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OR WISH LIST What do perioperative professionals have on their wish list in 2021? What items would be on your OR or ASC wish list?

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8 News & Notes 12 IAHCSMM: Why the Easy Way Isn’t the Best Way 14 Joint Comission: High-Risk Challenges in ASC Environments 16 AAMI: Update from KiiP Team: Survey Insight into Sterile Packaging 18 CCI: The Four Assumptions of Nursing Competency 20 OR Today Webinars

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INDUSTRY INSIGHTS

news & notes

Dräger Announces New Products Dräger’s new Ambia and Ponta ceiling supply systems offer hospitals flexibility in creating customized workstations that support specific clinical needs in the operating room (OR), intensive care unit (ICU) and neonatal intensive care unit (NICU).

The ceiling supply systems provide the ability to mount medical equipment and accessories on all four sides of the frame rail. This optimizes space and allows equipment and accessories to be placed exactly where they are needed. Free positioning of a mix of electrical and gas outlets on all panels make it possible to place more outlets on a media column or head.

The result, Ambia helps streamline workflow with the goal of increasing the satisfaction and safety of staff and patients – now and in the future. And with coordinated frame color selections and drawer decor variants, Ambia and Ponta can be easily integrated into any room concept, creating a patient-friendly environment. In addition, lighting options featuring warm, glare-free light, along with the ability to select from a range of RGB colors, helping to contribute to a calming and soothing atmosphere.

Ambia and Ponta feature intuitive user interfaces that support quick and easy operation. The arm brake handles feature touch-sensitive sensors that automatically release the brakes, allowing rapid positioning of the media heads or columns. The brake handle locations on the units can also be adapted to suit individual staff or workflow requirements for ideal ergonomics. The handles communicate using wireless technology, allowing them to be located almost anywhere on the system.

For infection protection, rounded profiles and smooth materials that are compatible with a wide range of disinfection products help make the Ambia and Ponta easy and fast to clean and disinfect. A range of cable management options help

eliminate cord clutter and assist with reducing exposed surface area and the accumulation of dirt. A touchless user control for operating ceiling and floor lights further supports infection prevention efforts.

In other news, Dräger has launched the new Savina 300 NIV, the latest ventilator in its Savina 300 family of ventilators.

The Savina 300 NIV features automatic leakage compensation to deliver consistent prescribed settings when faced with patient interface leaks. Its built-in turbine with rapid response time and external battery allows operation independent from the central gas supply to facilitate care continuity during patient transfers.

“Both acute and alternative care facilities rely on Dräger for the latest innovations in respiratory care delivered with integrity and dependability,” said Steve Menet, Dräger’s senior vice president of sales, hospital solutions. “Breathing is essential to life so for patients with respiratory challenges any disruptions in the effectiveness of non-invasive ventilation can jeopardize outcomes. With the launch of Savina 300 NIV, we are meeting clinician and patient demand for consistent and safe noninvasive mechanical ventilation in both acute and chronic care facilities.”

To help support patient comfort during NIV therapy, the Savina 300 NIV is compatible for use with the FitStar disposable mask, which features gel cushion technology to help reduce complications such as pressure points and skin irritation.

Available in four sizes, FitStar’s simple and breatheable headgear has a continuous range of adjustment to offer a custom fit while removing pressure from the bridge of the nose. The mask’s 360-degree rotating elbow facilitates optimal tube positioning and ease of mobility, while its quick-release headgear slides off easily with one hand.

GCB Medical Appoints New President GCB Medical Supply recently announced the appointment of Mark Faulkner as president. Faulkner has vast experience in the health care supply chain field having spent the last 38 years at Mass General Brigham, most recently as senior director, strategic supply chain and sourcing.

GCB Medical Supply is named after 3-year old Georgia Claire Bowen, the recipient of a neo-natal heart transplant at Boston Children’s Hospital in 2018. Georgia inspired a revolution in health care when her mother, Kate Bowen founder and

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OR TODAY | December 2021

CEO of GCB Medical, invented a pediatric specific garment, the Georgie, to replace the traditional hospital gown known as the Johnnie. It can now be found in several major academic hospitals across the country from the ICUs, to oncology to general medical floors.

As president, Faulkner will be responsible for business development, managing and growing the GCB Team, and managing distributor and GPO relationships.

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news & notes

Medline’s MedPack App Simplifies Custom Pack Ordering, Management Medline has announced the addition of push notifications to the MedPack App, a tool that enables clinicians to better manage pack contents and inventory. Developed in-house by Medline, the MedPack App allows partners to access the MedPack digital pack management system on the go to better support its partners who aren’t always in front of a computer screen.

Using a proprietary algorithm to match searchers with relevant results, the app enables customers to customize and manage medical pack inventory in real-time. The MedPack App empowers users in four core ways: •S earch and Scan: The app allows users to easily search any component through a cleansed global search, or by scanning the barcode of any single sterile item or Medline pack to instantly pull up information.

•Q uality: Through the app, users can report pack quality incidents to Medline’s quality team by scanning the barcode and taking a picture.

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• Quotes: Users can quickly create, approve and send quotes directly to their Medline rep for review while providing updates on when changes will arrive via Pack Tracking.

• My Packs: The app also provides visibility into the partner’s whole pack program anytime, including bills of material, component photos and descriptions, and current pack pricing.

Working with clinical and utilization experts, Medline partners can understand the needs of their specific specialties and identify gaps or redundancies to uncover alternative components that provide cost savings while maintaining high quality.

With over 35,000 sourced components and 14 million square feet of warehousing space, Medline is vertically integrated to provide end-to-end support for almost anything a surgical team may need.

For more information, visit medline.com/pages/medpack.

December 2021 | OR TODAY

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INDUSTRY INSIGHTS

news & notes

Encompass Group Receives Patient Warming System Patent Encompass Group LLC has received notice of issuance of a patent from the U.S. Patent and Trademark Office (USPTO) for its new Nova patient warming system. U.S. Patent Application No. 10805988B2 Metalized Fabric Heating Blanket and Method of Manufacturing Such.

“The Nova patent recognizes the years of research and development that have led us to this next-generation patient warming technology,” says Eric Howard, vice president and general manager TECHStyles, Encompass Group. “Thirty years ago, Encompass revolutionized patient warming with the original Thermoflect heat-reflective technology. This patent proves we’re doing it again.”

Nova combines a unique Thermoflect metalized fabric exterior layer with a proprietary carbon heating layer–managed by an external control panel–to warm patients without air movement.

It works by banking a patient’s heat before surgery and maintaining normothermia throughout the surgical process. This helps reduce the infection risks associated with forced air warming

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OR TODAY | December 2021

systems. And, with no moving parts, Nova is silent, eliminating a potential distraction in the OR. Nova was designed with both caregivers and patients in mind: It’s simple to apply and stays in place. The controller unit is easy to operate. And Nova doesn’t generate excess heat, so patients stay warm while clinicians remain cool.

“The many benefits of maintaining patients’ normothermia are well known. It helps improve patient outcomes, mitigate surgical site infections, limit hospital stays, enhance patient comfort, and reduce the cost of healthcare,” says Eric Howard. “And now, with Nova, clinicians have a better way to help patients do better.”

In other news, Encompass Group LLC. has named Steve Berg vice president, product strategy and development, healthcare textiles. In collaboration with the Encompass internal sourcing and product teams as well as the external national sales organization, Berg will direct and support company-wide strategic sales and product development plans for the health care market.

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news & notes

Adam Okada Joins Healthmark Industries Healthmark Industries has announced that Adam Okada is now a clinical education specialist for the company where he will provide clinical expertise on medical device processing, SPD education and standards.

Prior to joining Healthmark, he has had over 15 years of experience as a central services professional and clinical educator. Most recently responsible for clinical management at Beyond Clean, Okada primarily focused on providing education, consulting and educational

content for SPD professionals. He has also held many positions in the health care field as a central service professional from technician to management.

He is a Certified Registered Central Service Technician, a Certified Instrument Specialist, Certified Healthcare Leader, and served as a former president of an IAHCSMM Central California chapter. Additionally, he is a voting member of AAMI Industry Standards.

For more information, visit www.hmark.com.

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INDUSTRY INSIGHTS

IAHCSMM

True Value of Continuing Education: Why the Easy Way Isn’t the Best Way

By Tony Thurmond, CRCST, CIS, CHL, FCS terile processing (SP) professionals must continue acquiring knowledge and education to build their skills and help them complete their complex daily tasks to the very best of their ability.

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This article reviews several questions related to continuing education (CE), and how SP professionals can set their own high expectations and draw the greatest value from CE content, Note: The true value does not lie in the credits one receives from completing CE offerings; fulfilling CE credit requirements to maintain certification status is important, certainly, but the core value lies in our ability to strengthen our knowledge, skill sets and professionalism in the name of patient safety.

What is CE? CE, as it relates to health care, refers to a specific form of education that helps those in the medical field maintain competence and learn about new and developing areas within their field. CE is a vital tool for all health care disciplines, including SP, because it keeps us strong in knowledge and skill. It is what is required to give our patients any chance of success. ANSI/AAMI ST79, Section 4.3.1, states that “Education, training and standardized work practices decrease the risk of operator error during reprocessing and 12

OR TODAY | December 2021

helps ensure that personnel are conversant with the latest data and techniques.”

It further states that continuing education is required at regular intervals to review and update knowledge and skills and to maintain competency and certification. Without CE in medicine, the chance of patient successful outcomes becomes less of an attainable goal. It is a standard set forth in ANSI/AAMI ST79, whether you are certified or not.

Who needs CE – and why?

Every SP professional (technicians, leaders, educators, etc.) needs CE to maintain competence and knowledge of the complex processes they do each day. Early in your career, you may have thought that only certified technicians, nurses, doctors and the like need CE; however, that assumption couldn’t be further from the truth. Each person working in health care needs CE, whether they are certified or credentialed or not. If you are certified, you must submit your CE credits to maintain your certification(s).

For IAHCSMM certification, CEs must be completed once a year. The number of CEs required is determined by the number of certifications held. Understandably, IAHCSMM requires the education be approved and verified.

What is timed value of CE? The amount of credit earned during CE is based on the time committed to the education. For example, one hour of time

committed to a CE will equal 1 CE (½hour CE equals ½ CE credit and ¼-hour CE equals ¼ CE credit). This is the structure set forth by the accrediting agencies to show an individual has fulfilled the necessary time commitment to maintain their certification. Assuming you need 12 hours of CE to maintain your certification status – and assuming you are a full-time employee – that amount of CE is well less than 1% of the hours worked in a year (2,080). Is that enough? Do you feel that 12 hours of CE will fortify you to become the technician you aspire to be? What is the determined number of hours we as a profession would need to earn before each patient is truly considered safe? If we are truly committed to quality, safety and professionalism, 12 CE hours a year should not be the number we seek.

Where can I find CE? CE is everywhere. The pandemic created the need for vendors and organizations to develop more CE to be delivered and earned online. It seems everybody has developed programs that are educational; however, some of these offerings fall in line with a product they promote or sell.

That is fine if remains educational and doesn’t become merely a marketing or promotional tool.

Another concern is that some parties that offer CE content claim its worth two or three CEs, even when the time to complete them is much less than an WWW.ORTODAY.COM

INDUSTRY INSIGHTS

IAHCSMM

hour. This is where integrity comes into question (for us as the student/participant as well as the presenter). Presenters that assign a larger amount of CE credit than for what the content actually delivers are watering down the system and cheapening the value of the content.

If you, the SP technician, are willing to accept two CE credits for 35 minutes of material, I challenge you to ask yourself how you are truly benefiting. Although it’s certainly easy to take the shortcut, it’s important to understand that you’re also shortchanging yourself by not taking the opportunity to gain a more robust understanding of a subject.

IAHCSMM’s website has many outstanding CE offerings, including lesson plans, webinars and podcasts, and all are approved for CE credits. Local IAHCSMM chapters may also have scheduled meetings that include approved presentations for CE credit (these types of presentations provide a great opportunity to learn about a subject, while also networking with others who can share their personal experiences on various subjects.

Learning through interaction such as this is valuable, even if it doesn’t provide CE credits.)

What should I look for in CE? All SP professionals should be seeking educational opportunities that will help them advance for the betterment of their department, teams and customers.

We should seek CE that helps us brush up on the basics, broaden our skills sets and sharpen our talents across all areas of the department. We should also seek CE content on subjects that don’t come WWW.ORTODAY.COM

as easily for us, so we can boost quality, safety and efficiencies. If you’re a technician with hopes of moving into a leadership role, for example, you can take leadership-focused CE (even if you don’t hold leadership certification such as the CHL). Again, you should also seek out appropriately timed subject and material to get the full value. While much of the CE out there is available at no cost, we should treat each lesson plan or subject as if we paid a premium price for it. This will make us value its content more, and the content will be of value to us and our patients.

It’s also important to look for CE material that is in line with industry-leading standards and guidelines. Without that, you may not be learning the best practices. And again: If the information you are receiving is promotional in nature or marketing-focused, the opportunity to learn is lessened.

When should I seek CE? The quick yet accurate answer to that question is now (and frequently). CE may not always come to you; you will have to go out and get it. As a manager, it has been said to me many times that it is the hospital’s responsibility to provide CE to the employees. While I do agree that there should be organized and planned education for employees, I do not agree that the place of employment should provide all the education. We SP professionals have the responsibility to ourselves and our patients to continue advancing our education and building our knowledge and skill sets. Failure to do so makes for a stagnant technician who

will not be prepared when obstacles – or new opportunities – come their way.

What if we set aside time once a week (or at other intervals such as 10 to 15 minutes a day), and we truly buckled down and completed one CE per week (an attainable goal)?. By the end of the year, we will have accomplished over 50 hours of education. Again, it does not have to be to earn credits, but rather to earn knowledge. Even if we did just that, we are still under 1% of the time learning compared to the time we are working.

What do you hope to gain from seeking CE? Do you hope to gain that competitive edge on your co-workers?

Do you hope to impress your leadership to show that you are prepared for more responsibility? Whatever your goal, there will be two definite results from regularly pursuing CE. First, you will gain knowledge, confidence and the ability to employ protective measures when needed. Second, you will gain the ability to help give the patient the best outcome and success for their medical journey.

I hope all SP professionals accept my challenge of dedicating at least one hour a week (or 10 minutes a day) to CE. Each patient enters our facilities with the faith that the staff taking care of them is trained and knowledgeable on the work they do. It’s up to us all to do our best to give them that muchdeserved peace of mind.

