OR Today - February 2020

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PRODUCT FOCUS WASHER-DISINFECTORS

LIFE IN AND OUT OF THE OR

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CE ARTICLE EDUCATION

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OUT OF THE OR EXERCISE

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FEBRUARY 2020

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The OR of the Future SAVE THE DATE

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WITH BD CHLORAPREP™ PATIENT PREOPERATIVE SKIN PREPARATION WITH STERILE SOLUTION AND AN ALL-NEW STERILITY ASSURANCE LEVEL OF 10 –6.* At BD, patient health is an unrelenting priority. It’s why we’ve introduced a whole new level of sterility assurance for BD ChloraPrep™ Patient Preoperative Skin Preparation, the solution that more hospitals count on than any other brand. As pioneers in skin antiseptics, we are raising the performance bar above and beyond FDA skin prep requirements, making our market-leading solution even better. Because when it comes to patient health, no other option gives you more peace of mind. Now you can rely on the lowest risk of intrinsic contamination commercially available in the United States, with a sterility assurance level of 10 –6—reducing the risk of antiseptic solution contamination to less than one in a million.*1 Discover the confidence of BD ChloraPrep™ Applicators. Discover the new BD. *The SAL level indicates there is less than one in a 1,000,000 chance (1000x greater than the minimum requirement) that a sterile ChloraPrep™ applicator containing a sterile solution will contain a single (viable) microorganism following terminal sterilization of the ampules through the new manufacturing process of BD. 1 Degala S, McGinley CM II, Thurmond KB, inventors; CareFusion 2200 Inc., assignee. Systems, methods, and devices for sterilizing antiseptic solutions. US patent 9,078,934. July 14, 2015.

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OR TODAY | February 2020

contents features

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THE OR OF THE FUTURE Recent advances in medical technology make it easier to envision the OR of the future. Advances in virtual reality (VR), augmented reality (AR), artificial intelligence (AI), machine learning (ML) and robotic assisted surgery devices (RASDs) are all expected to shape the future of surgery.

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SEE CLEARLY THROUGHOUT LAPAROSCOPIC SURGERY

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A report states that the sterilization services market will be worth $3.31 billion by 2022. Factors driving market growth include the increasing incidence of HAIs, rising number of surgical procedures, a growing geriatric population and increasing incidence of chronic disorders.

The goal of this continuing education course is to encourage nurses to consider an academic nursing career, to help them learn what steps to take to become nurse educators, and to inform them about the consequences of the nursing faculty shortage.

MARKET ANALYSIS

Laparoscopic surgeons confront many challenges to their ability to see clearly during surgery. ClickClean from Medeon Biodesign allows them to clean the lens in seconds during laparoscopic surgery, without removing the scope.

CE ARTICLE

OR Today (Vol. 20, Issue #2 February 2020 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. Š 2020

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contents

PUBLISHER

features

John M. Krieg

john@mdpublishing.com

VICE PRESIDENT Kristin Leavoy

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EDITOR

SPOTLIGHT ON

John Wallace

Lori Wood

editor@mdpublishing.com

ART DEPARTMENT Jonathan Riley Karlee Gower Amanda Purser

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot

DIGITAL SERVICES

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Win a Bath & Body Works gift card!

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OR TODAY CONTEST

Cindy Galindo

RECIPE OF THE MONTH

Kennedy Krieg Erin Register

CIRCULATION Lisa Cover Jennifer Godwin

INDUSTRY INSIGHTS 10 News & Notes 21 See Clearly Throughout Laparoscopic Surgery 22 CCI: The American Nursing Workforce is Rapidly Changing 24 IAHCSMM: Building Better Relationships in the SPD, OR and Beyond 26 ASCA: Celebrating 50 Years of ASCs 28 Webinar Recap: Presenters Deliver ‘Excellent Information

30 Market Analysis: SPD Market Growth Continues 31 Product Focus: Washer-Disinfectors 36 CE Article: Who Will Teach Our Nurses?

OUT OF THE OR

8 | OR TODAY | FEBRUARY 2020

ACCOUNTING Diane Costea

EDITORIAL BOARD Hank Balch, President & Founder,

Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education Development, Competency and

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Beyond Clean

IN THE OR

48 Spotlight On 50 Fitness 52 Health 54 EQ Factor 56 Nutrition 58 Recipe 60 Pinboard

WEBINARS

David Taylor, President, Resolute Advisory Group, LLC Elizabeth Vane, Health Science Teacher, Health Careers High School

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INDUSTRY INSIGHTS

news & notes

Nihon Kohden Launches Life Scope SVM-7200 Series and NKV-550 Series Nihon Kohden has announced the launch of its Life Scope SVM-7200 Series vital signs monitor, a monitor designed for outpatient facilities and beds that traditionally are not continuously monitored. The monitor allows health care practitioners to quickly and easily measure three vital signs – blood oxygen, blood pressure and temperature.

Part of Nihon Kohden’s complete line of monitors, the Life Scope SVM-7200 provides customizable early warning scoring that helps clinicians identify patients who are deteriorating or at risk of deteriorating by combining vital signs data with observational information. If an at-risk patient is identified, the vital signs monitor can be easily converted to continuous monitoring mode for viewing of vitals within the Nihon Kohden Patient Monitoring System.

The Life Scope SVM-7200 Series vital signs monitor features a high-resolution, 8-inch color touch screen display that enables clinicians to quickly navigate to the information they need. It also includes the company’s pioneering inflation-based non-invasive blood pressure (iNIBP) measure, which automatically detects diastolic and systolic pressure while the cuff is inflating. Rather than inflating the cuff to a preset pressure and measuring blood pressure as the compression is released, Nihon Kohden’s iNIBP cuff inflates only to what is necessary to determine a patient’s blood pressure, making it more comfortable and faster than traditional devices.

Offered with a flexible configuration, the monitor is available with either Nihon Kohden, Nellcor or Masimo SpO2. The monitor also comes standard with wireless functionality, which will be utilized when the planned two-touch send-to-EMR feature is deployed in a few months.

The Life Scope SVM-7200 monitor is part of Nihon Kohden’s extensive line of Life Scope monitors, which cover every acuity level. All Nihon Kohden monitors are designed with the company’s premium-as-standard approach, which is based on the philosophy that every patient monitoring feature should be turned on and ready to

10 | OR TODAY | FEBRUARY 2020

use at a moment’s notice, and that all software upgrades and updates should be included without any additional charge.

The Life Scope SVM-7200 is crafted using the same exacting quality standards that all Nihon Kohden’s products are known for and is backed by a five-year warranty.

The product also comes with 24/7 clinical and technical support, and software upgrades and updates free for the life of the product.

Nihon Kohden also recently introduced the new NKV550 Series Ventilator System that offers a full suite of applications necessary in a critical care setting for patients of all ages – from neonate through adult. The NKV-550, introduced for the first time at the annual American Association for Respiratory Care Congress 2019 in New Orleans, is a ventilator that features an integrated touchscreen, intuitive user interface and onscreen help functions.

The NKV-550 was developed to seamlessly transition between invasive ventilation, noninvasive ventilation and high-flow oxygen therapy, allowing clinicians to respond to a patient’s respiratory support needs without having to change devices.

The NKV-550 also offers on-screen help tools to walk clinicians through critical ventilator troubleshooting. •

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INDUSTRY INSIGHTS

news & notes

FDA Clears Duodenoscope with Disposable Elevator Piece The U.S. Food and Drug Administration cleared for marketing in the U.S. the first duodenoscope with a sterile, disposable elevator component that will reduce the number of parts that need to be cleaned and disinfected (reprocessed) in between uses. The Pentax Medical Video ED34-i10T2 model duodenoscope is intended to provide visualization and access to the upper gastrointestinal (GI) tract to treat bile duct disorders and other upper GI problems.

“Duodenoscopes with a disposable elevator component represent another major step toward lowering the risk of infection among patients who undergo procedures with these devices,” said Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “Improving the safety of duodenoscopes is a top priority for the FDA since such devices remain critical to life-saving care for many patients in the U.S. We encourage manufacturers of these devices to continue to pursue innovations that will help reduce risk to patients, and also encourage hospitals and other health care facilities where these procedures are performed to begin or continue transitioning to devices with disposable components that are easier to reprocess.

Today’s clearance is another step in the FDA’s ongoing effort to advance the development and availability of safer duodenoscopes.”

Duodenoscopes are used in more than 500,000 procedures each year as a less invasive way than traditional surgery to drain fluids from pancreatic and biliary ducts blocked by cancerous tumors, gallstones or other gastrointestinal conditions. The flexible lighted duodenoscope, which is threaded through the mouth into the top of the small intestine, is a complex medical device with many small working parts that can be difficult to clean. The device can trap contaminated tissue or fluid in its crevices, and if not thoroughly cleaned and disinfected, it can transmit infection-causing bacteria between patients.

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The FDA has previously issued communications to health care facilities about following appropriate steps for cleaning and disinfecting these devices between use. In August, the FDA released a safety communication recommending that duodenoscope manufacturers and health care facilities transition to duodenoscopes with disposable components. Disposable designs can simplify or eliminate the need for reprocessing of certain components, which may reduce between-patient duodenoscope contamination. The FDA has previously cleared duodenoscopes with removable endcap components. This clearance is the first device with a disposable elevator component — a part that has been traditionally difficult to clean and reprocess. The elevator part of the duodenoscope facilitates access to the bile and pancreatic ducts, and is used to position endoscopic instruments during the procedure.

The Pentax Medical Video Duodenoscope ED34-i10T2 is intended to be used with endoscopic devices, introduced in the patient’s mouth, to provide visualization via a video monitor of and therapeutic access to the biliary tract (liver, gall bladder and bile ducts) through the upper gastrointestinal tract. Risks of using the Pentax Medical Video Duodenoscope ED34-i10T2 include the potential for injuries, including, but not limited to, burns, electric shock, perforation, infection and bleeding.

The Pentax Medical Video Duodenoscope ED34-i10T2 was reviewed through the premarket clearance (510(k)) pathway. A 510(k) notification is a premarket submission made by device manufacturers to the FDA to demonstrate that the new device is substantially equivalent to a legally marketed predicate device. As part of the premarket clearance review, the manufacturer submitted evidence to the FDA demonstrating that the device is substantially equivalent to a predicate device.

The FDA granted clearance of the ED34-i10T2 to Pentax of America. •

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INDUSTRY INSIGHTS

news & notes

Conversational AI Leader Announces OrbitaASSIST Orbita announced that it is now offering OrbitaASSIST, an award-winning, voice-enabled, AI-driven bedside virtual health assistant.

This market-proven solution offers an alternative or adjunct to traditional nurse call systems. Using a smart speaker configured with OrbitaASSIST, the patient can say things like “tell the nurse I need a pillow,” or “tell the nurse I’ve fallen.” Artificial intelligence (AI) and machine learning operate on the backend to triage, prioritize and intelligently route requests to appropriate care team members who view requests on mobile, tablet or desktop devices. The patient hears a natural language response such as “someone will bring you a pillow soon,” or “we’ve raised an alarm with the nurse.”

Leading OrbitaASSIST initiatives is Nick White, who was recently named Orbita’s executive vice president of patient care solutions. White complements the Orbita team with deep expertise in helping transform operations via technology following a nearly two-decade career with Deloitte Consulting in Australia, the UK and Southeast Asia.

“This solution was designed to solve a very real challenge for in-facility care settings where patients struggle to communicate their needs with busy care staff,” White stated.

12 | OR TODAY | FEBRUARY 2020

"By giving the patient a ‘voice’ through conversational AI, the specific information in a request can be processed, prioritized, and routed to the right care team member in the right place at the right time,” he stated.

According to White, in the solution’s first 18 months of pilot operation including use at Sydney, Australia-based Prince of Wales Hospital, more than 8,000 patient requests were made.

“Research shows the value of OrbitaASSIST in facilitating early identification of critical care needs and dramatically reducing the median time of response to calls for help – by as much as 70%,” he said. “The earliest adopters of this advanced bedside communication solution also saw a reduction in falls and other hospital acquired complications.”

High satisfaction scores came from surveyed users of the solution, where 87% of nurses reported feeling more confident in their ability to appropriately respond to patient requests and 100% of patients surveyed wanting it available if hospitalized again.

Orbita is now working with hospital providers as well as senior living and community-based care organizations in North America and Europe to provide the technology to patients and nurses. •

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INDUSTRY INSIGHTS

news & notes

S.S. White Technologies Provides Custom Flexible Shaft for Medtronic EVAR Device S.S. White Technologies has announced a custom flexible shaft that drives a new Medtronic device for Endovascular Aneurysm Repair (EVAR). Central to the innovative Heli-FX EndoAnchor System, the S.S. White shaft maneuvers and installs a staple to secure endografts in Abdominal Aortic Aneurysm (AAA) and Thoracic Aortic Aneurysm (TAA) cases.

Flexible shafts transmit rotary motion much like a solid shaft, but can be curved over, under and around areas in ways a solid shaft cannot. This allows the minimally invasive Medtronic applicator system to position the proximal and distal ends of an implant (an anchor) within a blood vessel and to deploy the spiral anchor into the vascular

wall.

S.S. White designs flexible shaft solutions for specific applications with expertise and experience. “S.S. White is an industry leader in understanding the customer requirement, and then translating that into the actual construction of the shaft,� says Mohan Krishnan, PhD, senior engineering director, supply management at Medtronic Cardiac and Vascular Group.

The Heli-FX EndoAnchor System shaft design includes laser-welded fittings for a reduced diameter.

Flexible shafts are commonly used in surgical applications, especially in surgical power tools and tools used in minimally invasive procedures. •

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INDUSTRY INSIGHTS

news & notes

Healthmark Offers LED Interchangeable Magnifier Healthmark Industries has announced the addition of the LED Interchangeable Magnifier to its ProSys Instrument Care product line.

Designed for items to be optically inspected, the LED Interchangeable Magnifier is manufactured with an interchangeable 5-diopter glass lens that has a 2.25x magnification, 360 rotatable lamp head and a fully enclosed spring balanced arm to prevent pinching hazards. Equipped with 64 ultra-bright white SMD LEDs with brightness adjustable controls, the LED Interchangeable Magnifier has a reach of 36 inches, max illumination of 950lm, wattage

of 6W and includes a table clamp with a 2-inch opening.

The LED Interchangeable Magnifier power supply has an input of 100-240V-50/60Hz -0.45A and output of 26V/500mA. Interchangeable lenses are offered in the following magnifications and diopters: 2.25x (5 diopter), 3x (8 diopter), 4x (12 diopter) and 4.75x (15 diopter). The LED Interchangeable Magnifier is available for individual purchase.

