Volume 15 Issue 5 by British Journal of Anaesthetic & Recovery Nursing

VOLUME VOLUME15XXISSUE ISSUE5XX

AUGUST 2016 SEPTEMBER 2008 ISSN: 1742-6456

BRITISH JOURNAL OF

ANAESTHETIC & RECOVERY NURSING

barna

British Anaesthetic & Recovery Nurses Association

Co-editors: Lucie Llewellyn and Theofanis Fotis

Volume 15, Issue 5, 2016

British Journal of Anaesthetic & Recovery Nursing The Official Journal of the British Anaesthetic & Recovery Nurses Association The United Kingdom’s Official Representative for the International Federation of Nurse Anaesthetists. In alliance with the American Society of PeriAnesthetic Nurses (ASPAN), the Irish Anaesthetic and Recovery Nurses Association (IARNA). Website: www.barna.co.uk Editors:

Lucie Llewellyn and Theofanis Fotis Email: editors@barna.co.uk

Advertising:

Lucie Llewellyn and Theofanis Fotis Email: editors@barna.co.uk

BARNA COMMITTEE Chair: Manda Dunne President: J.P.Nolan Treasurer: Markku Viherlaiho Co-editors: Lucie Llewellyn and Theofanis Fotis Secretary: Pauline Guyan IFNA representative: Manda Dunne International Liaison: Joni Brady Communications Manager: Markku Ahtiainen

Committee:

Manda Dunne Theofanis Fotis Lucie Llewellyn Markku Viherlaiho Pat Smedley Joni Brady Markku Ahtiainen Iswori Thakuri Pauline Guyan

Membership Enquiries Member: £40 (Nurse member) £50 (Associate member) www.barna.co.uk Subscription Enquiries Individual journal subscription: £58/$105 Institutional journal subscription: £210/$383 www.barna.co.uk Editorial Board Joni M Brady, MSN RN CAPA CLC, Pain Management Nurse - Nursing Administration, Perianesthesia Units clinical practice Council Mentor, Inova Alexandria Hospital, Alexandria, Virginia, USA Mary O’Brien, Senior Sister, Elective Orthopaedic Centre, Epsom, UK Professor Mark Radford, BSc (Hons), RGN, PGDip (ANP), MA (MED ED), ENB 183, FHEA, Chief Nursing Officer, University Hospitals Coventry and Warwickshire NHS Trust; Visiting Professor, Birmingham University UK Marianne Riesen, RNA, BSc Nursing, Member of IFNA Education Committee Journal Printing The Warwick Printing Co Ltd, Caswell Road, Leamington Spa, Warwickshire. CV31 1QD Production Lawrand Medical Publishing, Lawrand Ltd, PO Box 51, Pontyclun, CF72 9YY Tel: 02921 680068, Email: admin@lawrand.com, Website: www.lawrand.com The views expressed in articles are those of the author and do not necessarily reflect the views of BARNA. The inclusion of advertising within the journal does not mean that BARNA or its members endorse the products or services advertised. Enquiries regarding any products advertised should be made direct to the company concerned.

British Journal of Anaesthetic & Recovery Nursing The Official Journal of the British Anaesthetic & Recovery Nurses Association

CONTENTS From the Chairman Letter from the Chair, Summer 2016 Manda Dunne

Editorial Digital Nursing: Is it the answer to faster adaptation of health innovation? Fotis Theofanis. PhD, MSc, BSc, RN, FHEA.

Original Articles Management of perioperative hypothermia in the different hospitals of Nepal: A reflective account. Ishwori Thakuri. RN, BSC (Hons).

A new modified educational program for team training targeted to anesthesia and operating room nurses in specialist programs. Kenneth Nord, CRNA, MSc. Mats Johansson, CRNA, MSc. Anders Johansson, CRNA, PhD Associate professor.

Notes to Authors

British Journal of Anaesthetic & Recovery Nursing

From the Chairman

Vol. 15 (5), 5 © British Association of Anaesthetic and Recovery Nursing, 2016

Letter from the Chair, Summer 2016

Manda Dunne BARNA Chair

BARNA Built Bridges between Nurses in Anaesthesia.

cannot begin my letter without thanking everyone who came to the WCNA 2016 (World Congress of Nurse Anaesthetists) in Glasgow this last May, and for making it such a memorable event. What an incredible experience! All I can only say to those of you who missed it is that I am so sorry you were not there. Almost seven hundred delegates representing fifty-three countries attended which was amazing. BARNA hosted the World Congress on behalf of the International Federation of Nurse Anaesthetists for the first, and probably the last time in the history of the association. I don’t know why there was not more attendance from the UK but I will not dwell on negativity! I felt so proud of what we achieved and grateful to have had the opportunity to meet with so many speakers, delegates and professionals all working in the anaesthetic specialty from so many parts of the world. It was a truly wonderful and fulfilling experience and one which I shall remember far into my retirement! We were comfortably surrounded by support from the Royal College of Nursing with past and present representation, both from Scotland and England, opening and closing the congress. All spoke eloquently and precisely about the situation we are facing in nursing and the NHS and how we can make a difference particularly through education. And what a learning event this was! I notice that the RCN held their congress in ‘Glorious Glasgow’ which I felt was very fitting as they followed us into the exact same venue!

