reviews the incidence and surgical management of this complex pathology. Advanced planning and multidisciplinary coordination is crucial to successful treatment of this condition. There are implications for theatre staff of all professions to be confident and familiar with specialist equipment. Such cases represent a trend of multidisciplinary working that is increasingly part of current practice.
Abstract: Anderson, Rick Reading a recent article in 'The Atlantic' and the subsequent comments, I was struck again by how much confusion there is among the public about the difference between plagiarism and copyright infringement.
Abstract: Baker, Joy Don Perioperative nurse authors should strive to have their scholarly works published in a journal that adheres to high ethical standards, focuses on the readers' needs, and provides the opportunity for authors to disseminate their works effectively.
Abstract: Goudas, Lauren Open Heart International is a volunteer-driven organisation that provides a range of medical treatments to thousands of people in developing countries and also helps to train local practitioners in providing surgery themselves.
Abstract: Davies, Menna; Sutherland-Fraser, Sally; Taoi, Mabel Hazelman; Williams, Carollyn This article is the first in a series that will describe a collaborative project between Australia and the Pacific Island Countries (PICs) to develop a set of infection prevention standards which are context-specific to "limited resource settings", such as those found in PICs.
Abstract: Pope, Miranda Before 22 February 2011 I always believed that our disaster plan at work would involve mass casualties from a bus crash, something that I would ring home and say "Sorry there's been a big bus crash and we need to deal with the injuries. I'll be home later". So when the earthquake struck, at 6.3 on the Richter scale, it was very unexpected to be part of the disaster. It involved not only work but also home, family and the community.
Abstract: Rogers, Wendy AusMAT is a self-sufficient medical team comprising members from around Australia and New Zealand that can deploy nationally and internationally to disaster zones. Its multidisciplinary health team includes doctors, nurses, fire fighters (logisticians), paramedics, environmental health workers, pharmacists and radiographers.
Abstract: Spruce, Lisa; Van Wicklin, Sharon A Positioning the surgical patient requires special attention from the entire surgical team because anesthetised or sedated patients are not able to reposition themselves when needed to relieve discomfort or alert team members of the need for repositioning. Perioperative nurses must pay attention to positioning details and the possibility of injury at all times during the patient's procedure. This includes assessing the patient's circulatory, respiratory, integumentary, musculoskeletal, and neurological structures to help ensure that the patient is properly positioned and safe from injury. Working as a member of the surgical team, the perioperative RN is key to speaking up when positioning issues need to be addressed and helping to minimise the risk of injury to the patient. This "Back to Basics" article discusses positioning the patient in the prone position.
Abstract: Duff, Jed; Butler, Margaret; Davies, Menna; Williams, Robyn; Carlile, Jannelle Evidence-based practice has been demonstrated to positively impact patient outcomes; unfortunately, there are many factors that hinder the use of research evidence by healthcare clinicians. Our previous study reported a multisite survey assessing Australian perioperative nurses knowledge, practice, attitude, and perceived barriers to evidence use. This subsequent analysis used univariate and multivariate binary logistic regression with odds ratios (OR) and 95% confidence intervals (CI) to compare individual nurse and organisational characteristics with high evidencebased practice (EBP) use. Two individual nurse characteristics found to be related to EBP were postgraduate qualifications (OR 1.69, 95% CI 1.07-2.6, p=0.02) and previous research experience (OR 1.9, 95% CI 1.6-2.4, p=0.01). Organisational characteristics related to EBP included access to the internet (OR 2.04, 95% CI 1.3-3.0, p=0.001) and access to ongoing EBP education (OR 1.6, 95% CI 1.1-2.5, p=0.01). Previous research experience (OR 1.6, 95% CI 1.0-2.3, p=0.01) was the only independent predictor of EBP. Given our finding, we suggest that considerably greater effort be made to facilitate nurses involvement in research studies in the perioperative setting.
Abstract: Austin, Jennifer My great idea was to start a perioperative nursing journal club in my workplace, a small fourtheatre complex in a busy rural public hospital in NSW. It failed. As clinicians, we are usually more than happy to share our successes, but less ready to share our failures. The purpose of this paper is to share the experience of this failure, the mistakes I made, and the lessons I learned. It will discuss learning from our mistakes, the reality of evidence-based practice, journal clubs: barriers and requirements for success, and my own experience and reflections on attempting to start a perioperative nursing journal club.
Abstract: Jewell, Andrew Health services are the largest employer in the public sector. As one of Australia's most important industries, the recent revelations of the widespread issue of bullying and harassment are of great concern.
