Non-technical skills in operating room nursing: Ethical aspects.

BACKGROUND: Non-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate. AIM: To learn what ethical issues operating room nurses perceive as important regarding non-technical skills. RESEARCH DESIGN: Qualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke's six phases for thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT: Eleven experienced perioperative/operating room nurses working in an operating unit at a Norwegian university hospital. ETHICAL CONSIDERATIONS: Approval was given by The Norwegian Social Science Data Service in care of the hospital's Data Protection Officer. FINDINGS: Three main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety. DISCUSSION: Defending the patient's dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other's tasks and responsibilities and to talk to one another in a friendly manner. CONCLUSION: Being respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good 'flow' within the operating room team.

Perioperative nurses' experiences of caring for donation after cardiac death organ donors and their family within the operating room.

Background: Worldwide, operating rooms have seen the re-emergence of donation after cardiac death organ donors to increase the number of available organs. There is limited information on the issues perioperative nurses encounter when caring for donor patients after cardiac death who proceed to organ procurement surgery. Objectives: The purpose of this paper is to report a subset of findings derived from a larger study highlighting the difficulties experienced by perioperative nurses when encountering donation after cardiac death organ donors and their family within the operating room during organ procurement surgery from an Australian perspective. Methods: A qualitative grounded theory method was used to explore perioperative nurses' (n = 35) experiences of participating in multi-organ procurement surgery. Results: This paper reports a subset of findings of the perioperative nurses' experiences directly related to donation after cardiac death procedures drawn from a larger grounded theory study. Participants revealed four aspects conceptualised as: 'witnessing the death of the donation after cardiac death donor'; 'exposure to family'; 'witnessing family grief' and 'stepping into the family's role by default'. Conclusion: Perioperative nurses' experiences with donation after cardiac death procedures are complex, challenging and demanding. Targeted support, education and training will enhance the perioperative nurses' capabilities and experiences of caring for the donation after cardiac death donor and their family with the operating room context.

Operating room nurses' perception of professional values.

BACKGROUND AND SIGNIFICANCE OF RESEARCH: Nurses' awareness of professional values and how those values affect their behaviors is an integral part of nursing care. There is a large body of research on nursing professional values, however, a careful survey of the available literature did not yield any studies investigating the status of professional values in operating rooms. OBJECTIVE: This study aims to investigate the perception of operating room nurses of university hospitals toward professional values. RESEARCH PLAN: In this cross-sectional study, data were collected using Schank and Weis's Nurses Professional Values Scale-Revised. The collected data were analyzed in SPSS version 16. PARTICIPANTS AND SETTINGS: The 513 participants of the study consisted of operating room nurses and nurse anesthetists from six university hospitals. ETHICAL CONSIDERATIONS: This study has been approved by the ethics committee of the university. FINDINGS: The mean total professional values score of the operating room staff was found to be 100.84 ± 15.685, which indicates that the participants had a positive perception toward observance of nursing professional values in practice. The results showed that the participants considered the domains of justice and activism as, respectively, the most and the least important. The operating room staff's overall professional values scores were not found to correlate significantly with their ages, professional experience, university majors, or attendance at ethics workshops. However, a significant difference was found between the professional values scores of the female and male staff. The professional values scores of the operating room nurses and the nurse anesthetists were not significantly different (p value = 0.494). CONCLUSION: Operating room staff's awareness of professional values is essential to providing care to patients based on professional principles. Accordingly, there is need for programs to raise operating room nurses' awareness of their professional duties and improve their professional performance.

Evaluating ethical sensitivity in surgical intensive care nurses.

BACKGROUND AND AIM: Surgical intensive care nurses should have ethical sensitivity allowing them to identify ethical issues in order that they can recognize them and make the right decisions. This descriptive study was conducted with the aim of evaluating the ethical sensitivity of surgical intensive care nurses. MATERIALS AND METHODS: The research was carried out with the participation of 160 nurses in six Turkish hospitals, four state, one university, and one private. The data were collected using the "Nurse Description Form" developed by the researcher and the "Ethical Sensitivity Questionnaire." The percent, mean, standard deviation, median, minimum and maximum values, significance test for the difference between two means, variance analysis, Mann-Whitney U test, and Kruskal-Wallis Variance Analysis test were used to evaluate the data. ETHICAL CONSIDERATIONS: Ethical commission permission and the corporate permission of the hospitals were received before conducting the research. RESULTS: It was determined that the ethical sensitivities of surgical intensive care nurses were moderate based on the Ethical Sensitivity Questionnaire total score and subdimension score averages. A statistical difference was determined between the Ethical Sensitivity Questionnaire total score of surgical intensive care nurses and the institution where they worked, the period of working in the occupation, and the period of working in the intensive care unit (p < 0.05). CONCLUSION: Based on the results of the research, the organization of training and studies devoted to the elimination of ethical sensitivity differences between institutions and workers is suggested.