Tony Thurmond, CRCST, CIS, CHL, FCS, is an IAHCSMM Past-President who serves as central service manager at Dayton Children’s Hospital.

December 2021 | OR TODAY

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INDUSTRY INSIGHTS

Joint Comission

High-Risk Challenges in ASC Environments

By Susan Annicelli, RN, MA, MS, MSN he impact of the COVID-19 pandemic over the past 22 months has wreaked havoc within health care organizations across our nation. With lightning speed, the virus gained a foothold on health care organizations as the virus struck with deadly uncertainty and volatility.

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Almost overnight, ambulatory surgical centers (ASCs) experienced unprecedented stressors impacting financials, staffing, supply chain, workflow, scope of services and regulatory/statutory requirements. These stressors persist for many ASCs today. Against the backdrop of these challenges, The Joint Commission Ambulatory Health Care (AHC) accreditation process is back functioning at full operation. Our partnership with aligned health care organizations is stronger than ever as we cross the threshold to a dynamic new normal in health care. As persistent as the uncertainty and volatility of the virus is the amazing resolve, creativity and innovation of ambulatory surgical environments to meet COVID challenges head-on. The unyielding efforts to promote quality and safety has been palpable during The Joint Commission post-pandemic accreditation processes.

After the starts and stops of survey activity during 2020, The Joint Commission initiated a virtual platform for AHC surveys in January 2021 and resumed onsite surveys in March 2021.

Review of high-risk findings via the Survey Analysis for Evaluating Risk (SAFER) Matrix from within ambula14

OR TODAY | December 2021

tory organizations during January 1 to September 1, 2021 reveal a similar pattern of observations from pre-pandemic years. High-risk observations are often complex and can pose significant risk in the provision of care, treatment and service.

Top 10 Challenging High-Risk Standards 1. IC.02.02.01. EP2: Implementing infection prevention and control activities when doing the following: Performing intermediate and highlevel disinfection and sterilization of medical equipment, devices and supplies 2. IC.02.01.01. EP2: Using standard precautions,* including the use of personal protective equipment, to reduce the risk of infection 3. IC.02.02.01. EP1: Implementing an organization’s planned infection prevention and control activities and practices, including surveillance, to reduce the risk of infection 4. MM.01.01.03.EP2: Following a process for managing high-alert and hazardous medications.

Note: This element of performance is also applicable to sample medications 5. MM.01.02.01.EP2: Taking action to prevent errors involving the interchange of the medications on a health care organization’s list of look-alike/sound-alike medications. Note: This element of performance is also applicable to sample medications 6. N PSG 03.04.01 EP1 Labeling all

medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings.

Note: Medication containers include syringes, medicine cups and basins 7. MM.03.01.01.EP8: Removing all expired, damaged and/or contaminated medications and storing them separately from medications available for administration. (Note: This element of performance is also applicable to sample medications.)

8. LD.04.01.05 EP4: Holding staff accountable for their responsibilities 9. EC.02.04.03.EP4: Conducting performance testing of and maintaining all sterilizers. (These activities are documented) 10. EC.02.05.01.EP7: Providing a ventilation system with appropriate pressure relationships, air-exchange rates, filtration efficiencies, relative humidity and temperature in areas designed to control airborne contaminants (such as biological agents, gases, fumes, dust) [Note: Areas designed for control of airborne contaminants include spaces such as all classes of operating rooms, special procedure rooms that require a sterile field, caesarean delivery rooms, rooms for patients diagnosed with or suspected of having airborne communicable diseases (for example, airborne infection isolaWWW.ORTODAY.COM

tion rooms, rooms for patients with pulmonary or laryngeal tuberculosis, bronchoscopy treatment rooms), patients in “protective environment” rooms (for example, rooms for patients receiving bone marrow transplants), laboratories, pharmacies, sterile supply/ processing rooms, and other sterile spaces]

Avoiding Pitfalls Navigating a successful ASC accreditation survey is a rigorous process that requires continuous survey readiness. Following are tips to ensure a meaningful survey event: 1. Establish a point of contact within the ASC to facilitate the survey process (management of application, communication with the account executive, coordination of the survey event).

2. Identify all standards, elements of performance and documentation requirements that are aligned with the type of accreditation survey requested.

3. Familiarize staff with the tremendous resources available to ASCs via The Joint Commission secure extranet and dedicated ASC webpage.

4. Ensure current and up-to-date documentation of policies, plans, testing logs and all personnel/privileging files.

5. Invest in education and familiarization of front-line staff with the survey process. Mock tracers, interviews and rehearsal activity will pay dividends in reducing staff stress during the survey process.

6. Anticipate surveyors will utilize a hierarchy approach in assessing infection control requirements with top-tobottom flow from regulatory requirements to conditions for coverage (CfCs) to manufacturer’s instruction for use to evidence-based guidelines to consensus documents to organizational policy.

7. Be prepared to discuss a process improvement initiative that involves data collection and analysis as well as assessment of the culture of safety within the ASC. 8. Encourage open and candid communication among staff, leaders and the survey team. Joint Commission surveyors welcome learning about the challenges and opportunities of the ASC from staff at all echelons.

The Joint Commission AHC accreditation process is a not a sprint, but a commitment to excellence overtime.

Objectives are clearly defined: validate compliance with standards, provide a meaningful assessment of known and unknown risks and inspire and encourage an ASCs journey to become a high-reliable health care organization. As a committed partner in health care, the accreditation survey is a mainstay in achieving The Joint Commission’s mission to promote safety and quality across all health care domains.

Susan Annicelli, RN, MA, MS, MSN, is a ambulatory field surveyor, accreditation and certification operations, The Joint Commission.

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INDUSTRY INSIGHTS AAMI

Update from KiiP Team: Survey Insight into Sterile Packaging he delivery of a sterile, ready-to-use medical device is vital to delivering safe and effective patient care. Although conceptually a simple idea, the actual processes involved in delivering a sterile medical device to the sterile field involves a complex web of activities and stakeholders.

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The theme of the 2019 Kilmer Conference, held in Dublin, Ireland, was “Collaborate to Innovate.” During the conference, a group of packaging-minded professionals, including health care delivery professionals, packaging engineers, sterility assurance professionals, medical device manufac-

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turers, academicians and standards professionals held an ad hoc meeting. The opening question for participants was, “Are there any issues with sterile packaging that should be addressed collaboratively by the industry?” This open-ended question elicited a wide range of answers, all of which added up to the answer being “yes.”

The group’s most significant realization was that the chain of sterile packaging stakeholder groups exist within a series of silos. As a result, the group’s mission became breaking down those silos and working together. What started as an ad hoc meeting has evolved into a multidisciplinary effort to innovate the medical packaging space. Thus, the Kilmer innovations in Packaging (KiiP) project group was born.

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INDUSTRY INSIGHTS AAMI

The Last 100 Yards Each KiiP project group is responsible for defining its mission, scope, objectives and criteria for identifying and implementing projects. One of the groups, dubbed “The Last 100 Yards” is tasked with assessing sterilepackaged devices after they are delivered to the health care organization (including centralized distribution centers).

To that end, the group developed a survey targeting those within health care organizations responsible for handling sterile packaging. This included materials management, logistics, sterile processing professionals and staff involved in preparing and using the sterilized items for delivery of patient care. The survey focused not just on the items delivered sterile to the health care organization but also those prepared and sterilized by the health care organization itself. The objective of the survey was to identify areas for in-depth research and, ultimately, opportunities for improving the delivery of sterile items.

With 1,700 respondents answering some or all of the 61 questions in the survey, the level of participation was remarkable. Although sterile processing professionals were by far the largest group, a considerable number of operating room professionals also participated. A lesser number of respondents reported working in materials management/logistics and infection control.

Informative insights were gained from the survey results, including those pertaining to training-related questions.

As with the survey among IAHCSMM members, the KiiP team survey focused on “actual practice” questions. During real-life events, nonideal practices can and do occur, and this survey focused on those nonideal practices. The survey took a different approach, asking respondents whether they “had ever seen a coworker do X. “The responses revealed the need for further education and collaboration between end users and industry.

The KiiP project group continues to review and analyze the survey results. It is anticipated that a number of follow-up studies, articles and white papers will be generated in the coming months. The KiiP team will share these with the industry as they become available. For further information on the KiiP movement and how to join the team, follow it on LinkedIn. This is an excerpt from AAMI’s STERILIZATION CENTRAL column. Additional updates concerning KiiP team survey results can be found at aami.org/news

Authors Ralph J. Basile, MBA, is vice president of marketing and regulatory affairs at Healthmark Industries in Fraser, MI. Email: ralphjb@usa.net

Responses to Kilmer innovations in Packaging team survey question, “When did you receive the training? Check all that apply.

Responses to Kilmer innovations in Packaging team survey question, “Have you ever seen anyone double pouch by folding a portion of the inner pouch to fit in the other pouch for sterilization?

CFER, CRCST, CIS, CLSSGB, is interim director of education and quality at the Medical University of South Carolina in Charleston, SC. Email: malinda.elammari@gmail.com

Jennifer Benolken, CPPL, is MDM & regulatory specialist, packaging engineering, Tyvek, Medical Packaging, DuPont.

Email: jennifer.a.benolken@dupont.com

Erin Kyle, DNP, RN, CNOR, NEA-BC, is editor-in-chief of the Guidelines for Perioperative Practice at the Association of periOperative Registered Nurses in Denver, CO. Email: ekyle@aorn.org

Malinda Elammari, ST, CSPM, CSPDT, CSIS,

Jane Severin, PhD, CPPL, is vice president

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of technical solutions at Network Partners in Northville, MI. Email: jane.severin@networkpartners.com Katherine Olson, BS, is a staff packaging engineer at MicroAire Surgical Instruments in Charlottesville, VA. Email: katherine.olson@microaire.com Teri Meadow, MBA, is a healthcare market manager at American Packaging Corporation in Grand Rapids, MI. Email: tmeadow@americanpackaging.com December 2021 | OR TODAY

17

INDUSTRY INSIGHTS CCI

The Four Assumptions of Nursing Competency

By James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E) ccreditation standards shape the work of credentialing organizations such as the Competency and Credentialing Institute (CCI).

The Institute for Credentialing Excellence (2010) states that quality certification programs should have certificants, “ … engage in specified activities designed to measure or enhance continued competence.” This challenges nursing certification organizations secondary to assumptions which undergird nursing practice which I refer to as the “Four Assumptions of Nursing Competency.”

A

The first assumption regarding nursing competency is that addressing the issue is just too complex and exceeds the resources and expertise of licensing and regulatory entities, such as the state boards of nursing.

To enhance competency, some certification organizations and licensure boards use continuing education or other learning activities in their programs using the hypothesis that increasing knowledge will enhance competency. The evidence which supports this assumption is not strong and conclusive and many state boards of nursing have no continuing education requirements.

Secondly, there is a long-held assumption that competency is somehow sustained if a nurse maintains licensure. As Tilley states in her 2008 18

OR TODAY | December 2021

article, “Currently, in most states, a nurse is determined to be competent when initially licensed, continuing competency is assumed thereafter unless otherwise demonstrated.”

This assumption is tenuous at face value in that the licensure examination makes no attempt to measure specialty nursing practice of nurses further into their professional career.

Any number of events may impact nursing competency after licensure occurs to include the ageing process and physical ailments.

A third assumption is that somehow the education and clinical experience that occurs in the workplace will maintain competency. I spoke to that fact in 2008 in stating “This clinical learning takes place almost exclusively in the nursing work environment.” (Stobinski, 2008, p.

422). While nurses learn and acquire skill in the nursing work environment there is no guarantee that this learning is of sufficient quality to enhance or maintain competency.

A final assumption is that a periodic skills check-off process such as an annual skills fair ensures clinically relevant competency. Donna Wright, a well-known author on competency assessment casts doubts on such notions in a 2019 article in the AORN Journal. Wright states that, “The perioperative environment has so many technical skills and equipment that turn over constantly – if leaders have a competency for every technology, they are not going to make it.”

Fundamental to this issue is that

the definitions of competence and competency are not standardized. A very useful, recent definition of competency from Fukada (2018) is, “A cluster of elements, including knowledge, skills, attitudes, thinking ability and values that are required in certain contexts.” Fukada takes a holistic approach in that definition and established that competency is complex and multifaceted. This complexity is part of the issue for credentialing bodies as they attempt to establish competency assessment programs.

CCI is working diligently to integrate competency assessment methods into its programs. The PPCS-R instrument for the selfassessment of perioperative nursing competency instrument in the new CFPN credential facilitates selfassessments over the span of a career with linked, meaningful professional development activities. CCI likewise believes that the documentation of competency can be improved with innovations such as digital badges which are also used with CFPN. CCI will continue to address the complex issue of nursing competency in its credentialing programs in part because its accreditation standards require this work. As an organization, CCI also believes that this provides value to the certified nurses and serves the patients and their families well. CCI will debut new resources in 2022 to include perioperative specific preceptor programs, new digital badges and additions to recertification processes.

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REFerenCES 1.

we’re on instagram!

Fukada, M. (2018). Nursing Competency: Definition, Structure and Development. Yonaga Acta Medica. 61(1): 1–7. doi: 10.33160/yam.2018.03.001

2.

Institute for Credentialing Excellence. (2010). Defining Features of Quality Certification and Assessment Based

FOLLOW US

Certificate Programs. Accessed September 14, 2021 at:

@OR_TODAY

https://www.credentialingexcellence.org/Portals/0/ Docs/Accreditation/Features%20Document.pdf 3.

Stobinski, J. X. (2008) Perioperative nursing competency. AORN Journal (88)3. pp. 417-436.

4.

Tilley DS. (2008) Competency in nursing: a concept analysis. J Contin Educ Nurs. 2008;39(2):58-64.

5.

Wright, D. (2019). Shift Your Competency Mindset.

Accessed September 5th, 2021 at: https://www.aorn. org/about-aorn/aorn-newsroom/periop-today-newsletter/2019/2019- articles/mindset

James X. Stobinski, PhD, RN, CNOR, CSSM(E), is chief executive officer at Competency & Credentialing Institute (CCI).

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19

INDUSTRY INSIGHTS

WEBINAR SERIES

Webinar

Webinar Series Delivers ‘Relevant Information’ Staff report

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he OR Today webinar series continues to grow more popular as it delivers top-notch insights and “relevant information” to a range of health care professionals. The series has seen 3,419 individuals register for a webinar through midOctober with an average of 311 registrants per webinar. The sponsored sessions provide free continuing education opportunities.