Much on their agenda appeared to be focused on staff shortages, the suggestion of student nurses paying for their education and the everyday pressures we are facing. Nurses were encouraged to ‘find their voices and fight for the profession’ which I know seems difficult to do when you are bogged down with the everyday pressures and the constant demand on resources, which I know is overwhelming especially in the operating theatres. Overflow from A&E and Intensive Care over into the anaesthetic or recovery rooms needing a ventilated bed as ITU is full, is common place these days, and we have to carry on regardless which can have a negative effect on staff as well as patients. Talking to nurses from other countries it appears that we are all facing the same issues worldwide. I don’t know if it that makes me feel better or worse! The one thing I do know is that no matter what, even though we are working in tough times, the patients need us ‘like never before’ and we must indeed fight for our profession. There really are not enough nurses in our health service and that is a risk for patient care. We must be careful not to fill the gaps with untrained posts just to make up the numbers. We are a strong profession and we must take pride in our work and remember the words of RCN President, Cecilia Anim in her opening speech at congress, ‘by joining together, we can change things for the better, for our patients, for our colleagues and for ourselves. That is our strength’. Thank you! Manda Dunne BARNA Chair

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

British Journal of Anaestetic & Recovery Nursing

Editorial

Vol. 15 (5), 7 © British Association of Anaesthetic and Recovery Nursing, 2016

Editorial Fotis Theofanis. PhD, MSc, BSc, RN, FHEA.

Digital Nursing: is it the answer to faster adaptation of health innovation?

e live in the era of innovation and digitalisation. Over the last couple of decades technology has changed the way we interact, communicate and entertain. As such the way we work and practice couldn’t remain unaffected. The introduction of innovative and digital technologies within the healthcare sector have been defined under the umbrella of the term Digital Health. According to nuviun (a company based in London “passionate about innovation, technology and the future” Digital Health “is an umbrella term for all healthcare-related applications, technologies and delivery systems that result from the confluence of medicine, genomics and the technologies that comprise the digital space towards improved care quality, increased care access and reduction in the cost to provide it.” But how these developments affect our everyday practice and if at all how are they related? Recently, NHS England published a framework for nursing, midwifery and care staff summary document with the title: “Leading Change Adding Value”. In this document among the 10 commitments to support action of nursing, midwifery and care staff, one states: “we will champion the use of technology and informatics to improve practice, address unwarranted variations and enhance outcomes.

It is obvious then that Digital Health is directly related with our framework of practice. It has been identified though by HIMSS UK (a global, cause-based, not-for-profit organization focused on better health through information technology) and NHS England that there are barriers on promoting and developing this relation further. Among other there are few barriers related with us as health care practitioners, such as, lack of leadership, lack of integrated care, clinical reluctance (from the practitioners point of view) and lack of trust from the patients point of view. Last Summer, driven by personal interest and by identifying the widening of the gaps between the implementation of technology and our knowledge and practice, I talked about the need for a new disruptive framework of nursing practice, which I called Digital Nursing. It is about “bedside” nurses who have the knowledge and who harness the benefits of digital health in collaboration with IT professionals in order to enhance the “human touch”. Digital Health is already here and we need Digital Nursing to make the best of it. So stay tune and “e-connected” for more news and developments on this area!

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 ÂŠ British Association of Anaesthetic and Recovery Nursing, 2016

Original Article

British Journal of Anaestetic & Recovery Nursing Vol. 15 (5), 9-11 © British Association of Anaesthetic and Recovery Nursing, 2016

Part I. Management of perioperative hypothermia in the different hospitals of Nepal: A reflective account. Ishwori Thakuri RN, BSC (Hons) in Clinical practice/ Anaesthetic Recovery Nurse/ BARNA Committee Liaison/ Queen Elizabeth Hospital, Woolwich/ Lewisham and Greenwich Trust

This is Part I of my reflective account based on a visit to Nepal, aiming to share the experience of the practice on the management of perioperative hypothermia.

y visit to Nepal was completely a family holiday. Usually, I do not manage to visit my family every year. However, in July 2014, I managed to visit my family as well as my school and college friends too. I have learnt numerous things and achieved great anaesthetic nursing skills in Queen Elizabeth Hospital in England within last ten years; which is incredible. Similarly, I learnt all the basic skills of nursing back in Nepal. Therefore, I am always grateful to my senior colleagues and teachers, both here United Kingdom and in Nepal, whom contributed their time and efforts to make me a good nurse.