Value conflicts in perioperative practice.

BACKGROUND: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. OBJECTIVES: This study describes operating theatre nurses' experiences of ethical value conflicts in perioperative practice. RESEARCH DESIGN: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation. ETHICAL CONSIDERATION: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. FINDINGS: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient's care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient's best. This occurred when operating theatre nurses' competence was not taken seriously and was ignored in patient care. CONCLUSION: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations.

Pediatric Perioperative Nurses and the Ethics of Organ Donation After Cardiac Death.

Pediatric perioperative nurses are experiencing increased opportunities to participate in donations after cardiac death. An increased public awareness regarding transplantation has inspired more people to donate than in previous years. The demand for transplantable organs has led to opportunities that have increased donor candidates including living donors and cardiac death donors. Cardiac death in children is often sudden and unexpected, and is an emotional time not only for the family members but also for the hospital staff members, including perioperative nurses. However, when perioperative nurses adhere to standards and guidelines, they can perform their responsibilities in an ethical and compassionate manner and assist their team in doing so. This article reviews the guiding principles of pediatric organ donation after cardiac death, the phases of the process, and the ethical and moral issues surrounding donation.

Ethical Considerations for Care of the Child Undergoing Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a complex, highly technical surgical procedure that can offer hope for children born with congenital heart defects. The procedure may only briefly prolong a life, has limited potential for decreasing mortality, and may lead to serious complications, however. Perioperative nurses play an important role in caring for the child who requires ECMO. They are involved in assessing the child, implementing the plan of care, and facilitating communication between the child's family members and the health care team. Thus, perioperative nurses have a responsibility to consider the broad range of ethical issues associated with the procedure. By examining the ethical concepts of beneficence, nonmaleficence, autonomy, justice, and moral distress, the perioperative nurse can better understand the dilemmas that can affect the care and outcome of the critically ill child who requires ECMO.

Management of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in the perioperative period.

It is increasingly common for patients to be scheduled for anaesthesia and surgery with a 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decision in place. Updated guidelines for the implementation and management of DNACPR decisions were published jointly by the British Medical Association (BMA), the Resuscitation Council (UK) and the Royal College of Nursing (RCN) in 2014 (BMA, RC(UK), RCN 2014). The Association of Anaesthetists of Great Britain and Ireland (AAGBI) published specific guidelines in 2009 to guide the perioperative management of such patients (AAGBI 2009). In this article, we explain these guidelines with a focus on how DNACPR decisions are made and how they can be modified in order to permit appropriate surgery to take place.

Conflitos e dilemas éticos vivenciados pelo enfermeiro no cuidado perioperatório / Conflicts and ethical dilemmas experinced by the nurse in the perioperative care

O estudo objetivou compreender os conflitos e dilemas éticos vivenciados por enfermeiros no cuidado perioperatório de um hospital geral, em Salvador-Bahia. Optou pela abordagem fenomenologica de Edmund Husserl,por ter como objeto de estudo o fenômeno conflitos e dilemas éticos do enfermeiro no centro cirúrgico. A fonte de dados foi aentrevista fenomenológica. As análises ideográfica e nomotética possibilitaram a apreensão da estrutura do fenômeno com duas categorias: Compreendendo os conflitos e dilemas éticos vivenciados pelos enfermeiros no período perioperatório e os enfermeiros vivenciam conflitos e dilemas éticos no períodoperioperatório em contexto de deficiências de recursos humanos, físicos e materiais. Compreende-se que a escassez de recursos além da divergência de opiniões sobre uma mesma situação; dificuldade da equipe cirúrgica para chegar a um consenso; não atendimento das solicitações da equipe; ações realizadas sob tensão na unidade; desrespeito à autonomia dos enfermeiros durante a prática e escassez de recursos são os geradores deconflitos e dilemas no perioperatório. Recomenda-se às instituições investir em infraestrutura, recursos materiais e humanos no centro cirúrgico.

The study aimed to get to understand the conflicts and ethical dilemmas experienced nurses in the perioperative care of a general hospital in Salvador-Bahia. It was choose the phenomenological approach by Edmund Husserl, by having as object of study the phenomenon conflicts and ethical dilemmas of the nurse in surgical center. The data collected by phenomenological interview. Ideographic and nomothetic analyzes allowed the seizure of the phenomenological structure in two categories: Comprehending the conflicts and ethical dilemmas experienced by nurses in the perioperative period and Nurses experience conflicts and ethical dilemmas in perioperative period in the context of inadequate human resources, physical and material. It is understood that the shortage of resources and divergence of opinions on the same situation; difficulty of the surgical team to reach a consensus; not treatment of requests of the team; actions held under tension in the unit; disrespect for the autonomy of nurses during practice and scarcity of resources are the generators of conflicts and dilemmas in perioperative. It recommended to institutions to invest in infrastructure, material and human resources in surgical center.