The lenses can be purchased separately or together. • For more information, visit www.hmark.com.

Baxter to Acquire Seprafilm Adhesion Barrier Baxter International Inc. has entered into a definitive agreement to acquire Seprafilm Adhesion Barrier and related assets from Sanofi. The agreement is the latest example of Baxter’s continued focus on acquiring products and technologies that have a strong strategic fit with the company’s leading portfolio across the hospital, including in the operating room. The transaction contemplates a cash purchase price at closing of $350 million and is expected to close no later than the first quarter of 2020, following satisfaction of closing conditions.

“Seprafilm will be a strong complement to our leading hemostat and sealant portfolio, helping us continue to advance the art of healing with optimized patient care in the operating room,” said Wil Boren, general manager, Baxter’s

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Advanced Surgery business. “While Seprafilm is clinically recognized among surgeons globally, we plan to provide commercial support for the product through our dedicated surgery salesforce and pursue opportunities for expansion in certain countries.”

Adhesion prevention products, hemostats and sealants are important tools surgeons use to manage intraoperative bleeding and reduce adhesions.

Seprafilm currently has a global commercial presence including sales in the U.S., Japan, China, South Korea and France, among others. Sales of the proposed acquired products are expected to be approximately $100 million in the 12 months following close. •

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news & notes

Ventec Life Systems Announces VOCSN Multi-View VOCSN Multi-View provides complete patient trending and monitoring for ventilator dependent patients across multiple respiratory therapies including ventilation, oxygen, cough, suction, nebulization and additional patient monitors. Building on the integrated multi-therapy delivery of VOCSN, Multi-View is designed to summarize patient data and create trend reports to facilitate actionable and informed treatment decisions and care plans, drive proactive interventions, control costs and deliver seamless care across providers from hospital to home. The streamlined information is designed to provide decision makers a comprehensive picture of the patient’s respiratory wellbeing.

A recent Ventec Life Systems survey of 600 ventilator users and caregivers showed that 92% believe they would benefit from their providers having access to detailed reporting and information about their respiratory equipment in the home. Multi-View eliminates the guesswork and facilitates a more informed conversation about care between patients, caregivers and their physicians.

“VOCSN is the only system to deliver integrated respiratory care and Multi-View now provides relevant data for caregivers to make informed treatment decisions in a way that’s never been possible,” said Chris Kiple, chief executive

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officer of Ventec Life Systems. “Integrated Reporting opens a new chapter in respiratory care that we believe will lead to customized patient treatment plans, better health outcomes and more cost-effective patient care.”

Multi-View includes a smart summary across five therapies, a compliance calendar for tracking therapy usage, multi-therapy trending insights, as well as an alarm and settings summary. The trending summary empowers clinicians to quickly spot potential concerns which may proactively address problems before they lead to exacerbations or readmissions.

VOCSN Multi-View works across the continuum of care and is designed to enhance care for patients with neuromuscular disease, impaired lung function, spinal cord injury and pediatric development.

Security and stability is at the core of the VOCSN Multi-View connectivity. Through a partnership with Bridge-Tech Medical, data from VOCSN is transmitted in a secure, anonymized format to ensure patient data remains private. Multi-View will utilize Bluetooth technology to connect to additional monitors and integrate them into a single report. Reports can be pulled locally using the USB port on VOCSN, or wirelessly through Wi-Fi and cellular data to accommodate the mobility of VOCSN. •

FEBRUARY 2020 | OR TODAY |

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INDUSTRY INSIGHTS

news & notes

PDI Acquires Majority Share of Tru-D SmartUVC PDI announced the acquisition of a majority share of Tru-D SmartUVC, a pioneer in the UVC disinfection industry, and maker of the first UVC robot.

Supported by clinical research and featuring intuitive Sensor360 technology, Tru-D SmartUVC can accurately calculate the precise dose of UVC light needed to kill up to 99.9% of harmful pathogens and provides real-time reporting and analytical support for health care professionals. The addition of Tru-D, in partnership with its founder and president, Chuck Dunn, extends PDI’s Environment of Care portfolio from hard surface to total room disinfection, and addresses the industry’s need for an integrated approach to infection prevention.

“We are proud of our 40-year legacy in assisting the health care industry with products and solutions that help reduce the risk of infections,” said Zachary T. Julius, chief executive officer, PDI. “The acquisition of Tru-D is among our most recent efforts supporting our continued mission to reduce preventable infections, control associated costs, and ultimately help save lives across the health care continuum of care.”

UVC energy has been shown to be an effective and ecofriendly way to reduce the risk of dangerous microorganisms, including C. difficile, in any environment. In combination with highly compliant manual disinfection that included the use of surface disinfectant wipes, the CDC-funded Benefits of Enhanced Terminal Room-Disinfection (BETR-D) study showed Tru-D was able to reduce the relative risk of colonization and infection among patients in hospital settings.

“Investing in a broader array of infection prevention products and solutions is a critical element of PDI’s strategy and a vital element of our service to patients and customers,” said Kent Davies, president and chief operating officer, PDI. “In looking to address the needs of environmental service professionals, we identified Tru-D SmartUVC as an opportunity to provide a more integrated, data-driven product solution. With Tru-D, we found a company that not only shares our values, but also our mission to develop innovative technologies that make a real difference to health care professionals and patients.”

“With its extensive expertise as an infection prevention innovator, PDI is well positioned to help us further progress the growth and development of our SmartUVC technologies and continue to fulfill Tru-D’s mission to change the way health care works, by providing hospitals with leading-edge technology for terminal disinfection of health care environments,” said Dunn. •

16 | OR TODAY | FEBRUARY 2020

AAAHC Offers Transition Resources for Organizations Seeking New Accreditation Provider Transitioning to a new accrediting organization can be challenging, with much to consider when making a selection. The Accreditation Association for Ambulatory Health Care (AAAHC) has developed tools and programs to help ambulatory health care organizations better understand their options as they navigate accreditation changes.

As the health care landscape continues to evolve, it is imperative that organizations stay at the forefront of regulatory understanding and compliance to ensure patient safety and ongoing quality improvement. This makes finding the right accrediting organization that best suits the facility’s needs, a top priority.

AAAHC Standards are created and updated by experts in the ambulatory space, who bring their clinical, practice and technical knowledge to standards development. AAAHC surveyors are industry peers – medical and administrative professionals including registered nurses and physicians – with hands-on experience in a variety of outpatient settings and expertise in clinical and business operations.

AAAHC has redefined the approach to accreditation, implementing the transformational 1095 Strong, quality every day philosophy, a call-to-action that equips ambulatory leaders with the best of what they need to operationalize quality practices.

The 1095 Strong initiative centers on providing accreditation tools, resources, and relevant education to bring meaningful value to organizations and promote compliance with the Standards, all 1,095 days of the accreditation term.

“The AAAHC approach to the onsite survey is educational and consultative – not punitive,” said Adachi. “Our standards are easy to understand, and the scoring for individual elements of the standards is transparent. We have built our reputation on serving ambulatory health care organizations and are vested in their success.” • For more information, visit www.aaahc.org.

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When Quality Matters

BD Empowers Surgeons with New Technology BD (Becton, Dickinson and Company), a global medical technology company, announced the U.S. Food and Drug Administration has granted 510(k) clearance for the Phasix ST Mesh with Echo 2 Positioning System for use in abdominal hernia repair. Phasix ST Mesh with Echo 2 is a bioresorbable mesh with a removable positioning system designed to help simplify minimally invasive ventral hernia repairs.

This new device combines two technologies, Phasix ST Mesh and the Echo 2 Positioning System, into a single product. Phasix ST Mesh is comprised of a long-lasting, naturally derived bioresorbable mesh that includes a hydrogel barrier for intraabdominal placement. Phasix ST Mesh helps create a strong repair without the need for a permanent implant. The Echo 2 Positioning System is a pre-attached deployment and positioning device that is designed to help facilitate accurate and consistent mesh placement in minimally invasive ventral hernia repairs.

“Hernias are prevalent in the U.S. and worldwide, either as a result of naturally occurring weaknesses of the human abdominal wall or as a result of previous surgeries. While effective care options exist for patients, Phasix ST Mesh with Echo 2 Positioning System works with the body to rebuild tissue while gradually and predictably remodeling the area of weakness to provide a more durable repair,” said Namir Katkhouda, M.D., FACS; professor of surgery (tenure) University of Southern California. “The availability of this technology offers an exciting new option for surgeons, allowing abdominal hernia repairs the potential to be completed with more precision and in less time.”

Phasix ST Mesh with Echo 2 is commercially available in the United States. • For more information, visit www.bd.com.

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INDUSTRY INSIGHTS

news & notes

LG Introduces Enhanced Display Devices for Medical Environments LG Electronics Business Solutions is introducing larger, higher-resolution radiology and surgical monitors designed to offer hospitals and clinics improved work efficiency, advanced performance, expanded screen real estate and clean, minimalist designs. Demonstrated at RSNA 2019, the three new LG medical displays further expand the company’s diverse health care portfolio.

LG’s new 8-megapixel radiology monitor (model 32HL512D – FDA 510k Class II approval is pending) has a larger screen than its 27-inch predecessor.

LG’s new 4K surgical monitor (model 32HL710S) features a large ultra-high-definition display that leverages LG’s innovative technologies to provide highly detailed images, greater ease of use and reliability necessary for the OR. This monitor is engineered to provide low latency from video source to display. Its backlight brightness monitoring and control produce consistent flicker-free video. Model 32HL710S can be used with a wide variety of endoscopy cameras to provide remarkably smooth and accurate upscaling of Full-HD video.

The monitor also supports high dynamic range (HDR 10) content, delivering impressive contrast and colors when

18 | OR TODAY | FEBRUARY 2020

connected to an endoscope camera or other compatible devices. The advanced HDR 10 video format gives medical professionals a clear picture that’s easy to see and interpret.

LG’s surgical monitor has 4PBP and PIP modes as well as multiple video input ports to display visual information from several devices simultaneously. This enhances work efficiency by making it possible to view a comprehensive range of data on a single screen. For improved flexibility, the 32HL710S provides the Mirror and Rotate functions.

It also features easily-cleanable protective glass and has lightweight sleek design with a magnetic cover for precision cable management.

LG’s first cloud device for the health care market, model 24CK560N is the company’s user-friendly solution designed to improve workflow for busy hospital environments. A complete product in its own right, the 24CK560N features a DisplayPort video output for connection of second monitor. Its IPS panel produces vibrant images with consistent colors and contrast from any viewing angle, meaning groups can gather around and clearly see any content on screen.

LG’s new monitors were featured in the LG Business Solutions booth at RSNA 2019.

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INDUSTRY INSIGHTS Medeon

See Clearly Throughout Laparoscopic Surgery New technology to eliminate frustrating fogging and interruptions Laparoscopic surgeons confront many challenges to their ability to see clearly during surgery. Blood, smoke and steam repeatedly coat the scope, blocking or fogging the view.

Traditionally, a common solution has been to remove, clean and re-insert the scope repeatedly throughout surgery. This frustrating process disrupts the surgeon, and removals that take a few minutes add up over the course of a procedure. Two top surgeons have embraced a new technology that allows them to see clearly during surgery without interruption. ClickClean from Medeon Biodesign allows them to clean the lens in seconds during laparoscopic surgery, without removing the scope.

SUSTAINING A CLEAR VIEW FOR FASTER SURGERY, FEWER ERRORS We can’t perform surgery when we can’t see. Yet impaired visibility from fogging and smudging of the lens is a problem that pervades all laparoscopic surgery. We’re always looking for a solution. When we are intently focused on a colectomy, a hiatal hernia repair, a hysterectomy, WWW.ORTODAY.COM

or another procedure, loss of visualization at critical steps can be highly disruptive.

My colleagues and I found that in 83% of cases, we withdrew the scope for cleaning up to six times, losing up to 82 seconds per removal and up to 200 CCs of blood per case. Even in short, simple cases, it was easy to see the need for a change.

I recently began using the ClickClean device, which I find achieves our goal in a very simple, efficient way. I place my camera in the ClickClean device, which covers the scope lens with a biocompatible transparent film, and then proceed normally. Whether electrocautery smoke or body fluids obscure the lens, I simply click the trigger, which advances the film to give me a fresh, clear view. There’s no interruption and no cleaning time. We don’t face the risks of operating with a “dirty windshield.” ClickClean is simple and safe, with zero risk and significant benefits.

– Jay Redan, MD, FACS, Chief of Surgery, Advent Health-Celebration

AVOIDING INTERRUPTIONS DURING THE TOUGHEST COMPLEX CASES It is imperative that we all need a

View before cleaning (left). View after cleaning with ClickClean (right).

perfect view during surgery, especially with difficult cases.

If I have any bleeding or splatter on the lens during surgery, I want to fix it immediately without removing my camera from the patient. That’s why I’ve been using ClickClean. I’ve found that this very easy-to-use device gives me a clear view of the surgical field, which in turn gives me more efficient dissection and shorter surgery time.

It’s better for all of us.

For example, I recently performed a cholecystectomy on a 67-year-old man with a complicated medical history and acute on chronic cholecystitis. Inflammation at the neck of the gallbladder prevented safe dissection, so I placed a cholecystostomy tube using a 5mm camera without ClickClean. The steam and blurring during electocautery were so bad that I ended up switching back to my 10mm ClickClean camera for better visualization. This tough surgery was successful because I had access to clear visualization with ClickClean.

– Jessica Carlson, MD, General Surgeon, Curry Health Network, Gold Beach, Oregon For more information, visit medeonbio.com/ clickclean/ FEBRUARY 2020 | OR TODAY |

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INDUSTRY INSIGHTS CCI

The American Nursing Workforce is Rapidly Changing

By James X. Stobinski he makeup of the American nursing workforce is rapidly changing as our health care system transitions to valuebased reimbursement. As the CEO of the Competency and Credentialing Institute (CCI) I am witness to the evolving nature of the work of nurses with a focus on perioperative nursing. I am proud to say that CCI plays a small but significant role in this transition as we develop programs to assist perioperative nurses in their Continuous Professional Development (CPD) journey throughout a career.

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When I began my nursing career in the mid-1980s it was very typical for nurses to enter the profession with an associate degree or diploma of nursing, have a long, productive career and not complete any further academic education such as a BSN. The practice of nursing has become far more complex in recent years and new skill sets are needed. Nurses must now continue to acquire additional skills throughout their career or be faced with markedly decreased career opportunities. The skill sets now required for proficient nursing practice was not part of our pre-licensure education and, as nurses, we must devise methods to acquire these requisite skills.

