An evaluation of operating room throughput in a stand-alone soft-tissue trauma operating theatre.

BACKGROUND: Operating room time is a limited, expensive commodity in acute hospitals. Strategies aimed at reduction of non-operative time improve operating room throughput and capacity. We conducted a prospective study to evaluate and augment operating room throughput and capacity using context-specific work practice changes. METHODS: Following institutional and ethical approval, an interdisciplinary group designed and introduced a series of work practice changes specific to a stand-alone soft tissue trauma theatre, comprising modifications to patient processing, staff behaviours and additional anaesthesiologist hours. Time intervals relating to each patient were measured during a 16 week period before and after implementing work practice changes. The primary outcome measure was non-operative time, with daily caseload and cancellations amongst secondary outcome measures. RESULTS: 251 procedures were included over 58 working days (8 to 17 Monday to Friday). Non-operative time [55.6 (31.1) vs 52.3 (9.8) minutes, p = 0.48], daily caseload [4 [1-9] vs 4 [2-7], p = 0.56], and the number of daily cancellations [3 [0-11] vs 5 [0-8], p = 0.38], did not differ between baseline and study phases. Regional anaesthesia for upper limb surgery increased during the study phase [26/59 (44.0%) vs 10/63 (15.9%), p = 0.014] with resultant decrease in mean duration of recovery room stay [20.7 (17.7) vs 30 (20.5) minutes, p = 0.0001] and increased recovery room bypass [26/116 (22.4%) vs 6/135 (4.4%), p = 0.0002]. Avoidable delays accounted for 124.8 (72.2) minutes of theatre time lost each day. CONCLUSION: In conclusion, additional attending anaesthesiologist hours combined with work practice changes did not impact on measures of theatre throughput and capacity. The study identified important variables that contribute to avoidable delays, and points the way for future research.

Encouraging engagement at work to improve retention.

Similar professional standards link nurses together but healthcare professionals practise across a variety of areas and have different experiences of the workplace. It cannot be assumed that a positive experience in one setting will be replicated in another, even if it is in the same organisation. This article explores the factors that affect workplace culture and outlines the rudiments underpinning nurse engagement from a work perspective. It also analyses staff engagement in the health service sector by examining the status, certainty, autonomy, relatedness and fairness (Scarf) model, and demonstrates the relevance of this framework.

Plotting care: a modelling technique for visioning nursing practice in current and future contexts.

Health professionals in health-care organisations are frequently challenged to strategise their services, reshape patterns of care delivery and to adapt to changing environments. Relocation of services into new hospital buildings is one example of a situation that generates these challenges. In this paper the authors discuss an innovative modelling strategy that was employed to assist nurses to explore their current daily care practices, to visualise them in the context of proposed new buildings, and to work towards planning care in readiness for the new context. The modelling technique of 'plotting' is presented as a way of capturing the natural spatial-service wisdom that exists within teams, and assisting them to translate their knowledge of this to each other and to co-operatively work towards a new clinical future. Plotting will be of use to health professionals, clinical leaders and educators who are interested in spatial analysis of care and other health service practices.

Defining an anaesthetic curriculum for medical undergraduates. A Delphi study.

BACKGROUND AND OBJECTIVES: Anaesthesia is commonly taught to medical students. The duration and content of such teaching varies however and no consensus exists as to what constitutes an optimal curriculum. Anaesthetists possess the necessary knowledge and skills and operate in clinical settings suitable to provide training for medical undergraduates, especially in areas where deficiencies have been identified. This Delphi study was directed towards developing a consensus on an optimal anaesthesia, intensive care and pain medicine curriculum for medical undergraduates. METHODS: This Delphi survey consisted of three iterative rounds with feedback given at the start of each successive round in the form of the results of the previous round. The participants consisted of 27 consultant anaesthetists, chosen by the three Professors of anaesthesia in Ireland to be experts in undergraduate medical education. RESULTS: Thirty one consultant anaesthetists were chosen to participate in the study. Two consultants declined to participate. Two consultants were omitted from the first round in error and were not included in the remainder of the study. The response rate to the first round was 100%. Two hundred and nine individual items were included in the second questionnaire. 67% consultants responded to the second questionnaire and 59% to the third questionnaire. 74 Items achieved consensus level on completion of the study. CONCLUSION: This study demonstrated support amongst respondents for an expanded role for anaesthetists in teaching medical students. An expanded teaching role for anaesthetists would take advantage of the large number of anaesthetists in Irish teaching hospitals, their enthusiasm for teaching, the frequency of patient-consultant proximity and the likely value of their teaching to student learning outcomes. The consensus reached by this study does not recommend a comprehensive anaesthesia curriculum. Rather, more emphasis has been placed on anaesthetists teaching a broader range of knowledge, skills and attitudes relevant to every newly qualified doctor.