Recent webinars have explored forced air contamination, electrosurgical instruments, safe and on-time starts and OR metrics.

Forced Air Contamination The recent OR Today webinar “Forced Air Contamination Risk in the OR” was sponsored by Encompass and 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.

Presenter Victor R. Lange, Ph.D., JD, MSPH, ICP, CRC, CRA, is a health care epidemiologist and clinical research expert, as well as director of quality/risk management/infection prevention at AHMC-Greater El Monte. Respected for his research and leadership in the field of infection prevention, presenting and publishing nationally on the subject. Lange possesses legal and regulatory standard expertise and conducts ongoing surveillance, documentation and investigation of hospital-acquired 20

OR TODAY | December 2021

infections. He has implemented numerous clinical education programs, providing staff with essential knowledge and skills on infection prevention, ultimately improving both health care worker and patient safety.

The 60-minute webinar helped attendees understand the infection and cross-contamination risk associated with use of forced-air warming on patients in the operating room. Lange described a data correlation between forced-air warming device components and airborne contamination. He also discussed direct how webinar attendees can contribute to improved facility risk review and improved patient-warming and infection-prevention protocols. The presenter will introduce a background on patient-warming benefits, provide a literature recap of forced-air warming risk, review study objectives, methods, study results and conclusions.

The webinar also included a questionand-answer session. One attendee asked, “Would you please talk a bit more about the CFU level, is 10,000 CFU, OK?” “So, we did determine that – based on all the literature, the studies, the scientific evidence – anywhere from 10,000 CFU or less, this is sufficient,” Lange said to start his answer.

Another attendee asked, “Forced air warming is used in most hospital ORs, does the study indicate that certain pathogens are able to get through the filter?”

Lange said that was a very good question. In terms of Heffer filtration itself, HIPAA filters are, for the most part, approximately effective. He noted that it is important to use the correct filter and to

change the filter and pre-filter often.

He also answered a question about the ability to track infections that may have developed in these types of surgeries and other questions.

The webinar was well attended with 92 individuals tuning in for the live presentation. An on-demand version is available for others to view.

Attendees provided feedback in a survey.

“Thank you for opening up an entire new avenue for infection prevention to explore related to preventing surgical site infections. Who knew to look inside the hose of the patient warmers and the connections? I am afraid to look but will be sure to communicate this potential risk with my OR team and environmental services team members. I am grateful to have the opportunity to be proactive, that is why it is called infection prevention,” Director of Infection Prevention K. Mulholland said.

“These webinars are always full of relevant information that is pertinent to today’s OR,” said D. Pullman, CRNFA. “Very interesting and informative presentation,” Clinical RN Educator A. Gatto said.

Electrosurgical Instrument Best Practices The webinar “Perioperative and Sterile Processing Electrosurgical Instrument Best Practices: Stay Ready So You Don’t Have to Get Ready” was sponsored by Key Surgical and presented by SPD Clinical Educator Jamie Zarembinski, CCSVP, CER, and OR Clinical Educator Michelle Lemmons, RN, BSN, PHN, CNOR, CCSVP. It was eligible for one CE credit.

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In the webinar, Zarembinski and Lemmons reviewed the 2021 AAMI and AORN updated guidelines surrounding best practices for the care, evaluation and protection of electrosurgical instruments. The discussion detailed some of the changes that were made, why they are significant and how they impact the daily practice of sterile processing and perioperative professionals. Further, they talked through the consequences of a reactive approach to instrument care versus a proactive approach; stay ready so you don’t have to get ready.

A question-and-answer session provided additional insights. One attendee asked, “If installation damage is hard to see, what is the point of a visual examination?”

The answer was that sometimes you can catch something at the time of installation.

Another question was “How can SP and OR communicate installation damage?”

Zarembinski said that it is important to have a facility policy to lay out that communication pathway. So, if there is an installation failure, if it happens in the operating room, there is a way for them to communicate to sterile processing so that they know to keep an eye on that and send it out for repair.

More than 100 individuals attended the live presentation with even more logging on to view an on-demand recording of the webinar. Attendees provided feedback via a survey that included the question, “Why did you attend today’s webinar? And, was it worth your time?”

“Hands down worth my time. I’m working on completing an assignment that’s regarding insulated instruments,” Medical Supply Technician B. Yulfo said.

“I want to stay current with surgical services initiatives and care practices,” Vice President F. Roster said.

“Informative, insightful, interesting and very worthwhile,” said J. Harper, COO/SVP sterile operations.

Safe and On-time Starts The webinar “Maximizing OR Efficiency: How to Sustain Safe and On-time Starts” was sponsored by Ecolab and eligible for one CE credit.

With some surgeries delayed because WWW.ORTODAY.COM

of COVID-19, hospitals are focused on how to maintain surgical volumes without fear of compromising patient or staff safety. The webinar provided a dialogue with respected hospital leaders who explained how they pivoted during the early waves of COVID-19 to significantly increase cleaning efficacy, achieve faster OR turnover and identify cost-savings.

The hospital leaders also shared clinically proven environmental hygiene tips for how they did just that.

Key takeaways from the webinar included: • Guidance and best practices for balancing safety with faster turnover • How to clean better with fewer staff • How to improve the cleaning frequency and thoroughness of high-touch objects by up to 250% • Ways to enhance staff training opportunities (consistency, digital, etc.)

Questions from attendees were also answered during the presentations. Questions covered a range of topics including how to handle staff shortages, how to collect monitoring data, environmental hygiene monitoring methods and more.

More than 100 health care professionals registered for the webinar that is now available for on-demand viewing at ORTodayWebinars.live. Attendees provided positive feedback via a survey that asked attendees to describe the webinar in three words.

“Organized, efficient, updated,” said N. Collier, CRNFA. “Professional, data-driven, concise,” said S. Smith, principal.

“Informative, timely, relevant,” CSSD Technician I. Delos Reyes said.

“Excellent, knowledgeable, useful,” RN Educator C. Cornatzer said.

for surgeon, patient and staff satisfaction, but they are not the operating room’s most important metrics. The webinar explored how leadership needs easy access to current, actionable and reliable operating room utilization metrics to achieve optimal performance.

The webinar was well attended with 125 tuned in for the live presentation. A recording of the webinar is available for on-demand viewing.

A question-and-answer session provided attendees a chance to gain additional insights. One question was, “This all looks great, but our IT department is telling me that they don’t have the bandwidth to take on new projects. You mentioned that this is cloud based. What does that mean for my organization in terms of IT resources?”

DuBose replied, “Overall, it really is a pretty streamlined process, and we can accommodate and help out the IT team as much as possible.”

He added that the fastest implementation was about two weeks.

Attendees provided feedback in a survey that included the question, “How much new information did you receive from today’s webinar?”

“I liked knowing that turnovers and first time starts aren’t the biggest bang for your buck,” said S. Scully, Capital Health.

“Good information to discuss with my facilities,” Value Analysis Program Manager D. Bush said.

“Good review of information,” Nurse Manager L. Santimarino said.

For more information, visit ORTodayWebinars.live.

Thank you to our sponsers:

OR Metrics The webinar “Why Turnovers and Delays Are Not Your Most Important Metrics” was sponsored by LeanTaaS. It was eligible for 1 CE credit.

In this 60-minute webinar, Brooks DuBose from LeanTaaS’ iQueue for Operating Rooms implementation team explained where the opportunities lie and how to drill down to come up with actionable steps and strategies for meaningful performance improvement.

Turnovers and delays are good indicators of efficiency. They are important metrics December 2021 | OR TODAY

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market analysis

Report Forecasts Continued Medical Cart Market Growth Staff report he medical carts and workstations market is expected to grow at a compound annual growth rate (CAGR) of 14.1% from 2020 to reach $8.77 billion by 2027, according to a new market research report published

by Meticulous Research.

T

Over the last decade, medical cart workstations, or mobile computer carts, have played an important role in the medical and technological revolution. Not only do they provide ease of access for health care providers, but they also allow for compliance with federal health care mandates. These help to maintain and retrieve essential patient information whenever required. Also, treatment-specific carts are available to keep the medical instruments on it as per the requirement. These carts and workstations offer several features, including lighter design, scanner holders, locking wheels, among others to meet the ergonomic needs between mobile workstations and computers. Some of the advanced features also include integration of mobile health care applications designed for physicians and nurses, thereby enhancing the reach of health care professionals at point of care. Traditionally, the technologi22

OR TODAY | December 2021

cal advancements in the medical carts and workstations industry are driven by evolution of medical technologies.

Thus, rapid advancements in the field of care delivery are expected to further technological growth of the medical carts and workstations market over the coming years.

“As COVID-19 becomes widespread across the globe, the need for patient care has increased, and personal protection and medical equipment, including carts, are in high demand,” the report states. “In such conditions, carts/workstations play an important role in assisting health care workers. Also, manufacturers increased their production of carts and launched new carts, such as vaccine carts and accessories, such as sanitizer holders.

Grand View Research reports that the global medical carts market was valued at $1.28 billion in 2016 and is expected to witness a CAGR of 15.2% through 2025.

In a separate report, Grand View Market Research states the global radio-frequency identification (RFID) smart cabinets market size is expected to reach $1.5 billion by 2026. The rising need for proper inventory management in hospitals as well as pharmaceutical companies has led to increased demand

for RFID smart cabinets and thereby market growth.

The advantages associated with RFID smart cabinets include data accuracy, real-time tracking, and lesser inventory waste and equipment losses. These factors decrease the operational costs of hospitals and pharmaceutical companies, and therefore, the hospitals have started to adopt RFID smart cabinets for tracking of various items across the globe.

The medical devices used for surgeries and other medical procedures are expensive and require proper maintenance. Tracking of these high-value hospital inventories is important. RFID smart cabinets have enabled hospitals to eliminate some costs by avoiding misplacement and theft of expensive medical devices.

North America has dominated the RFID smart cabinet market because of the local presence of market players, government initiatives, availability of innovative products and advanced health care infrastructure. Increasing demand of RFID smart cabinets is expected to propel growth at a CAGR of 11.6% from 2019 to 2026.

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product focus

BK Workstations Workstation

BK Workstations are built with all enclosed aluminum.

The aluminum framing is reinforced to be sturdy, durable and made to last for 20 years or more. With four pull-out drawers that are deep and self-locking, it allows for easy filling, storage and cleaning. It is great for storing everything that you need to keep organized. The cart is perfect for phlebotomy blooddraw supplies like tubes, bandages, co-flex, gloves, inventory supplies or educational supplies. The two top pull-out aluminum shelves allow for a work surface to hold a laptop, clipboard, documents or all the tools you need readily available and at your fingertips. The 4-inch easy-rolling, locking casters make it the perfect mobile solution for on-the-go pushing effortlessly.

The cart is sturdy and stable with a low-profile design and weighs 55 pounds.•

MAC Medical

Closed Case Carts MAC Medical Inc. manufactures a full line of stainless steel Closed Case Carts that feature fully welded construction with inner skeletal system for strength and easy service bolt-on features. Closed Case Carts are utilized to securely and sterilely transport instruments and surgical supplies. Standard features include soundproof tops and doors, and 6-inch maintenance-free, high temperature stainless steel casters. Several optional features are available.

MAC Medical’s engineering capabilities allow it to custom design a case cart to provide a solution for any facility. MAC Medical manufactures top-quality medical equipment including warming cabinets, sinks, tables, casework and many other stainless steel products.•

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December 2021 | OR TODAY

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Total Scope

Deluxe EndoCart The Total Scope selection of Endocarts were developed by GI nurses as the safest and most efficient travel system. The Deluxe EndoCart is one of three fully customizable models that Total Scope offers and is an industry-preferred endoscopy cart. The lightweight carts have a zero-turn radius, allowing it to travel with ease.

Total Scope also offers a motorized deluxe option that eliminates the burden of manually pushing the cart from location to location. All of Total Scope’s endocarts, including its wide variety of accessories, are made in the USA and are easy to sanitize and maintain. Each cart goes through a 27-point inspection to ensure the highest quality. Plus, when working with Total Scope, customers are dealing directly with the manufacturer, which means they can provide repair services and replacement parts as needed. • For more information, visit endocart.com.

Case Medical

SteriTite Case Cart System The Case Medical SteriTite Case Cart system provides safe and convenient transport and storage of surgical devices and supplies. Features include durable stainless-steel construction, efficient use of space, adjustable perforated shelves to avoid tears in blue wrap, shock absorbing wheels with stainless steel casters and 2D bar code for tracking. Open case carts share the same enhanced features as closed case carts. They are designed to house sealed containers and supplies on individual shelves or to stack one on top of the other.

The carts are available in various sizes to meet the needs of the surgical specialty. A disposition monitor identifies clean/soiled loads.•

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OR TODAY | December 2021

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product focus

Capsa Healthcare

Avalo Anesthesia Cart The Avalo Anesthesia Cart is designed to provide organized and secure access to anesthesia medications and supplies. Avalo carts feature durable, high-impact panels, a lightweight design for easy maneuverability and smooth surfaces for easy cleaning. The anesthesia cart is available in a range of heights and drawer configurations, with a selection of optional accessories to support efficient workflow. Flexible divider systems and removable drawer trays provide optimal visibility, grouping and organization of medications and supplies. A choice of lock systems including keylock, simple keyless or keyless with auto-lock ensure secure access.•

Healthmark HushKarts

The HushKarts are designed for quiet mobility with rubber-cushioned 4-inch sealed bearing casters. Designed for convenient storage, each HushKart offers three shelves with slip resistant surfaces and raised edges. Ideal for use as surgical case carts, and for use by pharmacy, respiratory and CSD. Designed for easy cleaning, its cart-washer washable. The one-piece, double-wall polyethylene construction (no creaking bolts and no rattling metal) will not rust, corrode, dent or peel.

One-piece seamless construction eliminates hard-to-clean grooves and crevices. Available in three colors, establish a color-coding system to fit your needs. Choose a color (slate blue, dark brown, coffee beige) to coordinate with the décor. •

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CE570

IN THE OR

continuing education

Mind Your Manners…

Multiculturally s the nursing workforce increasingly reflects the changing U.S. population, nurses have many opportunities to collaborate and interact with other nurses from around the world. These experiences afford all nurses a chance to gain cultural knowledge and understanding that will ultimately enhance the delivery of culturally competent patient care. While white nurses continue to represent the majority of registered nurses, approximately 26% of the RN population is represented by nurses from culturally diverse racial and ethnic minority groups.