BSN completion courses and graduate level coursework are seemingly everywhere. When we also consider the ubiquity of online courses most nurses have ample opportunity to further their education. The market, in the form of available education programs, has built up to meet the needs

22 | OR TODAY | FEBRUARY 2020

of nurses. This availability of programs combined with the widespread availability of tuition assistance as a fringe benefit removes many of the barriers to pursuing additional education.

Many nurses whose highest level of education was an associate degree or diploma of nursing are now retiring from the profession. These nurses did not pursue additional education after licensure, but their replacements are increasingly educated at the baccalaureate level. Nurses now entering the workforce are compelled, by a variety of forces, to enter the profession with baccalaureate level education or to quickly complete a RN to BSN program shortly after entry. For those aspiring to fill a management role, graduate level coursework is increasingly required with an MBA often seen among perioperative nurse leaders and managers.

Much of this push to reach higher levels of academic preparation may be attributed to the requirements set by employers and to accreditation requirements such as those of the ANCC Magnet program. CCI believes that certification organizations have a role to play. In the policies and programs that support credentialing programs, certification organizations can facilitate and encourage baccalaureate level education for those entering the profession. Later in the course of career progression certification organizations can also promote graduate level coursework.

For perioperative nurses the recent change in emphasis by CCI from a CE focused system for recertification requirements to a system centered on lifelong professional development

is very favorable for many nurses. At CCI, we are seeing an increasing use of the professional development points system (points method) for those nurses pursuing additional academic education. A common path for nurses holding the CNOR credential is to fulfill recertification requirements using the points method for their BSN completion program and then progress on to graduate coursework. The subsequent completion of an MSN or MBA degree then fulfills the recertification requirements for the next recertification cycle.

At CCI, we strive to assist perioperative nurses with their professional development needs. We have recently published a whitepaper on BSN level education, and this will soon be available on our newly refreshed website and as part of a professional development activity in our learning management system. We embrace our small part in the professional development journey of perioperative nurses.

James X. Stobinski, PhD, RN, CNOR, CSSM (E), has in excess of 30 years experience in the operating room. He has 18 years of management experience in perioperative nursing and has published and presented extensively at the national level on perioperative management related topics. He also serves as adjunct faculty at Nova Southeastern University in Ft. Lauderdale, Florida and Wilkes University in Pennsylvania. In February 2017, he began serving as the CEO of the Competency and Credentialing Institute. He maintains an active research agenda centered on nursing workforce issues and certification.

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CHALLENGE THE CLEANING EFFICACY OF AUTOMATED WASHERS

Reveal the hidden areas of instruments with the TOSI® washer test, the easy to use blood soil device that directly correlates to the cleaning challenge of surgical instruments.

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When metered on to the stainless steel plate, the TOSI® is completely analogous to a stainless steel instrument soiled with dried blood. Placed in the see-through plas�c holder, the challenge is iden�cal to the areas of instruments typically hidden from view (i.e., box locks). The rou�ne use of this test will help insure that your instrument washer is performing at a consistent level, enhancing the rou�ne visual inspec�on of instruments.

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INDUSTRY INSIGHTS

IAHCSMM

Building Better Relationships in the SPD, OR and Beyond

By Julie E. Williamson orkplace and interdepartmental conflict are all too common occurrences in today’s health care landscape, and with time and resource constraints squeezing more and more health care professionals, it’s becoming even more challenging.

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Unchecked conflict can erode teamwork, trust and job satisfaction, and even worse, violence and bullying can erupt – all negative outcomes that can have a significant impact on patient care. Experts largely agree that negative conflict takes time and energy to resolve but ignoring it can lead to employees’ perception that conflict has been accepted as the new norm in the department.

Address conflict wisely Conflict, by definition, is simply a difference in viewpoint or opinion, and it isn’t inherently “bad.” In fact, it can lead to better relationships and outcomes if managers and employees are given the right tools to address it in a productive way.

Well-managed conflict can also play an important role in an organization’s success. In fact, industry leaders have witnessed how the most effective team members from different departments are those where employees feel safe enough to disagree, but do so in a more thoughtful, productive way.

When that happens, innovation and better decision making can result.

Targeted training is the most effective approach for curbing negative, morale- and efficiency-robbing conflict. A professional code of conduct should be established for all health

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care departments and professionals.

A disciplinary structure should be developed so the mechanisms and referral pattern to higher authority are well understood, which can lead to effective resolution at a lower level, findings have shown. The goal is for all employees to know and understand that the organization has firm limits on inappropriate behavior.

During tense situations, managers should encourage employees to physically step away from the conflict for a brief period to think rationally about how best to address the situation at hand. When individuals feel personally attacked or pressured, that can lead to emotional and potentially negative outcomes. Momentarily stepping away from a tense moment or situation allows managers to respond to the situation with a clearer head – and employees involved to enter a cooldown period that can lead to more rapid, effective resolution.

Effective communication is key Workplace conflict often erupts between employees because of a lack of communication – and this is equally true of interdepartmental conflicts where each side struggles to understand the needs and viewpoint of the other. A recent Society for Human Resource Management (SHRM) sur-

vey found that 72% of employees rank “respectful treatment of all employees at all levels” as the top factor in job satisfaction – and SHRM also found that misinterpreting others’ intentions is among the biggest drivers of conflict.

Other common contributing factors of conflict include when an employee believes another employee is not pulling their weight, or when unreasonable expectations or questionable requests are made.

To foster a fair, more positive working environment, managers must lead by example, demonstrating effective communication and encouraging employees to work through their differences by engaging in honest and fair discussions. Asking questions to help employees gain a better understanding of their colleague’s perspective is a particularly effective approach.

Although many experts agree that some conflicts are best resolved between the individuals involved, there are times when resolution won’t likely occur without some mediation from a manager. When conflict arises regarding departmental practices, for example, managers may find better success in steering employees to the standards and guidelines where the answer can be found. These critically important documents can help bring

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INDUSTRY INSIGHTS

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everyone toward the common goal of safety and quality.

Knowing how to manage conflict outside one’s own departmental walls is critical. It’s not uncommon for sterile processing (SP) professionals to face conflict from operating room (OR) professionals, which may present itself in the way of urgent (and, at times, hostile or unforgiving) calls or visits from surgical staff who demand that problems or needs be addressed immediately. Stern exchanges are not pleasant, but when employees and managers apply proper knowledge and communication tools, they can typically resolve those conflicts quickly.

Managing interdisciplinary conflict takes a facility-wide effort that involves team-based training and cooperation. Policies and procedures pertaining to conflict resolution and effective communication need to be in place and they should be consistent across all departments. When conflict arises between the SP department and the OR, some SP managers have found great success in visiting the OR with the SP employee to address situations face to face. The manager’s presence can help the employee feel more supported and the employee can learn valuable skills by participating in the discussion or seeing and hearing how the manager addresses the problem. Listening to the OR’s concerns

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can also help justify their urgency, especially when a situation such as a missing or malfunctioning instrument affects the patient on the table. At the same time, if the OR’s demands go against facility standards, guidelines and facility policy, this face-to-face communication will help set the stage for future improvements and expectations.

Creating a culture of accountability and understanding with both the SP department and OR teams helps build interdisciplinary trust and understanding. By and large, most employees want to do the right things for the sake of patient safety – and they want to help prevent future negative outcomes or conflicts from recurring. Empowering SP professionals to deal directly with OR staff issues is important – and so is ensuring that issues are being effectively addressed – but it’s equally important that the OR recognizes the many detailed, timeconsuming steps that must take place in the SP department to ensure that instruments are processed fully, safely and effectively, and in accordance with standards, guidelines, regulations and facility policy.

Julie E. Williamson serves as IAHCSMM’s communications director and editor. She has written hundreds of articles on topics related to central service, surgical services, infection prevention and materials management.

@OR_TODAY

ortoday.com FEBRUARY 2020 | OR TODAY |

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INDUSTRY INSIGHTS ASCA

Celebrating 50 Years of ASCs

By William Prentice n February 12, 1970, in Phoenix, Arizona, five physicians performed the first surgeries ever provided inside a freestanding ASC. This year, thanks to everyone in the ASC that day and to the legions of health professionals and others who have helped make the ASC model a success, ASCA is proudly celebrating 50 years of ASCs.

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Prior to 1970, much like today, both policymakers and patients were concerned about the escalating cost of health care and patient access to affordable care. Unlike today, with more than 5,800 Medicare-certified ASCs serving patients throughout the U.S., the idea of performing same-day surgery in a facility that operated independently from a hospital had never been tested. As government officials, insurance providers and physicians continued to look for answers, Wallace Reed, MD, and John L. Ford, MD, took action.

In 1968, a sketch of the facility the two physicians envisioned was committed to paper for the first time. Soon after, Reed and Ford defined objectives for their facility: • To make the “ambulatory patient” a matter of greater concern • To streamline the delivery of his/ her medical services • To reduce the cost of his/her care

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• To work for a broadening of his/ her insurance coverage • To provide a pleasant atmosphere for patient, staff and surgeons What followed was a long series of firsts and years of careful, steady progress toward initial acceptance of their idea and, much later, the overwhelming popularity of the ASC model we see today.

Considering the complicated regulatory environment ASCs operate in today and the millions of satisfied patients who have enjoyed the personalized service and highquality care ASCs provide, it might be difficult to imagine a time when there were no regulatory, licensing or accreditation requirements for ASCs and many patients were wary of having surgery outside a hospital.

It might also seem counterintuitive that, initially, many insurers and investors were skeptical of the idea, while government officials in the states and Washington, D.C., embraced and promoted it. Physicians, according to Reed, expressed a great deal of interest in the idea from its inception. Many hospital administrators, however, did not share their enthusiasm.

Fortunately, Reed, Ford and the others who quickly followed them, opened their own ASCs and devoted time and energy to giving patients access to the many benefits ASCs provide. They never lost sight

of the critical need to put patients first. At the same time, they worked inside their own facilities to provide only the best in ambulatory surgical care. The founders of the ASC community also worked in their state legislatures, in Washington, D.C., and with local and national licensing and accrediting bodies to establish standards of care that would guarantee patients an exceptional experience as well as outcomes that easily met or exceeded those in hospitals.

That tradition has carried through the entire 50-year history of ASCs. When ASCs began to seek approval for Medicare beneficiaries to have surgery in an ASC, members of the ASC community scheduled meetings, presented data and worked together with federal officials to create a framework that would ensure patient safety and top-quality care. That work continues today. Later, when ASCs saw the need to demonstrate the quality of care they provide, they not only asked Medicare to institute a national ASC quality reporting program, they helped develop quality measures that would be meaningful for patients, providers, insurers and others. That work also continues today.

Over the years, ASC physicians and staff also dedicated their time and talents to making surgery a better experience for patients. They

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INDUSTRY INSIGHTS

news & ASCA notes

have led advances in minimally invasive procedures, pain control and recovery care while meeting and exceeding their patients’ expectations for comforting, comfortable care. At the same time, they found ways to cut the cost of ambulatory surgery without compromising on quality.

I suspect that few who helped open and staff the first freestanding ASC in Phoenix, Arizona, in 1970 would have predicted that 50 years later, patients in the U.S. would have access to more than 5,800 Medicare-certified ASCs and that

more than 80 percent of all surgeries, including total hip and knee replacements and several spine and cardiology procedures, would be performed as outpatient procedures.

Yet, that is where we stand today.

In 2004, Reed made a prediction: “I think the future is bright. I think the potential for growth is tremendous if the focus remains on providing excellent patient care and keeping costs reasonable. We need to continue to make the patient the absolute

top priority, continue VIP treatment for surgeons and continue to make certain that there are financial benefits to the patient, the facility and the surgeon.”

With the ASC community’s continuing commitment to those guiding principles, his vision is just as true today as it was in 2004. ASCA is looking forward to seeing and celebrating the evolution of outpatient surgery over the next 50 years.

Thousands of ASC professionals.

Hundreds of exhibitors.

More than 50 educational sessions.

One can’t-miss event.

Early Bird Savings End March 13. Register Today!

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FEBRUARY 2020 | OR TODAY |

27

INDUSTRY INSIGHTS

WEBINAR SERIES

news & notes webinars

Presenters Deliver ‘Excellent Information’ Staff report he OR Today webinar “Human Factors and Quality Testing for Device Reprocessing” was sponsored by Healthmark and eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing.

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The 60-minute webinar featured Jahan Azizi, special projects manager at Healthmark Industries. Azizi discussed the best practices for testing defective equipment and instruments that can’t be easily visually inspected. He shared how to ensure a leak tester is working properly, and that electro-surgery equipment has proper insulation and continuity.

The webinar was well attended with 142 individuals participating in the live presentation and even more have viewed a recording of the webinar online. Attendees shared positive feedback in a post-webinar survey including a 4.0 rating on a 5-point scale.

Attendees also shared positive comments via the survey.

“This was a great webinar discussing human error when reprocessing instruments - it was interesting to hear the differences of opinion of those in the audience and see such discrepancy,” Infection Preventionist K. Acree said.

“The webinar was extremely well put together, educational, relevant to what I do. Knowledgeable presenter. I liked the poll questions as it gave me insight into what others are doing,” said P. Conklin, ICP. “It’s refreshing to hear an OR perspective on how certain re-useable medical equipment (RME) needs to be intricately processed over others due to the special components involved. This may take more than just the SPS department’s expertise in processing and may have to include all parties (OR, SPS and manufacturers) to articulate and provide vital input to ensure the most successful process.

We want to provide the most effective process for all RME for all patients’ procedures to guarantee quality care,” RME Coordinator/SPS Educator S. Cross said.

“Up-to-date, relevant information, well-informed speaker, informative slides, easy access to webinar and easy evaluation via email,” said P. Burton, clinical manager.

“This is a hot topic in the arena of endoscope reprocessing. The speaker discussed some relevant points that I have not seen in other presentations. Great information provided,” said C. Wahinehookae, endoscopy charge RN. “This webinar was very beneficial. I feel it should be a

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“ This webinar was very beneficial.

I feel it should be a mandatory webinar for our surgical techs, CSPD staff and any staff that cross train into CSPD.” – J. Nelson, clinical care leader surgery mandatory webinar for our surgical techs, CSPD staff and any staff that cross train into CSPD,” said J. Nelson, clinical care leader surgery.

Creating an Adaptable Culture The OR Today webinar “Create an Adaptable Culture: Best Practices for Implementing Change in a Clinical Setting” eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing.

The 60-minute webinar, sponsored by Surgical Directions, was presented by Dr. Tom Blasco, MD, MS, medical director, and Lee Hedman, BA, CAPM, SSM, executive vice president at Surgical Directions.