Those are as follows; 1. Grande International Hospital (Private Hospital) 2. Tribhuvan University Teaching Hospital (Semi-government, teaching hospital) 3. Bir Hospital (Government Hospital) 4. Kathmandu University Dhulikhel Hospital. Grande International Hospital

Whenever I learnt any new skills in Queen Elizabeth Hospital in London, I wonder how my colleagues are doing back home in the Nepalese hospital. Do they have similar health care facilities? Do they have I-gel, Propofol, difficult intubation equipments? Do they warm the patients using different warming devices? All these questions come in my mind and make me think if the Nepalese people have access to all of these crucial and accommodating facilities in the healthcare system like we have here in the United Kingdom. When I worked in theatres as an anaesthetic recovery Nurse back in Tribhuvan University, Teaching Hospital (from 1997 – 1999), my knowledge and skills were very limited about those facilities. I was aware of the only heating mattresses used for patients during surgery. The management of perioperative hypothermia was very limited and staffs were unaware of its consequences. Now, I have learned a lot about the management of the perioperative hypothermia/warming devices from 10 years of my work experiences at Queen Elizabeth Hospital. And also as a part of my degree, I have completed the project on the ‘efficiency of the different warming devices’. Therefore, I was curious to know if there were any management in place regarding the preventions and treatments of perioperative hypothermia. This personal curiosity motivated me to visit few different hospitals in Nepal regarding these matters.

Grande International Hospital is the one of the first international Hospital in Nepal established in February 2010. This Hospital has a 15 stories building, nine elevators, five staircases and sprawls over 298, 999 sq. ft. and also helipad on the 14th floor. The aim of this hospital is to meet the all the healthcare needs of the nation through unparalleled patient care. (GIH, 2014). This hospital has 10 operating theatres with multiple surgery facilities from general surgery to special surgery like, Neurological, open heart, Ophthalmology, etc.

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

Part I. Management of perioperative hypothermia in the different hospitals of Nepal: A reflective account.

Perioperative hypothermia management devices:

With Nursing Director (Ms Lal Devi Maharjan)

With Theatre Incharge (Sabitri Ranjit) I was very excited to go to theatre to see how this sophisticated private hospital has put the perioperative hypothermia management in place. With the permission of hospital and Nursing director (Ms Lal Devi Maharjan), I had a chance to visit inside the theatres, where I had a surprise meeting with my college friend, Sabitri Ranjit (Theatre In-charge ) after 17 years. Since we finished our nursing college in 1997, it was our first meetings. After, the surprise meetings, Sabitri took me around the theatres, where I saw the forced air-warming devices with disposable blankets, fluid and blanket warming cabinet and fluid and blood warming devices (hotline). According to Sabitri, staffs are aware of the perioperative hypothermia and its management too; as, they are getting the training time and again.

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 ÂŠ British Association of Anaesthetic and Recovery Nursing, 2016

Part I. Management of perioperative hypothermia in the different hospitals of Nepal: A reflective account.

Tribhuvan University Teaching Hospital

Tribhuvan University Teaching Hospital (TUTH) was established in 1983 with the help of JICA (Japan International Cooperation Agency). It has 600 beds with the variety of facilities. This semi- government hospital is the site of teaching and research activities of IOM (Institute of Medicine) where numbers of students from (basic to post-graduates) nursing, medicine and paramedics faculty come for the practical placements. Besides, it conducts medical research projects and provides a major impetus to Biomedical and Health Sciences Research in Nepal. It has a largest numbers of medical specialities with 22 different faculties in the hospital. This hospital provides best care to each patient through their integrated clinical services, education and research. Hospital also claims that they provide clinical services to the large numbers of patient each year and their last yearâ&#x20AC;&#x2122;s record shows around 400,000 patients were treated from basic medical surgical problems to open heart surgery and kidney transplant. At present, this hospital is leading the other hospitals in the country for the strong base of academic medical health field, integrated health services and the health researches too.

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 ÂŠ British Association of Anaesthetic and Recovery Nursing, 2016

British Journal of Anaestetic & Recovery Nursing

Original Article

Vol. 15 (5), 13-18 © British Association of Anaesthetic and Recovery Nursing, 2016

A new modified educational program for team training targeted to anesthesia - and operating room nurses in specialist programs. Kenneth Nord, CRNA, MSc Mats Johansson, CRNA, MSc Anders Johansson, CRNA, PhD, Associate professor

Abstract Background: Working in teams is becoming increasingly common and it places great demands on team members. We as authors of this paper believe that if the healthcare system’s objective is interprofessional teamwork, then it should also include students of all relevant professions in order to practice and learn together. Since 2010, the main author has developed a combined Clinical Educational Program (CEP- op) for learning and team training in the intraoperative context. The CEP- op is aimed at students (on advanced level according to the Bologna process (EUA, 2016)) who are attending the anesthesia or operating room- nurses program at the University of Lund, southern Sweden. Aim: This paper is to describe a new modified clinical education program for team- training. It is targeted at anesthesia and operating room nurses in specialist training programs who are undergoing their clinical education in an operating department. The pedagogical models that are used are reflective learning, peer- learning, problem based learning and inter professional education.

Content and implementation: The CEP- op consist of 4 parts: ”Simulation center”, ”Preparation in team”, ”Team training in the operating room” and ”Reflection and feedback together in the team”. ’CEP- op’ was conducted using everyday planned surgery programs. Selection of patients (ASA 1-3). Type of operation performed on the educational operating room was surgical, urological and obstetric. Conclusion: In the operating room context, our model leads to better levels of collaboration, teamwork, patient safety, peer- learning, peer- support and critical thinking. Collaboration with relevant educational programs at the University was essential to get approval for the CEP- op. We also found that it is important to have support among staffs in different key positions like heads of department, coordinators and general management. The participants expressed spontaneously that the program should be available henceforth. In conclusion, our model seems to improve the development of the participants.

