Reducing Opioid Consumption and Length of Stay After Bariatric Surgery: A Nonpharmacologic ERAS Intervention Bundle.

Purpose: To reduce opioid consumption and decrease length of stay (LOS) in bariatric surgical patients by implementing an evidence-based, nonpharmacologic enhanced recovery after surgery (ERAS) intervention bundle.

Design: Evidence-based practice project.

Methods: We developed and implemented a nonpharmacologic ERAS bundle from existing American Society of PeriAnesthesia Nurses Standards and bariatric and subspecialty surgical ERAS protocols to standardize the postoperative nursing care of bariatric patients.

Retrospective Analysis of Associated Costs and Sources of Variability in OR Utilization Across Weekdays.

Few studies have examined variability in OR utilization across weekdays. We conducted a retrospective analysis to determine OR utilization differences by day of the week and the source and financial effects of any variability. We extracted 55 months of data from a surgical data repository to calculate OR utilization, late starts, idle times, and delays for each weekday.

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center.

Background And Objectives: High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals.

Every drop counts: Providing lactation support to breastfeeding surgical patients.

Over half of surgeries in the US are conducted in physician-owned ambulatory surgery centers (ASCs). While ASCs provide cost-effective and quality healthcare comparable to inpatient hospitals, they often lack robust support services, including lactation support. This article presents key information on breastfeeding benefits, early weaning risks, and strategies for nurses in ASCs to educate and support patients who are breastfeeding.

Periop 101: Improving Perioperative Nursing Knowledge and Competence in Labor and Delivery Nurses Through an Evidence-Based Education and Training Program.

Introduction: To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience.

Surgical Team Structure: How Familiarity and Team Size Influence Communication Effectiveness in Military Surgical Teams.

Introduction: Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency.

Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies.

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure.

Case Report of Umbilical Artery Thrombosis in a Patient With a History of Heparin-Induced Thrombocytopenia.

Women are at increased risk of thromboembolism during pregnancy because of hypercoagulability associated with pregnancy. Heparin-induced thrombocytopenia (HIT) is an uncommon complication of heparin therapy, and patients with histories of HIT cannot receive any heparin-derived medications. Limited data exist regarding the clinical management of pregnant women with histories of HIT.

A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study.

Background: Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention.

Purpose: To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention.

Associations of Surgical Team Communication With the Layout of Physical Space: A Network Analysis of the Operating Room in a Military Medical Center.

Aim: To examine how the spatial topology of the operating room (OR) within the medical center impacts surgical team communication.

Background: Understanding the complex association between surgical team communication and the OR's spatial network location is critical to patient safety. Effective surgical communication is associated with fewer adverse events and medical errors.

Patterns in Urogenital Health in Active Duty Servicewomen: A Prospective Cross-Sectional Survey Evaluating Impacts of Water, Sanitation, and Hygiene Resources Across Three Military Environments.

Introduction: Female warfighters are at risk for sex-specific and frequently unrecognized urogenital health challenges that may impede their ability to serve. The constraints on water, sanitation, and hygiene (WASH) resources by austere environments, whether at home or abroad, require women to practice unhealthy hygiene behaviors that jeopardize their urogenital health. In this manuscript, we examine the use of WASH resources by U.

Impacts of Austerity on Urogenital Infection Rates in Active Duty Servicewomen.

Introduction: Female warfighters are at increased risk of urogenital infections (UGIs) when serving in austere environments with varying levels of access to water, sanitation, and hygiene resources. Urogenital infections among servicewomen were among the top five reported medical encounters and one of the top seven reasons for medical evacuation from deployed locations between 2008 and 2013. In this study, we examine the use of water and sanitation resources across three environments (home duty station, field training, and deployment) and analyze associations between water, sanitation, and hygiene resource access and UGIs during training or deployment.

Trust and Nursing: Delivering Effective Change Management and Driving a Culture of Innovation.

