OR Today Magazine June 2021 by MD Publishing

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contents features

COVID COMPLICATIONS: PANDEMIC INCREASES WORKPLACE STRESS, ANXIETY & BURNOUT The COVID-19 pandemic upended the U.S. health care system. As a result, health care professionals experienced unprecedented levels of stress, anxiety and burnout.

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Emotional intelligence (otherwise known

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as emotional quotient or EQ) is important

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and values gaps among generations.

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OR Today (Vol. 21, Issue #6) June 2021 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. © 2021

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CIRCULATION

INDUSTRY INSIGHTS 10 News & Notes 18 TJC: Strategies for a Successful First ASC Survey Experience: Lessons Learned from a Joint Commission Surveyor 20 CCI: The Certification ACtionfordDecision Point 22 IAHCSMM: Key Updates to Guideline on Reprocessing Flexible GI Endoscopes and Accessories 24 AAMI: Freely Available Sterilization Supplement Gets Second Installment 27 Webinar: Patient Positioning Explored 28 Corporate Profile: Cygnus Medical

32 M arket Analysis: Surgical Instrument Storage, Transport Market Grows 33 Product Focus: Instrument Storage & Transport 38 CE Article: Bridging the Generation Gaps

OR TODAY | June 2021

Diane Costea

WEBINARS Jennifer Godwin

EDITORIAL BOARD Hank Balch, President & Founder,

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

OUT OF THE OR

66 Index

ACCOUNTING

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IN THE OR

52 Spotlight On: Paula Axtel, RN, BSN, CNOR 54 Fitness 57 Health 59 EQ Factor 60 Nutrition 62 Recipe 64 Pinboard

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INDUSTRY INSIGHTS

news & notes

AORN is Conference-Ready fter more than two years of absence, the Association of periOperative Registered Nurses will be gathering in Orlando, August 7-10, for their annual conference – which includes four days of education sessions and three days with medical device manufacturers on the exhibit floor at the Orange County Convention Center. OR Today magazine will be in the exhibit hall at Booth #29062 giving away copies of the magazine, Nurse Pill stress balls and other items.

The association’s last Global Surgical Conference & Expo, planned for Anaheim in April 2020, was canceled due to alarm bells stemming from early news of the Coronavirus. For AORN, the decision to cancel was difficult; there were only a few reported cases at the time, and limited evidence was available to support their decision. In just weeks, though, the association pivoted to present a virtual conference that attracted more than 8,000 attendees. Meetings Director Emily O’Connell and AORN President Holly Ervine, MSN, RN, NPD-BC, CNOR, are confident the time is right to attract a large number of attendees and association members say they are eager to finally reconnect with each other. As healthcare workers, most are fully vaccinated and feel reassured that AORN will follow CDC recommendations on site including mask requirements, sanitizing and social distancing. “We understand not everyone is able to travel, either because of work demands or a general hesitation,” says O’Connell. “That’s why we will also present AORN Expo in a hybrid format for those who 10

OR TODAY | June 2021

want to attend virtually. Select education sessions and conference activities will be live-streamed, and virtual attendees will also have access to networking lounges, a new product showcase, scheduled talks and exhibitor presentations, and a library of on-demand education sessions.” The Virtual Registration Pass will be available for purchase in July. COVID-19 has influenced some of the educational content. Rose Sherman, EdD, RN, NEA-BC, FAAN will present “Perioperative Nursing Leadership 2021: Rebooting After a Life-Quake” to help nursing leaders rebuild their team members’ resiliency, many of whom are burned out and need non-traditional management support. Sherman’s session is presented as part of the conference’s Leadership Summit, a program designed for emerging leaders and nurse executives who want to focus on the business and management sides of nursing. “Perioperative nurses value our conference because the education sessions are developed by perioperative nurses for perioperative nurses,” says Ervine. “And they count on AORN Expo to obtain their continuing education credits. It helps that we offer 12 tracks of learning for different practice specialties and surgical settings such as ambulatory and outpatient.” AORN Expo includes keynote speakers of national renown, educational content that delivers recommendations and solutions to clinical, administrative, and team challenges, as well as access to perioperative leaders on the national and international levels. In all, the conference presents more than 100 education sessions and can provide as many as 200 continuing education credits. The Leadership Summit is an example of educational content that is designed

according to nurse roles and interests. In addition to Sherman’s presentation, Pamela Hunt, MSN, RN, NEA-BC, will present “True Leadership,” a session that will explore the characteristics of what a true leader “looks like and how they make other people feel about their work and achieving their passion.” Past Summit attendees enjoy the networking opportunities that come along with the 4-day Summit. They are in a gathering of their peers from coast to coast and able to compare notes on clinical and management issues they face in their facilities. Summit attendees can also attend the general conference, including education sessions and general sessions with keynote speakers. AORN’s perioperative nursing specialists will be presenting education sessions to guide evidence-based practice and policies for safe patient care. The Guideline for Retained Surgical Items is currently being updated and its lead author, Julie Cahn, DNP, RN, CNOR, RN-BC, ACNSBC, CNS-CP, will discuss significant revisions and key points in preventing RSIs in surgical patients. “It’s been a year of so many changes, in practice and in our personal lives,” said Ervine. “It will be extra special to come together as a profession, reconnect with old friends, and shake off the pressures we’ve been under.”

VISIT US AT BOOTH #29062 WWW.ORTODAY.COM

INDUSTRY INSIGHTS

news & notes

Aspen Surgical Acquires BlueMed Medical Supplies Aspen Surgical Products Inc. has acquired BlueMed Medical Supplies Inc. BlueMed is a manufacturer of disposable shoe covers and other personal protection products based in Montreal, Canada. Their products are used in health care, pharmaceutical and lab facilities where infection prevention and cross-contamination are paramount concerns. The acquisition of BlueMed strengthens Aspen’s portfolio of surgical disposables and

patient and staff safety products sold into the acute care market. “BlueMed is a highly synergistic fit for Aspen in terms of manufacturing and commercial operations,” said Jason Krieser, CEO of Aspen. “Coming shortly after our acquisitions of both Precept Medical and Protek Medical, the BlueMed offering further enhances our portfolio of high-quality products that address infection prevention in the acute care environment at a time when reducing

cross-contamination has never been more important.” “We are very excited to join forces with Aspen and contribute over a decade of product and automation development in the shoe cover business,” said Michel Kassar, president of BlueMed. “Our complementary businesses will create a stronger and more diversified offering across a wide spectrum of industries and solidifies our presence as a North American leader in the PPE business.” •

AAAHC Releases Quality Improvement Toolkit The growth of patient visits and procedures performed in ambulatory health care facilities underscores the importance of examining and improving patient safety and providing better quality of care. The Accreditation Association for Ambulatory Health Care (AAAHC) published a Quality Improvement in Ambulatory Care Toolkit to help facilities demonstrate their commitment to continuous quality improvement (QI) by developing an integrated QI program. “Our QI Toolkit provides a step-by-step approach to help organizations develop and execute an effective QI strategy in alignment with AAAHC Standards,” said Noel Adachi, MBA, president and CEO of AAAHC. “This premium resource provides organizations with thought leadership and guidance on creating and enhancing an organization’s quality culture of serving patients while also building teamwork and improving communication among staff.” AAAHC QI guidelines offer a comprehensive method to address known or suspected performance deficiencies in all areas of ambulatory care, such as clinical care outcomes, peer review, infection prevention and safety, patient satisfaction, and risk management, in an ongoing, systematic way. Organized into two parts, the toolkit provides an

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overview for assessing your QI program and implementing a comprehensive QI study. First, the toolkit presents a QI program assessment, using a series of questions through which organizations review their current QI policies and procedures. The questionnaire provides actionable recommendations and insights to move organizations toward an integrated, organized, ongoing, data-driven and peer-based quality improvement (QI) program. The second part of the toolkit outlines AAAHC’s “10 Elements” for QI studies and guides organizations through the necessary components of a successful QI study, focusing on goal setting, data collection and analysis, corrective actions, remeasurement and communication. “Many administrators view QI as data collection, but collecting data is just the beginning of the process,” said Cheryl Pistone, RN, MA, MBA, clinical director for AAAHC. “The toolkit helps health care organizations collect the right data, in a strategic and trackable way, and use it to build meaningful QI studies that solve problems and increase efficiency, aligning them with our 1095 Strong, quality every day philosophy.” • For information, visit aaahc.org.

June 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

Ecolab Introduces Training Solution Ecolab Inc. has added a new on-demand digital training solution to its operating room (OR) program. The Ecolab OR Program Reinforced is a comprehensive solution that now includes a digital training element to help hospitals improve the quality and consistency of clean for this critical care area. Built on Ecolab’s intuitive, cloudbased Lobster Ink learning management platform, the digital training includes more than 30 lessons. The training and cleaning processes used in this content have been awarded the AORN Seal of Recognition, which is reserved for the highest quality hospital staff training, education and in-service programs consistent with the AORN Guidelines for Perioperative Practice. “The impact of the global pandemic on hospitals, including unprecedented staff turnover, increases the need for easy-to-use, on-demand training,” said Beth Simermeyer, executive vice president and president of Ecolab’s global healthcare, life sciences and hand care businesses. “Ecolab understands that getting surgical procedures safely back up and running is key for hospitals to return to profitability. Our new training program helps operating room cleaning teams improve efficiency and consistency, helping improve on-time starts and safety for surgeries.” •

OR TODAY | June 2021

ECRI Evaluates CADD-Solis v4 Wireless Ambulatory Infusion System Smiths Medical has announced the release of the ECRI evaluation report for CADD-Solis v4 with wireless communication patientcontrolled analgesic (PCA) and epidural infusion pump. ECRI is an independent non-profit organization improving the safety, quality, and cost-effectiveness of care across all health care settings worldwide. The report highlights ECRI’s evaluation ratings, test results and purchasing recommendations for the CADD-Solis pump. The CADD-Solis v4 system is a continuation of Smiths Medical’s commitment to advance patient care and help improve patient outcomes through leading-edge technology. The CADD-Solis pump maintains the advantages of an ambulatory pump for patient mobility and provides a single system that effectively delivers IV PCA, epidural, peripheral nerve blocks and subcutaneous from pump to patient. For the hospital, the CADD-Solis system is designed to enhance patient safety through “smart programming” (use of medication safety software) and reduce the risk of tubing misconnections while providing a comprehensive and intuitive user experience for the health care provider.

“Smiths Medical is committed to patient safety and adoption of smart infusion pumps,” said Nathan Walker, director of ambulatory infusion at Smiths Medical. “The wireless bi-directional communication sets the foundation for integrating pain management data delivery directly into the patient records in the hospital’s Electronic Health Records (EHR auto-documentation), saving clinicians time charting and increasing documentation accuracy.” •

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INDUSTRY INSIGHTS

news & notes

Advanced Sterilization Products Announces New President Aisha Barry is the new president of Advanced Sterilization Products (ASP). “Aisha’s extensive health care background coupled with software and consumer products innovation will help strengthen ASP’s digital expertise, develop strategic alliances and expand our international sales presence,” said Barbara Hulit, senior vice president of Fortive’s Advanced Healthcare Solutions segment. “Aisha

has a proven track record of developing highly effective organizations, leading to sustained growth. She will build on our current growth trajectory and advance the company’s mission to protect patients during their most critical moments.” Barry joins ASP from Philips, where her most recent role was vice president and general manager for the patient monitoring category. She holds an MBA from Tuck School of

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June 2021 | OR TODAY

INDUSTRY INSIGHTS

news & notes

Kentucky Governor Signs Surgical Smoke Bill

Getinge Launches Interactive Virtual Hospital In addition to the physical experience centers where visitors can interact with Getinge’s products and solutions – a virtual hospital is now launching to simulate a state-of-the-art hospital environment online. First out is Getinge’s solutions for the intensive care unit. Getinge Virtual Hospital will provide a comprehensive tour of hospital departments fully equipped with Getinge products and technologies – similar to the real-world experience centers in Germany, China, Japan and the USA. “In times when travel and in-person contact is very limited, the possibility to step into our virtual hospital fills

OR TODAY | June 2021

a crucial gap. It also provides long-term possibilities for visitors who might not otherwise be able to come to any of our experience centers,” says Jeanette Hedén Carlsson, executive vice president of communication and brand management at Getinge. The tool uses elements inspired by gamification where visitors can take a virtual walk and explore freely, navigating in front of their screen or device where they want to go next. There are possibilities to lift, move, rotate and examine all products in detail – very similar to how they would be experienced in a real-life setting. •

Kentucky Gov. Andy Beshear has signed into law new legislation that will require licensed hospitals and ambulatory surgery centers to adopt and implement policies to prevent human exposure to surgical smoke. Surgical smoke results from thermal destruction of human tissue by heat producing devices such as lasers and electrocautery knives commonly used during surgery. The law becomes effective January 1, 2022 and covers all planned surgical procedures likely to generate surgical smoke. According to the Occupational Health and Safety Administration (OSHA), each year “an estimated 500,000 health care workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke.” This smoke, also known as plume, includes carbon monoxide, polyaromatic hydrocarbons and a variety of trace toxic gases. Prolonged exposure can lead to serious and lifethreatening respiratory diseases. The Association of periOperative Registered Nurses (AORN) in collaboration with the Kentucky Nurses Association spearheaded the law’s passage. “After hearing from our nurses about the need for uniform evacuation procedures to eliminate surgical smoke in their operating rooms, lawmakers agreed to take this action to ensure smoke-free operating rooms for the state’s surgical teams,” said Jennifer Pennock, AORN senior manager of government affairs. “There are no specific standards for laser and electrosurgery plume hazards, instead, the safety policies have been left to the facilities and, nationwide, too few have taken action to protect their health care workers. We hope Kentucky’s proactive legislation will lead other states to follow suit.” Kentucky joins Colorado and Rhode Island in enacting surgical smoke-free legislation. •

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INDUSTRY INSIGHTS

news & notes

Henry Schein Invests in Stradis Healthcare Henry Schein Inc. has announced a majority ownership position in Stradis Medical LLC, a transaction that strengthens Henry Schein’s commitment to the growing ambulatory surgery market. Based in Atlanta, Stradis Healthcare specializes in medical device packaging and custom procedure kits and trays. The company is a provider of customized procedure packs, minor trays and kits to surgical centers, private practices, oral surgeons and a multitude of surgical and clinical specialties nationwide. Privately held Stradis Healthcare was formed through a series of acquisitions beginning in 2000 and is now one of the only independent sterile medical kitting companies in the U.S, with facilities in

Atlanta and Waukegan, Illinois. The addition of Stradis Healthcare to Henry Schein’s Medical group will create a unique kitting, contract packaging and serialized pharmaceutical organization that will advance the mission of health care delivery, creating efficiencies and savings for providers, and facilitating the delivery of high-quality patient care. While Stradis Healthcare will maintain its own brand, management team, facilities and market positioning, this investment will accelerate Henry Schein Medical’s ability to provide innovative and customized solutions to practitioners, medical device companies and health care distribution partners while also creating new business opportunities.