Culture is commonly a significant barrier to change in hospital and surgical center ORs. Overcoming this barrier demands appropriate and thoughtful staff engagement in order to create buy-in and support for changes. Blasco and Hedman shared a few tips and tricks for creating a culture supportive of change. Ideas presented included governance structure to align leaders, building effective performance dashboards to engage and incent staff, executing routine operational tactics to keep everyone on the same page and more.

The webinar delivered knowledge regarding how to use governance to manage a changing environment and how to overcome staff objections to change. It also discussed how to run an effective daily huddle.

More than 100 individuals attended the live presentation. A recording of the webinar is available online where even more health care professionals can tap into the great insights discussed during the webinar.

Attendees praised the session via a post-webinar survey.

“Another outstanding webinar by OR Today, the information was relevant and may be incorporated into current practice,” Perioperative Consultant J. Greary said.

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INDUSTRY INSIGHTS

newswebinars & notes “ This training is a valuable resource to the OR field, receiving/distribution, prosthetics and sterile processing communities. A plethora of information often ‘hidden’ only to be found by much research on one’s part."

– B. Dreves, digital librarian “OR Today’s webinar hit the right spot to improve our daily operations,” Administrator M. Chang shared.

“OR Today webinars explore and focus on current trends and needs of the perioperative environment. They provide valuable current, up-to-date information to assist in this unique area of clinical practice and management,” Program Specialist Clinical Education C. Curcin said.

“Excellent information on building teams, avoiding working in silos and breaking down communication barriers,” Clinical Educator R. Scott said.

“I thought the presenter had a lot of good information.

I would like to try and work in some of his ideas into my clinical area,” Clinical Educator T. Dofflemyer said.

“Enjoyed this webinar, we are all working for the same results. Most of us have the same challenges and it is always helpful to hear successful stories,” Director of Surgical Services K. Coughlin said.

“The webinar was very informative and cleared up some questions,” SPD Manager V. Lopez said.

Tissue and Implant Tracking Requirements The OR Today webinar “Tissue and Implant Tracking Requirements in Healthcare” presented by Jesse Liebler was eligible for one (1) continuing education (CE) hour by the State of California Board of Registered Nursing.

In the webinar, Liebler, sales manager at TrackCore Inc., discussed the growing list of requirements surrounding biologic tissue and implantable medical devices in health care, as well as best practices to help manage these heavily regulated product types. Participants also learned about the UDI rule and how it impacts clinical documentation and reimbursement rates for implants.

The TrackCore-sponsored webinar had 199 attendees for the live presentation and even more have viewed a recording of the informative session online. It received a high rating and positive feedback via a post-webinar survey.

“Always interested in the most up to date information concerning tissue tracking as federal regulations can change. This was very integral to the nurses responsible for maintaining our tissue supply. Very informative,” Perioperative Services System

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Administrator S. Mandes said about the webinar.

“Excellent presentation. The information was very timely and useful for me,” said R. Hance, RN. “This training is a valuable resource to the OR field, receiving/distribution, prosthetics and sterile processing communities. A plethora of information often ‘hidden’ only to be found by much research on one’s part,” said B. Dreves, digital librarian.

“I had no idea there was a CFR associated with this! The webinar had excellent sources and was very informative,” Infection Control Officer C. Oglesbee said.

“Today’s information was so relevant because our clinical nurses have to document correctly so we comply with FDA and TJC. Biological tissue is a complex and confusing topic.

Today’s seminar broke it down into easy-to-understand information. I plan on a staff in-service using the information I learned in this webinar,” Clinical OR Educator B. Vuncanon said.

“This was such a good webinar. Very informative about guidelines and documentation especially being able to scan barcode info into save documentation time,” said K. Keefer, RN CNOR. “Love it.”

“This was an informative presentation that clarified many of the confusing aspects of tissue and implant regulations. The speaker was very knowledgeable and did a great job presenting,” said A. Brandor, chief sales officer.

For more information about the OR Today webinar series, including recordings of previous webinars and registration for upcoming sessions, visit ORToday.com and click on the “Webinars” tab.

Thank you to our sponsors:

FEBRUARY 2020 | OR TODAY |

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IN THE OR

market analysis

SPD Market Growth Continues Staff report isinfection ensures usage of pathogen free medical instruments such as endoscopes, surgical instruments and bedpans. Disinfection is a process of destroying pathogenic organisms and is achieved with the usage of various equipment and consumables such as disinfectants, detergents, washers and disinfectors.

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“Disinfectors represent a class of equipment used for cleaning medical devices, ensuring hygiene of the instruments.

The market witnessed a tremendous growth rate of 10.2% from 2014 to 2020 owing to increasing number of hospitalacquired infections (HAI),” according to Transparency Market Research (TMR).

“HAI occur due to the usage of improperly cleaned medical instruments.

In order to reduce such incidences, the demand for disinfectors is anticipated to grow during the forecast period.”

“Similarly, increasing number of surgeries in hospitals and clinics would also propel the growth of this market as for disinfecting medical devices (used in surgeries) and disinfectors are utilized,” the report states. “Likewise, increasing disposable income in developing countries will further augment the growth of the market as it would assist in increasing the affordability for availing medical services that require medical instruments and hence, disinfectors market would also grow. Moreover, increasing number of elder care institutions across the globe is likely to accentuate the growth of flusher disinfector and the overall disinfectors market.”

Considering the above mentioned

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factors, the market for disinfectors is expected to grow at a compound annual growth rate (CAGR) of 10.2% from 2014 to 2020 to reach an estimated value of $3.1 billion in 2020, according to the report.

TMR states that the market for disinfectors has been segmented on the basis of product type such as washer disinfectors, flusher disinfectors and endoscope reprocessors. The market for endoscope reprocessors and washer disinfectors accounts for the largest share throughout the forecast period. The growth of these segments is expected to be impressive owing to increasing usage of endoscopes and medical instruments due to rising incidences of various diseases such as cancer, cardiovascular diseases and others.

The market has also been segmented based on the usage of disinfectors in different health care facilities such as hospitals and clinics, pharmaceuticals and life-sciences companies and elder care institutes. The market for hospitals and clinics segment is expected to foresee highest growth rate during the forecast period, TMR states. Increasing number of hospitals coupled with rising number of surgeries performed are the prime factors augmenting the growth of this segment.

Geographically, North American and European markets accounted for the largest share by revenue of the global disinfectors market, capturing more than 70% of the total market in 2013 and expected to grow at a significant CAGR during the forecast period. This huge market share of these two regions is justified by the presence of large number of disinfector manufacturers in these regions.

A report from MarketsandMarkets states that the sterilization services mar-

ket will be worth $3.31 billion by 2022.

The report states that factors driving market growth include the increasing incidence of HAIs, rising number of surgical procedures owing to the rapidly growing geriatric population and increasing incidence of chronic disorders across the globe. In addition, the increasing outsourcing of sterilization processes by medical device manufacturers and outsourcing of hospital sterile departments to reduce health care costs are further increasing the demand for sterilized services. Moreover, factors such as the carcinogenic nature of ethylene oxide and difficulty in the sterilization of advanced medical instruments are limiting the growth of this market to a certain extent.

Market Study Report recently introduced the “2018-2023 Global Endoscope Washer-Disinfectors Market Report.” It provides an in-depth overview of industry and competitive landscape, covering multiple market segments and elaborates market outlook and status to 2023.

“Washer-disinfectors are defined by the Food and Drug Administration (FDA) as Class II medical devices intended for general medical purposes to clean, decontaminate, disinfect and dry surgical instruments, anesthesia equipment, hollowware and other medical devices,” according to Market Study Report.

Over the next five years, the report projects that the endoscope washerdisinfectors market will register a 7.4% CAGR in terms of revenue, reach $430 million by 2023, from $280 million in 2017.

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IN THE OR

product focus

Skytron Flex

The Skytron Flex was designed with versatility and throughput in mind. This ultrasonic washer-disinfector has the ability to process large loads with non-proprietary trays. The Flex has the ability to irrigate orthopedic, robotic, cannulated and non-cannulated instruments simultaneously, with a loading capacity of 125 pounds.

The Flex is able to clean with any DIN trays they already have, allowing them to save on the expense of buying additional trays. This ultrasonic cleans more trays in less time with fresh, clean water and detergent in every cycle. •

Getinge

86-Series WasherDisinfectors The Getinge 86-series Washer-Disinfectors are premium resources for your CSSD. Each model is easy to load, operate and maintain, improving employee workflows for increased efficiency. Getinge S-8668T offers a smarter process: using the multitasking capability with our well proven turbo concept to reduce the non-productive time, to enable and secure the most effective process in any given application. The result is industry-leading cycle times for both steam and electric powered washers. •

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FEBRUARY 2020 | OR TODAY |

31

IN THE OR

product focus

Belimed

WD 290 IQ The WD 290 IQ is Belimed’s solution for medium and large SPDs, where consistent performance, high throughput, efficiency and tailored automation enables busy departments to meet the increasing processing and growing productivity demands of today and the future.

As with its siblings, the WD 250 and WD 200, a high-volume water flow, with lower pressure, provides a better way to clean while using very little water and resources. •

Steelco DS 610

The Steelco DS 610 instrument washer is a large front loading or pass through unit that can accommodate multiple loads with different level racks. The powerful built-in HEPA filtered forced hot air drying system with adjustable time and temperature settings helps to ensure a complete drying of all instruments. It features a high visibility full glass door, telescopic bearing rails, soft touch control system on a glass panel with LCD color display to visualize cycle status and 20 standard programs for instruments and 20 additional custom programs are available. It also offers an optional RS 232 port for a printer connection to monitor and validate washing phases. •

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IN THE OR

product focus

STERIS

AMSCO 7053 HP Washer/Disinfector The AMSCO 7053 HP Washer/Disinfector takes productivity to elevated heights, offering the industry’s highest throughput and providing a complete and thorough clean to meet the demands of the busiest sterile processing departments. This washer/disinfector powers away soils with STERIS’s exclusive spray arms providing complete rack coverage with 120° range. This washer/disinfector is compliant with ANSI/AAMI ST 15883-2 and ISO 15883-2 standards for thermal disinfection. Touch screen controls allow easy operation for cleaning and intermediate-level disinfection of reusable surgical instruments and utensils. •

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FEBRUARY 2020 | OR TODAY |

33

+ PESKY FLY + DUST PARTICLES + UNNECESSARY DOOR OPENINGS

Endless Risks + METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)

+ POSITIONING THE PATIENT

+ STAPHYLOCOCCUS AUREUS

+ BACTERIAL CONTAMINATION

+ HAIR

+ LINT PARTICULATE

+ O.R. TRAFFIC

+ STAPHYLOCOCCUS EPIDERMIDIS

One Solution

The sterile field should be covered if it will not be immediately used or during periods of increased activity. – AORN 2019

> LEARN HOW TO COVER AND UNCOVER TABLES AT: tidiproducts.com/sterile-z-back-table-cover © TIDI PRODUCTS, LLC. ALL RIGHTS RESERVED. STERILE-Z IS A REGISTERED TRADEMARK OF TIDI PRODUCTS, LLC.

CE414

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continuing education

Who Will Teach Our Nurses?

BY SHEILA J. LEIS, MS, RN-BC

hroughout the world, nurses are called on to work in healthcare settings that are undergoing reform never before imagined.1 Patient needs and care delivery systems are more complex than ever. To give high-quality care, nurses must broaden their practice scope, master technology and information management systems, and coordinate care across teams of healthcare professionals.1 Educators must prepare nurses to enter a workforce that’s complex, uncertain and constantly evolving. According to the National League for Nursing, nurses must recognize that “a critical goal for the future is to endorse academic progression options for all nurses.”1

T

Not only do the qualifications of the current nursing workforce need to be updated, the Health Resources and Services Administration projects that

36 | OR TODAY | FEBRUARY 2020

we’ll need more than 1 million new RNs by 2020.2 The good news is that nursing program applicants, enrollments and graduates have increased.

The bad news is that despite increased enrollments, too many qualified applicants are being turned away from entry-level nursing programs, mostly due to faculty shortages.3 Some experts believe that even if colleges and universities could produce enough nurse educators to teach students on admission waiting lists, the problem still wouldn’t be solved. The prospect of not having enough nurses to meet the demand is now high on the radar for government and healthcare organizations. It makes many of us wonder: Who will be there to take care of me when I need it?

Safety and Science Endangered Ever since an Institute of Medicine (now called the Health and Medicine Division [HMD] of the National Academies) study found that as many as 98,000 people die each year as a

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity.

See Page 43 to learn how to earn CE credit for this module.

Goal and objectives The goal of this continuing education course is to encourage nurses to consider an academic nursing career, to help them learn what steps to take to become nurse educators, and to inform them about the consequences of the nursing faculty shortage. After studying the information presented here, you will be able to: •

Describe the impact of nursing faculty shortages on the nursing profession and the nation’s health.

•

Identify strategies to begin a path to becoming a nurse educator.

•

Describe the educational and personal qualities needed for an academic career.

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continuing education result of hospital stays – primarily from medical errors and hospitalacquired infections – patient safety has become a top priority.4 The role nurses play in monitoring patients to reduce adverse outcomes significantly affects preventable complications and deaths.4,5 Hospital medical errors have been noted to be the third leading cause of death in the United States, resulting in the death of nearly 700 persons per day.6 As University of Pennsylvania researcher Linda Aiken points out, there’s a growing body of evidence to suggest a more highly educated nursing workforce saves lives. According to Aiken, “Our research shows that each 10% increase in the proportion of nurses in a hospital with a bachelor’s degree is associated with a 7% decline in mortality following common surgery.”7 A summary of Aiken’s research is available.7 To create safer hospitals, an adequate number of well-prepared nurses must be available. In 2010, the HMD shook up the nursing field when it called for 80% of all nurses to hold BSN degrees by 2020.8 As a result, there’s been an increase in RN-to-BSN programs requiring additional qualified faculty.9 The nursing shortage – the nursing faculty shortage in particular – not only threatens patient care, but also advances in nursing science. As a profession, nursing is still young. It is only in the past few decades that nurse scholars and researchers have developed a scientific body of knowledge that promotes evidence-based practice. For nursing to fulfill its mission, these efforts must continue and expand. Nursing must have enough educators to prepare the next generation of nurses and enough researchers and scholars to continue to advance nursing science. The nursing field needs skilled educators who are qualified to do the studies needed to

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answer questions about how students learn and what teaching strategies are most effective. Recruiting more nurses into academic roles is crucial to doing the research to answer these questions.

The following forces drive the nursing faculty shortage:2,3 • More faculty are nearing retirement.

• The number of younger faculty has dropped.