A

Working cross-culturally requires nurses to appreciate the impact cultural differences have on interpersonal communication. Transcultural nurses are sensitive to these differences and strive to determine the most appropriate and effective ways to interact with diverse colleagues. When nurses communicate and collaborate productively with one another, they are much more likely to deliver culturally relevant care to their patients and improve the overall patient experience.

The purpose of this course is to present strategies for practicing cultural etiquette to facilitate positive communication and interactions between culturally diverse members of the healthcare team.

It is applicable to nurses in all settings.

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OR TODAY | December 2021

Working with Colleagues with Multicultural Backgrounds Clinical knowledge is essential for nursing practice, but it’s not enough. Working with colleagues and patients from diverse backgrounds, while often gratifying, can also be challenging. Part of the challenge lies in the limited resources nurses have for understanding relevant cultural information about acceptable norms and etiquette behavior.

Historically, white women have dominated nursing; however, the proportion of racial/ethnic minorities has been increasing. In the years from 2011 to 2015, whites have declined in proportion from 75% to 67%, while the proportions of Black/African Americans, Hispanics/ Latinos, and Asians have increased.1,2 In 2019, the highest number of internationally educated nurses working in the U.S. came from the Philippines (6,021), with India (669) ranked a distant second, followed by Puerto Rico (585), South Korea (461), and Nigeria (381).6 Regardless of year-by-year fluctuations in numbers, cultural sensitivity is important and will become even more so in the future with increasing numbers of racial/ethnic minorities entering the nursing profession.1,6 Although nurses know they should respect cultural differences, they may not be aware of some key differences that can have a big impact on staff relationships. As members of a multicultural and global society, it’s not acceptable to make a culturally insensitive mistake without

apologizing and saying, “I didn’t know.”

Each culture has its own traditions, rules, priorities and norms. Additionally, all nurses bring with them their own unique set of values and behaviors that are products of cultural ethnic, and gender identities.4 Today, nurses must go beyond having an awareness of these differences and being sensitive to them. To

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

Goal and Objectives After taking this course, you should be able to: • Explain two ways greeting etiquette differs around the world.

• Describe two common gestures that may be appropriate in one culture and offensive in another.

• Describe some common practices that can have a negative meaning to an international colleague.

• Identify at least one way to demonstrate culturally sensitive behaviors when interacting with members of culturally diverse groups.

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IN THE OR

continuing education ensure positive, cross-cultural interactions between diverse groups, nurses will need to develop strategies that bridge gaps in communication that may exist.

Such strategies will enhance the nursing team’s performance, productivity, and efficiency,7 and thereby, contribute to nurses’ and patients’ satisfaction.

Generalizations vs Stereotypes When discussing cultural differences, it is difficult to avoid making generalizations about various groups. A generalization is a statement about common trends or patterns of behavior within a group. Further information is needed to determine whether the generalization actually applies to a particular individual. All people are unique and should not be assumed to fit stereotypes. A cultural stereotype assumes that all people of a certain racial or ethnic group share the same values, beliefs, and practices. For example, if I meet a Mexican woman and assume she has a large family, I am stereotyping her. But if I think to myself that Mexicans often have large families and wonder whether Sonia does, I am generalizing, as opposed to drawing a conclusion based on stereotypes, which may be false. A stereotype is a prediction, conclusion or ending point with no effort to consider the possibility of individual differences. On the other hand, a generalization serves as a starting point for understanding others.8

Attitudes Toward Politeness When judging manners, a key point to remember is that Western beliefs and practices are not universally accepted as the best or right. What is polite and appropriate in one culture may be offensive in another. For example, in the United States, some people feel our culture has gone too far in efforts to communicate sensitively and politely, and avoid using language that could be offensive to some individuals, calling it “excessive political correctness9.” However, others feel that these efforts promote better collaboration, inclusivity and respect.4

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When discussing the concept of political correctness, one writer noted that, “choosing our words carefully makes a difference in promoting positive interactions and creates a welcoming space for all readers.”9 These ideas can be applied to any setting where individuals interact.

Making physical spaces more welcoming to new colleagues and other staff members in the workplace enriches the work environment for everyone. Being polite in our conversations helps soften our interactions and enables us to facilitate cooperation between ourselves and the persons with whom we interact.9 It is important for nurses to remember that people express politeness through both verbal and non–verbal communication.

Verbal Etiquette With increasing incivility within the United States, common phrases that exemplify courteous behavior like,” please,” “thank you,” “ma’am,” “sir,” “you’re welcome,” “excuse me,” “I beg your pardon,” and “I’m sorry” are often forgotten, but go a long way in developing and maintaining positive relationships because they show respect.2,3 Nurses interacting with international nurses who neglect to use these terms may easily misinterpret the behavior as rude. However, in certain countries, like Ghana “please and “thank you” are conveyed non-verbally through intonation (rise and fall of vocal pitch to convey attitude).4 When speaking cross culturally, the use of curse words or any words that are sexist, racist or derogatory to a specific group is always inappropriate3 Some words like “yep”, “yeah”, and “nope” that are often used to expedite a conversation or make it seem less formal can also be off-putting or confusing to persons who expect more professional behavior or who are unfamiliar with the meaning of these terms. 2 The Nurses’ Code of Ethics compels nurses to maintain civility in the workplace to avoid cultural insensitivity or rudeness, and to promote positive interactions between members of cultur-

ally diverse groups.5 While the nature of our verbal communication is critical in establishing and maintaining positive cross-cultural relationships, research tells us that our non-verbal communication is even more significant.10,11

Non-Verbal Etiquette Over 70% of face-to-face communication occurs non-verbally through body language, which includes gestures, tone of voice, eye contact, facial expressions, nodding, and use of space.12 Sometimes these messages complement our verbal communication. At other times, they can contradict the words we say. For example, nurses should avoid telling a patient they are busy, overwhelmed, frustrated, or tired. However, they may communicate those messages non-verbally through their facial expressions and other behaviors without saying a word. For this reason, nurses must be mindful of their own facial expressions and other body language that could reveal their deepest thoughts and emotions. Smiling is a nonverbal way to reduce tension between culturally diverse nurses and other staff members, especially during initial introductions and greetings.

Although some aspects of body language may be outside of a person’s conscious control, using gestures can help convey the exact intended message. However, cultural groups use many of the same gestures to communicate different messages. For example, common gestures (such as the “OK” sign or “thumbs up”) used in the United States can be misunderstood and considered rude by some cultural groups. These and other hand signs, such as the victory sign sometimes used by Americans (and even political leaders including some U.S. presidents) to signal “victory,” have different meanings for other cultures and are considered offensive.13 These hand gestures should simply be avoided in cross-cultural interactions.13 There are some gestures that are considered universal. For example, the

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IN THE OR

continuing education shoulder shrug with hunched shoulders and exposed palms facing out indicates, “I don’t know or don’t understand.”

A smile is also usually understood as a welcoming, positive gesture by most cultural groups. However, a smile can be used to conceal other emotions and thoughts.

Gestures coupled with verbal communication can enhance or clarify a message.

For example, nodding while expressing agreement or turning the head from side to side to indicate “no”, confirms the message that was verbally expressed.11,13 For nurses, it is important to determine if a non-verbal message matches that which is being conveyed verbally.

Cultural implications are part of many common interactions, such as shaking hands, making eye contact, respecting personal space, giving gifts, making conversation and dining. Nurses can apply business etiquette skills not only with coworkers but also with other colleagues in numerous professional situations. Business etiquette is important during job interviews, when serving on committees, attending conferences and other business meetings, etc.

Having knowledge of common cultural practices assists the nurse in building positive relationships. Common practices from different countries encompass wide variations and create the possibility of offending others, albeit unintentionally. As you develop a deeper understanding of cultural diversity, your relationships with international colleagues and patients will improve.11,14 Next, this course will discuss some forms of business etiquette that may have cultural implications and strategies for fostering positive interactions.

Greetings In the United States the custom of greeting others takes place in a variety of forms including the simple handshake, hugging, the fist-bump, or a “high five.” Each of these behaviors helps communicate thoughts and feelings of acceptance to the recipient. Other gestures are common in different cultures. For example, in Europe, (especially France), kissing on both cheeks 28

OR TODAY | December 2021

is a common greeting. It is essential for nurses interacting cross-culturally to “respect, learn, and understand” the powerful messages conveyed through gestures that may differ from those with which the nurse is familiar.11

The Handshake The nature of the handshake varies internationally and has led to some awkward moments between Americans and others, since both the preferred frequency of the handshake and the number of pumps or shakes of the hand sometimes differs between two individuals during the same encounter. British, Australian, German and American colleagues will shake hands on meeting and again on departure. Asian and Arabic cultures may continue to hold your hand even when the handshake has ended.11,14 There are three parts to an effective handshake: • Extend your right hand horizontally with your thumb up.

• Connect “web-to-web” with the other person. (The web between your thumb and index finger should connect with the web of the other person’s web.)

• Shake two or three times and drop your hand.

A handshake should be firm and confident. You should make eye contact and smile. You should also stand up (this includes women).

Because handshake etiquette differs around the world, a person should not judge a handshake offered by colleagues from different cultures by our standards.

For example, in the Philippines and in many European countries (such as Germany, Poland, and the Czech Republic), it is polite for a man to wait for a woman to extend her hand for a handshake.

Muslim and Hindu men typically do not shake hands with women. The firmness of the grip also has cultural implications. For example, the Chinese and Japanese typically use a softer and longer handshake, but the Japanese sometimes prefer a bow and limited body contact.

There is usually no touching between men and women.14 The gentleness of the handshake does not indicate a lack of assertiveness within these cultural groups.

“German and American colleagues shake hands upon meeting and again on departure. Most European cultures shake hands with one another several times a day.”14 In India, men greet men and women greet women with a light handshake after Namaste, the most common initial greeting.14 In Nigeria, men usually shake hands with the right hand and sometimes continue to hold the hand during the beginning part of the conversation.

Greetings are considered very important in Nigeria and are often extended. Saying a quick hello and moving on is viewed as rude14.

Kiss on the Cheek The kiss on the cheek greeting also varies among cultural groups. The French typically perform a double kiss on both cheeks; Australians, New Zealanders and Americans prefer a single kiss; while the British will avoid kissing altogether or take the European double kiss approach.

Dutch, Belgians, and Arabs prefer a triple kiss. Among Japanese, handshakes, kissing, and hugs are considered impolite. In China, men generally shake hands on meeting and on departure.

There is no touching unless it is with close family members.14

The Bow The bow is the typical greeting of the Japanese. If someone bows to greet you, take note of the depth of the bow because that indicates the status of the relationship between you. If you are greeting a person of equal rank or status, bow to the same depth as you have been “bowed to.” Typically, a lower ranking person bows first and lowest. As you bow, lower your eyes and keep your palms flat against your thighs.11,14 You can see that if you were interviewing a nurse from an Asian background and noted that she did not have a firm handshake, you might react negaWWW.ORTODAY.COM

IN THE OR

continuing education tively. It’s just as important for the Asian nurse to learn U.S. business etiquette.

Cultural sensitivity on both sides helps build positive relationships. In essence, people need to be able to adapt their etiquette to the culture in which they work.

With such wide variations in the types of greetings various cultures practice, nurses cannot possibly be familiar with all of them. However, becoming aware of the customs of colleagues and staff with whom the nurse is likely to interact will be helpful to reduce the potential for offending others and prevent cultural miscommunication.

Nice to Meet You Most people have felt awkward making introductions, being introduced, or introducing themselves to others. In some cultures, there is a certain order in which introductions should be made. For example, in the U.S., “the person of honor” method is common: 1. Say the name of the person of honor.

2. Introduce the other person to the person of honor and say something about them.

3. Return to the person of honor and say something about them.

“The person of honor” is the higherranking person in the organization. For example, if you are introducing a new colleague (Maria Sanchez) to the vice president of nursing (Veronika Deska), the vice president would be the person of honor. Following the steps outlined above. This interaction would go: “Veronika, I would like you to meet Maria Sanchez. Maria is our new diabetic educator. Veronika Deska has been our vice president of nursing since 2010.”

Never hesitate to introduce or reintroduce yourself to others. It’s easy to forget names, and it is so easy to make people comfortable by reintroducing yourself.

For example, “Hello. I’m Sandra Smith, and I work on the orthopedic unit.” The other person should return your greeting and introduce themselves. Introducing yourself in this manner is much more WWW.ORTODAY.COM

considerate than saying, “Hello, do you remember me?” Don’t forget that a handshake (along with a smile and good eye contact) usually follows an introduction.

In many cultures, people often exchange business cards when introductions are made. For example, in Japan, cards are presented after the bow or handshake and writing on a person’s business card without permission is considered rude.11,14

aware of your own non-verbal communication is important, especially when interacting with international colleagues.

To illustrate this principle, most Americans smile easily as an expression of happiness. However, in the Japanese culture, true happiness does not require a smile.14 People can even use facial expressions to convey an emotion opposite to what they are feeling. For example, in Asia, people may conceal negative emotions with a smile.16

Eye-to-Eye

Hand Gestures

Eye contact is a key component of business etiquette and has cultural implications. In the U.S., it is polite to look someone in the eye. For Americans, this demonstrates openness, sincerity, trustworthiness and confidence. However, because this is not true in some other cultures, eye contact needs to be interpreted within its cultural context.10 For example, in many Asian countries, looking away is a sign of respect.11 Here are some cultural differences associated with eye contact in several countries: • Mexico: Continued, intense eye contact is considered aggressive and threatening.2 • Japan: Prolonged eye contact is not the norm. Looking people directly in the eyes invades their privacy.14 This is similar to beliefs held by Native Americans who avoid direct eye contact as a sign of respect.15 • France: You should not be surprised if you are looked at more intensely than you expect. This can be intimidating for some, especially Asians and North Americans.14 • Great Britain: Often, the British do not look a person directly in the eye or maintain eye contact when talking.14

Exaggerated hand gestures can be distracting to people, such as the Chinese, who typically do not use their hands when speaking.13,14 Because gestures can be misunderstood or considered rude, here are some common gestures to avoid when you are outside the U.S.: • Thumbs up. This is considered crude throughout the Arab world.11 • The “V” sign. When the first and second fingers are extended, and the hand is clenched, it is considered rude in some cultures, such as in New Zealand.11 When this sign is made with the palm facing inward, it is offensive in Great Britain and Canada.11 • The “OK” sign. Making a circle with the thumb and forefinger with the other fingers raised, is offensive or rude in many countries, such as Germany, Spain, Mexico, and Brazil. It means “money” in Japan and “worthlessness” in France.11 • Pointing at another person.