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“With the addition of Stradis Healthcare, we are strengthening our commitment to the ambulatory surgery market and enhancing our offering by combining product portfolios and capabilities,” said Stanley M. Bergman, chairman of the board and chief executive officer of Henry Schein. “Ambulatory surgery centers play an important role in reducing the cost of health care. As a result of this partnership, Stradis Healthcare will advance Henry Schein Medical’s deep commitment to provide specialty solutions to customers along the health care supply chain. We warmly welcome our new Stradis Healthcare colleagues to Team Schein.” •

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INDUSTRY INSIGHTS

news & notes

FDA Clears New 3D Surgical Imaging System

Healthmark Offers New Shaver Leak Tester Healthmark Industries has announced the addition of the Shaver Leak Tester to its ProSys Instrument Care product line. The Shaver Leak Tester is specifically designed for pressure testing arthroscopic shavers in order to help identify leaks caused by failing seals. These seals degrade over time from repeated use and processing. The Shaver Leak Tester includes both a hand pump to apply pressure and a testing stop, made from polypropylene to create a temporarily closed system within the fluid pathway of the shaver to pressure test for leaks. Utilizing positive pressure, the user can determine if the internal seals are failing and the shaver needs to be sent out for repair. The Shaver Leak Tester helps in reducing the potential for cross-contamination, damage and costly repairs that result from using a shaver with leaks.

OR TODAY | June 2021

GE Healthcare recently announced 510(k) clearance from U.S. FDA for OEC 3D, a surgical imaging system capable of 3D and 2D imaging. OEC 3D will set a standard for interoperative 3D imaging with precise volumetric images for spine and orthopedic procedures. This new system combines the benefits and familiarity of 2D imaging with greater efficiency to increase access and usability to 3D. “We’re thrilled to introduce OEC 3D to clinicians who want amazing 3D volumetric images quickly during intraoperative procedures,” said Gustavo Perez Fernandez, president and CEO of GE Healthcare Image Guided Therapies. “Built on the successful OEC Elite C-arm platform, the familiar performance and functionality of the OEC 3D C-arm will make 3D imaging routine for complex spine and joint replacement procedures.” Developed in collaboration with health care professionals and institutions around the world, OEC 3D C-arm recently completed clinical evaluations in vivo and in simulated laboratory procedures. Clinicians involved commented on the excellent image quality of the 3D volumes stating they were similar to what they expect from a CT scan. Additionally, the simplicity of performing both 3D as well as 2D imaging on OEC 3D was noted as an improvement versus current methods. Revealing a new standard of interoperative imaging, OEC 3D provides a large 19 cm x 19 cm x 19 cm field of view with high resolution and detail. An advanced reconstruction engine quickly presents images on an intuitive Volume Viewer with advanced tools and analysis for surgical assessment. In addition, OEC 3D is open to interface with advanced intraoperative technologies such as navigation and robotics. For improved asset utilization, OEC 3D includes the recognizable 2D imaging experience of OEC C-arms for imaging versatility from general surgery to interventional cardio-vascular procedures, delivering a familiar user experience with the added benefit to quickly capture a 3D scan. •

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INDUSTRY INSIGHTS

news & notes

IAHCSMM Announces Election Results The International Association of Healthcare Central Service Materiel Management (IAHCSMM) has announced election results for four board of director positions. Marjorie Wall, MLOS, CRCST, CIS, CHL, CSBB, director of sterile processing for Kaiser Permanente in Downey, California, has been elected as the association’s next presidentelect. She will serve consecutive one-year terms as president-elect (2021-2022), president (2022-2023) and past president (2023-2024). Wall previously served a two-year term as

a director on the IAHCSMM Board (2019-2021). Joining Wall are the following three new directors, all of whom will serve a two-year term (2021-2023): Arlene Bush, CRCST, CIS, CHL, CER, systems educator for sterile processing and quality auditing for AdventHealth Central Florida Division in Orlando, Florida; Tracy Davenport, BHA, CRCST, CIS, CHL, manager of sterile processing (operations) for Northside Hospital Atlanta (Georgia); and Alison Sonstelie, CRCST, CIS, CHL, sterile processing lead coor-

dinator for Sanford Health in Fargo, North Dakota. “It is a privilege to welcome each of these new members to the IAHCSMM Board of Directors,” said IAHCSMM Executive Director Susan Adams, BS, CAE. “Each brings to the IAHCSMM board their rich professional experience and strong dedication to the sterile processing discipline, which will lend itself well to supporting the association and the needs of our growing membership.” The new board members took office on May 1, 2021. •

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June 2021 | OR TODAY

INDUSTRY INSIGHTS

TJC news & notes webinars

Strategies for a Successful First ASC Survey Experience

Lessons Learned from a Joint Commission Surveyor By Lorrie Cappellino, RN, MS, CNOR t is courageous for an ambulatory surgery center (ASC) to consider undergoing its first accreditation survey, especially while health care organizations, cities, states and our entire country are in the midst of reacting to an international pandemic.

The Joint Commission acknowledges the special pandemic-induced circumstances under which ASCs are currently operating and is mindful of the challenges throughout their survey process. We realize many ASCs are undergoing first-time surveys for a variety of reasons. Some may be newly minted businesses, others have returned to The Joint Commission after changing accreditation courses and others are long-standing ASCs under new leadership. Whatever the reason for the inaugural survey, rest assured that The Joint Commission survey and surveyors are tailored to the ASC’s distinct environment. The Joint Commission is unique in that it accredits organizations in more than 100 countries, providing more than 14,000 surveys, including 1,105 for ASCs annually. ASC surveys are conducted by specially selected and trained ambulatory surveyors with clinical experience in specialties including surgery center administration, nursing, process improvement, dentistry, surgery, radiology and anesthesia. The goal of every ASC survey is to provide a meaningful, in18

OR TODAY | June 2021

dividualized assessment for each ASC setting. Joint Commission surveyors vow to be open and transparent, validate areas in which organizations meet standards, identify leading practices and provide educational opportunities. Additionally, they strive to inspire ASCs to improve patient safety. The most difficult part of any new process is determining where to start. An accreditation survey evaluates a health care organization to determine if it is meeting important quality and safety standards. So, the best starting point may be to gather and study resources that detail those processes and standards. ASC leaders can begin with The Joint Commission’s Accreditation Handbook for Ambulatory Care which explains the survey process. Second, request a free trial. It is wise to take The Joint Commission up on our offer to request free 90-day access to the electronic version (Edition) of Joint Commission standards. This online document is searchable by both chapter and keywords. If your health care organization is seeking Deemed status through The Joint Commission, E-dition’s clear annotations regarding those requirements are helpful. Third, ask specific questions in advance. ASC leaders may submit questions about standards to experts at The Joint Commission’s Standards Interpretation Group. Fourth, purchase hard copies of manuals such as the Comprehensive Accreditation Manual for Ambulatory

Care (CAMAC) and other resources at www.jcrinc.org. Details provided in the manuals offer a wealth of information in an easily accessible format. Finally, locate online resources provided by The Joint Commission. Search online for helpful resources for ASC management, such as national patient safety goals, The Joint Commission “Perspectives,” and physical environment, environment of care and emergency management planning tools. At this point, you may be asking yourself, “How do I manage this volume of information?” Delegation often is the answer. Many successful ASC leaders assign “chapter champions” or teams to address critical details of National Patient Safety Goals and each of the 14 chapters of the CAMAC. They then conduct self-assessments and gap analyses before developing and creating processes to ensure they meet standards. ASC leaders also often conduct their own “mock” tracer activities to evaluate processes, identify risks and ensure continuous quality and safety for patients, staff and visitors. Given the many elements of performance required in the accreditation process, many ASC professionals may wonder what are the most cited observations related to ASCs over the past few years? Most of ASCs’ commonly cited opportunities to improve fall within the areas of Infection Control and Medication Management. Below are examples identified as WWW.ORTODAY.COM

INDUSTRY INSIGHTS

TJC news & notes

high or moderate risk and likely to cause harm to patients, staff or visitors. These are examples of observations published to organizations’ SAFER matrix at the end of accreditation survey. Frequently cited infection control issues: Lack of documentation regarding sterilizer biologic testing Failure to follow manufacturer’s instructions for use regarding mixing chemical disinfectants during instrument decontamination Non-compliance with OSHA requirements while transporting used surgical instruments Non-compliance of hand hygiene with selected clinical practice guidelines Frequently cited medication management issues: Failure to label high-alert medications in accordance with organizational policy Two or more medications ordered for the same indication (such as pain) Keep in mind that during survey, The Joint Commission is not focused on minor details like dust bunnies, but rather particulars of heightened importance relevant to an ASC’s specific high-risk areas. ASC leaders should pay particular attention to the following chapters of the CAMAC manual. They should evaluate the information, line-by-line to ensure every “t” is crossed, and “i” is dotted as they work toward their first survey experience. The recommended CAMAC manual chapters to review are: Infection Control: Sterilizer and high-level disinfection (HLD) management – monitoring of time, temperature and pressure biologic testing; sterilizer/HLD documentation; solutions used for decon/HLD/housekeeping mixed WWW.ORTODAY.COM

and used in accordance with (IAW) clinical practice guideline (CPG) including temperature and documentation Environment of Care: Sterilizer/ HLD equipment maintenance and cleaning done IAW MIFU; temp/humidity management, air exchanges/pressure in ORs, decon and rooms where sterile supplies are stored Human Resources: Competency assessment for those working in sterilization – ensure the process makes sense, (e.g., document qualified trainers and oversight, how often training/competency is assessed; ensure waived testing is accomplished; using two forms of testing/evaluation; ensure cultural diversity training for all) Life Safety: Fire Safety – Pay attention to detail with extinguisher, exit, fire door checks/maintenance; ensure timing/inclusion/ post-evaluations of fire drills; include all employees (i.e., licensed independent practitioners) in plan Record of Care: Ensure anesthesia and surgeon patient assessments are completed and documented IAW national, state, local and practice/policy guidelines Medication Management: Sound processes related to medication order sets, commonly confused and high alert medications, and medication security/avoidance of diversion My experience working as an operating room (OR) nurse and director for more than 30 years and currently viewing ASCs through the eyes of a Joint Commission surveyor, has shown me that that highly successful ASCs share several common traits when they undergo initial (and subsequent) accreditation surveys. If successful ASCs have senior leaders in multi-hatted positions, they

tend to maintain overall oversight, but coach and delegate portions of responsibilities for CAMAC manual chapter management to trusted mid-level leaders. Regarding identifying risk, effective ASCs leaders encourage and assign current and new staff members to use “fresh eyes” to conduct mock tracers to help identify areas of risk. Additionally, a path to ASC success includes physician involvement. For example, surgeon involvement in the oversight of standing orders, anesthesiologist oversight in determining what items are stored on a crash cart, and most importantly, medical director involvement in governance activities including patient selection criteria, privileging, emergency management decisions and policies as well as involvement in process improvement activities. Over the past year, The Joint Commission has developed a successful offsite survey process to facilitate accreditation when organizations have not been available for survey due to high countywide COVID rates. Although we know on-site individual patient tracers are crucial to enabling ASC leadership and surveyors to view the big picture of how organizations meet quality and safety standards, the offsite survey process is also extremely valuable. Learning alternate procedures for facilitation of future ASC surveys is imperative. If you have questions about an upcoming ASC survey or would like to discuss requirements for a first ASC surveyor, please contact your account executive or Pearl Darling, executive director of ambulatory care services at AHCquality@jointcommission.org. Thank you for your continued commitment to quality patient health care during this unprecedented time. Lorrie Cappellino, RN, MS, CNOR, surveyor, ambulatory health care, The Joint Commission. June 2021 | OR TODAY

INDUSTRY INSIGHTS CCI

The Certification Decision Point By James X. Stobinski, Ph.D., RN, CNOR, CSSM (E) he Competency and Credentialing Institute Research Foundation (CCIRF) administers the Perceived Value of Certification Tool (PVCT) survey instrument designed to measure the perception of the value of certification. This instrument has been widely used in dozens of studies documented in the peer-reviewed literature (Van Wicklin et al., 2020). These studies have shed increasing light on the perception of value held by nurses regarding certification. This data is of great interest to The Competency and Credentialing Institute (CCI) and the CCIRF.