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

A new modified educational program for team training targeted to anesthesia - and operating room nurses in specialist programs.

Since 2010, the main author of this paper has developed a Clinical Educational Program (CEP- op) for learning and team training in the intraoperative context. The CEP- op is aimed at advanced level students who are attending the anesthesia- and operating room nursing programs at the University of Lund, southern Sweden. The CEP- op is also aimed at junior physicians. Team training in the operating room

Introduction Working in teams is getting increasingly common and the approach places considerable demands on team members. We as authors believe that if a healthcare system’s objective is inter-professional teamwork, then students from all relevant professions should practice and learn together. The acronym TEAM in this area has been chosen according to the Acronyms and Abbreviations (2016) and could be explained as “Together Each Achieves More”. We as authors believe that all team members are equally important, both from an individual and team perspective. Further, all professional skills and experiences should be utilized if synergy is to be achieved within a team. When team members share in an altruistic way, their expertise and experience, leads to safer patient care and improved health care (Hoffman et. al, 2008. Hylin, 2010) In order to better prepare students for their future career, the authors of this paper identified that team- training should become a more integrated part of a student’s clinical education. Larsson Mauleon (2005) state in a doctoral thesis that recently graduate anesthesia nurses felt inadequacy in their profession. They claimed lacking of ability to provide intended anesthesia care to elderly patients. It was difficult or sometimes impossible to anticipate difficult situation and this led to uncertain anesthesia care. They had difficult to rely on their own judgment, for example to detect important clinical symptoms of the patient and therefore was in great need of technical surveillance equipment. They also experienced inadequacy in meeting with the patient. Furthermore, they felt it difficult to provide the excellent care they were supposed to be trained for. We the authors, claim that there is a need for improvement in both the supervision and the training opportunities for students and newly graduated nurse anesthetists. Hofling and Winther (2013) demonstrated in their master’s thesis that graduate operating-room nurses needed more “hands on training” in their clinical education. Furthermore, the students clarified that although they obtained adequate theoretical knowledge from the university, there was a need for further practical education, since professional practical skills are largely consolidated through repetition.

Aim The aim of this paper is to describe a new modified Clinical Educational Program (CEP- op) for team training. Background Perioperative nursing– anesthesia care Swedish nurse anesthetists are supposed to possess the knowledge and ability to identify and implement perioperative caring. Perioperative care refers to the care actions and activities carried out by health professionals in context (Lindwall & Post, 2000). The anesthetist nurse should be able to establish and maintain a clear airway, breathing and monitor blood pressure (the ABC rule). Be able to make quick decisions and to prioritize tasks when acute adverse events occur. The nurse anesthetist is part of the operating team and is responsible for the patient positioning and the prevention of pressure and crushing injuries. It is required to work for a good postoperative recovery, for example, when it comes to pain and nausea. Perioperative care should be done on the basis of evidencebased knowledge (ANIVA, 2008). Perioperative nursing– surgical care Swedish operating room nurses (SORNS, 2011) are responsible for the care of the patient before, during and after the surgical procedure. Operating room nurses should possess adequate knowledge to provide evidencebased perioperative care. The Operating Room nurse has an independent responsibility to ensure that hygienic and aseptic principles are ambient, so that the surgery can be carried out in a safe manner. Furthermore they independently have a systematical plan for organizing instruments and assisting in surgical procedures Clinical Educational Program- operation (CEP- op) According to the Advanced Level of Nursing Practice, all education programs should promote pro-independent problem- solving, the ability to critically assess context and to embrace developments within the area. The course curriculum in clinical training is of various educational goals so that the student acquires knowledge to become equal with their upcoming colleagues (HSL 1992: 1434, ch. 1, § 8 and 9).

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

A new modified educational program for team training targeted to anesthesia - and operating room nurses in specialist programs.

