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    Health Care Workers' Use and Cleaning of X-Ray Aprons and Thyroid Shields.
    AORN J 2017 Dec;106(6):534-546
    We evaluated the use and cleaning of x-ray aprons and thyroid shields by surveying rural hospital system health care workers who wear x-ray aprons and thyroid shields. One hundred fifty-five of the 173 respondents were RNs (89.6%), and 94 respondents were from inpatient or outpatient surgical settings (54. Read More

    Navigating Nursing Education.
    AORN J 2017 Dec;106(6):523-533
    All nurses must embrace lifelong learning and engage in academic progression to help transform health care. This article explores the various forms of nursing education and focuses on the types of degrees available, different practice roles and pathways, types of educational institutions and programs, and accreditation and its governing bodies. The benefits to nurses who pursue additional education include career mobility, additional responsibilities, and personal satisfaction. Read More

    Evaluation of a Brief Team Training Intervention in Surgery: A Mixed-Methods Study.
    AORN J 2017 Dec;106(6):513-522
    The aim of this study was to evaluate a brief team training program in relation to teams' observed nontechnical skills (NTSs) in surgery, teams' perceptions of safety culture, and the training implementation. We used mixed methods to analyze structured observations of 179 surgeries, semistructured interviews with surgical team members from four selected surgical specialties, and a survey. There were significant (P < . Read More

    Operation Clean Air: Implementing a Surgical Smoke Evacuation Program.
    AORN J 2017 Dec;106(6):502-512
    Surgical smoke is a hazardous byproduct of any surgery involving a laser or an electrosurgical unit. Although research and professional organizations identified surgical smoke as harmful many years ago, this byproduct continues to be a safety hazard in the OR. An interdisciplinary team at a large academic medical center sought to address the exposure of patients and perioperative team members to surgical smoke. Read More

    Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment.
    AORN J 2017 Dec;106(6):494-501
    Surgical site infections are unintended consequences of surgery that can cause harm to patients and place financial burdens on health care organizations. Extrinsic factors in the OR-including health care providers' behavior and practices that modify air movement, the physical environment, equipment, or surgical instruments-can increase microbial contamination. Microbes can be transported into the surgical incision by airborne or contact routes and contribute to a surgical site infection. Read More

    Results of the 2017 AORN Salary and Compensation Survey.
    AORN J 2017 Dec;106(6):476-493
    AORN conducted its 15th annual compensation survey for perioperative nurses in June 2017. A multiple regression model was used to examine how several variables, including job title, educational level, certification, experience, and geographic region, affect nurse compensation. Comparisons between the 2017 data and data from previous years are presented. Read More

    Clinical Issues-November 2017.
    AORN J 2017 Nov;106(5):443-449
    Heating, ventilation, and air-conditioning (HVAC) systems in the OR Key words: airborne contaminants, HVAC system, air pressure, air quality, temperature and humidity. Air changes and positive pressure Key words: air changes, positive pressure airflow, unidirectional airflow, outdoor air, recirculated air. Product selection Key word: product evaluation, product selection, selection committee. Read More

    Back to Basics: Environmental Cleaning Hazards.
    AORN J 2017 Nov;106(5):424-432
    Perioperative personnel must clean and disinfect the perioperative environment numerous times throughout the day to help prevent the risk of exposing patients to pathogenic microorganisms. However, this practice exposes perioperative team members to chemicals that could be harmful to their health. Exposure to cleaning and disinfecting products has been associated with potential health problems such as skin irritation, burns, rashes, and difficulty breathing. Read More

    Temporary Perioperative Tobacco Cessation: A Literature Review.
    AORN J 2017 Nov;106(5):415-423.e5
    Perioperative tobacco cessation decreases rates of surgical complications associated with the use of tobacco. The link between patient outcomes and reimbursement to health care providers and systems is another important motivating factor supporting temporary pre- and postoperative tobacco cessation to improve surgical patient outcomes. The optimal time frame for tobacco cessation to improve surgical outcomes has not been definitively established. Read More

    Epilepsy: Clinical Review and Surgical Options.
    AORN J 2017 Nov;106(5):393-414
    Epilepsy is the fourth leading neurologic disorder in the United States and affects the quality of life of approximately 2.9 million Americans. Despite modern progress in medicine and technology, the disease may prove to be drug resistant, a condition that serves as a primary indication to consider invasive treatment modalities. Read More

    Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice.
    AORN J 2017 Nov;106(5):378-392
    Nursing is an information-intensive profession, requiring nurses to have high information literacy and the skills to find, understand, evaluate, and use information from a multitude of sources. The advanced practice RN (APRN) is a valuable resource to support and guide nurses in this effort. The APRN's skills encompass understanding and implementing evidence-based practice, evaluating the organizational structure (eg, units, facilities, multisystem organizations) across the continuum of care, and facilitating collaboration between perioperative nurses and other interprofessional team members to sustain practice changes in the clinical setting. Read More

    Local Anesthetic Systemic Toxicity.
    AORN J 2017 Nov;106(5):367-377
    Local anesthetics are commonly used in the perioperative environment to facilitate surgical procedures or to provide postoperative pain management for patients. The use of local anesthetics, however, introduces the risk of complications resulting from local anesthetic systemic toxicity and the risks of increased morbidity and mortality for the surgical patient. Systemic toxicity from the injection or overdose of local anesthetics is a rare but potentially fatal complication that occurs in less than 1 in 1,000 patients. Read More

