Academic literature on the topic 'Australian College of Operating Room Nurses'

An Australian College of Operating Room Nurses (ACORN) submission (ACORN 2002–2008) recently stated that the specialities that suffered significantly from the transition of hospital-based nursing training to university training were the perioperative specialty, critical care and emergency. The main reason for this was that perioperative nursing was not included in the undergraduate nursing curriculum. Less than a handful of universities in Australia offer the subject as a compulsory unit. The University of Notre Dame Australia (UNDA) is one of these universities. This paper will provide an insight into the perioperative nursing care unit embedded within the Bachelor of Nursing (BN) undergraduate curriculum.

A survey of anaesthetic workforce was undertaken in departments in Australia and New Zealand approved for specialist training by the Australian and New Zealand College of Anaesthetists. When compared to a previous survey 17 years before, the results showed that the number of anaesthetics administered rose, the number of operating theatres (OTs) remained the same, but the surgical beds were reduced. There was a small increase (20%) in full-time specialists with a number of vacancies in establishment. There was, however, a large increase (80%) in Visiting Medical Officer (VMO) sessions and a 40% increase in Registrar positions. At the same time there were very large increases in Recovery Room nurses (125%) and Anaesthetic Assistants (100%). From this survey and other recent government workforce reports it is possible to derive certain workforce postulates—a specialist anaesthetist will on average anaesthetize approximately 1000 patients per annum, one in every nine people in the population will have an anaesthetic each year, and the working lifespan of a specialist anaesthetist is 30 years with 5% working half-time or less. All of this suggests that the correct Anaesthetists to Population Ratio (APR) should be reset to 1:8,500 for both Australia and New Zealand. The number of trainees required to supply a steady state replacement for this specialist workforce is also derived and the current number of training positions is shown to be in excess of these requirements. When the current shortfall in specialist anaesthetists is corrected there will need to be a gradual reduction (by approximately 40%) in the number of training positions to prevent an oversupply of anaesthetists. The factors which may potentially alter this forecast are addressed and include: change in the general population; ageing of the population; change in the average number of anaesthetics administered per anaesthetist per year; alteration in anaesthetists’ working lifespan; change in the age distribution of anaesthetists; increased economic usage of operating theatres and changes in the number of College approved training positions.

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.

Introduction:Sudden onset disasters exceed the capabilities of local health services. Emergency Medical Teams (EMTs), including the Australian Medical Assistance Team (AUSMAT), are a vital element of the Australian Governments capacity to respond to regional and international sudden-onset disasters. AUSMAT has the capacity to deploy an EMT Type 2 surgical field hospital and has been successfully verified by the World Health Organisation (WHO). All AUSMAT members must complete AUSMAT Team Member training. The National Critical Care and Trauma Response Centre, Darwin, Australia is responsible for all AUSMAT training.Aim:To educate and train the Surgical Team (perioperative nurses, surgeons, and anesthetists) in preparation for AUSMAT deployments in the austere environment.Methods:Prior to 2015, the surgical AUSMAT training was conducted via two courses: one for perioperative nurses and a separate course for surgeons and anesthetists. In 2015, the course was redesigned with the aim of collaborative training with all the Surgical Team Members. The new Surgical Team Course (STC) engages all three professions to learn alongside each other and discuss potential difficulties in techniques, the daily running of the operating room, and ethical discussions.Results:Since the rejuvenation of the STC, 15 surgeons, 17 anesthetists, and 18 perioperative nurses have completed the course. The attendees are familiarized with operational and clinical guidelines, the surgical field hospital, and operating room equipment including CSSD. A pivotal component of the course focuses on the essentials of medical records and Minimum Data Set reporting for EMTs as defined by WHO.Discussion:Since 2015, the NCCTRC has successfully run two courses. The revised collaborative model for AUSMAT STC has enhanced the quality of the program and subsequent learning experiences for participants.

A review of the first 2000 incidents reported to the Australian Incident Monitoring Study found 317 incidents which involved problems with ventilation. The major portion (47%) were disconnections; 61% of these were detected by a monitor. Monitor detection was by a low circuit pressure alarm in 37% but this alarm failed to warn of non-ventilation in 12 incidents (in 6 because it was not switched “on” and in 6 because of a failure to detect the disconnection). Failure of detection was usually with ventilator bellows descending in expiration. Complete failure to ventilate occurred in 143 incidents, most commonly because of a disconnection. Disconnection was associated, in one-third of the cases, with interference to the anaesthetic circuit by a third party and in nearly half with surgery on the head and neck. Leaks affected ventilation in 129 incidents, but in only 19 was ventilation totally lost; leaks associated with seal failure of the absorber were common. Misconnections occurred in 36 incidents, most commonly involving the scavenging system. The frequency of a complete failure to check an anaesthetic machine was greater when an induction room was involved than when only the operating theatre was the site of the incident. These incidents suggest that meticulous checking and monitoring for failure of ventilation, preferably using at least two separate, self-activating systems is highly desirable. The Australian and New Zealand College of Anaesthetists’ policy on low circuit pressure alarms, oximetry and capnography is vindicated by these reports.