This is considered impolite in Canada, Saudi Arabia, Belgium, and Portugal, and insulting in the Philippines.13 • Placing your hands on your hips.

This gesture suggests aggressiveness and can imply you are making a challenge in some countries, including Mexico and Argentina.

Facial Expressions When you meet, greet and converse with others, you may not think about your facial expressions and gestures. But being

15

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continuing education •

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•

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sidered inappropriate in many countries, including Australia and Taiwan.

Putting your hands in your pockets. This should be avoided in many countries, including Germany, Mexico, and Turkey.15 Snapping your fingers and whistling. This is considered taboo in China and is an obscene gesture in Belgium.14 Waving your hand. This gesture is offensive in Greece. The Greek way of motioning “goodbye” is to lift the index finger while keeping the hand closed.11

My Space or Ours?

Personal space issues can cause confusion when you interact with colleagues from different cultural backgrounds. We can unknowingly offend others by moving closer or farther away when conversing.

The concept of group rights has an impact on space. Cultures that give priority to the individual rather than the group (the U.S., Canada, and Northern and Western Europe) are more likely to value privacy. People from these cultures may feel uncomfortable when forced to sit or stand close to people they do not know well. On the other hand, when priority is given to the group rather than the individual (Asian cultures, many Latino and Mediterranean cultures, and most Arab cultures), group rights and shared space are important considerations. People from these cultures welcome physical closeness and may prefer to stand close to one another when holding a conversation.16 People in the U.S. usually stand about three feet apart when speaking. As a point of reference, after shaking hands, people do not move closer together or farther away. But the distance of comfort is more than three feet in Japan. The British maintain a wide physical space between conversation partners. In Italy, Mexico, and Argentina, the distance is closer. Chilean people stand closer than many Northern Europeans, North 30

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Americans, or Asians. When talking with Chileans, try not to back away. If you do, they will most likely step closer and close the gap. They may also put a hand on your shoulder or lapel.14 Nigerians and some other African cultures also find less than an arm’s length acceptable, except in Muslim countries where more distance is kept between men and women14

Time: Fixed or Flexible Punctuality is emphasized and expected in the U.S. This can create misunderstanding when dealing with colleagues from other cultures. Arriving late for interviews or meetings creates a negative impression in the predominant U.S. culture. Interestingly, if you had a meeting in Chile, you as an American visitor would be expected to arrive on time, even though your Chilean counterpart might be 30 minutes late.14 In Mexico and many South American countries, social events rarely begin at the scheduled time, and everyone is expected to arrive late. If you are invited to a party or dinner, try to ask what time you are really expected to attend. In China, however, punctuality is expected for business meetings and social events.

Arriving late or not showing up is an affront.14

Giving Gifts If you are attending a party or going to someone’s house for dinner outside the U.S., gift giving traditions are important to understand. For example, expensive gifts may be considered a bribe in China.

Gifts are exchanged with the right hand in the Middle East because the left hand is used for hygiene and considered unclean. Gifts of food such as baked goods are appropriate but avoid giving food containing pork or pork products. Offering to take business associates out for a meal is another way to offer a gift.17 What you consider a nice gift may not be the same for others. Some gifts can have a negative meaning. For example, a clock is associated with funerals in China, red flowers are for lovers in

Germany, and yellow flowers symbolize death in Mexico. Don’t give gifts made of silver to Mexicans; they associate them with trinkets sold to tourists.

In some cultures, such as South Korea, people will not accept a gift initially.

The refusal is part of the ritual. It is acceptable to be persistent until it is accepted.18 In some countries, people open a gift when they receive it, and in others, it is opened later. As an example, in China a gift is not opened when received to show that the act of giving is more valuable than the actual gift.

Small Talk In many professional and personal situations, small talk helps build rapport. By becoming aware of the conversational styles of those from other cultures, you learn what to expect and avoid. As a general rule, avoid discussing religion and politics. To be on the safe side, avoid telling jokes. Jokes are often misunderstood based on nuances of communication and language.16 What may be funny in one culture could be misinterpreted as sarcasm or making fun of someone in another.13 Safe topics include weather, traffic, sports, travel, art, and music. Avoid idioms, jargon, and slang (such as “ASAP” and “24/7”).

Customs for addressing people also vary. As a rule, it’s best to address people using last names in a formal manner (using Ms., Mrs., Mr., Dr., etc.) until you are invited to use first names. Note: You may not be invited to use first names.

You can build rapport if you notice the level of animation that people use in conversation. As an example, the British are often not very animated, nor are they excitable. You would do well to follow suit by not speaking in a loud voice or being overly emotional.11 On the other hand, Greeks use their hands and facial expressions to communicate. Keep this in mind when interviewing a colleague from a different cultural background.

What you may interpret as a lack of enthusiasm may be the normal range of affect for the person to whom you are WWW.ORTODAY.COM

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continuing education speaking.

The appropriateness of discussing family varies considerably. Asking about family is appreciated among MexicanAmericans, Navajos, and American Eskimos.16 However, in some Northern European cultures, asking about family is considered rude and too personal in a business setting. Follow the cue of your international colleagues when discussing family.

Although you may freely offer compliments to colleagues and friends, they are received differently in some cultures.

For example, Germans may be embarrassed by a compliment. What you may have considered a polite gesture may put a strain on a developing relationship.

Business discussions can be complicated by word choice. In some cultures, people avoid using the word “no.”

“Maybe” or “We’ll see” generally means “no” in Mexico and in Honduras. Also, in their desire to please, Hondurans may give you the answer they think you want to hear. So be careful how you phrase your questions. The Japanese response of “I’ll consider this” may actually mean “no.”14 In the U.S., nodding signifies agreement. However, in Southeast Asia, nodding means “I hear you,” not “I agree with you.” Direct disagreement is not a cultural norm, so members of these cultural groups may nod instead of voicing disagreement.16 As another example, American Eskimos seldom disagree with others in public. They may nod “yes” even if they disagree, just to be polite.16

Table Manners Many business decisions take place over a meal. You could be interviewing a candidate for a position, attending a dinner meeting, or enjoying holiday festivities.

This is an important area for considering cultural differences. You do not want to be caught off guard with your actions or, just as important, with your facial expressions.

Different dining styles exist. In the U.S., the American style is most common. The Continental/European style WWW.ORTODAY.COM

is the norm outside the U.S. With the American style, a person cuts meat with the knife in the right hand and the fork in the left hand. (A left-handed person uses the opposite hands.) The person cuts two or three pieces of meat or other food and then switches the fork to the right hand to eat the meat. The person places the knife across the top of the plate with the blade facing inward. Then the utensils are switched around and more food is cut.

This style is sometimes called the “zigzag” style.

With the Continental style, the knife stays in the hand with which the person writes, and the fork stays in the other hand. After a person cuts a bite-sized piece of food, the fork and knife may remain in the same hands while the fork transports the food to the mouth with the tines down. The silverware is not shifted around.

Good table manners vary from country to country. Be aware of your nonverbal expressions, and do not comment on table manners. For example, making a slurping sound while eating is acceptable to the Japanese. However, eating and drinking while walking in public is frowned upon, as is sneezing, spitting, and burping.14 Observe what people do with their hands during a meal. In many European countries, such as Austria, Spain, and Portugal, you should not put your hands on your lap during a meal.

Instead of laying a hand on your lap, your wrists should be placed on the table.19 If you are eating with your international colleagues at a cultural banquet, observe how they ask for more food and signal when they have had enough. For example, in Cambodia, cleaning your plate means you want more food. In China, taking the last bit of food from a serving dish signifies that you are still hungry. In Thailand, leaving food on your plate means the food was delicious, and you had enough.14 In some settings, your only utensils may be chopsticks. Your attempts at using chopsticks will be appreciated. If you haven’t learned how to use them,

you can ask for a fork. Never point your chopsticks at another person.14 When not using them, line them up on the chopstick rest. In many Arab countries, you will be expected to eat without utensils. Even if you are left-handed, you should eat with your right hand. 17

Summary The business etiquette described in this course give you an idea of the conflicts that can occur when interacting with colleagues from different cultures. These problems can occur when we meet new colleagues, conduct interviews, attend meetings, accept social invitations, work together in a clinical setting, or attend classes. Use these guidelines to develop awareness of cultural diversity. When in doubt, or when you see an action or gesture you are confused about ask someone from the same background what the action means.11 Being courteous and polite to others is a nursing responsibility dictated by our professional Code of Ethics. It is important for nurses and nurse leaders to model behaviors that promote civility in the workplace.20 Nurses should understand that manners and etiquette are about showing respect to others and maintaining dignity for all persons.21,22 Gloria Kersey-Matusiak, PhD, RN, is professor emerita from Holy Family University where she currently teaches as an adjunct in the graduate program in the School of Nursing and Allied Health Professions. She is the author of Delivering Culturally Competent Nursing Care: Working with Vulnerable Populations (2nd ed.) New York, Springer Publications.

Rebecca Smallwood, MBA, RN, has over 25 years of experience across a wide spectrum of healthcare settings including: rural and urban acute care hospitals, public health, ambulatory surgery center, higher education, and commercial organizations. Her roles have included: medical/surgical, ED, and OR staff and charge nurse; director of school health services/school nurse for PK-12th December 2021 | OR TODAY

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continuing education grades; public health epidemiology and bioterrorism preparedness; Infection control practitioner; quality management specialist; organizational development specialist; and educator. Prior to joining Relias as a SME and writer for acute care and payers, she provided healthcare learning and development consultation to Swank Healthcare and was the director of education services for Health.edu, a division of Texas Tech University Health Sciences Center. She has authored live and web-based educational content on clinical, patient safety, regulatory, leadership, patient experience and performance improvement topics. Rebecca earned a diploma in nursing from Methodist Hospital School of Nursing in Lubbock, Texas in 1989 and an MBA in Healthcare Administration from Wayland Baptist University in 2010.

References 1. Health Resources and Services Administration (HRSA). Distribution of registered nurses, by race/ethnicity, relative to the

com/wp-content/uploads/2015/03/ana3Issues-224.pdf 6. NCLEX Statistics: Quarterly Examination Statistics.2019 NCLEX Volume and Pass Rates. Accessed August 1, 2019 https:// www.ncsbn.org/NCLEX_Stats_2019.pdf 7. Agarwal P. How to create a positive workplace culture. Forbes. Accessed on August 29, 2019 at https://www.forbes.com/ sites/pragyaagarwaleurope/2018/08/29/ how-to-create-a-positive-work-placeculture/#3a26dcca4272 8. Bladh M L, Van Leeuwen M A. Nurse- toPatient: It’s more than good manners.

Nursing 2017.2017;47(8),53-56.

9. Dancyger L. The writer’s argument for po-

gust 28 at http://guide.culturecrossing. net/basics_business_student_details. php?Id=7&CID=96 15. eDiplomat. Mexico cultural etiquette. Accessed Aug. 26, 2019 www.ediplomat.com/ np/cultural_etiquette/ce_mx.htm 16. . Giger JN. Transcultural Nursing: Assessment and Intervention. 6th ed. St Louis, MO: Mosby/Elsevier; 2013.

17. Commisceo Global. Gift giving etiquette in the Middle East. Accessed Aug. 27, 2019 @ https://www.commisceo-glal.com/ Level C 18. Commisceo Global South Korea language, culture, customs and etiquette. Accessed Aug. 26, 2019 https://www.commisceoglobal.com/resources/country-guides/

writermag.com/writing-inspiration/essaysabout-writing/political-correctness/

south-korea-guide#CA 19. Etiquette Scholar. Table Manners. Ac-

10. Song, Soohoo. Politeness in Korea and

cessed August 28, 2019 @ https://www.

America: A comparative analysis of re-

etiquettescholar.com/dining_etiquette/

quest strategy in English communication.

Korea Journal. 2014; 54(1), 60-84.

11. Westside Toastmasters inc. Cultural Book

Health Workforce Chartbook Part 1: Clini-

westsidetoastmasters.com/resources/

cians. Accessed at https://bhw.hrsa.gov/

book_of_body_language/chap5.html

2. Mayne D. 10 Unique etiquette tips to

August 23, 2019 14. Cultural Crossing Guide. Accessed Au-

Accessed August 1, 2019 https://www.

of Body Language. Accessed at https://

part1.pdf

gestures_b_3437653?guccounter=1

litical correctness. The Writer. 2019; 132(6)

working-age population. United States

sites/default/files/bhw/nchwa/chartbook-

August 23, 2019 12. LaCour D. Face to Face. OD Practitioner.

2016;48(3):65-66. http://search.ebscohost.

table_manners.html 20. Parrish E. Civility and self-care in nursing go hand in hand. Perspectives in Psychiatric Care. 2016; 52, 81 doi:10.1111/ ppc.12163 21. Perlman H. Manners and Courtesy for all is a step forward. Psychology Today. 2018; Accessed at https://www.psychologytoday. com/us/blog/unmapped-country/201805/

use around the world. The Spruce. 2019.

com.holyfamily.idm.oclc.org/login.aspx?

Accessed August 1, 2019 at https://.

direct=true&db=asn&AN=116584658&sit

22. McNamee G. Civility vs. Decency. Virginia

thespruce.com/etiquette-around-the-

e=ehost-live. Accessed August 23, 2019.

Quarterly Review. 2018;94(3):224. http://

world-4158364

Level C

search.ebscohost.com.holyfamily.idm.

3. James D. How political correctness kills

13. Cotton G. Gestures to avoid in cross-cul-

manners-and-courtesy-all-is-step-forward

oclc.org/login.aspx?direct=true&db=asn&

language freedoms. Eureka Street.com.au.

tural business: In other words, keep your

AN=132521201&site=ehost-live. Accessed

2017; 27(17). Accessed August 3, 2019 at

fingers to yourself. Accessed at https://

August 23, 2019.

https://www.eurekastreet.com.au/article/

www.huffpost.com/entry/cross-cultural-

freedoms 4. Kersey-Matusiak G. Why can’t they speak our language: Working with culturally diverse colleagues. In Kersey-Matusiak.

2019. Delivering Culturally Competent Nursing Care: Working with Diverse and Vulnerable Populations. New York, NY. Springer Publications.