However, some fundamental questions emerged for CCI and the CCIRF from the PVCT data. Questions such as: What is the number of perioperative nurses? How many of these nurses are certified? Are we making progress in clarifying the perception of value for perioperative nursing certifications? As the CEO of both CCI and the CCIRF, and as a nurse researcher, I must state that we do not yet have definitive answers to these questions. Nursing specialty certification, except for advanced practice nurses, remains largely voluntary for U.S. 20

OR TODAY | June 2021

nurses. That is certainly the case in perioperative nursing where it is very rare that certification is a requirement for employment. Regarding specialty nursing certification, most nurses face a simple choice of whether they should expend the resources required for a voluntary certification. This choice can be conceptualized as a certification decision point or more easily just – the decision point. How nurses make their decisions about certification and the influences on those decisions is not well understood, but is of keen interest to CCI, the CCIRF and other nursing specialty certification groups. When concepts are not clearly defined, such as a nurse’s decision point on certification, exploratory research using qualitative methods is well suited (QuestionPro, 2021). Such research facilitates better understanding of complex, multifactorial issues. The CCIRF, which was launched in 2019, has funded two qualitative studies this year on how nurses make decisions regarding certification. The certification decision point occurs at predictable intervals for nurses. A nurse has a choice on whether to earn a voluntary credential and at the end of each recertification cycle to either recertify or allow a credential to lapse. As a certifying body, CCI must

clearly establish its value to perioperative nurses if it hopes for favorable action at these decision points. Part of the task is knowing its stakeholders better in order to include all perioperative nurses and provide value to them. The 2018 National Sample Survey of Registered Nurses gives the number of perioperative nurses as 310,054 in the hospital setting and 18,217 in free-standing ambulatory surgery centers (2019 a, p. 26). However, the survey response choice on the form reads, “Surgery (including ambulatory, pre-operative, post-operative, post aesthesia)” (2109 b, p. 7). Thus, many of these nurses are likely not eligible for CCI credentials centered on the intraoperative phase of surgical care. Thus, the total number of nurses performing intraoperative care cannot be discerned from these results. At present, there are over 40,000 nurses who hold one or more CCI certifications. The number of perioperative nurses and the ratio of those nurses that hold a CCI certification is unknown. A better understanding of the value that perioperative nurses place on certification coupled with more accurate data on the makeup of the profession can assist CCI to better meet the needs of nurses. In 2021, CCI will have numerous opportuniWWW.ORTODAY.COM

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ties to participate in research and surveys to gather more accurate data. There will also be opportunities for you to share your opinion with CCI, the CCIRF and researchers. Please consider taking the time to respond as we truly value the input you provide.

References Institute of Medicine. (2015). Future directions of credentialing research in nursing: Workshop summary. National Academies Press. QuestionPro Survey Software (2021). Exploratory research: Definition and characteristics. Accessed April 1, 2021 at: https://www.questionpro.com/

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Services Administration, National Center for Health Workforce Analysis. (2019 b). 2018 National Sample Survey of Registered Nurses, FORM NSSRN (02/01/2018), Rockville, Maryland. Van Wicklin, S.A., Leveling, M.E. & Stobinski, J.X. (2020). What Is the Perceived Value of Certification Among Registered Nurses? A Systematic Review. Journal of Nursing Scholarship, 2020; 0:0, 1–8. doi:10.1111/jnu.12579

James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), is Chief Executive Officer at Competency & Credentialing Institute (CCI).

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INDUSTRY INSIGHTS

IAHCSMM

Key Updates to ‘Guideline on Reprocessing Flexible GI Endoscopes and Accessories’ By Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS he American Society for Gastrointestinal Endoscopy (ASGE) – along with all organizations and members of the American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy and Standards of Practice committees – have updated the “Multisociety Guideline on Reprocessing Flexible GI Endoscopes and Accessories.” This article highlights some of the key changes.

The updated guideline states that staff training and competency of endoscope reprocessing skills are important aspects of infection prevention. It is recommended that reprocessing staff be trained on all the endoscope models they are expected to process and shown to have documented competency before being assigned to process them. The health care organization should then perform competency evaluations of endoscope processing personnel on a scheduled basis, as defined by the organization (typically, this occurs when one first assumes endoscope processing duties; at least annually; anytime a breach is identified; when a major technique or new endoscope or reprocessing accessory is introduced; and in the context of local quality control efforts). 22

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The delayed processing of endoscopes has become an area of greater focus. The updated guideline recommends that manual cleaning begin according to the instructions for use (IFU), which is usually within one hour after the endoscope is released from the procedure. If cleaning is delayed beyond this time period, the manufacturer’s IFU for delayed processing must be followed. It is recommended that soiled endoscopes be transported immediately to the reprocessing area in a fully enclosed, puncture-resistant, leak-proof containers with a biohazard label. It is also recommended that only clean cleaning implements are used; if reusable cleaning implements are used, they must be cleaned and disinfected between uses. Additionally, the guideline recommends the use of fresh cleaning solution for each endoscope. If the cleaning solution falls outside the recommended temperature and dilution range, it is recommended that it be replaced. If an endoscope undergoes highlevel disinfection, it is recommended to perform this disinfection step in an automated endoscope reprocessor (AER) using a high-level disinfectant or sterilant that is compatible with the AER and sterilizer IFU. The importance of adhering to the endoscope

manufacturer’s IFU for high-level disinfection was also emphasized. Some duodenoscopes contain an elevator wire channel that may not effectively be disinfected by some AERs and that this step should be performed manually. In addition, the endoscope and components should be attached using only approved connectors, per the AER and endoscope manufacturer’s IFU to ensure contact of all internal surfaces with the high-level disinfectant solution. If the AER cycle is interrupted, the entire cycle should be repeated. Recent research links incomplete endoscope drying to multiple outbreaks of waterborne organisms (data shows a reported endoscope contamination rate of 80%). This research signifies that the methods of drying flexible endoscopes need to change – and this multisociety guideline includes new drying recommendations. Prior to this newfound information, 70% to 90% ethyl or isopropyl alcohol was injected into the endoscope channels to dry the channels. Alcohol was recommended because it purged and promoted the evaporation of residual water within endoscope channels, thereby decreasing the chances for bioburden buildup. Little data exists regarding possible benefits of alcohol flushes. Based on WWW.ORTODAY.COM

INDUSTRY INSIGHTS

IAHCSMM

research, this guideline recommends drying the endoscope channels and areas not dried with a cloth with forced, pressure-regulated filtered air – with a sufficiently prolonged flow of medical air through all accessible channels. For best results, it is ideal for this step to occur simultaneously for all channels and for a duration of at least 10 minutes. Flexible endoscopes should be completely dried after processing and before use. Note: This guideline recommends following manufacturers’ IFU regarding the use of ethyl or isopropyl alcohol for drying endoscopes. There was a case report that switched to suctioning 70% alcohol through a duodenoscope working channel, followed by compressed air during the drying phase. It was reported that this helped contain an outbreak of Pseudomonas aeruginosa. In addition, a conclusion from the pulmonary literature suggests that using alcohol for drying purposes significantly reduces bronchoscope contamination rates; however, the fixation properties of alcohol could lead to the retention of organisms within the endoscope. At this time, there is no data to strongly support or refute the use of alcohol flushes for the drying of endoscopes. Proper storage of endoscopes is essential for preventing contamination. This updated guideline includes information on proper endoscope handling, WWW.ORTODAY.COM

including the need for personnel to perform hand hygiene and wear clean gloves during all phases of endoscope handling. Endoscopes may be stored in drying cabinets or conventional cabinets, and always in a way that does not allow for moisture to collect on or within the endoscope. Drying cabinets have connectors that force air through each endoscope channel. The endoscopes can be stored either vertically or horizontally. These storage cabinets use forced irrigation of endoscope channels with warm, filtered air during storage to achieve complete drying of the channels. Conventional cabinets require endoscopes to hang vertically, and active or passive ventilation with filtered air helps prevent moisture from forming on or within endoscopes. Passive cabinets without airflow directed into all channels are not sufficient for drying the endoscope from a wet state. Endoscope cabinets should be in a secure location that is near but not in the procedure rooms. Care and maintenance of the cabinet should be performed according to the cabinet IFU and the cabinets should be routinely inspected for damage and cleaned on a routine basis (and when soiled) with an Environmental Protection Agency-registered hospital disinfectant. This guideline does not

provide a specific amount of time that endoscopes can be stored before being considered contaminated. It is recommended that endoscopy units evaluate the available literature, perform an assessment regarding benefits and risks around the optimal storage time for endoscopes, and then develop a policy and procedure specific to their unit on endoscope storage time. The multisociety guideline also addresses recommendations regarding the use of simethicone. It is recommended that the endoscopy unit follow the manufacturer’s IFU on its addition in water bottles and irrigation devices, including cleaning and disinfection of endoscopes after its use. The guideline also recommends that documentation be put into place to provide traceability of endoscopes, including those that are loaned. The complete guideline is available on the ASGE website at www.asge.org (under the “ASGE guidelines” and the “Newly Published” tab). Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, serves as a Clinical Educator for the International Association of Healthcare Central Service Materiel Management (IAHCSMM). IAHCSMM provides certification, education and support to nearly 40,000 Sterile Processing professionals. June 2021 | OR TODAY

INDUSTRY INSIGHTS CCI AAMI

Freely Available Sterilization Supplement Gets Second Installment ollowing a unique collaboration between medical industry leaders, the Association for the Advancement of Medical Instrumentation (AAMI) has published the latest installment in a growing collection of best practices and strategies for the sterilization of medical devices and tools. The new document, titled “Industrial Sterilization: Challenging the Status Quo, Driving for Continuous Improvement,” is a freely available and peer reviewed supplement to AAMI’s journal, BI&T.

“This is the second in what is hoped to be an ongoing series of publications based on industry-led collaborations inspired by the 2019 Kilmer Conference,” authors Emily Craven and Joyce Hansen explain. The Kilmer Conference, revived by Johnson & Johnson with AAMI’s support in 2016 and chaired by Hansen, vice president of microbiological quality and sterility assurance at Johnson & Johnson, is a premier global forum focused on sterility assurance and sterilization. The conference welcomes professionals from industry, academia, government agencies and healthcare delivery organizations. During the 2019 conference, polling and subsequent meetings of the Kilmer Confer24

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ence Collaboration Modalities Team, co-led by Craven, director of global sterility assurance at Boston Scientific Corporation, revealed a strong need for a freely accessible collection of sterilization information and best practices. “The collaboration teams identified that the lack of innovation or change [in our industry] was often because individuals felt that there was a hurdle or roadblock that prevented action. They were not aware of the alternatives available,” said Hansen. “Until now, we as an industry haven’t done our best to preserve and publish the historical knowledge or rationales for why we have specific requirements.” The first resulting BI&T supplement, “Industrial Sterilization: Process Optimization and Modality Changes,” was their answer. Following its success, a call for abstracts was made to help this budding collection of knowledge grow. “For this second publication, the call for submissions focused on the need for case examples of successes and challenges and discussions surrounding collaboration and innovation to support product transfers between sterilization modalities, ensuring ethylene oxide (EO) process optimization, and overcoming challenges with reusable medical devices,” the authors explained. Examples of content featured in the new publication include an explora-

tion of the potential for inducing radioactivity in tools or devices processed with X-ray energy, safe methods for transitioning from gamma radiation to X-ray processing, best practices for making the use of EO sustainable, and other recommendations for helping professionals choose the right sterilization modality to fit their specific needs. “By publishing new research and methods, we lay the groundwork for supporting new standards and guidance to meet the needs of an everchanging industry, whether it’s novel sterilization methods to deal with sensitive materials, transfers between sterilization modalities, process optimization to meet capacity demands or sustainability initiatives, or the complexity of procedures associated with the safe reuse of medical devices,” the authors added. “Peer-reviewed publications help to improve the standards over time, thereby allowing ‘lessons learned’ to be adopted into the standards for clarification and/or expansion.” Hansen and Craven continue to call for submissions and already planning for a third document later this year. The response for this second installment was so robust that the authors admit they were unable to include every suitable submission. Instead, they are working to prepare a series of informative webinars to release before the next supplemental publication.

WWW.ORTODAY.COM

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newswebinars & notes WEBINAR SERIES

Webinar: Patient Positioning Explored Staff report he OR Today webinar “Patient Positioning: Positioning Your OR for Success” presented by Michelle Lemmons, RN, BSN, PHN, CNOR, Clinical Educator-OR with Key Surgical, was eligible for (1) CE credit. OR Today has been approved and is licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623.

The 60-minute webinar defined patient positioning, identified how to select patient positioners, specified how to inspect and maintain positioners and defined how to write policies and procedures. The webinar included a questionand-answer session. One attendee said, “We have surgeons who will position the patients with unapproved devices, how can we stop them?” “I was just reading an article the other day, actually, where they were talking about a surgeon, bringing things in from Home Depot for positioning devices,” Lemmons said. “It’s a great conversation.” “None of these other devices are tested or proven to help with redistributing pressure. So, it would be a WWW.ORTODAY.COM

great conversation to start with your team,” she added. “Start with your manager. Start with, if you have a positioning team, it is awesome to start with them. I realize every position is different and every surgeon really does have a unique way of positioning their patient for a reason, but then what, what is a tool that you can provide them that’s safe and effective outside of that. So, start having the conversation right away.” Another question was, “We find that towel rolls do provide the best stability for positioning? Is it OK to use them?” “Please, please don’t. Please stop using them. Towels are not going to redistribute pressure,” Lemmons said. “If anything, they are going to create pressure. They are not designed to distribute the pressure of the body over a surface area. They might keep it in place, but it’s not stable. Think about re-adjusting your pillow, when you’re sleeping, we all do things, but it’s kind of hard to translate that into this area. They’re not stable.” “Even though they might seem like they’re holding that patient in a stable place, they’re not designed for that,” she added. “They do create a big risk for pressure for patients.”

More than 150 attendees joined the live presentation. Attendees provided positive feedback via a post-webinar survey. “The lecture was informative and clearly presented. I plan to share the recorded webinar with my new hires currently in orientation,” OR Instructor L. Lee said. “I liked talking about rolling up towels and blankets and the explanation on how that is not good for the patient. This is seen in so many ORs. So many people use these as rolls, instead of actual gel rolls. It was made very clear that these should not be used and that AORN supports this,” said A. Gerak, RN. “I can absolutely relate to the examples and information shared in today’s presentation. I appreciate the solutions offered,” said A. Bivins, CST. For more information, visit ORTodayWebinars.live. Thank you to our sponsor:

June 2021 | OR TODAY

corporate profile Cygnus Medical

Corporate Profile Cygnus Medical s Cygnus Medical celebrates their 20th anniversary, we are taking a look at this unique company and how their family of products reflects the innovative style that has come to define them.