Student nurses' experiences of undignified caring in perioperative practice - Part II.

BACKGROUND: In recent years, operating theatre nurse students' education focused on ethics, basic values and protecting and promoting the patients' dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery. OBJECTIVE: The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice. RESEARCH DESIGN: The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique. PARTICIPANTS AND RESEARCH CONTEXT: Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. ETHICAL CONSIDERATIONS: The study was approved by the Karlstad University's Research Ethics Committee. FINDINGS: The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient's worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient's body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient's dignity in perioperative practice. DISCUSSION: In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. CONCLUSION: The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed.

Student nurses' experiences of preserved dignity in perioperative practice - Part I.

BACKGROUND: In recent years, operating theatre nurse students' education focussed on ethical value issues and how the patient's dignity is respected in the perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery. OBJECTIVE: The objective of this study was to present what operating theatre nurse students experienced and interpreted as preserved dignity in perioperative practice. RESEARCH DESIGN: The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique. PARTICIPANTS AND RESEARCH CONTEXT: Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. ETHICAL CONSIDERATIONS: The study was conducted accordance with the Declaration of Helsinki and approved by a local University Ethics Research Committee. FINDINGS: The findings revealed that students experienced that operating theatre nurses perserved patient's dignity in perioperative practice by being present for each other and making themselves known to the patient. Operating theatre nurses caring for the patient by being compassionate and preserved the patient privacy. The new understanding that emerged was that the operating theatre nurse students understood that the operating theatre nurse wanted to care for the patient like a human being. DISCUSSION: In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. CONCLUSION: Preserved dignity is an ethical and caring act. Ethical questions and how to preserve dignity in perioperative practice should be discussed more both in educations of healthcare professionals and in clinical practice.

Implied consent and nursing practice: ethical or convenient?

Nursing professionals in a variety of practice settings routinely use implied consent. This form of consent is used in place of or in conjunction with informed or explicit consent. This article looks at one aspect of a qualitative exploratory study conducted in a Day of Surgery Admission unit. This article focuses on the examination of nurses' understandings of implied consent and its use in patient care in nursing practice. Data were collected through one-on-one interviews and analysed using a thematic analysis. Nurses participating in this study revealed that they routinely used implied consent in their nursing practice. This article will look at whether implied consent supports or impedes a patient's autonomy.

Surgical nurses' perceptions of ethical dilemmas, moral distress and quality of care.

AIM: To describe surgical nurses' perceived levels of ethical dilemmas, moral distress and perceived quality of care and the associations among them. BACKGROUND: Nurses are committed to providing quality care. They can experience ethical dilemmas and moral distress while providing patient care. Little research has focused on the effect of moral distress or ethical dilemmas on perceived quality of care. DESIGN: Descriptive, cross-sectional study. METHOD: After administration and institutional Research Ethics Committee approval, a researcher requested 119 surgical nurses working in two Israeli hospitals to fill out three questionnaires (personal background characteristics; Ethical Dilemmas in Nursing and Quality of Nursing Care). Data collection took place from August 2007 to January 2008. RESULTS: Participant mean age was 39·7 years. The sample consisted mostly of women, Jewish and married staff nurses. The majority of nurses reported low to moderate levels of ethical dilemma frequency but intermediate levels of ethical dilemma intensity. Frequency of ethical dilemmas was negatively correlated with level of nursing skill, meeting patient's needs and total quality of care. No important correlations were found between intensity of ethical dilemmas and quality of care. CONCLUSIONS: Levels of ethical dilemma frequency were higher than intensity. Nurses tended to be satisfied with their level of quality of care. Increased frequency of ethical dilemmas was associated with some aspects of perceived quality of care. RELEVANCE TO CLINICAL PRACTICE: Quality of care is related to ethical dilemmas and moral distress among surgical nurses. Therefore, efforts should be made to decrease the frequency of these feelings to improve the quality of patient care.

Legal, professional and ethical considerations of advanced perioperative practice.

Advances within the NHS have recognised nurses in roles that go beyond the historical parameters of their initial training and role characteristics (DH 1999, DH 2000). Working within such a role creates added responsibilities of advancing practice and the continuing development of knowledge and skills. Nurses working at a higher level of practice will require an understanding of not only the professional and legal implications that new roles create, but also an awareness of the ethical dilemmas that will undoubtedly become increasingly complex (Bartter 2002). This article examines the professional, legal and ethical implications of advanced perioperative practice through the author's role as a surgical care practitioner (SCP).