5. Davis M. Inside ANA. Issues up close keeping pace: ANA’s revised code of ethics for nursing. Accessed August 28, OR TODAY | December 2021

Clinical VignettE ANSWERS 1. Answer: B. The person of honor” method for introductions follows these steps: 1. Say the name of the person of honor. 2. Introduce the other person to the person of honor and say something about them. 3. Return to the person of honor and say something about them. “The person of honor” is the higher-ranking person in the organization. 2. Answer: C. Personal space issues can cause confusion when interacting with others from different cultures. It is common in the U.S. to stand about 3 feet apart when speaking. 3. Answer: A. Yellow flowers symbolize death in Mexico. 4. Answer: D. As a general rule, avoid discussing religion and politics. Avoid telling jokes, which can be misunderstood based on nuances of communication and language. What may be funny in one culture could be misinterpreted as sarcasm or making fun of someone in another. Safe topics include weather, traffic, sports, travel, art, and music.

how-political-correctness-kills-language-

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2019 at https://www.americannursetoday.

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CE570 Clinical Vignette After graduating from nursing school, Janet Smith left her small farming community in the Midwest and accepted a nursing position at a medical center in a culturally diverse urban area on the East Coast. As a member of the recruitment and retention committee, you have been asked to mentor Janet.

1. How should you introduce Janet and the vice president of nursing (Terri London) to one another observing the “person of honor” method?

A. Find a private place to make the introduction, which is a sign of respect for both Terri and Janet.

B. “Terri, I would like you to meet Janet Smith. Janet is a new hire who will be working in the ED. Terri London is the vice president of nursing.”

C. Ask Terri to bring a small gift to present to Terri when they are introduced to one another.

D. “Janet, I would like you to meet Terri London. Terri is the vice president of nursing. Janet Smith is a new hire who will be working in the ED.” 2. As you observe Janet interacting with others and notice she may be making others uncomfortable by the space she maintains during face-to-face conversations. You can help her by telling her that: A. The British maintain a close space between conversation partners.

B. Placing a hand on the other person’s shoulder when speaking face-to-face is universally acceptable.

C. It is common in the U.S. to stand about 3 feet apart when speaking.

D. Chilean people are most comfortable with a wide space when talking.

3. You and Janet are going to a birthday party for a colleague who recently moved to the U.S. from Mexico. Which gift should be avoided?

A. Yellow flowers B. A gift certificate C. A clock D. A mirror 4. While at the party, you notice that Janet is having trouble making conversation. What would be good advice for Janet?

A. Jokes are always a good way to get a conversation started.

B. Ask colleagues about their religious backgrounds.

C. Explain how you voted in the recent presidential election.

D. Sports, travel, and music are safe topics for conversation.

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

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

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

Deadline Courses must be completed by 10/15/2022 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

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

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

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

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

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

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COMPANY SHOWCASE

PRODEON MEDICAL The Prodeon Medical, Inc. (PMI) initiative was started in 2016 with the mission of rethinking the treatment of the lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH), or more commonly referred to as “enlarged prostate”. PMI’s first product, the Urocross™ Expander System is a minimally invasive device under development1. The procedure referred to as Prostatic Urethral REshaping (PURE) uses a temporary implant intended to rapidly relieve symptoms. The implant is placed in the prostatic urethra using flexible cystoscopy, and because there is not a permanent foreign body or damage caused to any anatomical structures such as the bladder neck, the procedure does not preclude future treatment choices.

T

OR Today Editor John Wallace recently interviewed well-known urologists Drs. Bilal Chughtai, Dean Elterman, and Daniel Rukstalis with a focus on PMI (www.ProdeonMedical.com).

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Dr. Rukstalis is an experienced urologic oncologist at Prisma Health in Columbia, South Carolina. He specializes in the diagnosis and management of both benign and malignant disorders of the urinary tract, with a focus on minimally invasive surgery, advanced interventional imaging, and interventional urologic procedures such as targeted biopsy and ablation of tumors. Dr. Chughtai is an associate professor of urology and an associate professor of urology in obstetrics and gynecology at Weill Cornell Medicine. He is also an associate attending urologist at New York-Presbyterian Hospital. He specializes in voiding dysfunction, female urology, and neuro-urology. Dr. Elterman completed his medical degree followed by residency in urologic surgery at the University of Toronto. He became a fellow of the Royal College of Physicians and Surgeons of Canada in 2011.

He completed a two-year fellowship in voiding dysfunction, neuro-urology, female urology and pelvic reconstruction at Memorial Sloan-Kettering Cancer Center and New York Presbyterian Hospital/Weill Cornell Medical College in New York City.

Question: With a priority of overall bladder health, what future considerations might we see from patients and doctors regarding their treatment decision process?

Rukstalis: In the United States, medications have become the mainstay for managing symptoms associated with BPH. Common symptoms include frequent or urgent need to urinate, increased frequency at night, and difficulty starting to urinate. Medications cannot physically remove the obstruction that has been created by the prostatic tissue. The population is living longer and theoretically patients could be taking medications for longer periods. Over time, some medications are associated with a deterioration in the function of the bladder. Therefore, with new therapeutics, there is an opportunity to define an optimal balance between 1) symptom management with medications and 2) a mechanical procedure that addresses the obstruction.

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company showcase

UROCROSS EXPANDER SYSTEM (HANDLE AND DELIVERY CATHETER)

UROCROSS RETRIEVAL SHEATH

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PRE-IMPLANT

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Question: There are many exciting Minimally Invasive Surgical Therapies (MIST) in development for treating symptoms secondary to BPH. How do you envision the paradigm of your future treatment offering?

Chughtai: This is a chronic disease that will benefit from having new choices. I envision offering multiple therapeutic options based on varying mechanisms of action. Prostatic Urethra REshaping (PURE) could become a compelling option. The initial data is very exciting and seems like a promising option to offer patients.

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POST-RETRIEVAL

Question: What will be important for you to consider a MIST technology earlier in the treatment paradigm?

Chughtai: The new MIST options are very exciting in that they offer high amounts of clinical benefit with less risk than the gold standard surgery called transurethral resection of the prostate (TURP). An option that does not close any clinical doors would allow me to offer this to my patients sooner in the clinical pathway. A lot of patients are worried about the safety of any procedure and sometimes they go through great lengths to compensate within their daily lives with the bothersome urinary symptoms. However, a procedure that allows for future therapeutic options would allow for possible earlier use with these patients.

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Question: Do you think it will one day become the norm to offer MIST earlier in the treatment paradigm?

Elterman: There is evidence that untreated bladder outlet obstruction leads to permanent and irreversible damage to the bladder. As MISTs become better designed, less invasive, easier to insert and tolerate, I see a shift of placing a prostatic implant as preferable, more efficacious, and perhaps even more cost-effective than daily medical therapy.

Question: You are currently participating in research of the Urocross Expander System, what interests you about that technology?

Elterman: The Urocross Expander System is unique amongst the MISTs in that it’s compatible with many existing flexible cystoscopes which a clinic may already own. The technology is designed to be a temporary implant; thus, no permanent foreign body is retained. This leaves future options open if re-treatment is required years down the road.

Question: Men will have many choices in the future, what do you see as being the deciding factors?

Elterman: I believe patients and urologists will want to choose treatments which ameliorate symptoms, preserve sexual function, and have limited side-effects.

Ideally the device should be easy to insert and just as easy to retrieve allowing for future treatments, even perhaps with the same device years later.

1

CAUTION: Prodeon Medical Inc. products are

for Investigational Use Only and are not for sale in the U.S. or outside the U.S

36

OR TODAY | December 2021

SPONSORED CONTENT

Prodeon Medical Inc. President Paul Edwards Interview

Question: How was the company formed?

Edwards: In August 2021, Prodeon Medical, Inc (PMI) was spun out of a medical device incubator known as MedeonBio, Inc. The genesis of this program began with initial concepts from a prominent urologist in 2016. After having successfully completed a feasibility study, the Company is now at a key inflection point as we prepare for our US pivotal study.

Question: What is the unique value proposition of your technology?

Edwards: Our Benign Prostatic Hyperplasia (BPH) program developed a novel therapy, the Prostatic Urethra REshaping (PURE) procedure, using the Urocross™ Expander System and the Urocross Retrieval Sheath. The PURE procedure is a minimally invasive therapy that uses a delivery catheter to deploy a nitinol implant in the prostatic urethra. The Urocross Expander System is indicated for the treatment of men who are experiencing lower urinary tract symptoms (LUTS) associated with BPH. The implant is designed to be retrieved using the Urocross Retrieval Sheath. The unique value proposition focuses on delivering a therapy with several key goals in mind: 1. Is performed using a flexible cystoscope maintaining patient comfort peri- and post-procedure 2. Provides rapid resolution of symptoms 3. Minimizes need for post-procedural catheterization and allows patients to promptly return to normal activities 4. Preserves sexual function 5. Preserves the bladder neck. Bladder neck preservation potentially avoids the scarring and subsequent strictures. Preservation of the bladder neck also mitigates the potential of a side effect known as retrograde ejaculation. When asked, all sexually active men prefer to maintain normal antegrade ejaculation 6. Does not leave a permanent implant in the body.

Minimizes potential of future encrustation and losing patients to follow-up 7. Most importantly, the PURE procedure using the Urocross Expander System preserves future treatment options, if needed.

Question: What are the next steps for the company?

Edwards: PMI recently completed enrollment in a feasibility study known as the Expander-1 study. The next phase for the Company will be to commission a pivotal study in North America to assess the safety and efficacy of the Urocross Expander System and the Urocross Retrieval Sheath in a randomized and controlled clinical trial.

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COVER STORY

Wi OR sh Lis t

By Don Sadler

38

OR TODAY | December 2021

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COVER STORY

ith the holidays right W around the corner, you might be thinking

The most common wish list items had to do with OR and ASC staffing.

“I wish I had a magic wand and the nursing shortage would end,” said Bev Kirchner, president of the Texas Collaboration of periOperative Registered Nurses (TCORN). “More specifically, I wish we could figure out how to educate the students who want to be nurses in more significant numbers.”

According to Kirchner, nursing

to the number of baby boomer nurses retiring daily.”

Adequate OR staffing was also high on the wish list of David Taylor, MSN, RN, CNOR, the president of Resolute Advisory Group LLC. “ORs across the country are struggling with finding enough qualified, highly trained employees to cover their basic clinical needs,” he says.

“Having enough employees to staff the clinical needs and be able to provide education, training and mentorship – as well as allow for paid time off without interrupting operations – is an OR leader’s dream,” Taylor adds.

It’s not just perioperative employees either. Taylor says that health care organizations rarely staff their leadership roles appropriately.

“The OR may need a director, manager, assistant manager, charge nurse, educator and business manager just to name a few,” he says. “Instead, all the leadership roles are lumped together, making it nearly impossible for leaders to be highly functional.”

Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative services at Anmed Health,

“The biggest barrier to my organization in the coming years is human resources, or the lack thereof,” said Julie Brinegar, MBA, BSN, CNOR, CASC, the executive director of Surgery Center Cedar Rapids in Cedar Rapids, Iowa.

“My wish list would include providing a national advocacy campaign for the nursing profession to colleges and the public to assist in the staffing challenges we are facing and provide for a positive awareness of this great need,” adds Brinegar.

Hospital management has historically sought out experienced nurses for OR positions, Brinegar notes.

“However, creating awareness of the benefits of hiring more inexperienced nurses or new graduates could turn the tide and encourage them to seek out ASCs for employment.”

“The first item on my wish list would be to have all the staff I need whenever I need them without worrying about a nursing shortage, scheduling conflicts or competition from down the street or across town,” adds Julie Lewis, BSN, MBA, vice president of surgical services for

schools have no shortage of applications. “What they have is a faculty shortage,” she said, “followed by restrictive training requirements for hands-on experience. Perioperative nursing is in a crisis mode of operation and the shortage is only going to get worse due

offered a quick two-word reply to her wish list: “More staff!” she said.

“Even though positions are approved, recruitment is difficult.

Creative staffing models, such as hiring staff to just take call, might help,” she added.

GastroMD in Tampa, Florida.

“My wish is for experienced and available OR nurses so staff are not taxed and without capable persons to promote and provide exceptional and consistent patient care,” adds Deb Yoder, MHA, BSN, RN, CNOR, the

about what items are on your wish list or the wish lists of your family members and friends.

But what if you had a wish list for the operating room or ASC? What items would be on your OR or ASC wish list this year?

We decided to ask a number of different perioperative professionals this question. Following is a summary of their responses.

Staffing Tops the List

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December 2021 | OR TODAY

39

COVER STORY

Renae Battié, MN, RN, CNOR, AORN’s vice president of nursing

director of clinical operations at Surgical Management Professionals in Sioux Falls, South Dakota.

Kyle Dorshorst, RN, the clinical director at Ambulatory Surgical Center of Stevens Point in Stevens Point, Wisconsin, says he’s concerned about the culture and emotional health of the staff at his facility.

“I wish I could grant them all one day off every other week with pay through the end of the year,” he says. “This would give everyone time to refresh and revive.”

Eliminating Surgical Smoke and Improving Patient Safety Kay Ball, Ph.D., RN, CNOR, CMLSO, FAAN, a perioperative consultant and adjunct professor at Otterbein University in Westerville, Ohio, has been active in efforts to get surgical smoke legislation passed. So, it’s not surprising that having smoke evacuators in all operating rooms that use energy devices is at the top of her wish list.

“The hazards of surgical smoke continue to plague our perioperative environments so we must evacuate plume,” says Ball. “Smoke evacuation should be a standard practice since evidence-based research documents the hazards of the contents of the plume.”

“If I could have one Christmas wish for the operating room, it 40 OR TODAY | December 2021

would be that all surgical smoke is routinely evacuated and filtered,” adds Brenda C. Ulmer, RN, MN, CNOR. “I believe, and fervently wish, that one day we will look back and wonder why it took us so long to routinely opt for clean air while working to save lives in the operating room.”

“At the top of my wish list is for all perioperative services practitioners to work in an organization that puts patient safety and quality first,” says Sharon McNamara BSN, MS, RN, CNOR. “An organization where administrators provide support, resources and education on true teamwork principles, communication skills and transparency without retribution for errors.”

McNamara continues: “I wish for empowered health care practitioners to step forward, be brave and make sure that these changes are not flavor of the month but sustainable quality improvement initiatives that will improve care and keep patients and staff safe. And I wish for an environment of respect, valuing of diversity and patient-centered, physician-led, team-based care.”