• More opportunities exist outside of academia.

• There is a disparity between faculty and clinical salaries.

• There are financial barriers, including tuition costs, student loans, and lost income while in graduate school.

• There are older doctoral recipients, leading to shorter careers in teaching.

• Faculty workload demands and role expectations can lead to job dissatisfaction.

What It Takes Being a nurse educator takes a passion for quality patient care, high-practice standards, a commitment to lifelong learning, creativity, flexibility, and excellent communication and criticalthinking skills. It also requires a sincere desire to help students grow and develop. If you have these qualities or are willing to develop them, consider acquiring the educational background that will prepare you as a nurse educator. The nurse practice act in each state determines the qualifications nurse educators need. Some nurse practice acts distinguish between the academic qualifications of instructors who conduct clinical teaching and those who provide both classroom and clinical instruction. Accrediting agencies, such as the National League for Nursing (NLN) and the American Association of Colleges of Nursing (AACN) require full-time faculty to

have doctoral degrees.

Nurse educators with master’s degrees (which are generally required) begin their teaching careers as junior faculty, instructors or assistant professors. Many of today’s students continue to work while they study part time, and most graduate programs accommodate the needs of working nurses.

Students in master’s programs usually have bachelor’s degrees in nursing.

Some graduate programs offer BSNto-PhD programs and others have a generic master’s program for students with a non-nursing bachelor’s degree.

In these innovative programs, students move through courses at an accelerated pace. Many graduate programs require applicants to have a 3.0 undergraduate grade point average, and some require desirable scores on the graduate record examination (GRE).

Most schools require faculty to have doctoral preparation to be eligible for promotion to associate professor or full professor. In addition to teaching students, faculty members are often expected to demonstrate expertise in clinical practice, service, publishing, leadership, and research. Nurse educators fill positions ranging from adjunct (part-time) clinical faculty to deans of colleges of nursing. Students come from a variety of backgrounds, ranging from recent high-school graduates, to students with previous non-nursing careers to practicing nurses.

Usually, nursing faculty teach courses that correspond with the focus of their graduate nursing education program (e.g., adult, pediatric, psychiatric, obstetrics, critical care or community health nursing). Some faculty members also teach in areas in which they have evolved as specialists through academic preparation or personal study or experience (e.g., nursing leadership or healthcare management). Whatever the clinical or professional specialty area, nurse educators are first and foremost teachers and

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continuing education must be skilled in teaching strategies, evaluation of learning outcomes and curriculum development. They must know how to guide learners to reach their full potential.

No Ivory Tower Some clinicians think nurse educators work in an ivory tower detached from nursing’s real world. Nothing could be further from the truth. To be effective teachers, nurse educators must devote time to remaining clinically competent and aware of new developments in nursing practice and research. The number of hours faculty devote outside of regular work time to do that can be formidable. Wide variances in faculty workload have been identified, and faculty shortages result in increases in faculty workloads for those who are employed.10 Teaching is challenging but rewarding from professional and personal perspectives, as noted in the NLN’s Top 10 Reasons to Become a Nurse Educator.11 To find personal stories about the rewards of being a nurse educator, search the Internet for “Great Moments in Teaching Nursing.”

Nursing faculty members shape the knowledge and practice of new nurses on a grand scale. Many nurses remember the influence that nurse educators had on them by the way they practice nursing every day. As clinicians, we are responsible for our own practice and have control over the care we provide. Nurse educators have the opportunity to directly influence ways in which diverse generations of nurses work together to provide care.

Nurse educators in academic settings may work on 9 or 12-month contracts. Faculty salaries vary depending on a person’s title (e.g., assistant professor, associate professor), level of education, and the type

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Top 10 Reasons to Become a Nurse Educator11 10. You work in an intellectually stimulating environment.

9. You have autonomy and flexibility.

8. Your research creates knowledge and advances the field; your publications bring you prestige.

7. Your work has value to society.

6. You can teach anywhere in the world.

5. Using technology, you can teach from the beach or the slopes.

4. You encourage and educate eager minds, and you rejoice when your students surpass you.

3. You shape the future of healthcare.

2. You change lives.

And the No.1 reason to become a nurse educator: 1. You teach what you love.

of institution. Although the disparity between faculty salaries and those in clinical settings is cited as a barrier to entering academia, many nurse educators who work on 9-month contracts earn additional income by teaching during the summer or working on funded grant projects.

Nurse educators also have predictable and flexible hours that fit well with home and family responsibilities. In contrast to nurses in clinical settings, faculty members aren’t called on to work overtime and have regular time to learn, plan, and research. The rewards of a nursing academic career are many, and the future is bright for nurses who choose teaching as a career.

Traditionally, nursing students have been a homogenous group. Most were young women who entered nursing programs immediately after high school. In contrast, 21st-century nursing students are a diverse group.

There are more men in nursing today and more minority students, making knowing how to work with diverse students a crucial educator compe-

tency. In general, students are older than recent high school graduates and can be anywhere from their late 20s to their 50s and beyond. They are usually financially independent, bring work and life experiences to the academic setting and strive to balance their studies with job and family responsibilities. Many utilize tuition assistance programs from their employer.

Today’s educators know things have changed. One of the most significant changes in nursing education is the increase in online and distance learning programs. Faculty must be tech-savvy and know how to teach and evaluate students they don’t often see in the classroom. Another significant change is in the skills labs. Nurses have moved from using crude, plastic patient models to using high-fidelity human patient simulators. These lifelike simulators give students a realistic experience that mirrors what happens with real patients in the clinical setting. Human patient simulators allow students to recognize and respond to real-life situations. Instructors can

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continuing education build in scenarios for important bedside nursing care issues and introduce potential errors in care so students can learn the results of their actions in a controlled environment rather than in the hospital setting. No learning is more powerful than learning from your own mistakes.

What Students Want Today’s students expect coursework to be practical, relevant, and tailored to their needs. Often, classes are at satellite locations and scheduled one day a week or in the evening or on weekends to accommodate student work schedules. To meet students’ needs, nurse educators must be knowledgeable, creative and able to design educationally sound learning. They must know how to coach students, be mentors and apply evidence-based approaches to evaluating competencies. Many faculty members use new learning technology altering traditional classroombased education and make it possible for learning opportunities to occur in various ways (e.g., service learning, interactive video conferencing and standardizing didactic information across several sites). Today’s students are more tech-savvy and have 24/7 access to resources, such as the library and their instructors. Many students juggle family and work obligations with school work, often feeling overwhelmed and needing the support and flexibility of their educators.

Changes on the Horizon While much of nursing still occurs in hospitals, the profession is on the verge of a major transformation. In the past, nursing focused on taking care of dependent, ill people who were told, “We’ll take care of you… we know what’s best for you and you should do as we tell you.” Soon, many illnesses now treated in intensive hospital settings will be detected

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Example RN and Nurse Educator Competencies12,13 RN Competencies • Communication • Patient-centered care • Teamwork and collaboration • Evidence-based practice • System-based practice • Quality improvement • Safety • Informatics and technology • Leadership Educator Competencies • Facilitate learning and learner development and socialization • Use assessment and evaluation strategies • Participate in curriculum design and evaluation of program outcomes • Function as a change agent and leader • Pursue continuous quality improvement in the nurse educator role • Engage in scholarship • Function within the educational environment

and prevented in their early stages.

Nursing’s focus will be on including patients as partners in care and helping them make decisions about what’s best for them as individuals.

Now nurses are learning to tell their patients, “You know yourself best; tell me what’s most important to you” and “I want to teach you how to manage your health so you know what to do when I’m not here.” Major nursing responsibilities include counseling, teaching, and guiding people to achieve and maintain optimum health.

At the same time the “what” of nursing is changing, the “how” of nursing education is also changing.

Nurse educators are being asked to develop courses on bioterrorism, care for the elderly and vulnerable, genetics, health economics, health politics and policy, mass casualty response, palliative and end-of-life care and

patient-care management. These and other topics prepare 21st-century graduates to practice in a dynamic and unpredictable healthcare climate.

Students in nursing programs today enter an increasingly fast-paced, competitive, and business-oriented environment. Students need to learn how to provide care in multiple settings with diverse groups of patient populations. They must know how to set priorities, as today’s nurses know all too well that not every patient need can be met.

The NLN and other organizations, such as the Quality and Safety Education in Nursing Institute, stress that significant changes in nursing and nursing education are on the horizon. Educators need to have specific competencies to transform nursing education to maximize student potential and help each student develop competencies that promote profes-

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continuing education sional practice in a dynamic healthcare arena (see side bar).12,13 Many nurse educators today distinguish themselves by passing the NLN’s certified nurse educator exam, allowing them to put the credentials CNE after their name.14 As the need for leadership and research in nursing education is clear, there is also a need for more doctorally prepared educators (calling for more qualified educators to teach in doctoral programs as well).1, 15

Never Boring Today’s nurse educator will never be bored. The days of preparing lectures and standing in front of the classroom giving those lectures day in and day out are gone. Instead, nurse educators are working collaboratively with their students. From their first semester of school, students are taught how to be active participants in all learning. Because today’s schools and organizations realize the importance of creating learning cultures where everyone teaches and learns, and learning opportunities are considered an important part of each day in the classroom, clinical and simulated learning is often lively and full of shared experiences.

If you feel intimidated by the preparation educators must do to teach a course, you needn’t be. You’ll get help from fellow educators and also find you have many resources to help ease the time-consuming work of making course content come alive. For example, many publishers give their textbook users free, professionally developed PowerPoints and test banks. They also provide online tutorials, case scenarios and videos to facilitate and reinforce learning. There are many online resources, such as You Tube, Google, and Google Scholar, where faculty post PowerPoint presentations, lectures, activities, illustrations, clinical demonstrations and videos from experienced educators. Teaching and learning today is easier than it used to be and more vibrant and fun.

40 | OR TODAY | FEBRUARY 2020

Sneak Preview If you’re up to the challenge of an academic career, start by looking for ways to experience the joys and challenges of what today’s educators do. Seek out opportunities in your organization to precept or mentor new staff or nursing students and assess the rewards you gain. Volunteer to develop and teach in-service programs, so you can begin to experience the exciting work of reviewing nursing literature, evaluating directions for evidence-based practice and communicating new developments to your colleagues. Talk to nursing faculty members who bring students to your agency — ask them about what they find most satisfying about their work.

Contact experienced educators through social media (e.g., join nurse educator groups on LinkedIn to find an educator). Discussing the challenges related to being a new (or seasoned) educator is lively and informative. Many students use the virtual nurse educator community to get practical advice and to help find resources. It’s not unusual to read something like, “I’m thinking of becoming a nurse educator … any advice?”

After deciding a teaching career is for you, the next step is to locate a graduate program that fits your needs.

Fortunately, finding information about nursing education careers and graduate programs is easier than ever, thanks to the Internet. (See “Educational and Financial Resources” sidebar.) The AACN sponsors Career Center, an online resource that features nurse educator career profiles, a list of programs that prepare nursing faculty, financial aid information, open faculty positions and links to faculty development programs.

Federal and private funding are often available to help nurses who are enrolling in graduate nursing education.

Easing the Loan Load The Nurse Reinvestment Act includes a student loan repayment program for nurses who agree to serve as faculty

after graduation.16 In addition to developing an awareness of nurse educator careers and its rewards, the American Nurses Association and the AACN have been working to gain increased federal support for the Faculty Loan Repayment Program. This program, sponsored by the U.S. Department of Health and Human Services, offers up to 100% of a $40,000 loan re-payment for nurses who serve as full or part-time faculty members.17 Nurses for a Healthier Tomorrow, a coalition of nursing and healthcare organizations, is seeking ways to inspire a new generation of nurse educators.18 Its campaign features stories of nurse educators that highlight the rewards of teaching and a nurse educator career profile, accessible on the Nurses for a Healthier Tomorrow website.

Without nursing faculty, there won’t be enough nurses to meet the country’s needs. Nursing needs to attract an increasing number of men and women who want to work with students as their primary “clients” and who want to pursue teaching as their primary role.

Future nursing faculty, standing on the shoulders of past and present nurse educators, must be excited about designing and presenting effective curricula to students and dedicated to developing evidence-based teaching strategies for nursing’s future generations.

Now Is the Time If you like helping others develop to their full potential and would like a change, there is no better time than now to start a path toward being an educator. Simply put: We need you. Students need you to guide them toward reaching their goal of gaining the skills needed to give excellent patient-centered care.

They need your help to learn how to collaborate with various healthcare professionals and take their place as leaders (both at the bedside and within healthcare organizations). Educators need you to help alleviate the stress of

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continuing education Educational and Financial Resources

2. American Association of Colleges of Nursing Task Force on Future Faculty. Faculty shortages in baccalaureate and graduate nursing pro-

Master’s and doctoral degree programs: • All Nursing Schools • Best Nursing Degree • Peterson’s: Find the Right School for You

grams: scope of the problem and strategies for

Scholarships, fellowships, loans and loan repayment programs: • AACN • Discover Nursing • Nurses for a Healthier Tomorrow

Published June 2005. Accessed May 10, 2019.

expanding the supply. American Association of Colleges of Nursing Web site. https://www. aacnnursing.org/News-Information/PositionStatements-White-Papers/Faculty-Shortages.

3. Nursing faculty shortage. American Association of Colleges of Nursing Web site. https:// www.aacnnursing.org/Portals/42/News/Factsheets/Faculty-Shortage-Factsheet-2017.pdf.

Updated April 27, 2017. Accessed May 10, 2019.

their workload and allow them to be the teachers they know they can be. Patients need you to guide students and keep them safe; ultimately, they need you to ensure that when they call for a nurse, there’s one there to answer.

If you’re like most nurses who are thinking about going into education, you probably have excellent clinical skills and work experience that will be invaluable to you, your peers and students.

Most likely, you can recall bright teachers who had “been there, done that” with diverse patients and situations. You remember how much it helped to have teachers who could mentor and teach from experience.

You don’t have to do it all at once.

Consider your work and personal responsibilities and be realistic about your time. If you’re nervous, start by taking one course that you know is required and transferable, so you can see how it goes. Increasingly, today’s programs are willing to transfer credits. For example, having a course in statistics is often required and transferable. Not only will you get “the feel” of being back in school, you can get this course (one that can be quite rigorous) out of the way, while only taking one subject.

There’s no doubt that nursing education is challenging, but there are countless rewards. As the saying goes, “I didn’t say it would be easy. I said it

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would be worth it.” Be a nurse and you touch many lives. Teach a nurse, and the number of lives you touch grows exponentially. Why not join the ranks of nurses who can say, “I teach. What’s your superpower?”19

4. To err is human: building a safer health

EDITOR’S NOTE: Maureen Habel, MA, RN, the original author of this educational activity and Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, have not had an opportunity to influence the content of this version.