Filling a Vacuum: First Step™ Bedside Kits In 2002, the bedside cleaning of flexible endoscopes was a step many people thought was unnecessary. Although virtually all of the society standards called for wiping down the scope and suctioning enzymatic detergent through the channels at bedside, compliance on a national level was very bad. As Cygnus Medical’s Vice President of Sales Shaun Sweeney recalls, “I remember people saying, I will be brushing the scope across the hall in 5 minutes, so why bother? Or, why would I pay for a kit when we can make them ourselves.” Today, it’s common knowledge that you can’t brush a scope channel without first removing the initial gross contamination. It’s a layered process that depends heavily on the prior step being done properly. By packaging the preformulated enzymatic detergent and cleaning pad in a stand-up pouch, an endoscopy manager was now able to monitor and count how many kits were being used, or not being used. Formulations were exact and the process was repeatable no matter which staff members were involved. Over the years, the 28

OR TODAY | June 2021

importance of bedside cleaning has risen to the top and is now considered one of the most important steps in the high-level disinfection process. Today, First Step has become synonymous with flexible scope bedside cleaning. The convenience of having a ready-to-use, measurable process, has led to an overwhelming level of compliance.

Recognizing the true problem: Tray Belts™ Sterile Wrap Protection Sterilization wraps provide an effective barrier and method of preventing the microbial penetration of instrument trays. For years hospitals have struggled to protect wrap from small tears and abrasions that would compromise their efficacy. Foam corner guards were initially introduced as a way to protect the tray wrap from rips caused by the corners of the tray. Although it was a step in the right direction it did not really resolve the problem. The number of rips and abrasions were only reduced slightly or not at all. In many cases, having foam inside of the tray led to an uptick in wet packs as condensation saturated the foam. This only added to the delays. A large New York City hospital was struggling with this problem which wreaked havoc in the OR suites with constant case delays. A team from Cygnus Medical worked with the sterile processing manager to try to improve the corner guards. As Sweeney recalls, “the first revelation was that the tears and abrasions were not located in the corners and WWW.ORTODAY.COM

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The approach Cygnus Medical took was to balance the needs of reprocessing, safety, efficiency, materials management, and the environment.

dirty scopes was greatly reduced, (and yes, this actually has happened more than once.) For facilities that embrace the material management benefits of kits in the endoscopy suite, Cygnus Medical also offers endo kits with a full complement of components, but without a transport pad (or with for those so inclined.) One aspect of transport pads that often goes without mention is the amount of waste created by bagging up 20, 30 or even 50 dirty transport pads per day in municipal waste bags. A stack of 50 Oasis Trays fit in one compostable collection bag. They then turn to dirt after a few months in a landfill. Made from a renewable compostable resource lets hospitals make clinically sound infection control choices without sacrificing the planet. Oasis Trays have led to a range of related products that share in the goal of providing environmentally friendly products that solve nuanced infection control problems. • Signal™ Compostable Instrument Transport Bags, with double-layered removable Low-Tack Adhesive Labels that change from High-Level Disinfected to the Biohazard Legend. • Signal™, Multi-layered, Low-Tack labels that change the messaging as instruments change from sterile to contaminated. • SingleCycle™ Instrument Trays, a biodegradable, autoclavable, single-use surgical instrument tray. The past 20 years have been an exciting time for Cygnus Medical and we look forward to seeing what new innovations the next 20 will bring. For more information, visit cygnusmedical.com.

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market analysis

Surgical Instrument Storage, Transport Market Grows Staff report he surgical instrument storage and transport market is expected to follow related markets with continued growth over the coming years.

“The global surgical equipment market size was valued at $9.32 billion in 2020 and is expected to grow at a compound annual growth rate (CAGR) of 9.8% from 2021 to 2028,” according to Grand View Research. Large unmet surgical needs, growing health care costs, rising geriatric population and increasing surgical volume are projected to drive market growth during the forecast period. The long-term cost comparison study of medicine therapy with surgery revealed that early surgery is considered more cost-effective as compared to continuous medication, according to Grand View Research’s report. Patient awareness about the cost benefits of early surgical intervention is increasing with efficient patient counseling during physician visits. Grand View Research, in a separate report, also predicts growth in another related market. “The global medical carts market was valued at $1.28 billion in 2016 and is expected to witness a CAGR of 15.2% during the forecast period. Rising incidence of musculoskeletal injury and growing adoption of electronic medical records in hospitals are key contributors to market growth,” the Grand View Research report states. “Increasing adoption of mobile carts can be attributed to the availability of technologically advanced products that offer better configuration, construction, options and features to meet requirements of consumers.” Grand View Research adds, “Growing need to help medical and surgical staff is expected to propel market growth over the forecast period. On the surgical floor, a 32

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secure medication cart coupled with a tablet PC is more convenient than using a separate medication and computer cart. This saves space as well as cost. Critical care units have limited floor space and can benefit from such solutions. As a result, demand for medical carts in these units is expected to increase over the forecast period.” “The emergence of telemedicine/telehealth and availability of technologically advanced medical carts are among factors contributing to market growth. These products improve nursing efficiency, and this helps in better caregiving to patients. Rise in demand for point-of-care diagnostic technology is also a key growth driver,” the report states. Surgical procedures and an uptick in the number of surgeries performed is also expected to fuel market growth. “The procedure segment is expected to gain popularity in the coming years due to consistent usage of these carts in several hospital settings. These products are very helpful in operating procedures, such as cardiology and endoscopy, and provide access to essential therapeutics. These benefits are anticipated to propel the growth of the segment in the future,” Grand View Research states. A MarketsandMarkets report states, “The surgical instrument tracking systems market is projected to reach $338 million by 2025 from $180 million in 2020, at a CAGR of 13.4% during the forecast period. The growth of this market is majorly driven by the need to meet FDA Unique Device Identification mandates, the requirement for better inventory and asset management practices, and the growth of the surgical instruments market. However, high system costs, long investment cycles, and a lack of realization of ROI are expected to restrain the growth of this market during the forecast period.”

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product focus

CIVCO

TEE Transport Tray and Probe Storage Cabinet CIVCO offers a full range of products that protect, clean, transport, disinfect and store transesophageal (TEE) and endovaginal/endorectal ultrasound probes to help you maintain compliance with The Joint Commission (TJC). Protect your TEE ultrasound transducers with the TEE Transport Tray and probe storage cabinet. The transport tray features a reversible lid for easy clean/dirty indication. It protects expensive, delicate TEE probes from damage during transport while safeguarding the disinfected probe shaft from the handle, cord and connector. The storage cabinet provides a safe and clean environment by hanging probes vertically and keeping connectors and probes separate with a continuous flow of filtered air. •

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product focus

Cygnus Medical

Oasis Flexible Scope Transport Trays Reusable containers used for soiled and clean scopes have the potential of transferring contamination from one container to another, and bags and transport pads don’t offer rigid protection. Cygnus Medical solves this problem with the Oasis Flexible Scope Transport Tray. A single-use tray that offers rigid containment without the threat of cross-contamination. By incorporating a reversible lid with “Clean Scope” printed in green on one side, and the biohazard legend printed in red on the other, the risk of reusing soiled scopes is greatly reduced. Unlike other transport methods that create an extreme amount of waste, a stack of 50 Oasis Trays fit into one compostable collection bag. In a landfill the trays quickly turn into dirt. Oasis allows hospitals to make clinically sound infection control choices without sacrificing the planet. For more information, visit www.cygnusmedical.com.

gSource

SQC Twist Drill gRack The SQC Twist Drill gRack (gS 98.8187) stores 7 gSource SQC twist drills, 1 each (sold separately) 1.1mm to 3.5mm [.045” to .138”]. The drill rack folds to close for convenient sterilization and storage. When opened, it converts to a tabletop stand for use in the operating room. Drill bit diameter and reorder numbers are marked inside rack for easy identification. •

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product focus

Hänel Storage Systems

Rotomat Automated Sterile Storage Carousel The Rotomat stores, tracks and manages sterile instruments and PPE in the OR, SPD and central supply. This sterile storage solution makes use of a room’s full height to save floor space, allowing hospitals to store more in less space. The Rotomat improves inventory control, productivity, ergonomics and inventory security with a real-time fingerprint of picks and stocks, par levels and expiration dates. The system integrates seamlessly with other hospital software platforms (CensiTrac, SPM, Lawson, etc.), is designed for maximum up-time with builtin redundant features allowing it to be run 24/7/365 and can be customized to any application.•

Healthmark SST-2136

The SST-2136 is sized for complete surgical sets. The SST-2136 is ideal for retrieval of OR and OB instruments. Also, it is the right size for high volume ERs. It is available in three material configurations with a maxium temperature of 285°F for all Steristrainers. • For more information, visit hmark.com.

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product focus

KARL STORZ

No-Wrap Sterilization Containers KARL STORZ No-Wrap Sterilization Containers help providers realize cost savings while protecting their equipment investment and reducing the environmental impact of reprocessing. These custom designed containers are a trusted system for protection of endoscopic instrumentation during sterilization, transport and storage. KARL STORZ wrap-free containers provide effective sterilization while reducing waste and enhancing efficiency by eliminating the need for traditional medical blue wrap required for use with traditional sterilization systems. •

Key Surgical Smart Tags

The need for proper identification and documentation of surgical instrument sets during storage and transportation has always been a vital part of the process. The increased frequency of loaned instruments means that sets should be managed with a well-planned loaned instrumentation process. Processes should be simple and easy to follow. Smart Tags from Key Surgical are designed to support the process at each facility. The tags, designed to attach to the tray/set, are conveniently pre-printed (Loaned, Vendor, Priority, Broken, Re-Run) or blank. They also include a barcode feature for additional tracking. • For more information, visit keysurgical.com/tags.

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product focus

Owens & Minor SurgiTrack

Owens & Minor’s SurgiTrack is an end-toend case management solution that delivers the full list of disposable products needed to perform each procedure combined with powerful reporting capabilities that transforms a perioperative supply chain. Through this process, SurgiTrack improves efficiencies and lowers costs so that OR staff spends less time on supply chain activities. With 900 manufacturers to choose from and 350,000 products available to put in kits, SurgiTrack helps provide operating rooms with supplies closer to the point-of-care. •

Turbett Surgical Inc. Instrument Pod

Dramatically improve throughput in the OR and SPD by eliminating non-valueadded tasks of wrapping trays, inspecting blue wrap and emergency re-processing of sets. Hospitals and surgery centers using the patented Turbett Surgical Instrument Pod increase revenue by spending significantly less time processing instruments and setting up the sterile field. •

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CE478

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continuing education

Bridging the GENERATION GAPS 38

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continuing education

BY Sheila J. Leis, MS, RN-BC n today’s diverse healthcare setting, there’s a lively mix of five generations:1

•

Veterans - born 1922 to 1946

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Baby boomers - born 1946 to 1964

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Generation (Gen) X - born 1964 to 1980

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Gen Y/Millennials - born 1980 to 2000

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Gen Z/iGeneration - born 2000 to 2012

With most Veteran caregivers now retired and Gen Zs just coming of age, baby boomers, Gen X, and Gen Y make up most of the workforce. But understanding the values and beliefs of Veterans remains important for two reasons: 1) Veterans make up a large part of our patient population; and 2) Many of this generation are involved in valued volunteer positions. Giving patient-centered care and promoting teamwork requires understanding the values, beliefs, and communication styles of all five generations. This course will help you understand the similarities and differences among the generations and help you work well with patients and staff of all ages. Quality care depends on professionals of all disciplines who bring expertise that arises from their generational experiences. People born around the same time develop attitudes, values, work ethics, and standards shaped by a common history of events, images, and experiences.2,3 Generations live through the same national and world events and enjoy the same music and cultural memorabilia; they start school and work WWW.ORTODAY.COM

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 45 to learn how to earn CE credit for this module.

Goal and Objectives The purpose of this continuing education course is to provide nurses, social workers, occupational therapists, respiratory therapists, EMTs and paramedics, and nursing assistants with insights they can use to work with various generations more effectively. After studying the information presented here, you will be able to: • Describe similarities and differences among the five generations found in today’s clinical setting. • Identify tactics that can help you collaborate with generations different from your own. • Explain ways to promote teamwork and partnerships among diverse patients, families, and staff members.

at about the same time.3-5 Generational commonalities cut across racial and ethnic lines. Spanning 15 to 20 years, each generation views the world in its own way. Collective life experiences shape what generations value, what they expect in relationships, and how they filter, process, and communicate information. Understanding generational tendencies helps you develop partnerships with patients, families, and staff. It makes the difference between misunderstandings, hurt feelings, and feelings of isolation June 2021 | OR TODAY

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continuing education and effective communication, mutual respect, and feeling like an important part of a team.

The Big Picture To gain insight into “the big picture,” review the “Five Generations,” which summarizes the key events, cultural influences, and core work values of each generation.