Educational models Educational models used are Inter Professional Education (IPE), Peer- Learning (PL), Reflective Learning (RL) and Problem Based Learning (PBL). The aim of each model is to promote learning and professional development by developing courses that are both theoretically and practically based and feature team collaboration. Interprofessional education (IPE) The authors of this paper claim that increased training in perioperative care is needed in order to increase patient safety and that a student’s clinical training should place a greater emphasis on team-work. Ponzer (2009) emphasizes the need for new and innovative approaches to educational training of healthcare professionals. IPE is an example of such a team training. The definition of IPE is: “IPE occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care” (Caipe, 2002). WHO (2010) described, a convincing success when IPE was conducted in different health settings and educational programs. PEER- Learning (PL) PL is an educational model that sets the emphasis on the student’s activating approach (Blomqvist, 2006). Toppings (2005) defines that PL is; “The acquisition of knowledge and skill through active helping and supporting among the status equals or matched companions” (p. 631). The idea of PL is to stimulate to seize the students resources in both a structural and flexible way. PL includes collaboration, support, reflection and critical thinking. Feedback is used to place the student’s own learning in focus (a.a). Boud, Cohen and Sampson (1999) state that the PL model provides a valuable opportunity to develop a student’s learning and increasing independence in preparation for a lifelong learning. Reflective learning (RL) Carlson (2010) describes that reflection is an important part of the learning process. Reflection occurs when the tutor and student reconstruct a student’s experiences in a conversation, so that the significance of lived experience is deepened. The author also describes learning as an interactive process where the supervisor supervises the student with the goal of aiding learning. The author defines learning as “a qualitative change in the way individuals understand the context” (a.a. p.19). Problem based learning (PBL) This pedagogical model is based on learning through problem-solving rather than lectures. In PBL an individual or a group look for information to solve a problem, rather than relying on explanations or solutions from their supervisor or teacher. PBL places demands on the student’s curiosity, enthusiasm and the ability to solve the problems at hand.

Simulation Center

PBL promotes deep learning, which allows students to retain knowledge longer than superficial learning. It also promotes interaction between students and the context where they will work (Barrows, M.S., 1983, Neville, A. J, 2009, Woltering, et al, 2009). Facilitator/supervisors The authors are registered nurses with specialist training in anesthesia care. Our program was developed for anesthetist and theater room nurses as well as junior physicians under training. Permission was received from the clinic management of the surgery department at Skånes Universitetssjukhus MALMÖ and the University of Lund before beginning the program.

Preparation meeting

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

A new modified educational program for team training targeted to anesthesia - and operating room nurses in specialist programs.

Content and implementation Construction of the Clinical Educational Program- operation (CEP- op) Students from the anesthesia and operating room nurse program at University of Lund participated for total of ten weeks of clinical training in operating unite. This has been done repeatedly since 2011. At present the CEP- op is offered as part of the clinical training of those wishing to follow the Certified Registered Nurse of Anesthesia or Certified Operating Room Nurse course at Lund University. The aim of the program is to develop cooperation between team members and to independently manage perioperative care more effectively. Participants should be better prepared for their future careers when it comes to providing perioperative care. Participation in the CEP- op was endorsed by the head of the training program, Lund University, Department of Nursing and included in the curriculum. The CEP- op consists of four parts: i). “Simulation Center.” ii). “Preparation in team.” iii). “Team training in the operating room.” iv). “Reflection, feedback all together in the team.” Patient selection included (ASA 1-3 (ASA, 2014)) those undergoing elective urologic, surgical, obstetrics or plastic surgery. The team in training consisted of two anesthetists and two operating room students and sometimes a junior physician in practice. Simulation Center As part of the CEP- op, anesthetist nurse students and junior physicians spend a day at the simulation center. They receive team training that is based on inter/intraprofessional collaboration using a high- tech advanced full scale medical simulator and four realistic scenarios. Practical and theoretical methods are combined to provide participants with the tools and knowledge required for participating in the CEP- op. Preparation in team The day before the CEP- op, students have the opportunity to prepare themselves as a group. They jointly discuss patient cases in terms of surgical and patient position. They further discuss which anesthesia care plan and form that should be prescribed, and take part in a medical review of the patient. The anesthesia nursing students prepare a backup plan for airway, breathing and circulation: using the ABC rule. They also consider potential problems and what measures to take should they arise.

The operating nurse students prepare a care plan for surgery and a backup plan for dealing with possible complications during surgery. Together, they prepare for cooperation as a team, identify their individual roles and clarify who will take the principal role. Team training in the operating room The CEP- op takes place in an operating room. Two medium/ long operations are part of the training. In a supervisor role, both the anesthesia and operating room nursing students are given equal opportunities to implement perioperative care from both a “patient responsibility perspective” and an “assistant perspective”. The roles of the students are rotated between operations. The aim is to achieve the objectives of the syllabus for the clinical training concept of CEP- op. This includes: Communication (closed loop), Teamwork and Cooperation, Collaboration, Responsibility for patients perioperative care, Division of labour/roles, Supervisor function and Independent exercises to manage perioperative care. On the morning before surgery, the participants review the patient’s medical background, the surgery to be completed and the drugs and instruments that will be needed. The WHO’s checklist (before the start of surgery (WHO, 2008)) provides the framework. The students explain their planning to their supervisors. They also rationalize the perioperative care and describe varying different responses to possible complicating situations. In this session the supervisors take the opportunity to ‘catch up’ on any misunderstandings. The tutorial is run from a reflective learning perspective and the participants are encouraged to discuss and develop solutions to potential problems. The supervisors are constantly present in the operating room during the operation. The tutorial is conducted with a permissive environment for independent training for the participants. When needed, the supervisors ‘take over’ the care of a patient to ensure safety throughout the operating procedure. At the end of surgery, the patient responsible students (both anesthesia and operation room students) transport the patient to the recovery room and report to the recovery room staff.

Team training in the operating room

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

A new modified educational program for team training targeted to anesthesia - and operating room nurses in specialist programs.