5. Subirana M, Long A, Greenhalgh J, Firth

Relias LLC guarantees that this educational activity is free from bias.

6. Shanafelt T, Sinsky C, Swensen S. Prevent-

system. http://www.nationalacademies.org/ hmd/~/media/Files/Report%20Files/1999/ToErr-is-Human/To%20Err%20is%20Human%20 1999%20%20report%20brief.pdf. Published November 1999. Accessed May 10, 2019.

J. A realist logic model of the links between nurse staffing and the outcomes of nursing. J Res Nurs. 2014;19(1):8-23. https://doi. org/10.1177/1744987113481782.

able deaths in American hospitals. NEJM Catalyst Web site. https://catalyst.nejm.org/

Sheila J. Leis, MS, RN-BC, is a full time nursing faculty member at Indiana Wesleyan University. Her professional experience includes more than 15 years as a professional development specialist in a centralized nursing education department at an 800+ bed Magnet hospital. She has been certified in Medical-Surgical nursing for more than 25 years.

References

medical-errors-preventable-deaths/. Published January 23, 2017. Accessed May 10, 2019.

7. Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):18241830. doi:10.1016/S0140-6736(13)62631-8.

8. The future of nursing focus on education.

National Academies of Sciences, Engineering,

1. Academic progression in nursing education:

and Medicine Web site. https://iom.nation-

a living document from the National League

alacademies.org/Reports/2010/The-Future-of-

for Nursing. National League for Nursing (NLN)

Nursing-Leading-Change-Advancing-Health/

Web site. http://www.nln.org/docs/default-

Report-Brief-Education.aspx. Published Janu-

source/about/nln-vision-series-(position-state-

ary 26, 2011. Accessed May 10, 2019.

ments)/nlnvision_1.pdf?sfvrsn=4. Published

9. Nursing programs 2013-2014. National

January 2011. Accessed May 10, 2019.

League for Nursing web site. http://www.nln. org/newsroom/nursing-education-statistics/

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continuing education nursing-programs. Accessed May 10, 2019.

org/professional-development-programs/

Published August 20, 2002. Accessed May 10,

competencies-for-nursing-education/nurse-

2019.

10. Bittner NP, Bechtel CF. Identifying and

educator-core-competency. Accessed May 10,

describing nurse faculty workload issues: a

2019.

17. Faculty loan repayment. Health Resources

looming faculty shortage. Nurs Educ Per-

and Services Administration Web site. https://

spect. 2017;38(4):171-176. doi: 10.1097/01.

14. Certification for nurse educators. National

bhw.hrsa.gov/loansscholarships/flrp Updated

NEP.0000000000000178.

League for Nursing Web site http://www.nln.

August 2018. Accessed May 10, 2019.

org/professional-development-programs/ 11. Career as a nurse educator. National League

Certification-for-Nurse-Educators. Accessed

18. Nurse educator recruitment campaign.

for Nursing Web site. http://www.nln.org/

May 10, 2019.

Nurses for a Healthier Tomorrow Web site.

about/career-center/career-as-a-nurse-educator. Accessed May 10, 2019.

http://www.nursesource.org/campaign_news.

15. Nardi DA, Gyurko CC. The global nurs-

html. Accessed May 10, 2019.

ing faculty shortage: status and solutions for 12. Competencies. Quality and Safety Educa-

change. J Nurs Scholarsh. 2013;45(3):317-326.

19. “I teach – what’s your superpower?” Nation-

tion for Nurses (QSEN) Institute Web site.

doi:10.1111/jnu.12030.

al Association for Music Education Web site.

http://qsen.org/competencies. Accessed May

https://nafme.org/teach-whats-superpower/.

10, 2019.

16. Spigel S. Nurse Reinvestment Act. State of

13. Nurse educator core competency. National

Connecticut General Assembly Web site. http://

League for Nursing Web site. http://www.nln.

www.cga.ct.gov/2002/rpt/2002-R-0712.htm.

Published April 15, 2017. Accessed May 10, 2019.

Clinical Vignette Rebecca Bream, BSN, RN, has been a nurse for five years and is now considering a career as a nurse educator. What information should Rebecca have as she considers this career choice?

1. Nurse educators must have:

a. High practice standards b. Excellent communication skills c. An interest in helping students grow and develop d. All of the above 2. What is a possible disadvantage of an academic career?

a. The next generation is really difficult to deal with. b. It’s not easy to find a common commitment to nursing. c. The number of hours needed to maintain clinical expertise can be formidable. d. Nurse educators cannot maintain a predictable and flexible work schedule.

3. Which experience can help Rebecca make an informed choice about whether a career in academia is a good fit for her?

a. Volunteering to develop and teach an in-service program b. Becoming a member of the nursing practice committee c. Participating in quality improvement activities d. Spending more time in the medical library 4. To be promoted to associate or full professor, Rebecca should know that most institutions require full-time faculty to have:

a. A master’s degree b. A doctoral degree c. Nursing specialty certification d. Clinical nurse leader certification

Clinical VignettE ANSWERS 1. Answer D, All of these characteristics are requirements for nurse educators, along with such attributes as a passion for nursing, a commitment to lifelong learning, creativity, flexibility and critical thinking skills. 2. Answer C, One study showed that two-thirds of faculty underestimated the time needed outside of work to maintain clinical expertise and keep up with developments in nursing. 3. Answer A, Developing and teaching an in-service program will help Rebecca get the feel of what it’s like to be in a teaching role. Although laudable, all the other activities mentioned are unrelated to helping a person determine her or his match with a teaching career. 4. Answer B, Accrediting agencies, such as the National League for Nursing and the American Association of Colleges of Nursing, require a doctoral degree for full-time faculty positions.

42 | OR TODAY | FEBRUARY 2020

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CE414

How to Earn Continuing Education Credit 1. Read the Continuing Education article.

2. Go online to ce.nurse.com to take the test for $12.

If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.

DENVER, CO

Deadline Courses must be completed by 9/12/2022 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.

5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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VISIT ORTODAYLIVE.COM FOR THE FULL EDUCATIONAL LINE-UP

OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.

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Questions

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Nurse.com You can take this test online or select from the list of courses available.

Prices subject to change.

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

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43

The OR of the Future

By Don Sadler

T

rying to predict the future can be dangerous, especially when it comes to technology. There’s a long list of technology predictions that have failed to materialize, such as flying cars, nuclear-powered vacuum cleaners and mail delivered by rockets, to name a few.

However, recent advances in medical technology make it a little bit easier to start envisioning what the OR of the future might look like.

These include advances in virtual reality (VR), augmented reality (AR), artificial intelligence (AI), machine learning (ML) and robotic assisted surgery devices (RASDs).

A Decade of Advances “I think we’re going to see more technological advances in the OR over

44 | OR TODAY | FEBRUARY 2020

the next decade than we have seen in the last 100 years,” says David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC. “Virtual reality and robotic surgery tools used for diagnosing disease in surgery or at the bedside will become part of our everyday lives.”

Taylor points to the mapping of the human genome as an example of the power of technology in health care. “This was completed in 2001 at a cost of nearly $3 billion. Today it could be done for as little as $1,000 and by 2022 it might be cheaper than a lab test,” he says.

Reducing hospital acquired infections (HAIs) is one of the many benefits of adopting new technology in

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Surgeon Rafael Grossman, MD, FACS, says that new technologies like Google Glass will enable surgeons to perform minimally invasive procedures in ways once only dreamed about.

the OR, Taylor adds.

“CDC statistics indicate that one out of every 25 surgical patients, or 300,000 patients a year, will contract an infection,” he says. “Technology can have a tremendous impact in reducing this number.”

According to Bejoy Daniel, senior industry analyst, transformational health with Frost & Sullivan, operating rooms are transforming into “technologypowered, infection-free, sleek surgical environments. The new-age OR will be able to utilize intelligent and efficient delivery options to improve the precision and predictability of the services offered.”

A report prepared by Frost & Sullivan, “Analysis of the US and EU5 Hospital Operating Room (OR) Products and Solutions Market, Forecast to 2022,” predicts that by 2022, between 35 percent and 45 percent of ORs around the world will have transitioned or be in the process of transitioning to become integrated ORs.

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In an integrated OR, all of the technology and equipment are connected. “This includes, but isn’t limited to, patient information systems, medical records, audio, video, lighting and medical equipment,” explains Taylor.

“An integrated OR gives clinicians the ability to enable and control all

management, surgical workplaces, for Getinge.

“A hybrid OR is a combination of a surgical (sterile) environment with one or more imaging modalities,” Schneider explains.

“It goes beyond medical boundaries by combining a state-of the-art OR with an imaging system, such as

“ It goes beyond medical boundaries by combining a state-of the-art OR with an imaging system, such as angiography systems, CT scanners or MRI scanners.” – Thomas Schneider

functions of these devices from a single location using a touch screen or even voice activation,” Taylor adds.

Hybrid ORs take integrated ORs a step further, says Thomas Schneider, vice president of global product

angiography systems, CT scanners or MRI scanners,” Schneider adds.

“Combining more than one imaging system with an OR turns the hybrid OR into a cutting-edge multi-modality hybrid suite.”

FEBRUARY 2020 | OR TODAY |

45

Trauma patient outcomes improve significantly in the hybrid OR, notes Schneider, since patient transport between departments and medical teams is reduced. Since the patient remains in the sterile OR, the risk of health care acquired infections is reduced.

“In addition, hybrid ORs allow for closer collaboration among specialists throughout the treatment chain,” Schneider adds, “especially between radiologists and surgeons.”

Robotic Adoption is Widespread Many of the technological advances in the OR are being driven by the widespread adoption of RASDs, notes Daniel.

“RASDs have aided in the significant reduction of surgery-related complication rates from between 36 percent and 38 percent to between 12 percent and 15 percent,” he says.

Taylor adds that sales of robotic equipment are expected to nearly double in 2020 to $6.4 billion. “Robotics and VR will just become part of

46 | OR TODAY | FEBRUARY 2020

a clinician’s toolbox,” he says.

“Robotics are going to explode and be very different from what we’ve seen with current RASDs,” says Rafael Grossman, MD, FACS, a general and trauma surgeon who was one of the first surgeons to use Google Glass during surgery. “We will be able to

“These include not only the substantial initial investment required, but also the high ongoing operational expenses involved,” he says.

“However, we are convinced that the adoption pace of robotic-assisted surgery will accelerate significantly within the next few years,” says Schneider. “We have

“ Pilots learn how to fly aircraft and fire weapons using flight simulators before they do it for real. In the same way, new surgeons can learn techniques virtually before they operate on patients. The technology is so realistic that it doesn’t feel much different when they perform surgeries for real the first time.” – William K. Atkinson

perform minimally invasive surgeries in ways we’ve only dreamed about so far.”

Schneider acknowledges that while robotics is generally considered to be the technology with the greatest potential to change how surgery is done, key challenges remain.

seen many new RASD launches that will most likely take away significant market share from Intuitive Surgical’s da Vinci system, which currently holds almost a monopoly in minimally invasive robotic surgery.”

In addition, emerging technologies such as AI will take robotic surgery to the WWW.ORTODAY.COM

Hybrid operating rooms take integrated ORs a step further by combining a surgical (sterile) environment with one or more imaging modalities.

next level. “AI will lead to more automation, allowing us to perform robotic surgery with a smaller workforce,” says Schneider.

As for virtual reality, Grossman believes one of the most important uses of VR and AR in the OR is to train new surgeons. “Students can watch me perform a surgery in an adjacent room, instead of standing behind my back, and get the same perspective on the surgery that I have,” he says.

William K. Atkinson, Ph.D., MPH, MPA, FACHE, FACPE, a health care consultant and strategist, compares the use of VR and AR in training new surgeons to how the military uses these technologies in its training.

“For example, pilots learn how to fly aircraft and fire weapons using flight simulators before they do it for real,” says Atkinson. “In the same way, new surgeons can learn techniques virtually before they operate on patients. The technology is so realistic that it doesn’t feel much different when they perform surgeries for real the first time.”

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The Role of Machine Learning and AI

“ During surgery, AI can continuously analyze and combine information from surgical images recorded before and during surgery, suggesting different paths to the surgeon.” – Thomas Schneider

According to Schneider, machine learning and artificial intelligence will have a huge role in the OR of the future.

“The automation of logistical processes that ML and AI allow ensures that the right medical device is available at the right time and in the right place,” Schneider says.

“This automation also confirms that the right clinical decisions will occur in a highly stressful environment.”

“With ML and AI as decision support, the IT system can analyze millions of prior outcomes based on the current situation and suggest the most desired process and guidelines to the OR manager,” Schneider adds. “This will significantly reduce surgery delays and cancellations.”

AI can also eliminate cumbersome tasks during surgery, such as diming the lights when going to endoscopic surgery or providing the right table

position at specific points during surgery.

“During surgery, AI can continuously analyze and combine information from surgical images recorded before and during surgery, suggesting different paths to the surgeon,” Schneider explains. “At the same time, the continuous analysis of the images taken during surgery will provide suggestions as to the next steps of the procedure.”

The Sky’s the Limit Grossman believes that “the sky is the limit” when it comes to the OR of the future.

“The possibilities are only limited by our creativity and imagination,” he says.

FEBRUARY 2020 | OR TODAY |

47

SPOTLIGHT ON:

LORI WOOD

BY MATT SKOUFALOS

Among the various responsibilities she’s enjoyed in a 35-year nursing career, Lori Wood has held directcare, education and management positions. But no matter what assignment she’s undertaken, “My heart is with the critical care patients,” she said.

Wood entered the field in 1983, having completed a two-year nursing program at Valencia Community College. She started work in Florida, and moved to Georgia not long after, lured by incentives that would support her pursuit of a bachelor’s degree.

“But I came to love critical care patients, and I didn’t go back and get my bachelor’s degree until I was 50 years old,” Wood said. “My family lives in Florida, and that was my biggest motive in getting my bachelor’s degree: future employment.”

At Piedmont Newnan Hospital in Newnan, Georgia, Wood started out in the intensive care unit before eventually transferring to the recovery room to recapture

48 | OR TODAY | FEBRUARY 2020

a few more of her weekend hours. But it was in the ICU, in December 2018, that she met 27-year-old Jonathan Pinkard.

Wood would come to learn that Pinkard had been in and out of area hospitals with chronic cardiac care needs for four months. He had been diagnosed with heart failure, mostly due to the complications related to managing his intravenous medication after discharge. Pinkard, who is on the autism spectrum, struggled with the difficulty of the orders.