The novel coronavirus disease (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to many countries, including Indonesia. The outbreak started within early March 2020 and in just less than a month the virus has infected 1285 patients and 114 death in Indonesia by March 30, 2020 [1]. It does not only take many lives of patients, but also our colleagues as health care providers. On behalf of the Indonesian Journal of Cancer, we would like to express our deepest condolences to all patients and especially to our doctors, nurses, and all health care workers, who could not survive in the battle against this virus.Looking at how serious the disease is, it is estimated that the situation will give major changes to cancer patients’ management, and unfortunately, it is happening in the middle of our efforts to upgrade cancer management in Indonesia. It is going to be a hard time, but we must be ready to overcome the COVID-19 crisis in the field of oncology. Let us take a brief look at published articles and recommendations in oncology.A recent publication by Liang et al. [2] in China revealed that cancer patients with COVID-19 had higher risk of severe events, which were defined by more frequent intensive care unit admission, requirement of mechanical ventilator, and higher death rate, hence they also proposed to withhold chemotherapy and elective surgery for stable cancer in the endemic areas. However, this initial result of 18 cancer patients out of 1590 COVID-19 cases should be interpreted cautiously because of insufficient evidence to be recommended in every cancer patient [3]. More robust evidence is needed to address this issue in the field of cancer, from prevention, screening, advances in therapies, until palliative management. In the meantime, some guidelines have been proposed by several oncology socities [4-6]. Postponing cancer screening and elective surgeries such as in benign disease and risk-reducing surgery sound-wise for the time being, but surgical oncologists should remember that most of the cancer surgeries cannot be considered “elective”. American College of Surgeons has also released a triage guideline for surgical cases and recommended using the Elective Surgery Acuity Scale (ESAS) from St. Louis University to assist surgical decision-making [5]. To date, no direct evidence has been reported to support withholding radiotherapy, chemotherapy, and immunotherapy in daily cases, although some practice changes in several situations such as postponing, switching, or stopping aggressive adjuvant treatment in stable and low-risk cancer could be considered [4-5]. We must underline the potential harm of delaying cancer treatment and the benefit of reducing the risk of COVID-19 infection or vice versa. Individual discussions with patients should be made because many factors will contribute to giving the best answer.We are preparing for skyrocketing COVID-19 cases in Indonesia within the next few days or weeks. How do we prepare without letting behind our main goal as oncologists to care for cancer patients? A published article by Ueda et al. [7] could be a good example for us to start with and to learn how they managed the cancer service during the early outbreak in Washington. They started with patients’ triage, education for patient and family through handouts and web-site, and strengthening the policy of “stay at home”. A phone triage line, providing personal protective equipment (PPE), and also test to symptomatic medical staff, were provided. In outpatient service, rescheduling visits of “well” patients, or postponing the second consultation for patients who already had treatment access in initial health care, were being conducted. Telemedicine also plays an important part of their strategy. Cancer surgery was their priority when PPE, team members, and bed capacity were available. A surgeon-to-patient phone call discussion was made when a delay in schedule was expected. Many patients with aggressive hematologic malignancies were managed not to get a treatment delay and planned to conduct a limitation for clinical trials except for the studies that will bring benefit to participants. They also mentioned that it is imperative to discuss ethical issues in the end-of-life setting when a final-stage patient acquires COVID-19 [7].Managing cancer surgeries in our surgical oncology unit is not so simple even in the time before COVID-19, since many complex and urgent cancer cases were referred to us. When the outbreak occurred, the continuity to perform surgery has been even more challenging for us. We decided to proceed with the surgery and several adjustments were made to make sure the safety of patients and team members. Neither benign cases nor breast reconstructions are performed at the moment. Emergency conditons, aggressive-behavior cancer, and post-neoadjuvant chemotherapy surgeries are also prioritized. The onco-microsurgical reconstruction is only performed for complex head and neck cancer, soft tissue sarcoma, and cancer treatment-related lymphedema with the risk of having dermatolymphangioadenitis. Having an urgent complex case on the table, I am fortunate and honored to work with dedicated colleagues and operating room team who are willing to follow our strict rules: we do not do multiple surgeries or outpatient clinic service on the scheduled day; the surgery must be started early to avoid late hours working time; which could reduce the physical and mental health of each team member; everyone must stay focused with their parts, so “quick-in-quick-out” surgery can be accomplished to prevent or reduce patients’ immunosuppressive effect due to a long surgery; a well-screened patient and the availability of PPE is mandatory before the surgery is started. It is just a modest example and we are aware that adjustment of our current protocol should be done when new scientific evidence and hospital policies are made. As the world is struggling for the battle against COVID-19, our role as oncologists, especially in Indonesia is very crucial for cancer management. Indonesia has a different situation compared to the other countries. In the current crisis, we must act scientifically and creatively. Thus, urgent works are needed: scientific COVID-19 and cancer management recommendations must be released from our oncology societies or related hospitals; hospitals’ board must establish firm policies and logistics which could protect the safety of patients and medical workers; any kind of scientific study related to cancer and COVID-19 in Indonesia must be endorsed and published. It will not be easy, but once we pass the test, we will be pleased to know that we have made a significant contribution to save our patients, others, and knowledge.

Occupational exposures of healthcare workers tend to occur because of inconsistent compliance with standard precautions. Also, incidence of occupational exposure is underreported among operating room personnel. The purpose of this project was to develop national estimates for compliance with standard precautions and occupational exposure reporting practices among operating room nurses in Australia. Data was obtained utilizing a 96-item self-report survey. The Standard Precautions and Occupational Exposure Reporting survey was distributed anonymously to 500 members of the Australian College of Operating Room Nurses. The Health Belief Model was the theoretical framework used to guide the analysis of data. Data was analysed to examine relationships between specific constructs of the Health Belief Model to identify factors that might influence the operating room nurse to undertake particular health behaviours to comply with standard precautions and occupational exposure reporting. Results of the study revealed compliance rates of 55.6% with double gloving, 59.1% with announcing sharps transfers, 71.9% with using a hands-free sharps pass technique, 81.9% with no needle recapping and 92.0% with adequate eye protection. Although 31.6% of respondents indicated receiving an occupational exposure in the past 12 months, only 82.6% of them reported their exposures. The results of this study provide national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses in Australia. These estimates can now be used as support for the development and implementation of measures to improve practices in order to reduce occupational exposures and, ultimately, disease transmission rates among this high-risk group.