Since the CEP- op runs in everyday operating program, it was a challenge to the organization of the department, and also to the tutors and students. The most appropriate operating rooms, according to patient type and their resultant surgery, were chosen. Acute patients were never considered for the CEP- op, since it wasn’t possible for the participants to prepare themselves. Reflection & feedback meeting

Reflection, feedback all together in the team At the end of the day all the participants and tutors meet for feedback. They evaluate the day’s work in a reflective learning spirit: What went well and what could go better. As before, feedback should focus on: Communication, Teamwork/Cooperation, Collaboration, and Responsibility for patient’s perioperative care, Division of labor / roles, Supervisor function and Independent exercise to manage perioperative care. All contributors participate in this meeting. Implementation of the ’CEP- op’ Permission was obtained from the clinic management to implement a pilot test with anesthesia nursing students. Thereafter, group-evaluations included both students and tutors. As the program was considered a success it was decided that the concept should be developed and implemented for future students. Based on the evaluation, the concept was developed to a full Clinical Educational Program (CEP- op). Since it is a university hospital, no consent was requested from the patients. This decisions was approved from the management of the hospital. All important medical staff (anesthesiologist, surgeons, operating room staffs, coordinators and the responsible program directors of the two education programs at the University) were briefed in full considering the program. ’CEP- op’ was conducted using everyday planned surgery programs. Selection of ‘education theatre’ was done by reading journals before selecting patients (ASA 1-3) and the type of surgery. Total responsibility for the wellbeing of the participants was ensured and a debriefing group was available should difficult situations arise during participation in CEP- op. However, so far this competence have not been used. Discussion and conclusion Collaboration with the educational programs at the University was essential to get approval for CEP- op. The CEP- op was new for everyone in our department, including the facilitators, and was challenging. We found that it was important to have support from staff in differing key positions. It was also essential that at least one facilitator was available to deal with the various problems that can occur during CEP- op runs.

It was important to get full approval from all managers before an education program of this magnitude started. However, we as facilitators felt that this ‘learning model’ worked well. Participants were keen to participate in the CEP- op concept in future. The students also stated that the program should be available in the henceforth. In conclusion, our model seems to improve participant developments in the area of collaboration, teamwork, patient safety, peer- learning, peer- support, perioperative care and critical thinking.

AUTHORS Kenneth Nord, CRNA, MSc, is a nurse anesthetist at Skåne University Hospital, Malmö, Sweden. Email: kenneth-nord@hotmail.com Mats Johansson, CRNA, MSc, is a nurse anesthetist at Skåne University Hospital, Malmö, Sweden. Email: mats.mj.johansson@skane.se Anders Johansson, CRNA, PhD, is associate professor at Lund University, Sweden. Email: anders.johansson@med.lu.se Photografher: Mats Johansson Address correspondence to: Kenneth Nord CRNA, MSc Department of Intensive and perioperative Care University Hospital S-221 85 Malmö Sweden E-mail: kenneth-nord@hotmail.com Keywords Anesthesia, operation, team training, collaboration, peer-learning, problem based learning, interprofessional education, reflective learning.

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

A new modified educational program for team training targeted to anesthesia - and operating room nurses in specialist programs.

References Acronyms & Abbreviations. What does (Electronic) Downloaded 17 February 2016. www.abbreviation.com/TEAM American Society of Anesthesiology. (2014) ASA Physical status classification system. (Electronic) Downloaded 27 February 2016. http://www.asahq.org/resources/clinical-information/asaphysical-status-classification-system BARROWS, H.S., 1983. Problem-based, self-directed learning. JAMA : The journal of the American Medical Association, 250(22), 3077-3080. Blomqvist, (2006) Mediated peer (to peer) learning. Doctorial thesis, The Royal Instutute of Technology. Lärarhögskolan, Stockholm. Boud, Cohen och Sampson (1999) Peer learning and assessment. Assessment & Evaluation in Higher Education. 24 (4) 413-426. CAIPE. (2002) InterProfessional Education. (Electronic) Downloaded 21 februari 2016, från http://www.caipe.org.uk/about-us/defining-ipe/ Carlson, E. (2010) Sjuksköterskan som handledare. Doctorial thesis, Malmö Högskola. Malmö: Holmberg. EUA. European University Association, 2016. Downloaded 23 February 2016 http://www.eua.be/ Hofling, M. & Winther, S. (2013) Nyutexaminerade operationssjuksköterskors upplevelser av sin första yrkesverksamma tid - en kvalitativ intervjustudie. Master thesis. Östersund. Mitt universitet, Institutionen för hälsovetenskap.