Abstract: Foran, Paula Thank you very much to the nearly 400 members who completed the recent educational needs survey. You may recall there was a list of 'possible' topics, and members were asked to score these in order of preference or to provide their own completely different subjects for educational presentation. So that ACORN can better meet our members' educational wants and needs, the data collected from this survey will now be used to provide webinar education that you, the members, have requested. Findings have revealed the most popular topics from the list I suggested. Comments provided in the 'other' section will be very useful as they have either provided information on the details that will be required within the previously suggested topics, or are completely new topics I had not considered. Thank you for these great ideas.
Abstract: Johnson, Julie; Osborne, Sonya The release in December 2015 of the updated Surgical Hand Antisepsis, Gowning and Gloving Standard as part of the Asepsis and Clinical Care suite of standards continues the focus on clinical practice guided by evidence-informed decision making rather than a traditional approach which favoured "practising the way it has always been done".
Abstract: Osborne, Sonya Since the release of the 2014-2015 ACORN Standards at ACORN's 2014 national conference in Melbourne, there have been a number of updates to our national standards.
Abstract: Sutherland-Fraser, Sally One hundred years after the beginning of World War One, Australians and New Zealanders commemorate the work of Anzac nurses with a voyage from Athens to Istanbul.
Abstract: Kitney, Patricia; Tam, Raymond; Bennett, Paul; Buttigieg, Dianne; Bramley, David; Wang, Wei A structured approach to communication between health care professionals contains introduction/identification; situation; background; assessment and request/recommendation (ISBAR). ISBAR was introduced into the post-anaesthetic care unit (PACU) of a large Victorian health service in 2013. The aim of this study was to measure the effect of an education program on ISBAR compliance.
Method: A pre/post-test design using a 14-item audit tool was used to measure compliance to ISBAR before and after an education intervention in two acute hospitals in Melbourne, Victoria. The intervention consisted of one 30-minute education session to anaesthetists, and two 30-minute education sessions to PACU nurses, combined with visual cues using ISBAR wall posters.
Results: In Hospital A, significant improvement from pre- to post-audit was found in the items of cardiovascular assessment (χ2 (1) = 4.06, p < .05), respiratory assessment (χ2 (1) = 12.85, p < .01), analgesia assessment and actions (Fisher's exact test p < .05) and responsibility + referral (χ2 (1) = 4.44, p < .05). For Hospital B significant improvement was found in communication difficulties (χ2 (2) = 13.55, p < .01) and significant decreased performance was found in respiratory assessment (χ2 (1) = 8.98, p < .01) and responsibility + referral (χ2 (1) = 13.26, p < .01).
Implication for practice: The results from this study cohort suggest an augmented education program may produce mixed results for ISBAR compliance. More than education and visual tools may be required to improve PACU ISBAR compliance.
Abstract: Flanigan, Kathy Standard 5 of The National Safety and Quality Health Service (NSQHS) is Patient Identification and Procedure Matching. As Nursing Executive Lead on this Standard within my own facility for Accreditation in 2014, I was provided an opportunity to develop a better understanding of the importance of this Standard.
Abstract: Spruce, Lisa As a new nurse in the OR, Jill found it to be an exciting and rewarding place to work. She had a fantastic orientation and a great preceptor. She was given plenty of time to learn and feel confident in her new role. Then she met Dr Cook.
Abstract: Foran, Paula The Australian population is ageing which, in turn, will lead to an increased demand for surgical health services. So too the perioperative nurse matures, with over 50 per cent of the current Australian perioperative nursing workforce being older than 51 years; 41 per cent are between 51 and 60 years, and 15 per cent are older than 60 years of age.
Abstract: Steel, Catherine Clinical handover encompasses the transference of vital patientcentric information to ensure the continuity of care and optimise patient safety.
Abstract: Murphy, Katharine; Walker, Kim; Duff, Jed; Williams, Robyn The aim of this study was to identify which items should be included in a pre-operative checklist based on recommendations by nurse experts in order to promote patient safety and effective communication in the perioperative environment.
Method: Thirty-five nurses participated in this e-Delphi study, which was conducted online via SurveyMonkey . Each survey presented participants with a list of potential items for inclusion in a pre-operative checklist. Participants were asked to identify items they felt should be included in the checklist with the option to include comments. Comments were de-identified and shared with other participants to allow confidential interaction. The surveys were analysed for consensus, determined as agreement between at least 70% of participants.
Results: Three survey rounds were completed. Forty-six items achieved consensus for inclusion in a pre-operative checklist.
Conclusion: The 46 items which achieved consensus were condensed to a list of 25 items categorised as: 1. Patient and procedure verification; 2. Preparation; and 3. Assessments. The findings of this study provide an evidence base for development of pre-operative checklists, to promote patient safety and effective communication in the perioperative environment.
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