Kathryn Schroeter

Advocacy in Perioperative Nursing Practice

Advocacy describes the act of pleading for, supporting, and active espousal. It implies taking action to achieve a goal on behalf of oneself or another. In nursing, the patients wishes often serve as the impetus for advocacy. Perioperative nurses function as advocates and accept responsibility to safe-guard the rights of surgical patients. This article describes historical aspects of and conceptual problems in nursing advocacy, and it presents case studies that demonstrate advocacy by the perioperative nurse.

Ethical perception and resulting action in perioperative nurses.

This study examined whether perioperative nurses (n = 40) were able to perceive and identify selected ethical issues occurring within their practice setting. The nurses described ethical conflicts and identified factors influential to their ethical decision making. The issues reported were organized into five categories: consent/advocacy, impaired provider/potential for unsafe practice, misrepresentation by care provider, disrespect for patient, and provider judgment/competency. The results of this study support that perioperative nurses both perceive and identify specific ethical issues in the surgical environment. Analysis of their reported actions revealed that the most common methods used for ethical conflict resolution were reporting to the immediate supervisor or personally confronting those directly involved.

Ethics in Perioperative Practice—Principles and Applications

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Associations (ANAs) Code of Ethics for Nurses with Interpretive Statements. In this first of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the first statement, which emphasizes respect for people.

Moral distress in critical care nursing: The state of the science.

Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.

The value of certification.

WWW.JOURNALOFTRAUMANURSING.COM 53 validating specialized knowledge, indicating professional growth, attainment of a practice standard, personal challenge, and professional commitment, challenge, and credibility. Values related to certification can be intrinsic, such as personal satisfaction and/or achievement, or they can be extrinsic, such as an increase in pay or unit/organizational recognition. Whatever motivates individuals toward a goal is driven by values. Does this mean that only certified nurses can be excellent nurses? Of course not. It may just mean that not all nurses value the credential and also believe that it is not necessary to their practice. That is a choice that each individual nurse can make. In some organizations, there is a push for increasing the number of certified nurses in all units and there are varying reasons for this trend, that is, Magnet designation, Institute of Medicine recommendations etc. What then is driving this trend? Over the past decade, the number of research studies that have explored the relationship between certification and nursing practice has been increasing. The results of these studies could be shifting the value that is currently being placed on nurse certification by those who manage health care organizations.

Bridges and Barriers: Patients' Perceptions of the Discharge Process Including Multidisciplinary Rounds on a Trauma Unit

Discharge planning is a complex process and ideally begins early in the patient stay. Despite evidence about the importance of discharge readiness, there is limited literature about the patients view during this transition. The goal of this study was to explore patient perspectives about the discharge process, including multidisciplinary rounds. Multidisciplinary rounding is a process where care providers from various specialties meet to communicate, coordinate patient care, make decisions, and manage responsibilities. The theme found was “bridges and barriers to discharge.” Participants identified timelines and tasks, communication, social support, and motivation as helpful and medical setbacks, insurance limitations, and infrequent communication as hindrances to the discharge. Future research is recommended examining efficacy of various discharge models and examination of communication and support throughout hospitalization.