Larsson Mauleon, A. (2005) Care for the elderly A Challenge in the anesthesia context. Doktorsavhandling, Karolinska Institutet: Sollentuna: Baran tryck. Lindwall, L. & von Post, I. (2000) Perioperativ vård- den perioperative vårdprocessen. Lund: Studentlitteratur. NEVILLE, A.J., 2009. Problem-based learning and medical education forty years on. A re-view of its effects on knowledge and clinical performance. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 18(1), 1-9. Nielsen, K. & Kvale, S. (1999) Mästarlära. Lärande som socialpraxis. Lund: Studentlitteratur. Swedish society of anesthesia- and intensive care, ANIVA. (2008) Kompetensbeskrivning- Legimiterad sjuksköterska med specialistsjuksköterskeexamen med inriktning mot anestesi sjukvård. (Electronic) Downloaded 18 February 2016. http:// www.aniva.se/kompetensbeskrivningar/ Swedish society of surgery care & Swedish nurse association (2011). Komptenensbeskrivning för legitimerad sjuksköterska med specialistsjuksköterskeexamen inriktning mot operationssjukvård. Stockholm. (Electronic) Downloaded 18 february 2016: http:77www.seorna.com/media/31056/ kompbesskrivning.pdf SOSFS 2008:1 Social Board´s regulations on the use of medical devices in health care.(Electronic) Downloaded 17 february 2016 https://www.socialstyrelsen.se/ publikationer2008/2008-10Topping, K. (2005) Trends in peer learning. Educational Psychology. 25 (6) 631-645.

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Hoffman, S. J. Rosenfeild, D. Gilbert, J.H.H. & Oandasan, I.F. (2008) Students leadership in interprofessional education: benefits, challenges and implications for educators,researchers and policymakers. Blackwell Publishing Ltd. Medical Education: 42: 654-661.

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British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

Notes to Authors

British Journal of Anaestetic & Recovery Nursing Vol. 15 (5), 21-22 ÂŠ British Association of Anaesthetic and Recovery Nursing, 2016

Information for Potential Authors

he British Journal of Anaesthetic and Recovery Nursing publishes the following types of articles, but welcomes any submission of relevance:

Editorials Original articles Original research Study day and conference reports Correspondence Case reports Notices Review articles News articles Audit reports Unit Interviews (www.barna.co.uk) Select â&#x20AC;&#x2DC;BJARNâ&#x20AC;&#x2122; then â&#x20AC;&#x2DC;Introduce Your Unitâ&#x20AC;&#x2122;

SUBMITTED MATERIAL Authors are requested to submit a copy of their typescript as a â&#x20AC;&#x2DC;wordâ&#x20AC;&#x2122; document, preferably by email as the Editor cannot accept responsibility for damage to/or loss of material discs. When a paper is accepted for publication, it is done so on the understanding that it is not being submitted simultaneously to any other journal in the English language. The Editor will make editorial and literary corrections as she sees fit. Any opinions expressed or policies advocated do not necessarily reflect the opinions or policies of the Editor or the British Anaesthetic and Recovery Nurses Association. Any article submitted should contain:

Title of the article Initial and name of each author Relevant qualifications Name and address of the department or institution to which the work should be attributed Name, address, telephone number and e-mail address for the author responsible for correspondence Abstract or summary and section headings if suitable

DIAGRAMS, ILLUSTRATIONS AND PHOTOGRAPHS All diagrams, pictures or illustrations should have a short description or caption sent with them. Titles should appear above each table or figure. They should also be referred to in the text. Photos should be sent as an attachment and as a jpeg file, along with where you wish them to be placed.

HARVARD REFERENCING References should be presented in the Harvard style. The accuracy of the reference you provide is your responsibility. In the text your reference should state the

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 ÂŠ British Association of Anaesthetic and Recovery Nursing, 2016

Notes to Authors

author’s surname and the year of publication e.g. [Smith, 2002] unless the reference is at the beginning of the sentence when only the date is put in brackets e.g. Smith [2002] states y If there are two authors, you should give both surnames [Smith and Black, 2001]. When a source has more than two authors, give the name of the first named author followed by ‘et al’, however do not use et al in the reference list, credit must be given to all authors. Where a quotation is used within your paper; the author, date and page number should be given, e.g. ‘For many years the recovery unit has been viewed as the ‘‘Cinderella’’ of the operating department. Indeed twenty-five years ago many hospitals did not have recovery units and post surgical patients were recovered on the surgical wards directly from theatres.’ (Oakley and Spiers, 2004 P 137) A list of all the references in your manuscript should be typed in alphabetical order, on a separate sheet entitled ‘References’ at the end of the paper. Each reference to a paper needs to include authors’ surnames and initials, year of publication, full title of paper, full name of journal, volume number, and first and last page numbers. References should conform to the Harvard style. Here is an example: Wilson S, Forrester A (2002) The way forward for anaesthetic and recovery nursing. Accident and Emergency Nursing 13(1), 1–8. References to books should be given in a slightly different form, as in this example: Radford M, County B, and Oakley M (2004) Advancing Perioperative Practice. Cheltenham: Nelson Thornes. When using an edited book, the author of the chapter will be used in the text and in the reference list and will be referred to in the following way: Oakley M and Spiers C (2004) Chapter 6 Principles of Recovery Practice. IN Radford M, County B and Oakley M (2004) Advancing Perioperative Practice. Cheltenham: Nelson Thornes.