Five Generations 1. Veterans (also called Traditionalists or Silent Generation): born 1922 to 1946 Key Events • Great Depression • World War II • Korean War Cultural Influence • Rise of labor unions • Golden Age of radio, movies • National pride Core Work Values • Respect for authority • Hard work, stoicism in the face of higher work loads 2. Baby boomers: born 1946 to 1964 Key Events • Vietnam War • Space Race • Assassinations of John and Robert Kennedy, Martin Luther King Jr. • Watergate Cultural Influence • Civil Rights Movement • Women’s Liberation • TV, rock ’n’ roll • Drug use • Counterculture, hippies Core Work Values • Social consciousness • Teamwork • Competition, optimism • Willingness to work long hours • Love-hate relationship with authority • Lifelong learning 3. Gen X: born 1964 to 1980 Key Events • Challenger explosion 40 OR TODAY | June 2021

• End of Cold War • MTV • AIDS • First latchkey children Cultural Influence • Alternative lifestyles knowledge • Drug use continues • Ethnically diverse friends • Single-parent households • Technological advances (video games, cordless phones, internet, email) • Early exposure to TV violence, adult subjects Core Work Values • Life/work balance • Self-reliance • Technological literacy • Irreverent humor, informality • Risk taking • Lifelong learning • Want feedback • Pessimism, skepticism • Acceptance of diversity 4. Gen Y/Millennials: born 1980 to 2000 Key Events • Columbine shootings • 9/11 and anthrax attacks; random violence; bioterrorism; natural disasters (earthquakes, hurricanes, tsunamis); Iraq and Afghanistan wars • Globalization; economic recessions; financial fraud (e.g., Enron) • Privacy laws; uninsured and healthcare costs rise • Human genome mapped; highfidelity simulators; stem cell and genetic research • Sexually transmitted diseases increase • Same-sex marriage • Racial diversity (43% are nonwhite, highest share of any generation) Cultural Influence • The same as Gen X, plus: • Internet grows (Google, Facebook, Twitter, YouTube, reality shows, viral videos, security

cameras) Electronic books; online learning Smart phones, iPads, texting, and instant messaging are major communication tools. • Culturally diverse groups; alternate lifestyles • Concerns about cyber, school, and workplace bullying; civic duty; environmental concerns • Body piercings; tattoos; rap music • Few attachments to traditional political and religious groups • Connected to personalized networks of friends, colleagues, and like-minded groups through social and digital media • Burdened by educational debt and financial hardships • Marriages delayed Core Work Values • Life/work balance • Empowerment; authentic leadership • Safety, security, privacy, preparedness • Healthy work places; safety and learning cultures • Cultural diversity • Confidence, optimism • Teamwork • Authority figures not held in awe • Like change, multitasking, and need positive feedback • Casual dress, fun • Skeptical and less trusting of others 5. Gen Z (also called Gen M [multitasking], Gen C [connectedness], the Net Generation) and iGeneration (iPhone/iPad): born 2000 to 2012 Key Events • Similar to Gen Y, plus: • Members question whether Social Security will be available when they retire • Global financial crisis • High educational loan debt Cultural Influence • Similar to Gen Y, plus: • •

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continuing education •

Access to many resources (more than Gen Y) • More access to mentors • Parental pressure to succeed • Schools are more engaging • Never knew a time without digital technology • Challenge perceived social injustices Core Work Values • Similar to Gen Y, plus: • Life/work flexibility • Work online at a rapid pace • Share observations on various issues, media, and products • Digital technology is second nature When studying the generations, you can see many differences. For example, baby boomers value teamwork, but Gen Xers value self-reliance and like to work independently. Yet, there are similarities: Gen X, Y, and Z crave work/life balance and flexibility; baby boomers and Gen Y value teamwork. These commonalities can be a framework for talking with and motivating both patients and healthcare professionals and staff. Each generation has strengths that can be used to the team’s advantage. Veterans and baby boomers have years of knowledge to share. Gen Xers get to the crux of problems quickly. Gen Y approaches tasks with entrepreneurial spirits, working with tenacity while still having fun. Gen Z, the children of Gen Y, also shows these characteristics and are likely to be even more entrepreneurial than their parents.6 Although it is important to understand each generation’s shared experiences, do not get trapped by stereotypes. People in the same generation may have experienced an event very differently. For example, baby boomers recollect the Vietnam War differently. Some served in the military and protested the war before and/or after their service, or both, and returned home feeling isolated and traumatized. Each person’s experience is unique. Consider the importance of underWWW.ORTODAY.COM

standing generational attitudes in the following two examples. Sandy, 55, can’t understand 36-yearold Matt’s obsession with avoiding overtime. This is a classic case of generational conflict. Baby boomers like Sandy feel committed to getting the job done, no matter what. Gen Y nurses like Matt want work/life balance. Neither view is correct — it is a matter of different perspectives. Who is to say that it is more important to cover the shift than to play catch with your son in the backyard? Optimistic baby boomers may be frustrated with skeptical Gen X colleagues until they realize that skepticism is a Gen X trait. The key is to be nonjudgmental — just as we are nonjudgmental of patients. Who says one generation’s world view is more correct than another? Understanding generational viewpoints helps you enrich rather than obstruct relationships.

Working Together To minimize the effects of generational conflicts, try the following tactics. Find a common purpose: A mutual goal brings people together. It might be true that Gens Y and Z like to have fun at work and want work/life balance. And it might be true that baby boomers approach work more as a “mission” and may be workaholics. But put both groups in a room, toss in a few Veteran and Gen X, Y, and Z team members, and you’ll find an important common goal: quality patient care. Keeping the focus on the common goal of excellent care brings generations together. Communicate in ways that consider generational preferences: Gen X, Y, and Z feel comfortable with the latest technology and often prefer email and texting to other forms of communication. Veterans may throw their cell phones in a drawer and forget about them. Notes on the bulletin board and face-to-face meetings are better ways to reach them. Use

several methods, including email, meetings, and bulletin board postings, to reach all generations. In important situations, like communicating with patients at home or working with specific team members, discover individual preferences for communication. Include a mix of generations on work teams to get a variety of talent: Veterans tend to be conservative conformists oriented to the past, as well as logical thinkers. Baby boomers value learning about issues through group discussion. Pragmatic Gen Xers like to find solutions for problems quickly. Gen Y tends to embrace change and be optimistic, tenacious, and team oriented. Including representation from each generation, along with a leader willing to hear all views, enriches the team and leads to outcomes team members are likely to support. Make the most of the differences: Team-oriented baby boomers will likely perform well on committees. Clinical practice issues or quality improvement initiatives are ideal for the questioning, skeptical Gen X, Y, and Z clinicians. These generations enjoy participation and feedback as well as creativity and innovation. They are ideal for positions on technologyrelated committees and helpful in teaching others about technology. Avoid storytelling: We all create stories in our head based on what we believe is true. We are all Steven Spielberg directing our own movies. However, our interpretations are colored by our own perceptions and may be based on a faulty understanding of the facts. For example, imagine that four Gen Y team members are laughing and talking as they sit in the break room. A baby boomer may think, “They’re goofing off again.” In reality, the group is brainstorming on how to ensure better handoffs between the unit and long-term care facilities. Sociable Gen Y and June 2021 | OR TODAY

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continuing education

Z clinicians enjoy solving problems informally with peers. Of course, all generations must be sensitive to how their behavior appears to the public, patients, and other healthcare professionals. Keep a sense of humor and give credit when it is due. Recognizing generational strengths and laughing together at our human tendencies and imperfections reduces stress and bridges generational gaps. We may be from different generations but we’re all human. Think of the wisdom, recognition, and humor offered in the following quotes. My generation is not strong. My grandfather fought in World War II. I had a panic attack during the series finale of “Breaking Bad.” ─ Matt Donaher7 There was no respect for youth when I was young, and now that I am old, there is no respect for age — I missed it coming and going. ─ J.B. Priestly7 What we call a generation gap is usually the result of an interaction gap. ─ Unknown8

A Perfect Match In learning situations, such as orientation and skill acquisition, matching team members of the same generation is a good approach. These matches can encourage learning because both learner and teacher “speak the same language.” However, matching may be impossible for three reasons: 1) There is an unequal distribution of generations in the workforce;9 2) Veterans, boomers, and Gen Xers usually have the most experience; and 3) Gen Y and Z staff may not be seasoned enough to guide other clinicians in the management of complex patients and their families. However, they may be well suited to help peers of the same generation who need orientation on basic care management. When teacher-learner matches include people from different generations, each can learn much from the other; do not worry if you end up with a match of 42

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different generations. Of most importance in teaching-learning situations is ensuring that the personalities involved are compatible. Compatible personalities learn well from each other while incompatible ones spend more time struggling with frustration, hurt feelings, and misunderstandings than learning.10 Take advantage of generational inclinations. For example, the exposure of Gen Y members to team sports has made them excellent team players.9 Baby boomers and Gen Y enjoy learning from group discussions, which is good to know when developing education programs. A survey of 5,400 workers found that baby boomers, Gen X, and Gen Y share a common expectation of opportunities to learn, grow, and advance in their jobs. 11 Healthcare executives find that baby boomers and Gen Y share a lot so similarities in habits that those individuals may not even realize exits. 12 This bond between boomers and Gen Y may actually be historical, as noted in the following quote from historian and philosopher Lewis Mumford on generational bonds: Every generation revolts against its fathers and makes friends with its grandfathers.13 Gen Z is fast becoming the largest population group, and will comprise 32% of the global population by 2019, moving ahead of millennials, who will account for 31.5% of the global population. Gen Y/ Millennials will continue as the largest portion of the population in the world’s four largest economies (United States, China, Japan and Germany).14 Because Gen X, Y, and Z were exposed to diverse groups and lifestyles more often, they are likely to be naturally less judgmental in caring for patients from various patient populations (e.g., families with same-sex parents, multiracial families, and people with piercings and tattoos). Their ability to accept others also helps them work well with healthcare workers and professionals from various family and cultural

backgrounds. Accept differences, but only to a point. Gen X, Y, and Z tend to dress more casually. Veterans and baby boomers may be turned off by body piercings and purple hair. Younger generations may resist clothing restrictions. Remember, it is what is inside that counts. Also remember that managers must consider patients’ perceptions. For example, patients often believe sloppy professionals are unqualified. All healthcare workers need to remember that there is a good reason for dress codes: Research shows that following a dress code not only affects patient outcomes, it affects the image of the profession.15

Tailor Teaching If you are assigned to help new staff members develop their clinical skills, tailor your teaching to the generation as follows. Veterans: This generation likes formality in interpersonal interactions and enjoys learning from authoritative experts in structured teaching sessions. Present facts and use lessons from experience as examples. Veterans typically do not question authority figures — invite questions and check frequently for understanding. Realize that people in this group are considered “digital foreigners.” They had no experience with technology growing up, but we must respect their experience. They may not be comfortable with technology, but this adaptable generation can, with repeated hands-on practice, become proficient. Be patient. Asking Gen X and Gen Y members to coach Veterans in the use of technology represents an opportunity to bridge the generations.3 Baby boomers: Many boomers prefer formal, organized education rather than self-study technology techniques. Unlike younger generations, who see learning as a tool to achieve goals, baby boomers value learning for learning’s sake. They enjoy learning in a relaxed, caring, and respectful atmosphere, and tend to WWW.ORTODAY.COM

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continuing education

be highly motivated and driven. Baby boomers are “digital immigrants” (they were not born into the digital age, yet many of them embrace digital technology, even with limited skills). Some Veterans and baby boomers never used technology and resist it altogether, in which case they are considered to be digital foreigners (they come from another era and do not want to learn about the new). Baby boomers have different views about learning, which may lead to conflict with Gen X, Y, and Z. Gen X: Born just as it was becoming normal to own home computers, people in this generation are well-adapted “digital immigrants.” Gen X tends not to focus on the past (lessons learned) but on results that can be achieved. They want to learn what they need to know and lose interest in information that is just “nice to know.” With this group, deliver information in small chunks and provide regular feedback. Members of this generation learn better by doing than by reading. Written material should include bullet points and summaries to accommodate a generation used to scanning lots of information for relevance. Members of this fiercely independent generation respond well to self-study approaches that let them learn at their own pace and on their own time. Do not forget to include time for fun. Use humor and be relaxed. Gen Y and Z: Born into the digital world, Gen Y and Z members are “digital natives” (for them, there never was a time when computers and technology were not part of everyday life). Computers and video games shaped their learning style.4 Because this generation has used the internet most of their lives, they have developed a preference for random browsing and rapid information retrieval. Gen Y members are less interested in learning “facts” and more interested in learning how to find and retrieve information when needed.3 Realize that while many of this group know a lot about the internet, some of WWW.ORTODAY.COM

them are not as aware of the implications of the internet (e.g., many have to clean up their Facebook pages before applying to schools and jobs). Gen Y and Z are used to instant communication with cell phones, text messaging, and wireless connectivity. They process information rapidly, which may result in shorter attention spans.6 They like learning through discovery, expressing their views, and incorporating their experiences into their learning. Because most Gen Y and Z members are technologically savvy, many in this group value creativity more than technological skills. Foster creativity with members of this group and challenge them with new information. Be ready for questions and give plenty of feedback. Set up daily meetings, but also give instant feedback frequently. Do not feel like you must have all the answers. Instead, ask, “Who wants to find out and let us know?” This provides an opportunity for this group to shine. Gen Y and Z patients and staff do not think linearly; rather, they display a random thought process that wanders haphazardly before integrating into a coherent pattern and drawing a conclusion. Use graphics instead of printed text, and let them learn by trial and error when possible. These clinicians need lots of time for orientation and skill acquisition. They are accustomed to a busy schedule and get bored easily. Move quickly to keep their interest. Remember that Gen Y and Z grew up with forensic investigations on TV — they usually understand when you ask, “What’s the evidence that supports these interventions?” Gen Y and Z healthcare patients and workers may struggle with social skills. They are used to electronic communication and texting, and may feel lost in face-to-face situations. Think about the following example of one Gen Y learner’s challenges related to social skills that was posted on an educator listserv: “I sent one of my students in to inter-

view a patient about being in the ICU. The student sat there looking uncomfortable and had very little to say. When I asked her what happened, she said, “I just wish I could have texted him.” This story seemed absurd to many on the listserv. But this student was speaking from the experience of Gen Y. Clearly, younger generations may need help to build their confidence and skills in face-to-face communications. Generations together: Use the above approaches to create a diverse group. For example, provide Gen X and Y learners with interactive digital modules to learn about a piece of equipment and allow plenty of hands-on time. Provide extra time for less tech-savvy learners, such as Veterans and baby boomers, to practice with equipment.