Continuing Education and Use of Technology Ball would also like to see continuing education budgeted for all periopera-

tive team members – both nurses and techs. “The skill level of surgical team members must be kept current as new advancements and technology continue to be introduced to advance surgical procedures,” she says.

“One of the first budget items to be cut is usually funds for staff education,” adds Ball. “This is unsafe as nurses and techs need to continually learn in order to stay abreast of advancements and keep our patients safe.”

Dorshorst would also like to be able to identify and purchase technology that would make the role of the perioperative staff more efficient and patient-centered. “The goal would be for staff to spend less time on charts, computers and non-productive tasks, thus creating more time for staff to spend with patients,” he says.

Nik Unterkircher, the manager of digital learning strategy and design for the Association of periOperative Registered Nurses (AORN), echoes Dorshorst’s technology wishes. “My hope is that nurses will become excited about the use of new technology in their education,” she says.

“We are tech-forward in the OR and that gives us an important foundation to embrace emergent learning platforms that can identify our knowledge gaps and customize our individual education,” Unterkircher adds. “Let’s take advantage of technology that can WWW.ORTODAY.COM

COVER STORY

Nik Unterkircher, the manager of digital learning strategy and design for the Association of periOperative Registered Nurses (AORN)

support our professional development and advance our practice.”

Thinking big, Taylor would like to see a redesign of the standard operating room. “Today’s ORs are too small to accommodate additional personnel and equipment needed for complex procedures,” he says. “Smaller ORs require a great deal of planning and manipulation of the schedule to keep the flow of procedures moving.

“In addition, the shape of all ORs should be the same to avoid having to adjust to new positions or equipment and supply locations,” Taylor adds. “There should be adequate wiring to allow equipment needing electrical supplies to be positioned as needed for a procedure.”

Taylor would also like to see more storage space in the OR. “There is never enough storage to adequately meet the daily needs of an OR,” he says. “Appropriate storage cabinets and rooms designed for equipment should be available in the correct numbers and size to store and protect the supplies and equipment intended for those areas.”

Taylor also believes that the preference card system at hospitals could be improved. “Early in my career, preference cards were WWW.ORTODAY.COM

written on five-by-nine cards and kept in a file near the OR,” he says. “A hospital might have 100 or so cards for all of the surgeons and could easily add or remove items in real time.”

“Today a hospital could have thousands of electronic preference cards, making it nearly impossible to keep them updated,” Taylor adds. “This does not help staff prepare properly, adds touch points to every procedure and is costly.”

Taking Pride in Perioperative Nursing Renae Battié, MN, RN, CNOR, AORN’s vice president of nursing, emphasizes the career satisfaction that most perioperative nurses experience. “We are incredibly proud of our direct influence on the quality of care that surgical patients receive and contribution to the health of our community by providing needed access to life-changing procedures,” she says.

“My wish is for all perioperative nurses to finish every day with pride in the value they bring to the surgical team and patients’ safe outcomes,” says Battié. “And that the stories of their impact attract many more future nurses to the perioperative profession.”

Erin Kyle, DNP, RN, CNOR, NEA-BC, AORN’s editor in chief of the Guidelines for Perioperative Practice, turned to AORN’s team of guidelines authors for their OR wish list.

Top Wishes of AORN Guidelines Authors

At the top of this list is maximizing the capabilities of today’s technology, such as improved tracking of instruments, equipment, personnel and even patients. For example, one author wished everything in the OR could be wireless and cordless.

Other wishes centered around total elimination of surgical errors and surgical site infections, with the added wish of never having to be concerned about the sterility of items used on the sterile field.

All guidelines authors agree on one simple wish: They want accurate pick lists and preference cards along with the all the necessary resources available when and where they are needed.

December 2021 | OR TODAY

41

Spotlight On:

Jana Mazzo,

RN, RDMS

By Matt Skoufalos

A

sk registered nurse Jana Mazzo why she’s in the health care field, and the answer is a simple one: she wanted to make helping people her life’s work. From that basic principle, however, she’s developed a career that’s as varied and interesting as the nursing field itself.

Mazzo’s started off in the neonatal intensive care unit at Cooper University Hospital in Camden City, New Jersey, where she supported premature and micro preemie babies – those born weighing less than one pound, eight ounces, or before 26 weeks of gestation. When Mazzo herself became pregnant with her first daughter, she left the NICU to work in outpatient nursing for Weisman Children’s, a pediatric specialty organization in Marlton, New Jersey; today, she is a nurse esthetician in Newtown Square, Pennsylvania.

Before Mazzo entered the field of nursing, however, she worked as a registered diagnostic medical sonographer (RDMS) for MobilexUSA of Pennsauken, New Jersey, a subsidiary of TridentUSA Health Services, which provides advanced mobile diagnostic services across the country. She traveled across Pennsylvania, New Jersey, Delaware and Maryland performing diagnostic ultrasound services in remote facilities, including nursing homes, rehabilitation homes and jails. When Mazzo had the opportunity to perform fetal ultrasounds, however, she knew she’d found her niche.

“When you’re doing medical ultrasounds, you know what you’re going to expect; it’s static,” she said. “With fetal ultrasound, it’s a dynamic thing. You’re chasing around a baby who’s face-planted in the placenta, or sucking on the umbilical cord; you see them yawn, or swallow the amniotic fluid. It’s priceless seeing people’s faces. You’ll never see the same thing twice.”

Because she so delighted in sharing the moments of discovery that sonography offers expectant parents, Mazzo decided to open her own ultrasound

42

OR TODAY | December 2021

clinic, Womb Service, in Audubon, New Jersey. Womb Service offers elective 2D, 3D, 4D and HD ultrasounds to parents who want to leverage contemporary medical imaging technology to take a look at their children in utero. She likens the service to a family portrait studio, where parents-to-be can get images of their babies before they’re born.

“My goal working in health care was to make everything more accessible, because pregnancy is a time when people have a lot of questions,” Mazzo said.

“We want to help. Since we are medical professionals, we point out everything [during the scan], and answer any questions that they have.”

Customers are required to have had a medical ultrasound prior to their session, and studies are performed only

by RDMS-credentialed sonographers; Mazzo or her partner. The only difference between the elective ultrasounds she offers and the medical ultrasounds that are a component of routine prenatal care is that no radiologist interprets the images she captures.

“They’re doing this for fun,” Mazzo said. “On the off-chance we see something [of concern], we have all their doctor’s information, and we report it.”

Elective ultrasound, while not intended to provide diagnostic medical information, does offer developmental details that parents want, she said. These include “early gender reveals, peace-ofmind scans,” and, in the third trimester, “really clear, distinct facial shots, where

you see exactly what the baby looks like.”

HD ultrasound yields high-resolution images, but the GE Ultrasound Voluson scanner that is the backbone of Mazzo’s studio also features post-processing capabilities that can offer a strikingly clear portrait of a child at various stages of gestation. When parents see those photos, their faces communicate “instant relief,” Mazzo said. For families awaiting a first child, those who’ve had difficulty trying to conceive, or even women who know they are pregnant but whose babies aren’t big enough to perceive physically, the process can be transformative, she said.

“I love all my people; I did have one person who I got to really know [because] this was her rainbow baby,” Mazzo said. “She came in, so nervous, once every three or four weeks, just to check on him. Just seeing the heartbeat, she would audibly exhale. He was born perfect.”

Unlike in her other health care roles, where patients receive care, and then move along, Mazzo said she enjoys the opportunity elective ultrasound offers her to circle back with families after their babies are born. She often has the opportunity to compare their baby photos with the ultrasound images she’s captured in her studio, and many of her customers return during subsequent pregnancies.

“I get to see a lot of people afterwards and follow their journeys,” Mazzo said. “It’s very rewarding. I feel like it

goes back to wanting to help, and to bring everything together.”

Mazzo also uses the opportunity of capturing ultrasound images to have broader conversations about perinatal health with her customers, offering resources for lactation consultancy, midwifery and CPR. In the future, she hopes to develop a “daddy boot camp” to help educate new fathers, and she’s been certified to teach parenting classes, for which she’s writing a curriculum.

“I give them information that they can read at their leisure,” Mazzo said. “I want them to know that the resources are definitely there. I want to be a one-stop shop for perinatal health.”

When she’s not working in nursing or running her ultrasound business, Mazzo enjoys spending time with her extended family, who live just seven houses down from hers. Her husband and daughters all enjoy visiting their relatives and grandparents, and Mazzo considers herself fortunate to be able to raise them in the town of her youth. She’s also pursuing her real estate license, the better to support her family’s realty business.

More than anything, however, Mazzo said the opportunity of operating her own business has yielded the chance to show her own babies the work that goes along with welcoming a new family member into the world.

“It’s great that I get to bring my girls here, and they can see what I’m doing,” she said. “I’m glad they can experience that.”

December 2021 | OR TODAY

43

OUT OF THE OR fitness

3 Daily Do’s for Better Core Stabilization and Strength

By Miguel J. Ortiz s we get closer to the new year, health and exercise will continue to be a topic of conversation with ourselves and others. A lot of us, depending our circumstances, might have been sitting down more or continued patterns of inconsistent workouts and poor eating behaviors. The lack of movement, and too much sitting for so many Zooms calls, has led to a weaker core and poor breathing in many individuals.

A

What people need to understand is that proximal core strength will enhance distal joint strength. Which basically means that a stronger core means stronger hips, shoulders and knees. So, who wouldn’t want that? The problem is that most people think they need a lot of time, but you don’t. Consistency with proper movement is the name of the game and all you need to do is practice these three movements daily. Whether you take 5 minutes or 30 minutes, these three movements – when done properly regardless of how much time you have – will have a tremendous effect on your core stability. They will have you moving much better going into the new year.

The first movement is going to start 44 OR TODAY | December 2021

on the ground to isolate the core. If you are not on a carpet or soft surface you will need a mat as we begin with the classic “dead bug” (tinyurl.com/ ygnqgv7r). This movement may look easy, but it requires focus to do it properly. Start with knees bent at 90 degrees and arms punching toward the ceiling. You want to start by moving opposite arm and leg while maintaining your back on the floor and extend the arm and leg as far as possible. This helps strengthen your core and helps with coordination. It also opens up the hip and shoulder.

The second movement includes a kneeling position and starts to involve upper body rotation. It challenges your balance which, again, is very important when it comes to core strength. This exercise is the “kneeling torso rotation” (tinyurl.com/ yh39hw5v). Once in a comfortable kneeling position, active the back foot, seated up right with arms in an extended position. If your right foot is in front you want to lift your right arm toward the ceiling and rotate to your right as your reach behind while keeping your arms 90 degrees.

In this kneeling position, it focuses on challenging the core by stabilizing the hips but requires rotation of the upper body. The trick is to maintain

stability while taking the upper body through a different range of motion.

Lastly, the third movement goes in and out of a standing and seated position. You will need a chair or bench. This exercise is the squatted torso rotation and reach (tinyurl.com/ yz5plfbj). By doing this movement from a seated position, we are able to concentrate more on the stretch of our shoulder and back. Start by being ready to squat and once down open one shoulder away and toward the ceiling while using the opposite arm to create leverage and drive that leg wide. For example, when rotating to the right you should feel the stretch in your right shoulder, right lower back and left inner thigh.

I would highly recommend preforming these movements daily for a total of 10 reps per movement at minimum. Enjoy these movements and stay tuned as we progress and keep our bodies moving into the new year.

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

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45

OUT OF THE OR health

COVID Orphanhood Impacts Thousands By family features ne U.S. child loses a parent or caregiver for every four COVID-19 deaths, a new modeling study published today in Pediatrics reveals. The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response – both for as long as the pandemic continues, as well as in the post-pandemic era.

O

From April 1, 2020 through June 30, 2021, data suggest that more than 140,000 children under age 18 in the United States lost a parent, custodial grandparent or grandparent caregiver who provided the child’s home and basic needs, including love, security and daily care. Overall, the study shows that approximately 1 out of 500 children in the United States has 46

OR TODAY | December 2021

experienced COVID-19-associated orphanhood or death of a grandparent caregiver. There were racial, ethnic and geographic disparities in COVID-19-associated death of caregivers: children of racial and ethnic minorities accounted for 65% of those who lost a primary caregiver due to the pandemic.

Children’s lives are permanently changed by the loss of a mother, father or grandparent who provided their homes, basic needs and care. Loss of a parent is among the adverse childhood experiences (ACEs) linked to mental health problems; shorter schooling; lower self-esteem; sexual risk behaviors; and increased risk of substance abuse, suicide, violence, sexual abuse and exploitation.

“Children facing orphanhood as a result of COVID is a hidden, global pandemic that has sadly not spared the United States,” said Susan Hillis, CDC researcher and lead author of the study. “All of us – especially our children – will feel the serious

immediate and long-term impact of this problem for generations to come. Addressing the loss that these children have experienced – and continue to experience – must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa.

Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

For more information, visit www.nih.gov.

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47

OUT OF THE OR EQ Factor

Emotional Intelligence: More Than Just Emotions By daniel bobinski, M.Ed. few years ago a man named Bill wanted to learn how to be a better manager and leader. He found an executive coach, and everything went great during their first meeting until the coach mentioned emotional intelligence (EQ). Bill said he had no interest in dealing with people’s emotions, he just wanted more effectiveness from his team.

A

Thankfully, Bill agreed, albeit reluctantly, to learn about EQ. A common misunderstanding is that emotional intelligence means learning only about emotions. Emotions are just part of the picture. A simple way to define EQ is understanding that people want to feel safe, and exercising good EQ means creating an environment in which people can thrive while operating within their natural motivational, behavioral and cognitive styles without feeling criticized or squelched.

HOW DO EMOTIONS FACTOR IN?

All humans are emotional creatures, and it’s important to remember that emotions factor into all aspects of how we operate.

For example, emotions play a large role in how we develop learned motivators. Strong positive or negative emotional experiences between the ages of 48

OR TODAY | December 2021

0 and 4 can create lasting imprints, and those imprints can attract us to or repel us from different activities.

As an illustration, think about a young child whose parents regularly criticize wealthy people, describing them as greedy and selfish. Such a strong emotional imprint can drive that person to avoid acquiring wealth throughout her whole life. A fear of criticism from those who care most about her may get in the way of her financial stability.

Learning EQ doesn’t require psychological training, it just helps to know that an emotional imprint affects what “drives” us.

