Deborah Spratt

AORN Ergonomic Tool 5: Tissue Retraction in the Perioperative Setting

Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction. During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction. Ergonomic Tool #5: Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered.

Workplace Safety Equals Patient Safety

or many years, AORN has been a leader in creating a safe environment for the patient in the OR and other procedural areas. Perioperative nurses provide care that adheres to the AORN standards and recommended practices. AORN provides orientation tools like Periop 101: A Core CurriculumTM. Collaborations among AORN staff members, member volunteers, and representatives of other organizations have resulted in tool kits to address safety factors such as surgical briefings, time out, and debriefings. I believe that workplace safety is an integral part of patient safety. There are many pieces to creating a safe work environment, and much work has been done by AORN in cooperation with experts in various fields and health care organizations.

Collaborating to Nurse the Heart and Spirit

S ometimes, in our busy lives, we forget how important the role of nursing the heart and spirit really is. In honor of Valentine’s Day I asked some of my nursing colleagues to share stories that they felt demonstrated this theme. These stories show that collaboratingdwhether with patients to help improve their own care or with other health care providers to enhance patient caredcan lift the hearts and spirits of both patients and the nurses who care for them. Some details of these stories have been changed to protect patient anonymity. Two of the stories shared illustrate how patients can let nurses know what is needed to help make them feel secure and cared for. In the first story, the nurse’s compassion and humanity help to calm a frightened patient:

Collaborating for a Stronger Organization and Collaborating With Colleagues in Other Countries

C olleagues, in celebration of a new year, I would like to challenge each of you to recruit one new AORN member. We are an organization of approximately 42,000 perioperative registered nurses, but this represents only a quarter of the perioperative nurses employed in hospitals, free-standing ambulatory surgery centers, and office-based surgery settings. Our members are passionate about patient safety and workplace safety. I invite you to share that passion with your colleagues. It is said that in numbers, there is strength, and I believe that our members recognize that promoting and growing the organization leads to better care in the OR. This month I would also like to discuss several opportunities I have had recently to discuss the value of AORN in other countries.

Collaborating for Better Care of Our Veterans

V eterans Day is November 12th, and I want to use this month’s President’s Message to honor our veterans and to spread the word about a program called Joining Forces. Veterans face many issues when they return from combat and try to reintegrate into life at home, a process that can be difficult for friends and family members to fully understand. Research being performed at Harvard Medical School, Boston, Massachusetts, is showing that our newest group of combat veterans appear to be growing old before their time, especially those with blast-related or traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD). Signs of diseases typically seen in middle age, such as heart disease, diabetes, slowed metabolism, and obesity, are appearing in young veterans. A study from the Centers for Disease Control and Prevention found that veterans ages 24 to 64 years hadmore than twice the rate of these diseases than nonveterans. These issues raise concern about how to provide care for veterans now and in the future. Joining Forces was organized by First Lady Michelle Obama and Second Lady Jill Biden, EdD, to help returning veterans and their families obtain help and support from all sectors of society. AORN, other nursing organizations (eg, the American Nurses Association, the American Association of Colleges of Nursing, the National League for Nursing, the American Organization of Nurse Executives, the American Academy of

Collaborating for a Diverse Workforce and Membership

C olleagues, one of my personal values is promoting diversity. I am fortunate to work in an organization that supports this value and to work with a diverse group of individuals who respect this value. This month, I would like to talk about how we can promote and maintain diversity in the workplace and in our professional organization. This is important because we have become a diverse nation, as evidenced by the following:

Collaborating for a great congress and beyond.

C olleagues, in this Post-Congress issue of the Journal, I wanted to share with you some of my personal Congress highlights. The Opening Session was an emotional experience, honoring current and past AORN leaders and our active military members. Past President Anne Marie Herlehy, DNP, RN, CNOR, made two important announcements during the Opening Session. The first was that the American Nurses Association has officially endorsed AORN’s position statement “One perioperative registered nurse circulator dedicated to every patient undergoing a surgical or other invasive procedure.” As surgery moves out of the OR to other settings, both in and out of acute care hospitals, it is important that all patients receive the same standard of care during their surgical experience. The second announcement was that AORN has signed on to “Joining Forces,” a comprehensive national initiative led by the White House and First Lady Michelle Obama, to mobilize all sectors of the community to help service members and their families. This is important to AORN members because there is a steady stream of veterans and military service members returning to each of our communities throughout the country. Although the US Department of Veterans Affairs (VA) provides care for more than eight million veterans, returning veterans may or may not have access to VA experts in their local community. Approximately 50% of our returning military members receive care in a military or VA system; the rest are cared for in their home communities. Because nurses represent the largest health care workforce and are present in every community, we care for our military service members, veterans, and their families in every professional setting. We also know these wounded warriors as family members, friends, neighbors, and colleagues. Thus, we need to be engaged in this effort to give them the support they deserve, particularly when it comes to employment, education, and wellness. The Congress educational sessions were outstanding. I hope that members who were not able to attend are taking advantage of the AORN eCongress. Registration opened shortly after Congress for the event, which began in May, and this is a great way for members to be connected to the Congress experience. There is also an Exhibit Floor that you can browse to help you keep up with the newest products and services.

Collaborating for Patient Safety

C olleagues, as promised last month, I would like to continue with my discussion of the February 22, 2012, TODAY Show story on infections caused by unclean surgical instruments, what the subject means to us as perioperative nurses, and why we must do our part to address the issue of instrument care and handling. The story was prompted by the Center for Public Integrity report “Filthy surgical instruments: the hidden threat in America’s operating rooms.” The genesis of both these reports was a study by Pritish Tosh, MD, of the Mayo Clinic Division of Infectious Diseases, and colleagues on an outbreak of surgical site infections that occurred after arthroscopic procedures in one hospital. The TODAY Show story focused on one patient who had undergone a shoulder procedure and was diagnosed some weeks after with an infection. On investigation, it was determined that the lack of cleanliness of the instrumentation used during the procedure was the culprit for this infection and others. Not only was this national news on television, but many of the journals I get, both in print and online, also addressed the story. There were common themes as authors noted the complexity of surgical instrumentation, the length of time it takes to properly clean and sterilize surgical instruments, the lack of education or certification for those health care employees doing the work, and the surgical processing department (SPD) environment. One of the pictures shown during the television piece that had the most effect on me was of reusable suction devices that had been cut in half lengthwise. It was apparent that getting these instruments clean had been a long-term problem with no good solution. The SPD, or central sterile supply department as it may be called, performs work that is basic to safe patient care in the OR. Too often these members of our perioperative team are only acknowledged when problems occur and everyone is looking for someone to take the blame. My goal with this message is to help AORN members understand the complexity of the problem and their role in the solution.

Collaborating Through Association Partnerships and Association Leadership

C olleagues, AORN has partnerships with many professional associations, accrediting bodies, and national organizations. For example, we participate in the Council on Surgical & Perioperative Safety (CSPS), an incorporated multidisciplinary coalition of the seven professional organizations whose members are involved in the care of surgical patients. Each of these seven organizations has two voting members on the CSPS, which constitutes the Board of Directors. In addition to AORN, the members are