Motivating for Success Whether you are working with patients, students, or staff, you can use the following methods to mentor and motivate. Veterans: Show respect and an interest in what they have to say. Acknowledge that they have experiences from other generations can benefit. Ask them how to perform a task or procedure. Baby boomers: Ask them about themselves and their families. Give them recognition for their work. Be delicate with criticism; first, find something to praise. Remember that baby boomers like group consensus. They respond well to positive feedback when reaching goals or when they are faring better than others of a similar age. Gen X: Provide constructive feedback. If you are in the position to do so, give them some freedom in setting their schedules. Keep in mind that they may work around the rules rather than tell you they are unhappy with them. Gen Y and Z: Find out their goals and how to provide support. Provide strong mentorship and step-by-step June 2021 | OR TODAY

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continuing education

guidance. These individuals may be reluctant to speak up when a mentor or a unit is not a good fit, so be alert to the signals, such as not asking many questions. Provide coaching in face-to-face communication to overcome dependence on technology for communication.

It’s How You Look at It ome people see the glass half empty, S others half full. Similarly, some healthcare practitioners view generational differences as hurdles while others view them as strengths that open a world of possibilities for collaboration. Leveraging the strengths of each generation gives the team a boost in its quest to deliver quality care. EDITOR’S NOTE: Diana Halfer, MSN, RN, Cynthia Saver, MS, RN, and Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, past authors of this educational activity, have not had an opportunity to influence the content of this version. Relias LLC guarantees this educational activity is free from bias. SHEILA J. LEIS, MS, RN-BC, is a fulltime 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.

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beall/8-key-differences-between_b_12814200.

articles/2018-08-20/gen-z-to-outnumber-

html Published November 5, 2016. Updated

millennials-within-a-year-demographic-trends.

Nov. 6, 2017. Accessed July 8, 2019.

Published Aug. 20, 2018. Accessed July 8, 2019.

7. Quotations about generations. Quote Garden Web site. http://www.quotegarden.com/

15. Sulanke J, Shimp K. What works: Imple-

generations.html. Accessed July 8, 2019.

menting an evidence-based nursing dress code to enhance professional image. Am

8. Vinsomes. Vinsomewonders. https://vin-

Nurse Today. 2015; 10(10). https://www.ameri-

somequotes.files.wordpress.com/2013/11/

cannursetoday.com/works-implementing-

generation-gap.png. Accessed July 8, 2019.

evidence-based-nursing-dress-code-enhance-

workforce: Challenges for the health care

professional-image/. Accessed July 28, 2019.

industry workforce. John J. Heldrich Center

9. Brack J. Maximizing millennials in the

for Workforce Development Web site. https://

workplace. University of North Carolina Kenan-

www.heldrich.rutgers.edu/sites/default/files/

Flagler business school Web site. http://ex-

products/uploads/NTAR_Issue_Brief_Aging_

ecdev.kenan-flagler.unc.edu/blog/maximizing-

Workforce_Health_Care_Final.pdf. Published

millennials-in-the-workplace. Published Nov. 6,

March 2013. Accessed July 8, 2019.

2014. Accessed July 8, 2019.

44 OR TODAY | June 2021

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CE478 Clinical Vignette Lindsay, a 25-year-old new graduate, is starting work on your healthcare team. You are assigned to be her preceptor. 1. Which tactic would best help you in mentoring Lindsay? a. N ot monitoring her too c. Asking her to conduct a closely as she performs procedure to see whether simple procedures she applies evidence b. G iving her feedback d. Asking her about her about how she compares career goals and how you with those of a similar can support them age 2. You are preparing Lindsay to learn a complex procedure. Which method would likely work best to help Lindsay learn? a. P roviding a lecture in c. G iving her a brochure a classroom, and then about the procedure to testing her knowledge keep handy b. D irecting her to d. D iscuss your experiences complete an interactive with performing the digital module on the procedure as a learner procedure 3. Margaret Jones is a 66-year-old supervisor working the same shift as Lindsay. To help Lindsay develop a good relationship with her supervisor, you should advise Lindsay to: a. A ddress her as “Margac. B reak the rules to show ret” to build camaraderie the supervisor she is b. C all her “Ms. Jones,” creative unless told otherwise, to d. N ever volunteer for show respect overtime to demonstrate her independence 4. Lindsay has been working for three months, and you’d like for her to become more involved in the organization. Which committee is likely to be a good fit for Lindsay? a. Technology assessment c. Clinical practice b. Quality improvement d. Staff retention

Clinical VignettE ANSWERS 1. Answer: D, Lindsay is a member of Generation Y. One way to mentor this generation is to learn about their goals so you can provide support. 2. Answer: B, Lindsay is a “digital native,” so she would be most comfortable with an interactive computer program. 3. Answer: B, Ms. Jones is of the Baby Boomer generation, which values respect for authority. 4. Answer: A, Lindsay’s expertise in technology makes her an ideal candidate for the technology assessment committee. WWW.ORTODAY.COM

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COVID

COMPLICATIONS PANDEMIC INCREASES WORKPLACE STRESS, ANXIETY & BURNOUT By Don Sadler The past year-and-a-half has been a time unlike any that most nurses have ever seen due to the upending of the nation’s health care system by the COVID-19 pandemic. As a result, the health care profession has dealt, and is still dealing, with unprecedented levels of stress, anxiety and burnout among all nurses, including those in the OR. Stress, depression, anxiety and even suicide were already high among health care workers before the pandemic, says Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative services at Anmed Health. “We were dealing with two times the rate of suicide among physicians and over 20 percent of nurses were suffering from PTSD,” she says. “The pandemic is presenting clinicians with even greater workplace hardships and moral dilemmas that are likely to exacerbate existing levels of burnout and related mental health problems,” Dennis adds. “How they cope with these emotions can affect their well-being, the care they give to others and the well-being of the people they care about outside of work.”

Roller-Coaster Emotions Looking back to the beginning of the pandemic, perioperative nurses shared WWW.ORTODAY.COM

the same type of roller-coaster emotions felt by all nurses, notes Phyllis Quinlan, Ph.D., RN-BC, the career coach for the Association of peri-Operative Registered Nurses (AORN). “They were wondering, ‘Is this real? How can this be happening? And how am I going to care for patients and keep my family safe?’ ” says Quinlan. “These questions were soon replaced by the reality that their life and nursing practice were going to be seriously altered for an indefinite period of time.” Most perioperative nurses were concerned about keeping the ORs open, the potential of deployment to a place beyond their comfort zone and skill competency, and the ever-looming chance of being furloughed. “Some spoke about being very unsettled while others were struggling with real fear,” says Quinlan. “Still others struggled with what Dr. Brene Brown calls ‘comparative suffering,’ ” Quinlan adds. “Once they became aware of the enormity of what was being asked of their colleagues, they found themselves battling self-imposed guilt for not ‘suffering’ equally and feeling as though they got a ‘free ride.’ ” Of course, there have also been nurses experiencing the grief and bereavement associated with the loss of a family member, friend or colleague to the pandemic. “There is no timetable for working through loss and grief,” says Quinlan. June 2021 | OR TODAY

“There is no timetable for working through loss and grief. It is a very personal experience that can be triggered long after the actual loss of a loved one.” – Phyllis Quinlan, Ph.D., RN-BC, the career coach for the Association of peri-Operative Registered Nurses (AORN)

“It is a very personal experience that can be triggered long after the actual loss of a loved one.” “We should not hesitate to offer specialized grief counseling before a staff member becomes overwhelmed,” Quinlan adds. In thinking back to the beginning of the pandemic, Dennis says she initially thought COVID-19 was just another virus. “I definitely was not prepared for the impact,” she recalls. According to Dennis, experiencing or witnessing traumatic events impacts everyone differently. “Sometimes the stress can be managed successfully but other times individuals may experience clinically significant distress or impairment, such as acute and post-traumatic stress disorder or secondary traumatic stress,” she says. “Compassion fatigue and burnout may also result from chronic workplace stress and exposure to traumatic events during the COVID-19 pandemic,” Dennis says.

A Myriad of Feelings “Nurses are human too and have experienced a myriad of feelings and emotions during the pandemic,” says David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC. “Bereavement, isolation and fear have triggered many of the mental health conditions that have been reported as a result of the pandemic.” “Unfortunately, some health care 50 OR TODAY | June 2021

providers are managing their stress with increased levels of alcohol and drug use,” Taylor adds. Taylor is concerned that we have yet to see the worst of these symptoms among nurses. “Nurses suited up for work every day and continued to care for the sick,” he says. “I believe many of their emotional responses and symptoms due to the pandemic will be delayed and have a profound impact on the profession going forward. PTSD will plague some for years to come.” According to Taylor, nearly 30 million surgical procedures were canceled or postponed worldwide because of the pandemic. “As a result, many perioperative nurses stopped being OR nurses and began caring for patients with and without COVID-19 on inpatient units and in the ICUs,” he says. “Many of these nurses who stepped up to the challenge during the crisis are now returning to their ORs and working harder than ever to help their organizations catch up with the backlog of elective procedures,” says Taylor. Some nurses have not had a chance to process their grief or other mental and emotional strains as a result of the pandemic because the demands placed upon them are not over yet, Taylor adds. “I’m afraid many nurses will experience longterm effects as a result and each will process their stressors differently and at varying times,” he says.

High Stress Levels Karen Reiter, RN, CNOR, RNFA, CASC, is the CEO of DISC Surgery Center in Newport Beach, California. She recalls the intense stress many nurses experienced at the onset of the novel coronavirus outbreak. “At the beginning of the pandemic, the stress level among our nurses was high,” she says. “They were challenged with their children at home and wondering if it was safe to come to work and were they doing everything correctly to protect themselves and their family from the virus.” Not surprisingly, her staff was also worried about whether the ASC would remain open or have to shut down. “Money was definitely a big concern,” she says, but her facility remained open throughout the pandemic. “We also continued paying any full-time staff members who caught the virus for the entire time they were out sick, so their families were not harmed financially.” Reiter says there were lots of tears over the past year as well as increased friction and fatigue among her staff. “We were desperately short staffed with nurses going out sick and our per diem staff who worked in the main hospitals no longer being available to us,” she says. Some positive experiences did emerge from the ordeal. “It created more of a team,” says Reiter. “We all pledged to live a WWW.ORTODAY.COM

certain way to reduce the risks to ourselves and each other. Also, one of our owners used his charity to charter a 747 to China and bought back 184,000 N-95 masks for use in our ASC, and then he donated the rest to hospitals.”

Holistic Resilience Dennis stresses the importance of holistic resilience when it comes to caring for oneself in the midst of these trying circumstances. “The question is: How do we care for ourselves so that we might be able to care for others?” she says. “On an airplane they tell you to put the oxygen mask on yourself first so you can help others, but this goes against the grain for many nurses,” Dennis adds. “But if you don’t, there won’t be anything left in the tank. As nurses, we have to rest, recharge and sleep.” There’s an important distinction between resilience and endurance, says Dennis. “Endurance is the ability to withstand hardship or adversity over an extended period, while resilience is the ability to adjust to, recover or grow from it,” she explains. “While we’re in the midst of the intensity of the pandemic, it’s OK simply to endure.” “But endless endurance leads to collapse,” says Dennis. “When we’re working this hard, resilience means coupling the intensity of our work with periods of relaxation and recovery.” Dennis encourages nurses to make time for activities that allow them to disengage from the intensity and rejuvenate their mind and body. “Sufficient sleep, healthy eating, regular exercise and moments of quiet all help balance out the stress of our work,” she says. To help nurses cope with the stress, anxiety, burnout and other factors resulting from the pandemic, the American Nurses Foundation and a consortium of other health WWW.ORTODAY.COM

care organizations teamed up to create the Well-Being Initiative. “This is a multi-tiered approach to support the mental health and well-being of America’s nurses who are on the frontline of diagnosing, treating and caring for the individuals and families impacted by the COVID-19 pandemic,” says Allison Nordberg, program director of the American Nurses Foundation. The feedback provided by nurses who have participated in the WellBeing Initiative programs has been overwhelmingly positive. “Nurses have reported that the programs have given them the opportunity to reflect and feel supported,” says Nordberg. “There are several multi-week programs which have been shown to decrease participants’ stress levels and have a positive impact on nurses even after the program concludes.” More information about the Well-Being Initiative is available at nursingworld.org/thewellbeinginitiative.

Staying Optimistic Quinlan believes that the biggest emotional and mental challenge for perioperative nurses is trying to stay optimistic and resilient in the face of relentless and persistent uncertainty. “We are not built for navigating uncertainty for this length of time,” she says. “While we are accustomed to powering through for days, weeks and on rare occasions even a month, this challenge has been ongoing for more than a year now and has taxed everyone to their limit.” Dennis offers some suggestions to help OR nurses and perioperative nursing leadership cope with these challenges and increase their resilience. “First, there has to be open communication among coworkers and their supervisors about the stress they’re feeling,” she says. “Everyone needs to feel free to talk openly about how the pandemic is affecting

them professionally and personally.” Other suggestions from Dennis include the following: • I dentify factors that cause stress and work together to identify solutions. • Ask about how to access mental health resources in your workplace. • R emind yourself that everyone is in an unusual situation with limited resources. • R ecognize that you are performing a crucial role in fighting this pandemic and that you are doing the best you can with the resources available. • I ncrease your sense of control by keeping a consistent daily routine when possible – ideally, one that is similar to your schedule before the pandemic. • Try to get adequate sleep and make time to eat healthy meals. • Take breaks during your shift to rest, stretch or check in with supportive colleagues, coworkers, friends and family. • G et as much exercise as you can and spend additional time outdoors. • Engage in mindfulness techniques such as breathing exercises and meditation. • I f you are being treated for a mental health condition, continue with your treatment and talk to your provider if you experience new or worsening symptoms. “Amidst adversity, there is always an opportunity to learn and grow,” says Dennis. “But after the pandemic ends, we do not simply want to return to the way things were before, which included more than one-third of nurses suffering from burnout and up to 20 percent reporting symptoms of PTSD.” “We want to do better,” Dennis stresses. “We have challenging and important work to do, and the world needs us now more than ever.”