Delirium dichotomy: a review of recent literature.

Delirium remains a commonly occurring problem for older people and staff in acute care settings. The aim of this review of current literature is to find contemporary evidence on which to base practice modalities. Although the literature provides an exposition of the concerns with which practitioners are currently faced and highlights the consistent themes identified, there is little research evidence regarding the effectiveness of treatment protocols for the management of older people with delirium in acute care setting.

The scope of private practice nursing in an Australian sample.

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.

The influences on and experiences of becoming nurse entrepreneurs: a Delphi study.

There is little known about private practice nursing as an area of advanced practice. As more nurses take the option to develop private practice, the experiences of and influences on nurses currently in private practice might be a useful guide to the pitfalls and difficulties which might be encountered. In addition, an understanding of the experiences of and influences might assist nursing organizations and health services to provide support to nurses who play an integral part in health care delivery in the community. A research study was undertaken utilizing a two-round Delphi Technique to elicit and assess consensus on the reasons for nurses going into business and the experiences they encountered in becoming and being a nurse entrepreneur. The study instrument in round one comprised a questionnaire with statement headings inviting opinions on the influences and experiences of nurses in business. In the second round, levels of agreement were elicited from responders on collated opinions from round one, including statements formed from comments written in round one. The initial questionnaire also included closed questions to obtain a profile of nurses in private practice. Responders were 59 nurses in private practice in round one and 54 nurses in round two. The themes raised could be grouped under headings of influences, advantages/disadvantages, education/experience, skills/knowledge, characteristics and barriers. The level of agreement on the themes was reasonably high. Dissent occurred on issues of increased income, professional image and support structures. This Delphi study has identified key areas of consensus on the experiences of nurses in private practice who have extended their career into the business arena. It has also identified areas in which further work needs to be carried out to understand this work of nurse entrepreneurs.

Patterns of nursing: a review of nursing in a large metropolitan hospital.

In this Clinical Practice Development (CPD) project we set out to identify and describe current approaches to the management and delivery of nursing care in an Australian Metropolitan Teaching Hospital. Using a simple descriptive design, data were collected to elicit patterns of care provided by nursing teams. We sought to demonstrate patterns described by nursing teams (interviews) and actual patterns of care (observation). As expected there was a degree of incongruence between the espoused and actual patterns of care. Interview data revealed that most study wards had a view of nursing that emphasizes meeting the total care needs of patients and their families through offering biopsychosocial and educative care. The observational data revealed that a relatively large proportion of time was expended on activities that were not regarded as important by staff when interviewed (e.g. documentation) while relatively small amounts of time were observed to be spent educating patients or communicating with relatives of patients. The identification of this type of gap creates a dissonance in clinicians that can be used to stimulate change through CPD. Clinicians used the information to stimulate discussion and to rewrite team value statements.

Development of a group model of clinical supervision to meet the needs of a community mental health nursing team.

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term 'clinical supervision' is itself problematic in that it implies an hierarchical, rather than a nurse-centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.

Continuing competence and the regulation of nursing practice.

A study commissioned by the Australian Nursing Council Inc. sought to develop an approach to the maintenance of continuing competence in nursing that is broadly acceptable to nurses in all States and Territories. The study involved a comprehensive review of the international literature and this paper provides an overview of statutory regulation of professions with particular reference to regulation of the nursing profession. A definition of competence and competencies and a discussion of beginning and continuing professional competence are presented, followed by a review of current indicators of continuing professional competence used by a variety of professions in Australia.

Nurses' and patients' perceptions of dignity.

It is generally agreed in the nursing literature that the maintenance of patient dignity is an important element of nursing care that is highly valued by patients. Despite this, dignity is seldom defined and there are few guidelines that nurses may use in their practice to safeguard individual patients' dignity. This phenomenological study aimed to uncover patients' and nurses' perceptions of dignity, formulate a definition of dignity based on the experience of patients and nurses, and identify nursing practices that maintain or compromise patient dignity. The study found that the characteristics nurses associated with dignity were many and varied. Important elements in the meaning the nurses ascribed to the notion of patient dignity were the elements of respect, privacy, control, advocacy and time. The themes which emerged from the patient interviews were similar to those which emerged from the interviews with nurses. The characteristics that patients attributed to dignity and its maintenance included respect, privacy, control, choice, humour and matter-of-factness.

Nurses' views on competency indicators for Australian nursing.

This paper reports on a project commissioned by the Australian Nursing Council Inc that sought to develop an approach to the maintenance of continuing competence in nursing broadly acceptable to nurses in all states and territories. This project involved extensive consultation with nurses, consumers and key stakeholders on appropriate competence indicators. Findings suggest that a majority of nurses support the development of competence indicators but most are confused about the nature of competence.