    Clinical Issues-October 2017.
    AORN J 2017 Oct;106(4):338-345
    • Bowel isolation technique in minimally invasive surgery Key words: minimally invasive surgery, bowel isolation technique, bowel resection. • Covering hair that has escaped a surgical cap Key words: OR attire, head covering, sterile technique. • Surgical head coverings Key words: skull caps, bouffant caps, quality control, quality initiative. Read More

    An Integrative Review of Postoperative Accelerated Recovery Protocols.
    AORN J 2017 Oct;106(4):324-330.e5
    We undertook an integrative literature review of articles pertaining to perioperative nursing care provided to patients using postoperative accelerated recovery protocols. To select the articles, we searched the MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature, and LiteraturaLatino-Americana e do Caribe em Ciências da Saúde databases. We identified 329 studies, 13 of which met our inclusion criteria and described perioperative nursing care activities. Read More

    The Role of Emotional Intelligence in Perioperative Nursing and Leadership: Developing Skills for Improved Performance.
    AORN J 2017 Oct;106(4):317-323
    Many responsibilities of perioperative professionals involve concrete tasks that require high technical competence. Emotional intelligence, referred to as EQ, which involves the ability to relate to and influence others, may also be important for perioperative professionals. High EQ has been linked to higher performance in the workplace, higher job satisfaction, lower turnover intentions, and less burnout. Read More

    Surgical Head Coverings: A Literature Review.
    AORN J 2017 Oct;106(4):306-316.e6
    Microorganisms that cause surgical site infections may either be present on the patient's skin or mucous membranes or transmitted to the patient by health care personnel, the environment, or other items in the perioperative setting. This literature review analyzes the evidence used to support the recommendation that perioperative personnel should cover their heads, hair, and ears in the semirestricted and restricted areas. A literature search produced 27 articles related to bacterial shedding from skin and hair, pathogenic organisms present on the hair and ears, and case reports of infectious organisms passed from health care providers to patients. Read More

    A Communication Training Program to Encourage Speaking-Up Behavior in Surgical Oncology.
    AORN J 2017 Oct;106(4):295-305
    Patient safety in the OR depends on effective communication. We developed and tested a communication training program for surgical oncology staff members to increase communication about patient safety concerns. In phase one, 34 staff members participated in focus groups to identify and rank factors that affect speaking-up behavior. Read More

    Maximizing Efficiency and Reducing Robotic Surgery Costs Using the NASA Task Load Index.
    AORN J 2017 Oct;106(4):283-294
    Perioperative leaders at our facility were struggling to meet efficiency targets for robotic surgery procedures while also maintaining the satisfaction of the surgical team. We developed a human resources time and motion study tool and used it in conjunction with the NASA Task Load Index to observe and analyze the required workload of personnel assigned to 25 robotic surgery procedures. The time and motion study identified opportunities to enlist the help of nonlicensed support personnel to ensure safe patient care and improve OR efficiency. Read More

    Guideline Implementation: Positioning the Patient.
    AORN J 2017 Sep;106(3):227-237
    Every surgical procedure requires positioning the patient; however, all surgical positions are associated with the potential for the patient to experience a positioning injury. The locations and types of potential injuries (eg, stretching, compression, pressure injury) depend on the position. Factors that may increase the patient's risk for an injury are the length of the procedure and risk factors inherent to the patient (eg, weight, age, frailty). Read More

    Back to Basics: Pneumatic Tourniquet Use.
    AORN J 2017 Sep;106(3):219-226
    Pneumatic tourniquets are commonly used in surgeries involving the limbs to achieve a nearly bloodless surgery and an optimal operating field or when administering regional anesthesia during surgery on a limb. Complications can arise from the use of tourniquets, including nerve injuries, pain, compartment syndrome, pressure injuries, chemical burns, and tissue necrosis. More serious injuries-including deep vein thrombosis, thermal damage to tissues, severe ischemic injuries, and rhabdomyolysis-also can occur. Read More

    An Integrative Review of the Hands-Free Technique in the OR.
    AORN J 2017 Sep;106(3):211-218.e6
    Sharps injury rates are proportionally higher in perioperative areas than in other practice settings. The hands-free technique (HFT) has been shown to decrease the hazards of sharps injuries when passing sharps during surgery. We reviewed and synthesized research studies regarding compliance with the HFT and factors facilitating its use using a key word search of online databases and a secondary search of references. Read More

    Professional and Regulatory Infection Control Guidelines: Collaboration to Promote Patient Safety.
    AORN J 2017 Sep;106(3):201-210
    Professional organizations and regulatory agencies collaborate on infection prevention and control guidelines to support preventing and controlling infection in the surgical setting. More specifically, regulatory and accrediting agencies, professional associations, and advisory committees create and promote the use of evidence-based recommendations for preventing surgical site infections. Many agencies perform accreditation surveys to ensure compliance with these standards and guidelines. Read More

    The Effect of Offloading Heels on Sacral Pressure.
    AORN J 2017 Sep;106(3):194-200
    Offloading a patient's heels during supine surgical procedures is a common practice to prevent heel pressure injuries. This practice may increase sacral pressure and jeopardize sacral skin integrity, but prophylactic dressings may help protect sacral skin. The purpose of this study was to examine the effects of offloading the heels and of multilayered silicone foam dressings on sacral pressure. Read More

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