“Each time the home health nurses came to check on him, his central line would be out, his medication would not be infusing, his blood pressure would be low, or his blood sugar would be low,” Wood said. “He just could not maintain or keep up his medications.”

Complicating matters for Pinkard, whenever he was discharged from a hospital, staff didn’t know where to take him.

He had no family in the area. With only the help of his local church community, Pinkard ended up in shelters and hotels, and was inevitably readmitted soon after

because he wasn’t able to follow the postdischarge plan himself.

“I had been trying, going from hospital to hospital, to a men’s shelter, to a hotel, with all that medication that I had,” Pinkard said. “Some information really overwhelmed me; they had to break it down.”

“I thought I was going to be on thin ice the time this all happened,” he said.

Eventually, Pinkard, who had been a candidate for heart transplant surgery, was removed from a list of prospective patients because he didn’t have anyone to help him recover after the procedure.

Reading this information in his chart, Wood was struck by his circumstances.

She thought on it, talked with her family and eventually decided to become Pinkard’s temporary legal guardian so that she could help shepherd him through the process.

“After finding out about his diagnosis and current living situation, I felt sorry for him,” she said. “I couldn’t fathom the kind of position he was in.”

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Nurse Lori Wood hugs Jonathan Pinkard at the Piedmont Award ceremony where she was recognized for her achievements.

“This lady right here is a miracle. That’s all I can say about it. It’s just amazing. She’s a lifesaver.”

“My kids are basically raised,” Wood said. “I had space in my house. I am a nurse. I felt like I was in a position to help him out.”

Pinkard’s friend from church floated the idea to him, and got him transferred to Wood’s floor. The two began to develop a rapport to allow Pinkard to see if he was comfortable with the idea of Wood caring for him. From there, their relationship blossomed, and when it was time for Pinkard to undergo his surgery, Wood was with him every step of the way – so much so, that he nicknamed her “Mama” for the care with which she’s guided his five-month recovery.

“This lady right here is a miracle,” Pinkard said. “That’s all I can say about it. It’s just amazing. She’s a lifesaver.”

Born and raised just south of Columbus, Georgia, Pinkard came to the Newnan area in the course of working for the Georgia Vocational Rehabilitation Agency, where he is about to enter his fifth year. Thanks to Wood’s intercession, he was expected to return to work in January 2020.

“My family has been no help at all, so it’s been between ‘Mama’ and my church family that’s been helping me with all this,” Pinkard said. “I really enjoy spending time with [Wood]. Really, it’s been a joy being with her.”

In the time they’ve shared together, the two have formed a tight bond over the little things. Early on in the process, Wood came home from the store to find Pinkard watching Family Feud, “and I thought, ‘This’ll be okay,’ ” she remembered. Both share a love of college football – although Pinkard is an Alabama fan, and Wood follows rival Georgia – and Pinkard’s even come around on The Hallmark Channel, thanks to Wood’s enjoyment of it.

“It was very easy to be around him because we had lots of things to talk about,” she said. “He’s very sweet. He’s very helpful around the house. He’s got a very giving heart.”

Pinkard hopes that people will enjoy their story not only as a positive tale of how he was helped by a generous stranger in a moment of need, but also as a jumping-off point for discussions about self-care and cardiac health.

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“We need a whole lot of positive influence in today’s society,” he said. “It takes a village to work together. In 2020, I want to tell people my story, and I want to give them some tips on how to take care of their heart, and maintain their heart so they don’t have heart failure like I did. You can be healthy for a long period of time.”

Wood has drawn significant notoriety for her decision to care for Pinkard, including a commendation from her employer. She has no regrets in having done so, and she’s pleased to see him make a full recovery. Yet she said there’s a certain distance she observes from seeing the tale told in the third person.

“I don’t really identify that it’s me up there,” she said. “I’m not different from anybody else, I just felt led to help.”

Wood does understand why the story has such broad appeal.

“We’ve crossed over black-and-white boundaries, handicap boundaries, male-and-female boundaries, age boundaries, that a lot of people wouldn’t be able to do,” she said.

But to her, there’s a simpler explanation as to why it all worked out.

“If God put something in your heart, you need to follow Him and trust in the results,” she said.

FEBRUARY 2020 | OR TODAY |

49

OUT OF THE OR fitness

How Often Do You Recover From Exercise?

By Miguel J. Ortiz hat’s the first thing that

W comes to mind when you think of exercise recovery? This is an important question to ask yourself as your first answer usually leads to what you may need most. If not, it can help you understand what your body may need. So, take your time introducing recovery work into your regiment as it will tremendously help any goal.

From weight loss to strength training, recovery work is essential.

There are a lot of different ways you can introduce recovery into your daily routine. From general massage treatment to sleep or foam rolling and stretching classes, we understand there are plenty of recovery techniques we can use but where do we start? Here are my top three tips on how to introduce recovery work into your exercise routine.

First, do warm ups and cool downs.

This is by far the most underutilized part of a workout, especially for adults.

When you’re on any sports team, coaches will always give the players a warm up consisting of light stretching, calisthenics, etc. It’s a start that is done at every practice and game. So, why do we stop when we get older? The main reason is because people will say

50 | OR TODAY | FEBRUARY 2020

they don’t have enough time. But have you considered efficiency? When you warm up the body with stretching and light movements it can prevent injury, help increase fat burning during the workout, increase muscular contractions and reduce stiffness. I recommend starting with at least 5-10 minutes of light stretching before exercise and 5-10 minutes after for a cool down. You may think it’s taking away from the workout, but you will feel stronger and more efficient during your exercise routine.

Second, for every hour of work spend half the time on recovery. Yes this is outside and not included in the warm up and cool down, as sometimes you may need more to fully recover.

This has been a huge game changer for people finding themselves still sore after workouts. If you worked out for 40 minutes (don’t include the warm up and cool down period) then stretch for an additional 20 minutes when you get home. To prioritize this, make sure to concentrate on muscle groups that are really giving you a hard time. If you have been really sore in your hamstrings, take some time to stretch/massage those areas. If you are having trouble doing it yourself, this is where getting a massage or hiring a professional can help.

Third, lengthen before you strengthen. Regardless of the muscle groups, your training always ensures you can

lengthen the muscle to its full capacity or as best as possible before you begin to strengthen it. This concept has helped me tremendously when it comes to muscular efficiency. If a muscle is already tight then doing strength training will only tighten it up even more.

This can lead to improper movement patterns, poor exercise form, increased soreness, lack of oxygen and blood flow to certain areas and even start to cause joint pain. When a muscle can be used for its full potential you’ll notice it can also help with muscular growth, general increase of strength, prevent joint pain, help with proper form and help neuromuscular efficiency.

These three tips will help you increase your recovery, relax those sore muscles and crush future workouts.

The faster you can recover, the faster you can get back to moving. Recovery is essential to your progress and should not be taken for granted. Have fun with your workouts and always remember to stretch when you have some extra time, it will do your body good.

Miguel J. Ortiz is a personal trainer in Atlanta, Georgia. He is a member of the National Personal Trainer Institute and a Certified Nutritional Consultant with more than a decade of professional experience. He can be found on Instagram at @migueljortiz.

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OUT OF THE OR health

Can Eye Exam Reveal Alzheimer’s Risk?

By Kelly Bilodeau ooking for clues about the health of your brain? You might want to pay a visit to your eye doctor. Research increasingly links common eye conditions – glaucoma, age-related macular degeneration and diabetic retinopathy – to risk for Alzheimer’s and other forms of dementia.

L

What’s interesting about the study results, says Albert Hofman, M.D., Ph.D., chair of epidemiology at the Harvard T.H. Chan School of Public Health, is that cataracts, another common agerelated eye condition, had no apparent connection to dementia risk. This gives scientists an important clue about the cause of dementia and Alzheimer’s disease, he says.

“My view, and one of the possible explanations that the authors present, is that these three eye diseases and Alzheimer’s and dementia have a joined etiology” – that is, a common causative factor. “All are linked to cardiovascular disease,” says Hofman.

How are eye conditions linked with cardiovascular disease?

Glaucoma is a condition marked by increased pressure in the eye that can lead to vision loss. It has been linked to high blood pressure, diabetes and poor blood circulation.

Age-related macular degeneration involves breakdown of the macula, the part of the retina responsible for sharp central vision. It has also been linked to heart disease.

52 | OR TODAY | FEBRUARY 2020

Diabetic retinopathy occurs in people with diabetes when high levels of blood sugar damage blood vessels in the retina. There are strong links between diabetes and cardiovascular problems.

Cataracts – clouding of the lenses of the eyes – are more likely to develop as people age. However, they don’t appear to increase the risk of cardiovascular disease, Alzheimer’s disease or other types of dementia.

Eyes on Alzheimer’s The "Adult Changes in Thought" study, which began in 1994, included 5,400 dementia-free adults. Participants were followed until they decided to leave the study, died or developed dementia.

Research published in Alzheimer’s & Dementia in 2019 analyzed data drawn from the "Adult Changes in Thought" study. This time, the researchers focused on 3,800 of those participants, both with and without eye disease at the start of the study. Some 792 of them went on to develop dementia.

Study authors found that people with age-related macular degeneration were 20% more likely to develop dementia compared with people who did not have the eye disease. People with diabetic retinopathy were 44% more likely to develop dementia than those without.

People in the study with a recent glaucoma diagnosis – but not participants with established disease – had a 44% higher rate of dementia. It’s not clear why there was a difference between people with new or existing disease.

Can eye exams be used to predict – and better still, prevent – Alzheimer’s?

While these findings show a link between three eye diseases and brain risks, one important question remains: what does this information mean for you? Can an eye exam tell you if you are destined to develop dementia in the future? More importantly, can it help you prevent it?

Someday the answer to those questions may be yes. For now, however, eye exams are valuable in detecting eye disease early so it can be treated – but they can’t yet yield much predictive information about your brain’s future health, says Hofman.

But there are lessons we can take from the study when it comes to avoiding Alzheimer’s disease. Today the only known way to prevent Alzheimer’s and other forms of dementia is to prevent cardiovascular disease.

“Doing all the things that you would do to prevent heart attack and stroke are likely beneficial to prevent Alzheimer’s disease,” says Hofman. This means treating high blood pressure and cholesterol, eating a healthy diet, getting enough sleep and maintaining a regular exercise program.

If you have a family history of cardiovascular disease or a history of cardiovascular-related eye diseases, you may want to be even more aggressive in controlling your personal risk factors, says Hofman.

Kelly Bilodeau is executive editor at Harvard Women’s Health Watch.

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OUT OF THE OR EQ factor

The Value of Self-Awareness By daniel bobinski or several millennia, people have realized the value of self-awareness. In fact, the Greek phrase, “gnothi sauton,” (know thyself) was a common saying as far back as at least 550 BC. For the last 40 years or so, the phrase, “know thyself” has been the foundation for all reputable leadership training. And, for the last 25 years, self-awareness has been the starting point for learning emotional intelligence.

F

Self-awareness can be defined many ways, and at the risk of sounding philosophical, it has many layers, too.

In his best-selling book “Emotional Intelligence,” Daniel Goleman defines self-awareness as “knowing one’s internal states, preference, resources and intuitions.” My definition is a little simpler, but covers similar territory: “Perceive and assess our own emotions, desires and tendencies.”

The way that I teach it, a good starting point for knowing yourself includes understanding your behavioral style, which includes both your strengths and weaknesses. This is not always easy! I remember when my first coach had me take a DISC Assessment almost 30 years ago.

Among other things, it pointed out my strengths and weaknesses. On

54 | OR TODAY | FEBRUARY 2020

the outside I tried to look composed, but inside I was devastated! Right there on the paper it was saying I had weaknesses! I didn’t want weaknesses.

I wanted only strengths.

As it turns out, simply knowing that you have strengths and weaknesses is just one level of self-awareness. It’s coming to grips with those weaknesses that takes you to a whole different level. By doing so, you develop not just self-awareness, you also gain self-acceptance by realizing that you are capable in some areas, and not as capable in others.

I’m being transparent with my story because I want you to understand how it works. Part of the reason that self awareness is the cornerstone of the EQ model is that you develop some grace and mercy toward yourself. Then, when you own that – when you come to grips with accepting your own weaknesses – then you have a foundation for being able to display empathy toward others. And empathy is vital when practicing emotional intelligence.

I firmly believe that it’s hard to understand others in any real depth if you don’t have a gracious understanding and acceptance of your own strengths and weaknesses.

After behavioral style, another area we need to be aware of is our cogni-

tive style – the strengths and weaknesses in how we notice and process information plus how we make decisions.

It’s also valuable to understand our personal motivations. Some are innate and some are learned, but motivations drive our behavior, and it’s good to be consciously aware of what drives us.

Remember, we can’t stop at just knowing these things about ourselves.

The real value of self-awareness comes in accepting ourselves as we’ve been designed.

Bottom line, self-awareness is the cornerstone of emotional intelligence.

When you understand the strengths and weaknesses of your behavioral, cognitive, and motivational styles, then you can become a better selfmanager. But that’s a topic for a different column.

Daniel Bobinski, M.Ed. teaches teams and individuals how to use Emotional Intelligence, and his videos and blogs on that topic appear regularly at www.eqfactor.net. He’s also a best-selling author and a popular speaker at conferences and retreats.

Reach him at daniel@eqfactor.net.

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REASONS to attend

CONTINUING EDUCATION Take a break to sharpen your skills.

Learn valuable best practices, look at proven case studies and countless other new ideas.

3

2

MEET FACE-TO-FACE WITH PEERS There’s nothing like being in a room of like-minded colleagues.

LOCATION Take a break from the summer heat in the refreshing Rocky Mountains!

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OUT OF THE OR nutrition

Let’s Talk About Cancer, Food and Exercise

By Charlyn Fargo often have clients come in asking what they should eat to prevent cancer. What’s important to prevent nearly any disease is a healthy diet. That translates to lots of fruits and vegetables, whole grains, lean meat and low-fat dairy. I’m not a proponent of eliminating any food group from your meals.

I

The American Institute for Cancer Research offers a few insights into common myths surrounding cancer.

Here are a few of the most popular: Myth: Cancer is caused by inherited genes, so there’s nothing you can do about it.

Actually, 40% of cancer cases are preventable by eating a healthy diet, maintaining a healthy weight, being more active and not smoking.

Only 5-10% of cancers are caused by genetic syndromes, according to the institute.

Myth: Soy can increase your risk for cancer.

Research shows that soy foods in moderation are safe for those diagnosed with cancer and those without cancer. Soy foods contain fiber, nutrients and phytochemicals that can help prevent cancer.

Myth: There is not enough evidence to link stress and cancer risk.