Secondary references canEDITOR be used, but overall these LETTERS TO THE should be avoided. With the advent of the internet there are very few that will beto unavailable to Readers are primary welcomesources and encouraged write about authors. a secondary reference any topicThe thatrationale relates tofor theusing practice of anaesthetic and is that thepractice author or is relevant unable totofind the primary source recovery contents of the journal. and use the secondary reference. If a Suchmust letterstherefore will be published under ‘short communicasecondary reference has totobesomething used, theyou text should tion’ and can be in relation have read read; cited ofbynews, Brown in the Smith journal,[1978] or an item etc. [2004]. In the reference list it is Brown that is listed as the reference, because if the Smith reference had been used it would WE WAITING be theARE primary reference. FOR YOUR

EMAILS AND PHONE CALLS

LETTERS TOand THE EDITOR The Editor in Chief relevant members of the committee would be pleased to hear from any potential authors. Please Readers are welcome write about do not hesitate to contactand us. Ifencouraged having yourto work published any topic that relates to the practice of anaesthetic sounds like a scary prospect, drop us an email and we and will recovery practice or relevant to contents ofroad the journal. offer advice and support and start you on the to being Such letters will beinpublished ‘short communicain print. Publishing the Britishunder Journal of Anaesthetic and tion’ and can be in relation to something you have read Recovery Nursing is an excellent opportunity for profesin the journal, or an item of news, etc. sional and personal enhancement. So come on, your journal is growing: Be part of it.

WE ARE WAITING FOR YOUR information for potential authors’ to: EMAILS AND CALLS Lucie Llewellyn andPHONE Theofanis Fotis, Editors-in-Chief, E-mail: editors@barna.co.uk The Editor in Chief and relevant members of the committee would be pleased to hear from any potential authors. Please do not hesitate to contact us. If having your work published sounds like a scary prospect, drop us an email and we will offer advice and support and start you on the road to being in print. Publishing in the British Journal of Anaesthetic and Recovery Nursing is an excellent opportunity for professional and personal enhancement. So come on, your journal is growing: Be part of it. information for potential authors’ to: Lucie Llewellyn and Theofanis Fotis, Editors-in-Chief, E-mail: editors@barna.co.uk Kenes UK 1st Floor Chesterfield House 385 Euston Road London NW1 3AU

Secondary references can be used, but overall these should be avoided. With the advent of the internet there are very few primary sources that will be unavailable to authors. The rationale for using a secondary reference is that the author is unable to find the primary source and must therefore use the secondary reference. If a secondary reference has to be used, the text should read; Smith [1978] cited by Brown [2004]. In the reference list it is Brown that is listed as the reference, because if the Smith reference had been used it would be the primary reference.

British Journal of Anaesthetic & Recovery Nursing Vol. 15 No. 5 © British Association of Anaesthetic and Recovery Nursing, 2016

VOLUME ISSUE 5XX VOLUME 14 VOLUME 15 XX ISSUE ISSUE1-2

AUGUST MAY2016 2013 SEPTEMBER 2008

BRITISH JOURNAL OF

ANAESTHETIC & RECOVERY NURSING CONTENTS FROM THE CHAIRMAN

EDUCATION

FROM THE CHAIRMAN The Power Within You

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Manda Dunne

Letter from the Chair, Summer 2016 Manda Dunne EDITORIAL

From the Editor’s Perspective Theofanis Fotis EDITORIAL

Innovation the EOC Way The Appointment of a Transfer Link Nurse: Is it the Answer to a Busy PACU’s Prayers? Jessica Inch, Suzanne Tyne

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CONFERENCE REPORT ●

ORIGINAL ARTICLES Editorial ●

Effect of Pre-warming on Reducing the Incidence of

Digital Nursing: Inadvertent Peri-operative Hypothermia for Patients IsUndergoing it the answer to Anaesthesia: faster adaptation of health General A Mini-review innovation? Lucie Llewellyn

Fotis Theofanis. PhD, MSc, RN, FHEA. ● Parental Refusal of Consent forBSc, their Child’s Medical Treatment: An Ethical, Professional and Legal Dilemma Liz King Shoulder Operation Counselling in Day-Surgery Patients in ORIGINAL ARTICLES Finland: Patients’ Perspective Terhi Haapala, Mira Palonen, Päivi Åstedt-Kurki Management of perioperative hypothermia in the

7 11

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different hospitals of Nepal: A reflective account. Ishwori Thakuri. RN, BSC (Hons).

A new modified educational program for team training targeted to anesthesia and operating room nurses in specialist programs. Kenneth Nord, CRNA, MSc Mats Johansson, CRNA, MSc Anders Johansson, CRNA, PhD, Associate professor

NOTES TO AUTHORS

Journal Production Lawrand Medical Publishing Lawrand Ltd PO Box 51 Pontyclun CF72 9YY Tel: 02921 680068 Email: admin@lawrand.com Website: www.lawrand.com

The Irish Anaesthetic and Recovery Nurses Association (IARNA), 11th National Conference, 29 September 2012, Kilkenny Pauline Guyan

PROFESSIONAL ISSUES ●

BARNA Members and Non-members Need Defending Markku Viherlaiho

NOTES TO AUTHORS

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