Compassion Fatigue: An Unwanted Reflection of Your Reality

economy, compassion fatigue can be very costly, both personally and professionally for nurses and financially for institutions. Figley 3 explained that compassion fatigue is experienced by those individuals who help others in distress. These helpers may be subsequently traumatized through their efforts to empathize and show compassion. This often leads to inadequate self-care behaviors and increased selfsacrifice in the helper role. Compassion fatigue has also been described as secondary traumatic stress 3 resulting from caring for patients in physical and/or emotional pain or stress. I wonder if it is just assumed that nurses or other health care providers are prepared to deal with just about anything. The reality, however, is that health care providers have the same emotions as other human beings faced with horrific tragedy. The difference is that health care providers are trained to put their feelings aside temporarily while providing urgent care to critically ill patients. In an article in the Boston Globe after the bombing at the marathon, there was a story that highlighted the emergency department staff members who, after providing life-saving care to the blast victims, let down their guards and wept openly. I am sure that they were not alone in their feelings. Sometimes a patient’s emotions are strong and a nurse may “catch a ride” and experience the patient’s emotions to a high degree. This type of emotional ride, when consistently experienced, may result in compassion fatigue. Nurses who provide trauma care are in a prime position to become victims of compassion fatigue. Just like it sounds, when nurses are unable to relieve stresses that build, they add up and take a toll, which can reach a critical point if not addressed. Compassion fatigue is something that all nurses and health care providers should be aware of. So how can nurses deal with this condition? Why do some nurses deal with it better than other? One researcher, Suzanne Kobasa, 6 identified the concept of “stress hardiness” or resistance to stress. She identified characteristics of those who have stress hardiness. Stress hardy people do not spend time ruminating over why things have to change; they are not frightened by it, and they accept it as being a natural part of life, not a threat but rather an opportunity to learn and grow. DOI: 10.1097/JTN.0000000000000037 Soap operas have been on television for more than half a century. Reality shows have been on television for the past couple of decades, and news broadcasts have permeated our homes for as long as many of us can remember. Viewers are drawn to the experiences of others’ lives. Whatever the reason, vicarious feelings or life-affirming experiences, we all can be affected by what we see and hear via the media. But for nurses, and especially for trauma nurses, the impact can be profound—for not only are we subjected to the media coverage of horrific events but we also experience them firsthand on a daily basis as a part of our practice. It is no wonder that trauma nurses’ reality reflects an intense perspective of the awful and sometimes gruesome impact that traumatic experiences can have on others. Trauma nurses provide care for those who are victims of these terrible tragedies and, as a result, become exposed to an insidious condition known as compassion fatigue. The term “compassion fatigue” evolved from such names as secondary posttraumatic stress, secondary victimization, and vicarious trauma. Compassion fatigue was first described by a nurse as a concept from her work with emergency department personnel. 1 It has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. 2,3 Compassion fatigue affects nurses in terms of not only job satisfaction and emotional and physical health but also the workplace environment by decreasing productivity and increasing turnover. 4 It can also have a negative impact on nurses’ personal relationships. The potential to develop compassion fatigue could be called an occupational hazard of providing empathic, relationship-based care to patients and families. The impact of compassion fatigue on nurses can be acute and intense. It may cause stress-related symptoms and job dissatisfaction among caregivers and decreased productivity and job turnover within the health care system. 5 In today’s

Structural Empowerment: The Magnet Model Applied to Perioperative Nursing

Included in the concept of structural empowerment are the specific components inherent to the empowerment of nurses in the organization. Empowered nurses are more apt to practice skills such as decision making, problem solving, care provision, and changing of care as needed. The concept of empowerment is intrinsic to nursing practice because nurses are licensed to provide care; with licensure comes associated power, responsibility, and accountability. Kanter identified four integral structural conditions to empowerment:

The ethics of empowerment.

W hat do you think of when you hear the word ‘‘empowerment’’? Do you think of control, influence, authority, command, or domination? Or do you think of ‘‘ethics’’? Can being empowered reflect a nurse`s ethical practice? If we limit our focus of the term ‘‘empowerment,’’ we limit our ability to understand and define empowerment on a conceptual level. Empowerment is more than controlling others and our surroundings. Empowerment can support our ethical practice as nurses by reinforcing the power that is inherent to our role as patient advocate as well as to our professional integrity and accountability. We as individuals are empowered by our role, our licensure, our knowledge and expertise, and by our relationships with our patients and other healthcare providers. Empowerment should not be a destination that we strive for, but rather a journey that develops as we mature and evolve in our personal lives and professional practice. Thus, there should be no final stage in which further growth and change is unnecessary.

Implementation of an Event‐Related Sterility Plan

A paradigm shift from a time-related sterility method to an event-related sterility assurance plan is possible if the nurse managers approach to OR staff members is well researched and properly presented. Following research protocols and providing a methodology and rationale to staff members will enhance the success of the implementation process. A successful paradigm shift to an event-related sterility system has the potential of increasing knowledge, improving practice, empowering staff members, and saving money, time, and effort.