56 | OR TODAY | FEBRUARY 2020

Actually, this one isn’t a myth; the link between stress and cancer remains unproven.

Myth: Artificial sweeteners are linked to increased cancer risk.

The truth is there is no strong evidence that links sweeteners, such as saccharin and aspartame, to cancer.

Myth: Coffee is cancer-fighting.

Good news for coffee drinkers: Strong evidence shows that coffee actually reduces the risk for endometrial and liver cancers.

Myth: Eating organic foods versus conventionally grown produce offers you protection against cancer.

The most important thing is to eat fruits and vegetables – more than you do now. There is no strong evidence to support the idea that organic foods offer additional protection against cancer over conventionally grown foods.

It’s Never Too Late To Exercise Here’s proof that it’s never too late to start that walk or trip to the gym: In a new study, the American Institute for Cancer Research found that exercise helped prevent and slow breast tumor growth – even among women who had been diagnosed and were waiting for surgery.

Granted, this was a small study – only 49 women – but it convinced me that there is power in that morning

walk. I come from a genetic pool of breast cancer; my mother, a survivor, had it twice. Her mother died too young to know. So, I’m attentive to all things related to breast cancer.

This study, published in the journal Clinical Cancer Research, found that exercise had a direct biological effect on breast cancer tumors. Researchers also found that exercise protects against postmenopausal breast cancer, colon cancer and endometrial cancer.

As the study reports, “Women in the exercise group did both strength training and moderate-level aerobic activity – like walking – at two weekly trainer-led sessions and unsupervised at home. The control group focused on relaxation and visualization techniques.” The exercise group increased their activity by an average of 203 minutes a week, compared with 23 minutes in the control group. After 29 days, exercise appeared to impact tumor gene expression, especially in pathways involved in inflammation and immune regulation.

Charlyn Fargo is a registered dietitian at Hy-Vee in Springfield, Illinois, and the media representative for the Illinois Academy of Nutrition and Dietetics. For comments or questions, contact her at charfarg@aol.com or follow her on Twitter @NutritionRD. WWW.ORTODAY.COM

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OUT OF THE OR recipe

Tarte Tatin Serves 6 to 8 • 1 sheet all-butter puff pastry, about 8 ounces (store-bought is fine)

Recipe

• 1/2 cup unsalted butter

the

58 | OR TODAY | FEBRUARY 2020

• 1/2 cup sugar • 8 to 10 Macintosh apples, peeled, cored and cut in half • Whipped cream, creme fraiche or French vanilla ice cream, to accompany 1. Defrost the puff pastry. Once defrosted, sprinkle a surface with flour and roll out the dough into an 11-inch round so that it will fit over the skillet. Set aside.

2. Meanwhile, preheat the oven to 400 F. In a non-stick ovenproof 10-inch skillet, melt the butter on medium heat. Add the sugar, and stir until combined, about 2 minutes to make a caramel sauce. It may look a little lumpy.

3. Place the apple halves, standing on their side, in concentric circles around the edge of the pan. They should be close together so that they support one another, standing upright.

4. Place an apple half in the center, using enough apples so that the apples fit very snugly in the pan. Cook the apples and caramel sauce, adjusting the heat to low simmer, for about 12 minutes or until the caramel is dark brown and apples are slightly tender.

5. Place the skillet in the oven for about 5 minutes to cook the apples. Remove with oven mitts, and place on a trivet. Carefully place the pastry dough over the top, using a small knife to tuck the excess pastry into the rim of the skillet. Increase the heat to 450 F, and bake another 20 minutes or until the pastry is crisp and brown.

6. Remove the skillet from the oven with two oven mitts. Let it rest 5 minutes. Run a knife around the edge of the pastry and the skillet to make sure it will invert easily. Invert the tart onto a 12-inch platter. Serve warm or room temperature with whipped cream, creme fraiche or French vanilla ice cream.

BY Diane Rossen Worthington Diane is an authority on new American cooking.

She is the author of 18 cookbooks, including “Seriously Simple Parties,” and a James Beard Award-winning radio show host. You can contact her at www.seriouslysimple.com.

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OUT OF THE OR

Sweeten Up Your Valentine’s Day Meal

recipe

he first time I tasted this classic, upside-down apple tart, glistening with dark brown liquid caramel and sitting on a crispy puff pastry crust, I was smitten. It didn’t hurt that I had my first slice in a famous Paris pastry shop.

Tarte Tatin is my pick for sweetening up your Valentine’s Day meal. The story goes that two sisters who ran Hotel Tatin were making traditional apple tarts, but one of the sisters dropped a pie on the floor, turned it over and served it as Tarte Tatin. It has other folklore stories attached to its history, but I love the idea of rescuing a dessert into a new variation that has received international acclaim through the years.

I have been making French tarts since I graduated from Le Cordon Bleu decades ago. I always thought Tarte Tatin would be too complicated to make at home. It didn’t seem Seriously Simple to me. How could something this fantastic be easy to make?

Turns out that it is easy to prepare with only a few ingredients, as long as you don’t mind peeling and coring some apples.

I recently decided to retest my old recipe to see if home cooks could master the technique and the recipe with good results. It took me three tries to get it right, and I learned a lot along the way.

First of all, make sure to use either a cast-iron skillet or a nonstick skillet for ease in reversing the tart. Second, I tried different store-bought frozen puff pastries. I recommend an all-butter variety. You’ll need to completely defrost it before rolling it out for best results.

Another challenge: the apples. I tried Pippin apples, and my dessert went from Tarte Tatin to Apple Sauce Tart! The apples were too soft when I cooked them. I tried Golden Delicious and still found them to be too soft after baking. Finally, I selected Macintosh and found this variety held up best on the two-step baking process.

Lots of recipes call for quartering the apples, but I like to halve them for a pretty presentation. Once you figure out how to stand the apple halves up and arrange them on the outer rim of your pan, you are in business! Make sure they hug each other tightly, because apples give up space as they cook and you want the tart to look bountiful.

I like to present the tart on a cake stand, and it helps to have someone assist you in reversing it. To serve, accompany with whipped cream, creme fraiche or French vanilla ice cream. Don’t worry if there is a lot left over. It’s amazing how fast it will disappear, and it’s pretty yummy for breakfast the next day.

T

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FEBRUARY 2020 | OR TODAY |

59

OUT OF THE OR pinboard

NEW

OR TODAY

CONTEST F EBRUA RY

YEAR OF THE NURSE OR Today joins the World Health Organization in celebrating the 200th anniversary of Florence Nightingale’s birth and the Year of the Nurse in 2020. As part of the celebration, OR Today will feature perioperative professionals in a new contest! You could win a Bath & Body Works Gift Card! Every nurse is a leader! Please share a memory that illustrates a time when a nurse in your life or career served as a leader. Help us shine the spotlight on these leaders while at the same time encouraging others to lead.

Please visit ORToday.com/Contest to share your story or email it to Editor@MDPublishing.com. Each entry will be entered into the contest.

The Winner Gets a $25 Bath & Body Works Gift Card!

were born to stand “Why fit in when you uss

out?”

l aka Dr. Se – Theodor Seuss Geise

OR TODAY THIS MONTH'S CONTEST WINNER Submitted by:

Sharon Greene Golden, , olden eene G E,FCS r G n Sharo T,CER,SM CS BA,CR

60 | OR TODAY | FEBRUARY 2020

BA,CRCST,CER,SME,FCS

Manager Central Sterile Processing Adventist HealthCare Shady Grove Medical Center Rockville, MD

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

HOME-HIT DELIVERS QUICK, SIMPLE WORKOUT How much do you exercise? Government guidelines suggest that, in order to stay healthy, adults should perform at least 150 minutes of moderate aerobic activity every week – that’s exercise that gets your breathing and heart rate up.

A new study, published in The Journal of Physiology investigated a home-based high-intensity interval training (Home-HIT) program and studied its benefits for clinically obese individuals with an elevated risk of heart disease.

Previous research has demonstrated that under controlled laboratory conditions, that individuals can get the same benefits from three 20-minute exercise sessions, as from the government-recommended 150 minutes. However, the question is whether data produced in highly controlled laboratory environments can be translated to the real world.

The research team at Liverpool John Moores University was interested in whether Home-HIT is a time-efficient strategy that helps to reduce other common exercise barriers such as difficultly with access to exercise facilities due travel time and cost.

In the study, 32 obese people completed a 12week program of either: 1) a supervised, lab-based

cycling HIT program, 2) the government-recommended 150 minutes of moderate intensity exercise or 3) a home-based HIT program of simple body weight exercises suitable for people with low fitness and low mobility, and performed without equipment. For all of these regimens, the exercise was performed three times per week.

The researchers measured a range of health markers in these participants, including body composition, cardiovascular disease risk and the ability to regulate glucose. They found that the homebased HIT was as effective as both the governmentrecommended 150 minutes and the supervised, labbased HIT program for improving fitness in obese individuals.

“An exercise regimen, such as Home-HIT, that reduces barriers to exercise, such as time, cost and access, and increases adherence in previously inactive individuals gives people a more attainable exercise goal and thus could help improve the health of countless individuals,” said study author Sam Scott. • For more information, visit https://physoc.onlinelibrary. wiley.com/doi/10.1113/JP278062.

STRESS-FREE BREAK More Americans are finding it increasingly difficult to make time away from the office stress-free and enjoyable. For many, it has become almost impossible to turn off those connections to work, kick back and truly relax.

Virginia Tech workplace expert Bill Becker says just the mere thought of checking in with work is enough to keep someone from really unwinding.

“This idea that you might get an email, this kind of always worrying about being connected seems to be much more damaging,” according to Becker, an associate professor in the Pamplin College

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of Business who studies organizational behavior.

“Constantly checking for emails, pings and alerts keeps you in your work mindset and doesn’t allow you to disconnect and recharge,” said Becker.

Some workers simply find it easier to stay connected than to have to deal with hundreds of email messages after your vacation.

“The solution to avoiding frequent interruptions is different for everyone. For some, checking email once a day or even doing half an hour of work, then putting the phone away, can mitigate mindless checking,” said Becker. •

FEBRUARY 2020 | OR TODAY |

61

INDEX

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ALPHABETICAL Action Products, Inc.……………………………………… 53

C Change Surgical……………………………………………… 6

Ruhof Corporation…………………………………………… 2,3

AIV Inc.…………………………………………………………………17

Cygnus Medical…………………………………………………… 9

SIPS Consults………………………………………………………13

ALCO Sales & Service Co.……………………………… 53

Doctors Depot…………………………………………………… 4

STERIS/Microsystems……………………………………… BC

AORN……………………………………………………………………19

Healthmark Industries Company, Inc.………… 23

TIDI………………………………………………………………… 34-35

ASCA………………………………………………………………… 27

MD Technologies Inc.………………………………………IBC

BD………………………………………………………………………… 5

OR Today Webinar Series……………………………… 20

CATEGORICAL ANESTHESIA

INFECTION CONTROL

REPROCESSING STATIONS

Doctors Depot…………………………………………………… 4

ALCO Sales & Service Co.……………………………… 53

MD Technologies Inc.………………………………………IBC

ASSOCIATION

Cygnus Medical…………………………………………………… 9

Ruhof Corporation…………………………………………… 2,3

Healthmark Industries Company, Inc.………… 23

SAFETY

AORN……………………………………………………………………19 ASCA………………………………………………………………… 27

CARDIAC PRODUCTS C Change Surgical……………………………………………… 6

CARTS/CABINETS ALCO Sales & Service Co.……………………………… 53 Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 23 STERIS/Microsystems……………………………………… BC

CS/SPD MD Technologies Inc.………………………………………IBC Ruhof Corporation…………………………………………… 2,3

DISINFECTION Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2,3

DISPOSABLES ALCO Sales & Service Co.……………………………… 53

ENDOSCOPY

MD Technologies Inc.………………………………………IBC Ruhof Corporation…………………………………………… 2,3 SIPS Consults………………………………………………………13 TIDI………………………………………………………………… 34-35

INSTRUMENT STORAGE/TRANSPORT Cygnus Medical…………………………………………………… 9 Ruhof Corporation…………………………………………… 2,3

Healthmark Industries Company, Inc.………… 23 TIDI………………………………………………………………… 34-35

SINKS Ruhof Corporation…………………………………………… 2,3

SKIN PREPARATION BD………………………………………………………………………… 5

TIDI………………………………………………………………… 34-35

STERILIZATION

LIGHTING/VIDEO PRODUCTION

Cygnus Medical…………………………………………………… 9

STERIS/Microsystems……………………………………… BC

MONITORS Doctors Depot…………………………………………………… 4

ONLINE RESOURCE OR Today Webinar Series……………………………… 20

Healthmark Industries Company, Inc.………… 23 MD Technologies Inc.………………………………………IBC

SURGICAL MD Technologies Inc.………………………………………IBC SIPS Consults………………………………………………………13 STERIS/Microsystems……………………………………… BC

OR TABLES/BOOMS/ACCESSORIES

TIDI………………………………………………………………… 34-35

Action Products, Inc.……………………………………… 53

SURGICAL INSTRUMENT/ACCESSORIES

STERIS/Microsystems……………………………………… BC

C Change Surgical……………………………………………… 6

OTHER

Cygnus Medical…………………………………………………… 9

AIV Inc.…………………………………………………………………17

Healthmark Industries Company, Inc.………… 23

MD Technologies Inc.………………………………………IBC

PATIENT MONITORING

TELEMETRY

Ruhof Corporation…………………………………………… 2,3

AIV Inc.…………………………………………………………………17

AIV Inc.…………………………………………………………………17

STERIS/Microsystems……………………………………… BC

POSITIONING PRODUCTS

TEMPERATURE MANAGEMENT

FALL PREVENTION

Action Products, Inc.……………………………………… 53

C Change Surgical……………………………………………… 6

ALCO Sales & Service Co.……………………………… 53

Cygnus Medical…………………………………………………… 9

WARMERS

FLUID MANAGEMENT

PRESSURE ULCER MANAGEMENT

STERIS/Microsystems……………………………………… BC

MD Technologies Inc.………………………………………IBC

Action Products, Inc.……………………………………… 53

WASTE MANAGEMENT

GENERAL

REPAIR SERVICES

MD Technologies Inc.………………………………………IBC

AIV Inc.…………………………………………………………………17

Cygnus Medical…………………………………………………… 9

HOSPITAL BEDS/PARTS

Doctors Depot…………………………………………………… 4

Cygnus Medical…………………………………………………… 9 Healthmark Industries Company, Inc.………… 23

ALCO Sales & Service Co.……………………………… 53

62 | OR TODAY | FEBRUARY 2020

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