Trust is foundational for all interpersonal communication and activities in an increasingly networked and interdependent world. Trust is also essential to the effective delivery of health care and for building collegial environments rich in innovation and readily adaptable to change. As the world's most trusted profession and vested peer collaborators across interprofessional health care teams, nurses are uniquely qualified to shepherd change and foster an innovation mindset across organizations and systems.

Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status.

Purpose: To describe differences in perioperative RN job satisfaction by specialty certification status.

Design: A retrospective, exploratory, cross-sectional design.

Methods: We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales.

Fire in the Operating Room: Surgical Case Report From a Forced-Air Warming Device Equipment Fire.

Surgical fires are critical life-threatening events that can result in patient morbidity and mortality. This case report describes an equipment fire originating from a forced-air warming device occurring during a shoulder arthroscopy operation and discusses how the surgical team responded to mitigate risks to the patient and staff. Rapid response by the anesthesia professional and the surgical team helped prevent the fire from negatively impacting patient and staff safety.

The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital.

Background: Job satisfaction is significantly associated with retention. Although several factors are associated with job satisfaction and retention (pay, leadership, mentorship), the association of demographic characteristics has been understudied in the literature.

Purpose: To explore whether professional role and demographic characteristics are associated with job satisfaction and intent to stay among nurses and physicians in a military medical center.

Job satisfaction among nurses and physicians in an Army hospital: A content analysis.

Background: Lower job satisfaction is associated with increased turnover. Although factors that contribute to job satisfaction are well documented, less is known about job satisfaction among health care professionals in military hospitals.

Purpose: To explore areas of most and least satisfaction with work among civilian and military nurses and physicians in an Army hospital.

Relational Coordination Among Military and Civilian Nurses and Physicians in an Army Hospital: Do Demographic Characteristics and Professional Roles Matter?

Objective: The aim of this study was to explore whether demographic characteristics and professional roles are associated with relational coordination (RC) among nurses and physicians.

Background: The increased race, age, and gender diversity in the nursing and medical workforce raises questions regarding how well nurses and physicians communicate and interact. Relational coordination is a unique framework to enhance teamwork and care coordination among healthcare professionals.

Operation Allies Refuge and Operation Allies Welcome: Military Perioperative and Perianesthesia Nursing Support to the Afghan Evacuation Mission.

Nursing has a long and celebrated history of providing life-saving care during crises and periods of great need. Following the government collapse in Afghanistan and the withdrawal of US troops, a severe humanitarian and human rights crisis emerged. The US military participated in one of the largest and most complex humanitarian missions in history to aid Afghan relief efforts.

Relational Coordination as a Predictor of Job Satisfaction and Intent to Stay Among Nurses and Physicians in the Military Health System.

Introduction: Job satisfaction and retention of military and civilian nurses and physicians who work in military treatment facilities (MTFs) are critical to maintaining quality of care and operational readiness. Civilian nurses and physicians working in MTFs supplement staffing for active duty military nurses and physicians and support operational readiness when military nurses and physicians deploy in wartime crises or humanitarian efforts. Decreased retention of military and civilian nurses and physicians can negatively impact operational readiness and patient care outcomes.

The Paradox of Network Inequality: Differential Impacts of Status and Influence on Surgical Team Communication.

Introduction: Introduction: Healthcare is a dynamic and complex system predisposed to adverse events caused by human and technical errors. The ability of multidisciplinary clinicians to effectively communicate clinical information influences healthcare quality. Authority gradients, culture, and organizational hierarchy frequently constrict communication and contribute to surgical adverse events.

Military Surgical Team Performance: The Impact of Familiarity, Team Size, and Nurse Anesthesia Students.

Purpose: To examine the key factors impacting surgical team performance in a military medical center.

Design: A retrospective, exploratory, cross-sectional design.

Methods: We reviewed 751 orthopedic surgical cases to determine the association of surgical team familiarity, surgical complexity, team size, and the presence of student registered nurse anesthetists (SRNAs) with the surgical performance measures of total operative time, turnover time, and on-time surgical start.