June 2021 | OR TODAY

Spotlight On:

Paula Axtel

, RN, BSN, CNOR

Interim Senior Director of Perioperative Services with St. Mary Medical Center of Long Beach, California

By Matt Skoufalos lthough motherhood awakened the feelings of caregiving that first led Paula Axtell to consider pursuing a career in nursing, it was confidence in her academic abilities that inspired her to believe she could be successful at the job.

“After I started having children, I felt like a natural caregiver,” Axtell said. “My own test was, I took a medical terminology class and a certified nursing assistant class. I felt like if I could do that part of the work, I could do the rest.” “I felt like having a college degree was necessary in my life, and I wanted to be a good role model for my children,” she said. Her college degree empowered her to eventually become the interim senior director of perioperative services with St. Mary Medical Center of Long Beach, California. Her nursing journey, however, actually began with some weekly 700mile treks. While her family was stationed at U.S. Army Fort Riley in Kansas, Axtell and a 52

OR TODAY | June March2021 2021

trio of other military wives enrolled in nursing school at Kansas Wesleyan University and commuted there together, an hour each way, throughout the program. When her then-husband was transferred to Fort Sill, in Lawton, Oklahoma, Axtell took a year off, but returned to complete her program at Kansas Wesleyan as a commuter. Once a week, she made the 700-mile round trip from Oklahoma, staying with friends from Sunday through Wednesday while she went to classes. To boot, Axtell was pregnant with her fourth child at the time. “There were a few times that I was making that drive back, and I would pull over and vomit beside the road, and clean myself up and keep going,” Axtell said. “It just became part of what you do to push through.” More than once, she felt like she was on the verge of quitting. But some timely intercession from an instructor – “You’ve got this; all you have to do is show up” – helped inspire her to stay the course. “I am so thankful today for those words,” Axtell said. “It’s changed my life.” After completing her associate’s degree, Axtell went directly into the operat-

ing room at Southwest Medical Center in Lawton, “because I knew that was where I belonged.” “I never looked back from there; it’s always felt like home [in the OR],” she said. “These are the most vulnerable times that our patients will ever experience; they’re truly putting their lives in our hands. We have to ensure their safety.” Axtell’s commitment to providing the highest quality of care in the safest manner was honed from the earliest days of her career; even now, she said, “That’s the message I send to my team.” “When it comes to safety and quality, we never waver,” she said. “That’s a hard line, and I think teams need to hear that. They need to know that it’s important, and it’s at the forefront of everything we do every day.” “There’s so much of what we do in the OR that could easily become redundant,” Axtell said. “If you don’t stay on your toes, it’s easy for your practice to become complacent. We have to remind our teams that this is someone’s mother, someone’s sister, someone’s child. We treat our patients the way we would want to be treated.” WWW.ORTODAY.COM

Paula Axtell’s nursing journey included a 700-mile round trip commute to college, a mission trip to Uganda and a personal tragedy. Away from work, she enjoys spending time with her grandson Caleb.

After three years in Lawton, the family was transferred to Korea for a year; when they returned, Axtell joined Jackson County Memorial Hospital in Altus, Oklahoma. From Oklahoma, they moved to Albuquerque, New Mexico while her mother-in-law battled terminal cancer, and Axtell took on multiple roles with the Lovelace Health System there. “That’s really where I got my start in leadership, and had the opportunity to grow as a leader,” she said. “I worked with some really good leaders who saw potential in me, and helped me advance into managerial positions.” In her managerial roles, Axtell works to build relationships with her staff and find ways to strengthen partnerships among members of her team. She counts that skill among the most critical to her roles in nursing leadership today. Conferring a sense of presence and support to those she supervises and under whom she works instills their confidence in her work among a variety of stakeholders. “You have to listen actively,” Axtell said, “you have to be present; you have to gain that respect and build those relationships. When you start to partner, then it gives you the ability to interact more collaboratively.” “The relationship you have with surgeons is completely different from that with the nurses on the floor,” she said. “They’re just people too. They expect the OR and their team to be ready for procedures. They want you to answer questions. They want you to critically think. And as long as you do that, you’ll gain their respect, because we’re a team.” Axtell eventually parlayed her leaderWWW.ORTODAY.COM

ship experience into interim assignments at health care facilities across the country; since 2016, she’s been working on shortand long-term contracts in a variety of settings from Idaho to California. By the spring of 2017, Axtell had gotten divorced, and was working to complete her bachelor’s degree from Grand Canyon University; working full-time and writing papers at night, “just trying to figure out who I really was.” “For 30 years of my life, I had been a wife and a mother, and now I was just me, an empty-nester, a student, single and working full-time,” she said. “But I had some of the best times in my life, and some of the best growth that I had personally and professionally.” Axtell also had the unfortunate experience of seeing nursing care from the patient perspective after her oldest son was fatally injured in a car accident. While donor services worked to find recipients for his organs, the attention that the hospital staff at HonorHealth Deer Valley showed him refreshed her perspective on her chosen profession. “They were so wonderful,” Axtell said. “We waited in ICU for four days to find organ recipients, and his level of care never changed. He had such severe head trauma that he couldn’t sustain life on his own; but for moments during that time, I looked at the monitor and I looked at him.” “If I had to remind myself that he’s not here and there’s no hope, what must it feel like for laypeople who look at the monitor and don’t understand?” she said. “That part was a little challenging, at times, to accept.”

As a travel nurse, Axtell didn’t expect to find a traditional level of support in her grief from coworkers at Glendale Memorial Hospital, the facility where she was working at the time. Yet those peers supported and embraced her unexpectedly, providing a comfort she hadn’t anticipated. “People who didn’t even know me just came up and hugged me,” Axtell said. “It was such a comforting feeling. I’ve always felt like God picks me up and puts me where I’m supposed to be, and that’s how I choose my contracts and my assignments. That one for sure was where I was supposed to be.” When she’s not working, Axtell enjoys traveling for fun as well as for work. Five years into her career on the road, she’s still invigorated by the opportunity to learn, explore and connect with people along the way. And, in September 2019, she got to realize a lifelong travel dream: participating in a medical mission to St. Mary’s Hospital Lacor in Gulu, Uganda. “That’s why I do this,” she said. “It gives me the opportunity to give back. And everywhere I go, I’m still learning. It’s hard to leave the teams when you work so closely with them, but I have so many new colleagues and friendships that I’ve met along the way. It’s a wonderful experience.” “My son did leave me a gift: a beautiful little grandson, Caleb, and he’s three now,” she said. “I think maybe finding a permanent position at home where I can finish my master’s might be the next thing on the agenda for me.”

June 2021 | OR TODAY

OUT OF THE OR fitness

Plyometrics, Slowing Down Before Speeding Up By Miguel J. Ortiz have always told my clients that it’s important to learn how to slow down before you speed up or move fast. For example, Ferraris don’t have a Fiat suspension. They have a Ferrari suspension because the speed of the car requires balance.

Another example is snow skiing. Before one decides to ski down the slopes fast they must first learn how to slow down. Unfortunately, not enough people apply this to their workout routines and they get inconsistent results, injuries and/or joint pain. Not to mention the exercises that involve jumping, like a box jump, tend to make people feel either excited because it looks fun or scared to even try it. Regardless of how you feel, I want to make sure you’re more confident about your jumping ability. I want to provide some simple tips and warm up exercises that will be sure to have you jumping in no time. Whether you’re a beginner, or just need a refresher, utilize these exercises to keep your body ready for anything. Before we take off, we need to understand what bounding feels like for the ankle. Jumping rope is a simple movement that helps get the ankle joints active 54

OR TODAY | June 2021

and the knees soft. Being able to control your ankles with light bounding movements that include landing softly on the balls of your feet, like jumping rope, will help when it comes to future plyometric exercises. If you’re unable to do jumping jacks or jump rope, I recommend starting there and building up endurance before working on power. The second movement is a kettle bell swing. One reason this movement can help is because of its ability to focus on core stability while ensuring quality glute activation. When performing plyometrics we are generally looking for quality hip extension and that requires strong glutes. When it comes to power and box jumps, we need strong glutes. Because we’re looking to leave the ground, having quality body awareness is as important as controlling a kettle bell. It requires momentum control like a box jump or general plyometrics. We have to be able to control the power that we want to produce. The third exercise is known as a depth jump. What’s great about this exercise is that we learn to work on the landing or absorption of the movement from a short distance. I would start on top of a 45-pound plate like or 6-inch platform. It is vital to land soft and to absorb the

movement. From the elevated position, we can step forward and absorb into a squat position, distributing weight evenly through the legs and core so that when landing it does not bother the ankles, knees and hips. The fourth, and last movement, is a squat jump reset. This movement is where we finally begin to leave the ground before even attempting to jump on anything. We start by absorbing one’s body weight into a squat and then jump into the air – using one’s arms – just like you would during a box jump. The only difference is that when one comes down to land the weight can be absorbed into the ground. The key is to land soft like a cat, come to a standing position and reset for another rep. Use these movements wisely and remember that a simple warm up can go a long way. By slowing down, you can speed up. You are definitely going to do your body and joints a huge favor. 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. WWW.ORTODAY.COM

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OUT OF THE OR health

New Biomaterials Can Be ‘Finetuned’ for Medical Applications esearchers in the UK and the United States have succeeded in “fine tuning” a new thermoplastic biomaterial to enable the rate at which it degrades in the body and its mechanical properties to be controlled independently.

The material, a type of polyester, has been designed for use in soft tissue repair or flexible bioelectronics by a team at the University of Birmingham in the UK and Duke University in the U.S. Materials that successfully replicate the necessary elasticity and strength of biological tissues, but which also biodegrade over an appropriate timescale are extremely difficult to engineer. This is because the chemistry used to produce a material’s mechanical properties will also typically govern the rate at which it degrades. In a new advance, the team has now shown how the addition of succinic acid – a product found naturally within the body – can be used to control the degradation rate. In a new study, published in Nature Communications, researchers showed how the polyester biomaterial degrades gradually over a period of four WWW.ORTODAY.COM

months, with healthy tissues growing into and eventually replacing the implant. Tests in rats were also carried out to confirm the material’s biocompatibility and safety. By varying the amounts of succinic acid, the team could control the rate at which water penetrates the material and hence the degradation speed. Usually, the structural changes that increase degradation speed would cause a loss of strength, but this material has been designed with specific stereochemistry that mimics natural rubber and allow its mechanical properties to be finely controlled. This means any loss of strength can be compensated for by making suitable stereochemical adjustments. This is a significant advance that has so far not been achieved in any other degradable biomaterial. Co-author of the study Professor Andrew Dove explains, “Biological tissues are complex with varying elastic properties. Efforts to produce synthetic replacements that have the right physical characteristics and that can also degrade in the body have been ongoing for decades. Part of the challenge is that a ‘one-size-fits-all’ approach doesn’t work. Our research opens up the possibility of engineer-

ing biological implants with properties that can be fine-tuned for each specific application.” Professor Matthew Becker, who holds dual appointments in chemistry and mechanical engineering and materials science at Duke, notes that the biomaterials and regenerative medicine communities have been severely limited to a few materials which lack the diversity of properties reported in this study. “The materials we have developed offer a real advance in the ongoing search for new biomaterials,” Becker said. “The tunable nature of the material makes it suitable for a range of different applications, from replacement bone to vascular stents to wearable electronics. Additional work to prove the biocompatibility of the material and its use in more advanced demonstration is ongoing.” The research was funded by the National Science Foundation, the John S. and James L. Knight Foundation, the European Research Foundation and the National Health and Medical Research Council of Australia. The technology is the subject of international patent applications filed by the University of Warwick and Akron University. June 2021 | OR TODAY

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OUT OF THE OR EQ factor

Have You Ever Been Mismanaged? By daniel bobinski, M.Ed. ometimes when I do a workshop, I’ll ask attendees if they’ve ever been mismanaged. If I ask that question, almost all the hands in the room go up. Tragically, this phenomenon is not rare, and it’s often a factor in someone deciding to find work elsewhere.

In early 2020, Business.com published an article on why people leave a company, and I think if you examine the top 10 reasons, you’ll see most of them have to do with being mismanaged. • Their work arrangements are not flexible • Their boss lacks empathy • They feel disengaged • They feel undervalued • They feel underutilized • They feel overstressed/overworked • They have no opportunities to advance • They’re burned out • The company’s culture is poor • They feel a lack of trust/autonomy First, notice that money does not appear on the list. This alone should be an eye-opener for managers. But in my opinion, it’s the second bullet point that’s the fulcrum for almost every other bullet point on the list: bosses lacking empathy. This is not a difficult fix. If managers understood emotional intelligence WWW.ORTODAY.COM

better, they would be able to demonstrate empathy. And if they had empathy for their team members, they’d be much better at understanding the needs of those team members. Having emotional intelligence would enable managers to be aware of when their people felt disengaged, undervalued or underutilized. They’d also know when their team members felt stressed, overworked or burned out. Also, managers would recognize when their company’s culture was impacting employee morale, which also impacts workplace trust. In other words, managers who acquire and practice emotional intelligence could eliminate three fourths of the reasons people feel mismanaged and leave their jobs. Sadly, those who need emotional intelligence the most often want it least. Too many managers ignore learning about emotional intelligence because it has the word “emotional” in it, and they think it’s a bunch of fluffy nonsense. Nothing could be further from the truth. In the early 1990s, researchers went to 200 companies worldwide in search of the difference between average and top performers. They found that in managerial positions and in jobs requiring technical skills, twothirds of the difference between average and top performers was an ability to understand and practice emotional intelligence. Emotional intelligence (otherwise

known as emotional quotient or EQ) is even more important in leadership and professional positions. The researchers found that four-fifths of the difference between average and top performers at those levels is emotional intelligence. Think about it. If a manager had solid self-awareness of his or her strengths and blind spots, plus the ability to exercise good self-management skills, he or she would have a solid EQ foundation. From there, he or she would need to build what I call “social awareness,” and then good “relationship management” skills. There’s much to unpack there, so I will break down these components into specific actions for learning EQ in the next issue.

Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him through his website, MyWorkplaceExcellence.com, or his office at 208-375-7606.

June 2021 | OR TODAY

OUT OUTOF OFTHE THEOR OR recipe nutrition

Food Starts with Soil By KIRSTEN Serrano gave a talk recently and was asked to give a list of 5 things not to eat. The truth is, I dread questions like that because they want a soundbite, not substance. Instead of me rattling off a 5 “bad foods” list, I challenged the group to eat closer to the soil. Real food starts with soil. It is a concept that is simple yet profound.

The closer the food is to soil, the better it is for you. Instead of “good” and “bad” foods, start by eating real food. The good and the bad then sort themselves out. Carrots come from the earth. Chicken breasts do not just appear shrink-wrapped and ready to go. Most kids have no idea where food comes from. Many, many times, I have had to identify my produce for the grocery store cashier. It is not their fault, and it is not yours either. No one is teaching us about food. We have disassociated our food from soil and for good reason. Modern food life is fast, convenient, processed and packaged. It is ready to go and often does not look like anything that came from the earth. Eating for health truly means eating closer to soil. Try to reduce the steps, locations and processing that comes between you and your meal. When you are shopping and eating, think about that food’s chain of custody. The shorter a food’s chain of 60 OR TODAY | June 2021

custody, the more nutrient-packed it usually is. Consider a peach. On one end of the peach food-quality spectrum, if you will, you have the perfect peach. Maybe you pull it off your very own tree. At the other end, imagine a peach-flavored gelatin cup. There are multiple things going on here. First, that whole peach has a truly short chain of custody. You picked it yourself and enjoyed it at its height of flavor and nutrition. You witnessed it springing from the soil. The gelatin cup ingredient list is long, likely does not have any actual peaches in it, and you cannot even begin to tease out the chain-of-custody of all those ingredients. Most certainly you cannot imagine it having anything to do with soil. Cultivating a life with food that is close to the soil is not a soundbite. It is a direction to head. You can start heading that way slowly. Here are a few ideas to get you started. • Shop the perimeter of the grocery store. That is where the whole foods are. Produce, dairy, meat, bakery. • Unless you have money to burn, cook. • I recommend not paying much attention to claims on packages. There are a few label designations that do mean something, and even more that mean very little. You will always be further ahead looking at ingredient lists. Food is not

healthy because it is labeled natural, gluten-free, vegan or anything else. It is healthy because of what is in it. • When there is an ingredient list, do you understand what is on it? By the time you get to the second or third mystery ingredient, you are starting to wade too deep into the sea of simulated food. • Grow something. Anything really. A pot of herbs on your porch is fine. The point is to make the connection between soil and food. • Connect with a farmer. They are the ones with the food after all. Keep that food chain-ofcustody short! Convenience is great, but do not sacrifice your health for the sake of it. It is a terrible trade. Making food easier to prepare and eat is not a problem. Making completely new foods and making foods “better’’ through ultra-processing is a problem. Kirsten Serrano is a nutrition consultant, chef, farmer, food literacy educator and the best-selling author of “Eat to Your Advantage.” You can find out more about her work at SmallWonderFood.com.

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OUT OF THE OR recipe

Lemon Cheesecake with Fresh Fruit INGREDIENTS: • 1 1/4 cups graham cracker crumbs

Recipe

• 1/4 cup sugar

the

• 1/4 cup butter, melted • 2 packages (8 ounces each) cream cheese, softened • 1 can (14 ounces) sweetened condensed milk • 3 eggs • 1/4 cup fresh lemon juice • 1 teaspoon vanilla extract • 1 orange, peeled and separated • 8 raspberries • 3 mint leaves, for garnish

By Family Features

OR TODAY | June 2021

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OUT OF THE OR recipe

An Unforgettable Fruity Flavor By Family Features resh fruit is finally in season. When the sun is out and kids are hitting the pool, it’s also time to indulge in some sweet fruit flavors. Watermelon, berries, bananas and more can all be found near perfect ripeness at grocery stores or farmer’s markets during the warm summer months.

On a hot day, there is almost nothing better than trying something new that sounds delicious. Throw your apron on, prepare your kitchen and get baking. If you’re craving something sweet with no ideas about where to start, try this sweet Lemon Cheesecake with Fresh Fruit. It’s tangy and rich and allows you to escape to the summer oasis of your dreams, at least for a few minutes. It has the smooth, creamy texture of cheesecake mixed with a hint of tart lemon juice. Topped with raspber-

Lemon Cheesecake with Fresh Fruit SERVINGS: 6-8 1. Heat oven to 350 F. 2. In medium bowl, combine graham cracker crumbs, sugar and melted butter. Press firmly into 9-inch springform pan. 3. In large bowl, beat cream cheese until fluffy. Gradually beat in sweetened condensed milk until smooth. Add eggs, fresh lemon juice and vanilla

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ries, mint and oranges, the burst of fresh fruit enhances the cheesecake flavor. It’s the perfect sweet treat for summer for people of all ages with its bright colors and varying flavors. In a bowl, mix graham cracker crumbs, sugar and melted butter then press into a springform pan. Beat cream cheese, sweetened condensed milk, three eggs, lemon juice and vanilla extract then pour it on top of the graham cracker mixture. Bake for 50-55 minutes before cooling completely in the fridge and adding fruit and mint leaves. The outcome is a fluffy cheesecake with a small hint of lemon topped with your favorite fresh fruits. It’s a delightful, sweet and satisfying recipe your family can make again and again to enjoy during those warm summer months. Find more recipes perfect for summer at Culinary.net.

extract; mix until combined. 4. Pour into pan. Bake 50-55 minutes, or until center springs back when lightly pressed. 5. Chill in refrigerator until completely cooled. Arrange orange slices around border of cake and place raspberries in middle. Top with mint leaves.

June 2021 | OR TODAY

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

pinboard

RAISING BIG DREAMERS WAYS TO HAVE CAREER CONVERSATIONS WITH KIDS By Family Features

re-pandemic, Take Your Child to Work Day was an opportunity for children to peek behind the mysterious veil

• Help your children imagine turning their passions into careers. Not every block builder turns into an architect.

of “work” – to see what their parents do all day and begin

Some go into construction, some into engineering and some

to dream about the careers they might like to pursue when

pursue other careers entirely. When children express an

they grow up.

interest in a specific career or type of work, help them think about the kinds of skills they could work on now to help turn

For some parents, every day might feel like Take Your Child

that dream into a reality. Help your children make connec-

to Work Day. For others, health and safety concerns might

tions between the things they like to do now and the kinds

make it impossible to bring children to their workplaces.

of careers that could lead to. Maybe there’s an activity or

That doesn’t mean it’s any less important to take some time

volunteer experience your children could do, or a club they

to help your children imagine turning their passions into

could join, that would help nurture that passion and expand

careers.

their skill set.

“Children need exposure to the possibilities that exist

• Break career stereotypes. Point out diverse people do-

so they can envision themselves doing what inspires them

ing jobs as you see them in the community or in books or

in the future,” said Content Architect Rashelle Chase from

media – like female firefighters, male teachers or biracial fe-

KinderCare Learning Centers’ education team. “Learning

male vice presidents – and talk about the diverse viewpoints

about different career options also helps children learn

and experiences each person can bring to his or her career.

about how the world works and the different types of roles

Be active about squashing gender stereotypes whenever

and systems that are in place to help society function.”

you see or hear them. Encourage your children to pursue

Consider these tips from the experts at KinderCare to infuse some of the Take Your Child to Work Day spirit into everyday life.

• Expose your children to a variety of career options.

their ambitions and let them know you believe in them and their ability to succeed in whatever career they want. • Help your child to see “work” and “jobs” as positive things, especially after rough days. Be honest about the

Young children tend to think of careers in terms of the kinds

struggles and successes you have in your own career. Cel-

of jobs they see adults doing, like doctors, firefighters and

ebrate your successes and talk with your children about how

teachers. Help your children discover careers that are new

you problem-solve or persevere through tough times. Model

to them. Talk about essential workers and why they are

coping skills your children can apply to their own “job” –

depended on so heavily. Share details about the work your

school. It’s important for children to understand one can

immediate and extended family members do – perhaps you

still find fulfillment and passion in a career even if there are

could arrange a virtual call so your children can see a family

tough moments.

member at work. Point out other kinds of workers as your child encounters them, whether that’s during a walk around the neighborhood or while reading a book.

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For more ideas, visit kindercare.com.

June 2021 | OR TODAY

INDEX

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ALPHABETICAL Action Products, Inc.……………………………………… 58

Calzuro.com…………………………………………………………15

MedWrench……………………………………………………… 46

AIV Inc.…………………………………………………………………21

CS Medical…………………………………………………………… 5

OR Today Webinar Series……………………………… 56

ALCO Sales & Service Co.……………………………… 58

Cygnus Medical………………………………………28-31, BC

Ruhof Corporation…………………………………………… 2-3

AORN………………………………………………………………… 67

Healthmark Industries Company, Inc.………… 26

Soma Technology………………………………………………13

ASP…………………………………………………………………………61

Innovative Medical Products…………………………… 6

Sympliant………………………………………………………………17

Avante Health Solutions…………………………………… 4

Key Surgical………………………………………………………… 9

TBJ Incorporated……………………………………………… 25

C Change Surgical…………………………………………… 55

MD Technologies Inc.……………………………………… 55

CATEGORICAL ANESTHESIA

Soma Technology………………………………………………13

ASSOCIATION

AORN………………………………………………………………… 67

C-ARM

Soma Technology………………………………………………13

CARDIAC PRODUCTS

C Change Surgical…………………………………………… 55

CARTS/CABINETS

ALCO Sales & Service Co.……………………………… 58 Cygnus Medical………………………………………28-31, BC Healthmark Industries Company, Inc.………… 26 TBJ Incorporated……………………………………………… 25

CS/SPD

CS Medical…………………………………………………………… 5 MD Technologies Inc.……………………………………… 55 Ruhof Corporation…………………………………………… 2-3

DISINFECTION

INFECTION CONTROL

ALCO Sales & Service Co.……………………………… 58 ASP…………………………………………………………………………61 CS Medical…………………………………………………………… 5 Cygnus Medical………………………………………28-31, BC Healthmark Industries Company, Inc.………… 26 MD Technologies Inc.……………………………………… 55 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated……………………………………………… 25

INSTRUMENT STORAGE/TRANSPORT

Cygnus Medical………………………………………28-31, BC Key Surgical………………………………………………………… 9 Ruhof Corporation…………………………………………… 2-3

INVENTORY CONTROL

Key Surgical………………………………………………………… 9

MONITORS

Soma Technology………………………………………………13

ONCOLOGY SERVICES

Avante Health Solutions…………………………………… 4

ASP…………………………………………………………………………61 CS Medical…………………………………………………………… 5 Cygnus Medical………………………………………28-31, BC Ruhof Corporation…………………………………………… 2-3

ONLINE RESOURCE

DISPOSABLES

Action Products, Inc.……………………………………… 58 Innovative Medical Products…………………………… 6 Soma Technology………………………………………………13

ALCO Sales & Service Co.……………………………… 58

ENDOSCOPY

Cygnus Medical………………………………………28-31, BC Healthmark Industries Company, Inc.………… 26 MD Technologies Inc.……………………………………… 55 Ruhof Corporation…………………………………………… 2-3 Sympliant………………………………………………………………17

FALL PREVENTION

ALCO Sales & Service Co.……………………………… 58

MedWrench……………………………………………………… 46 OR Today Webinar Series……………………………… 56

OR TABLES/BOOMS/ACCESSORIES

OTHER

AIV Inc.…………………………………………………………………21

PATIENT MONITORING

AIV Inc.…………………………………………………………………21 Avante Health Solutions…………………………………… 4

POSITIONING PRODUCTS

FLUID MANAGEMENT

MD Technologies Inc.……………………………………… 55

Action Products, Inc.……………………………………… 58 Cygnus Medical………………………………………28-31, BC Innovative Medical Products…………………………… 6

FOOTWEAR

PRESSURE ULCER MANAGEMENT

GENERAL

RENTAL/LEASING

HOSPITAL BEDS/PARTS

REPAIR SERVICES

Calzuro.com…………………………………………………………15 AIV Inc.…………………………………………………………………21 ALCO Sales & Service Co.……………………………… 58

OR TODAY | June 2021

Action Products, Inc.……………………………………… 58

Cygnus Medical………………………………………28-31, BC Soma Technology………………………………………………13

REPROCESSING STATIONS

MD Technologies Inc.……………………………………… 55 Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated……………………………………………… 25

RESPIRATORY

Soma Technology………………………………………………13

SAFETY

Calzuro.com…………………………………………………………15 Healthmark Industries Company, Inc.………… 26 Key Surgical………………………………………………………… 9

SINKS

Ruhof Corporation…………………………………………… 2-3 TBJ Incorporated……………………………………………… 25

STERILIZATION

ASP…………………………………………………………………………61 Cygnus Medical………………………………………28-31, BC Healthmark Industries Company, Inc.………… 26 MD Technologies Inc.……………………………………… 55 TBJ Incorporated……………………………………………… 25

SURGICAL

Avante Health Solutions…………………………………… 4 MD Technologies Inc.……………………………………… 55 Soma Technology………………………………………………13

SURGICAL INSTRUMENT/ACCESSORIES

C Change Surgical…………………………………………… 55 Cygnus Medical………………………………………28-31, BC Healthmark Industries Company, Inc.………… 26 Key Surgical………………………………………………………… 9

TELEMETRY

AIV Inc.…………………………………………………………………21

TEMPERATURE MANAGEMENT

C Change Surgical…………………………………………… 55

WASTE MANAGEMENT

MD Technologies Inc.……………………………………… 55 TBJ Incorporated……………………………………………… 25

Avante Health Solutions…………………………………… 4 CS Medical…………………………………………………………… 5

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