Linda K. Groah

Effect of job strain and depressive symptoms upon returning to work after acute coronary syndrome

The purpose of this study was 2-fold: to assess whether job strain and depressive symptoms were independent predictors of the timing of return to work after acute coronary syndrome, and to determine whether the association of job strain and timing of return to work was moderated by depressive symptoms. In this 6-month longitudinal study, a total of 240 employed women and men who were admitted to hospital with acute coronary syndrome were consecutively recruited in the United States and Japan. A structured interview and medical record review were conducted to collect baseline data during hospitalization. At 2 and 6months post-hospitalization, we mailed a questionnaire to assess the timing of first day of return to work and presence of depressive symptoms. It was found that job strain was a significant independent predictor of a later return to work, even after controlling for potential confounding variables. In addition, when depressive symptoms were treated as a time-dependent covariate, patients who had Beck Depression Inventory-II scores of > or =6 to <16 or > or =16 were slower to return to work than patients with scores <6. An earlier return to work might be promoted by interventions focused on reducing psychological job demand, increasing perceived job control, and treating depressive symptoms.

Strategies for Preventing Wrong Site, Wrong Procedure, Wrong Patient Surgery

Note from column coordinator Charlotte Guglielmi: It is my pleasure to introduce a new column for our journal. I have heard time and time again that nurses need to better understand the different perspectives that each member of the surgical team brings to the table on topics that affect the care we deliver to our patients. We know that teamwork and effective communication enhance the safe care of patients. This column will provide a venue for colleagues from multiple disciplines to share opinions and commentary on some of the most critical clinical issues that face all of us. As each topic is identified, a critical question will be posed to the authors who will respond from their perspective. Linda Groah, AORN executive director and chief executive officer, will conclude each discussion with a summary of AORN’s response to the issue. I am

Your responsibility in documenting care

“Nurse criminally liable-false nurses’ notes,” the headline read. An operating room supervisor and others were criminally indicted for falsifying the OR record. The supervisor, two orthopedic surgeons, and an anesthesiologist permitted an orthopedic device salesman to participate in a total hip arthroplasty without the patient’s consent or knowledge. The physician was charged with the intent to defraud and conceal the crime of unauthorized practice of medicine and assault. The physician had failed to make a true entry in his operative report because he did not refer to the salesman’s participation. The nurse was indicted for failure to include the salesman’s name on the operating room record.’ In another case, two nurses and four physicians were sued for the wrongful death of a maternity patient who had had three prior uneventful deliveries. Three hours following a fourth uneventful delivery, she was dead apparently from hemorrhaging. Testifying as an expert witness, a registered nurse said: The nurse’s notes for this patient were poorly kept. The notes possibly were written after the patient was pronounced dead. The notes suggested poor communication among the nursing staff about the patient’s case and condition. 0 The patient’s vital signs were poorly monitored, and a nursing diagnosis should have led the nurse to conclude that hemorrhage was possible. The expert witness testified that the nurse did not exercise on behalf of the patient all of the skills and knowledge she should have gained as part of her professional training. She said the nurse’s notes depicted neglect of the patient. If in fact the nurse took reasonably good care of this patient, she failed to maintain a meaningful truthful record of the care provided.2 In the end, the court ruled in favor of the physicians and nurses because their actions could not be linked directly with the patient’s death. In commenting about the case, lawyer William Regan points out the nurses might not have been sued in the first place had their notes been clear and complete. He adds that they probably will always be associated with the suit even though they were cleared. In the past, the only reference to surgery in the nurse’s notes was often “patient to OR,” and “patient from recovery room.” Nothing indicated the patient had received nursing care while he was in surgery. These legal cases demonstrate that undocumented care is no longer acceptable or appropriate. Documentation is a matter of professional survival. What would you do if you were subpoenaed a year from now to testify about

Hand-held Communication Devices: Friend or Foe?

he explosive spread of hand-held commuT nication devices in the past decade has opened up new horizons for communication and access to information. Today, at the touch of my finger, I can connect with family, access my bank account, read my e-mail, check in for a flight, and receive reminder notifications from my calendar. It has been reported that there are more than 255.4 million wireless subscribers in the United States, and a 2012 market research study indicated that 85% of US physicians use smartphones. Like many other industries, health care has been widely affected by this rapid advance in both positive and negative ways.

10 years in, why time out still matters.

n January, The Joint Commission’s Universal Protocol for the Prevention of Wrong Site, Wrong Procedure, and Wrong Person SurgeryTM turned 10 years old. During the past decade, the Universal Protocol has become widely adopted and is nearly synonymous with patient safety. Its three fundamental components are preprocedure verification, site marking, and time out. Perioperative practitioners who use the Universal Protocol to prevent medical errors have learned that process alone does not provide a safety net for preventing wrong-person, wrong-site, or wrong-procedure events in the surgical setting. According to The Joint Commission, failures in leadership, communication, and human factors were the top three causes of more than 900 wrong-site surgeries reported from 2004 to 2013.

Sustaining a Culture of Safety: Are We One Step Forward or Three Steps Back?

or more than a decade, I have been committed to improving the safety culture in the surgical setting. Often, I have engaged in activities and conversations with perioperative colleagues and professionals that were focused on the overall progress toward safer care for all patients. However, it seems that consensus across the medical profession never can be reached on this topic. As the literature reports, part of the problem is that the concept of safety culture is still poorly defined. What we do know is that efforts toward consensus are ongoing.