Emotions also factor into behavioral styles. Those with Dominant/Driver styles tend to have short fuse. They get angry easily, but they cool off just as quickly. Influencing/Expressive types tend to be enthusiastic. Steady/Amiable types tend not to display their emotions, but it’s good to remember that still waters run deep. Conscientious/Analytical styles tend to fear the consequences of bad decisions.

Finally, know that emotions are also tied to Cognitive styles. Extraverts get excited about being with others, whereas introverts get emotionally drained if they’re around people too long. They need time to recharge! Also, “Feelers” tend to process information with greater expression, whereas “Thinkers” process in a more “matter-of-fact” fashion.

Bottom line, learning EQ isn’t all about studying emotions. However, knowing how emotions impact our motivations and how emotions are displayed in different behavioral and cognitive styles will give you insights in how to be a more effective manager or leader. EQ is not about controlling other’s emotions; it’s about knowing what to expect and adapting instead of criticizing.

In other words, if you know your own style and the styles of your coworkers, you can anticipate people’s tendencies and plan for them, thus making you more effective. This is what happened with Bill. And yes, now he’s a much more effective manager and leader.

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 at MyWorkplaceExcellence.com or call his office at 208-375-7606.

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OUT OF THE OR pinboard nutrition

The Sweetener That is Also a Superfood

By Kirsten serrano urprise! There is a natural sweetener that packs a powerful nutrition punch.

S

Blackstrap molasses is brimming with vitamins and minerals. Among sweeteners, molasses is a standout and you could even call it a “superfood.” To produce table sugar, sugar cane is juiced. It is then boiled three times to extract the sugar crystals and that’s how we get white sugar. Blackstrap molasses is the viscous syrup left after the third boiling and has the concentrated nutrients. This gives blackstrap molasses an impressive nutrient profile. One tablespoon contains just 47 calories and 20% of your daily iron needs, 17% of calcium, and 11% of magnesium, to name a few.

Look for organic unsulfured blackstrap molasses. Sulfur dioxide is sometimes used in processing, in part for its preservative properties. Some say there is a negative effect on taste. There is also a possible connection between sulfur dioxide and an allergic response to sulfites for some people.

Blackstrap molasses is still sugar and should be used sparingly. It is roughly 1/4 glucose, 1/4 fructose and 1/2 sucrose.

The glycemic index is 55 compared to table sugar’s 80. Of all the sweeteners, it 50 OR TODAY | December 2021

is far and away the most nutritious, but, like any sweetener, it can be overdone.

Reality is there is no miracle sweetener, but molasses has something significant to offer beyond sweet taste.

You have heard about empty calories and sugar is the main culprit. Not only does sugar spike your blood sugar and cause inflammation, but it actually depletes nutrients from your body. Magnesium, Vitamin C, Vitamin D, calcium and chromium are all stolen from your body to process the sugar you eat. Magnesium and chromium are critical nutrients for maintaining blood sugar control. The more we indulge the deeper we dig the nutrient deficit hole. Talk about a bad deal!

Molasses has a strong flavor and is not suitable for everything, but I urge you to give it a second glance. I like the flavor of molasses and use it when I can. A favorite seasonal treat is my recipe for a Gingerbread Latte. Here is what you need: 12 oz freshly brewed black coffee 2 scoops collagen powder (support joint, hair, nails, gut health and more) 1 tsp ghee or MCT oil 1 Tb organic unsulfured blackstrap molasses

1/4 tsp pie spice 1/4 tsp ground ginger Here comes the ridiculously easy part: Put everything in your blender and whip it all together. It’s a delicious nutrient dense treat and perfect for the season.

Molasses is a time trusted ingredient in gingerbread, baked beans and BBQ sauces, but that same complexity of flavor can do so much more. Try making a shoofly pie this holiday season for an old-fashioned treat. Brussels sprouts are a fantastic match for molasses whether you use it as a glaze for roasted brussels or make my Molasses Mustard Vinaigrette (smallwonderfood.com) for a shaved brussels sprout salad.

Enjoy the season and add a little molasses.

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

Peanut Butter Saltine Candy YIELD: 45 pieces INGREDIENTS: • Nonstick cooking spray (butter flavor)

Recipe

• 1 sleeve (4 ounces) regular saltine crackers • 1/2 cup butter • 3/4 cup creamy peanut butter • 1 cup granulated sugar • 2 cups milk chocolate chips • 1/2 cup peanut butter chips • 1/2 cup rough chopped, dry roasted peanuts

the

By Family Features

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OR TODAY | December 2021

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OUT OF THE OR recipe

Holiday Sweets Made to Share mong the decorations, gifts and gatherings of loved ones, there’s perhaps nothing quite like family favorite foods that call to mind the joy of the holidays.

Whether your loved ones relish building gingerbread houses or dining on an all-in feast, looking forward to annual traditions is part of what makes the season so special.

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This year, you can add to the fun with a new annual activity by creating a delightful dessert with the help of little ones and adults alike. With an easy recipe like Peanut Butter Saltine Candy that calls for just

Peanut butter saltine candy Yield: 45 pieces 1. Preheat oven to 400 F. Line 10-by15-by-1-inch pan with aluminum foil. Spray foil with nonstick cooking spray then lay saltines flat in single layer on prepared pan. Set aside.

2. In heavy duty, 1-quart saucepan over medium heat, combine butter, peanut butter and sugar. Stir constantly until butter and sugar are melted, bringing mixture to boil. Boil 3 minutes, stirring frequently. Pour cooked mixture over saltines and bake 5 minutes.

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a handful of ingredients, you can get the whole family involved in the kitchen.

Ask your little helpers to measure out ingredients while a grownup prepares the pan and uses the stove. Once the base is finished baking, call the kids back to sprinkle chocolate chips and peanut butter chips over the top.

After your candy creation is cooled, just break it into pieces meant to be shared with the entire family. An added benefit: all can enjoy the nutrient-rich flavor of peanuts, which rise to superfood status by delivering 19 vitamins and minerals and 7 grams of protein per serving.

Find more holiday recipes at gapeanuts.com.

3. Remove from oven and sprinkle chocolate chips over saltines. Let cool 3 minutes then spread melted chocolate completely over saltines.

4. Sprinkle peanut butter chips evenly over chocolate. Return pan to oven 1 minute to soften chips. Pull pointed tines of fork through softened peanut butter chips to partially cover chocolate. Sprinkle chopped peanuts on top, gently pressing into candy.

5. Let cool on rack about 15 minutes then place in freezer 3 minutes.

Remove from freezer and break into pieces. Store in airtight container.

December 2021 | OR TODAY

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viors rather a h e b f o s e ri se a is “Leadership s.” than a role for heroe – Margaret Wheatley

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The News and Photos

OUT OF THE OR

that Caught Our Eye This Month

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Photo courtesy of Getty Images

MANAGING GRIEF DURING THE HOLIDAYS

Establish Boundaries During the Holidays

By FAMILY FEATURES

Acknowledge the Loss

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Families can find ways to honor their loved one’s physical absence during holiday celebrations by incorporating their spirit into celebrations and holiday traditions. Examples of this could be decorating ornaments in ways that are symbolic of a loved one, cooking their favorite meal or making a memorial donation to a favorite charity.

he holidays, as well as birthdays and other celebrations, are often difficult for anyone who has experienced the death of a loved one, particularly during the first year of adjusting to life without them.

The holiday season may result in a renewed sense of grief, especially as well-intentioned individuals are encouraging those who are grieving to participate in traditional festivities. While there can be joy in being together with family and friends, the holidays can also bring feelings of sadness, loss and emptiness.

For those who find themselves struggling with grief during the holidays and other celebrations, consider these ideas from Remembering a Life, an online resource from the experts at the National Funeral Directors Association.

Talk About Grief Grief isn’t a linear journey. Ignoring pain and emotions won’t make it go away. Don’t be afraid to talk about grief with others.

Confiding in close family and friends can help a grieving person feel heard and understood.

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Friends and family may encourage a grieving person to participate in the holiday just as they normally would. While these intentions are typically good, it is important for the bereaved to set boundaries and focus on what they want. While grieving, one should openly and honestly discuss wishes with friends and family and clarify what they are comfortable with and have the emotional bandwidth to do.

Reflect On and Embrace Fond Memories Memories of a loved one, both from the holidays and other special times, are an important legacy. Rather than ignoring these memories, talk about them with family and friends. It’s OK to laugh and it’s OK to cry. One way to facilitate this activity is with Remembering A Life’s Have the Talk of a Lifetime Conversation Cards, which can help families share stories and memories about loved ones and themselves. It can make for a meaningful activity during holiday gatherings.

It is important to remember that even though an individual may be grieving, they can still celebrate and enjoy the holidays.

Find support and resources for grief during the holidays and other special times of the year at RememberingALife.com.

December 2021 | OR TODAY

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Scrapbook

Georgia Council

2021 SCRAPBOOK

ore than 100 people attended the 2021 Georgia Council of periOperative Registered Nurses Annual Conference in Atlanta, Georgia, which was powered by OR Today magazine, from October 22-23.

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The Georgia Council of perOperative Registered Nurses is the collective voice of the Georgia Chapters of the Association of periOperative Registered Nurses (AORN). Its mission is to advocate for excellence in perioperative practice and health care in Georgia, uniting and empowering perioperative nurses.

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3 OR TODAY | December 2021

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Georgia Council 1. The Georgia Council was kicked off with a welcome reception and vendor networking event, sponsored by Stryker.

2. The first presentation was AORN’s President Holly Ervine’s “Advocacy Partnership: AORN and You,” where she discussed the importance of the relationship between AORN and grassroots members.

3. OR Today’sJennifer Godwinis pictured at the registration desk, where she helped about 100 people check in for the event.

4. Attendees were able to earn up to 5.75 CE credits over the course of the conference..

5. Marren Morris drummer Christian Paschall presented “Serve the Song First: Music as Selfcare for the Soul” with his mother and current AORN President-Elect Vangie Dennis.

6. The exhibit hall was filled with 30 vendors from all over the country.

7. An attendee won a beautiful gift basket during the door prize raffle.

8. The final keynote “Crisis to Advocacy: The Road Less Traveled” was presented by Angela Hohn, who was diagnosed with lung cancer in 2020 and advocates for nurses fighting against surgical smoke in the OR.

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INDEX

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ALPHABETICAL Action Products, Inc.……………………………………… 47

C Change Surgical……………………………………………… 9

OR Today Webinar Series………………………………… 4

AIV Inc.…………………………………………………………………51

Cygnus Medical………………………………………………… BC

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

ALCO Sales & Service Co.…………………………………19

Healthmark Industries Company, Inc.………… 45

Soma Technology……………………………………………… 11

AORN………………………………………………………………… 59

MD Technologies Inc.……………………………………… 47

TBJ Incorporated……………………………………………… 49

ASP………………………………………………………………………… 5

MedWrench……………………………………………………… 37

CATEGORICAL ANESTHESIA

HOSPITAL BEDS/PARTS

REPROCESSING STATIONS

Soma Technology……………………………………………… 11

ALCO Sales & Service Co.…………………………………19

MD Technologies Inc.……………………………………… 47

ASSOCIATION

INFECTION CONTROL

Ruhof Corporation……………………………………………… 2

AORN………………………………………………………………… 59

ALCO Sales & Service Co.…………………………………19

C-ARM

ASP………………………………………………………………………… 5

RESPIRATORY

Cygnus Medical………………………………………………… BC

Soma Technology……………………………………………… 11

Healthmark Industries Company, Inc.………… 45

SAFETY

Soma Technology……………………………………………… 11

CARDIAC PRODUCTS C Change Surgical……………………………………………… 9

MD Technologies Inc.……………………………………… 47 Ruhof Corporation……………………………………………… 2

CARTS/CABINETS

TBJ Incorporated……………………………………………… 49

ALCO Sales & Service Co.…………………………………19

INSTRUMENT STORAGE/TRANSPORT

Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.………… 45 TBJ Incorporated……………………………………………… 49

CS/SPD MD Technologies Inc.……………………………………… 47 Ruhof Corporation…………………………………………… 2-3

DISINFECTION ASP………………………………………………………………………… 5 Cygnus Medical………………………………………………… BC Ruhof Corporation……………………………………………… 2

DISPOSABLES

Cygnus Medical………………………………………………… BC Ruhof Corporation……………………………………………… 2

MONITORS Soma Technology……………………………………………… 11

TBJ Incorporated……………………………………………… 49

Healthmark Industries Company, Inc.………… 45

SINKS Ruhof Corporation……………………………………………… 2 TBJ Incorporated……………………………………………… 49

STERILIZATION ASP………………………………………………………………………… 5 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.………… 45

ONLINE RESOURCE

MD Technologies Inc.……………………………………… 47

MedWrench……………………………………………………… 37

TBJ Incorporated……………………………………………… 49

OR Today Webinar Series………………………………… 4

SURGICAL

OR TABLES/BOOMS/ACCESSORIES

MD Technologies Inc.……………………………………… 47

Action Products, Inc.……………………………………… 47

Soma Technology……………………………………………… 11

Soma Technology……………………………………………… 11

SURGICAL INSTRUMENT/ACCESSORIES

OTHER

C Change Surgical……………………………………………… 9

AIV Inc.…………………………………………………………………51

Cygnus Medical………………………………………………… BC

PATIENT MONITORING

Healthmark Industries Company, Inc.………… 45

AIV Inc.…………………………………………………………………51

TELEMETRY

MD Technologies Inc.……………………………………… 47

POSITIONING PRODUCTS

AIV Inc.…………………………………………………………………51

Ruhof Corporation……………………………………………… 2

Action Products, Inc.……………………………………… 47

TEMPERATURE MANAGEMENT

FALL PREVENTION

Cygnus Medical………………………………………………… BC

C Change Surgical……………………………………………… 9

ALCO Sales & Service Co.…………………………………19

PRESSURE ULCER MANAGEMENT

WASTE MANAGEMENT

FLUID MANAGEMENT

Action Products, Inc.……………………………………… 47

MD Technologies Inc.……………………………………… 47

MD Technologies Inc.……………………………………… 47

REPAIR SERVICES

TBJ Incorporated……………………………………………… 49

GENERAL

Cygnus Medical………………………………………………… BC

ALCO Sales & Service Co.…………………………………19

ENDOSCOPY Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.………… 45

AIV Inc.…………………………………………………………………51 58

OR TODAY | December 2021

Soma Technology……………………………………………… 11

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