OR Today Magazine September 2022 by MD Publishing

20 INDUSTRY INSIGHTS Rethinking Drapes 27 MARKET ANALYSIS Patient Positioning Market 42 SPOTLIGHT ON Dr. David Spiegel 50 RECIPE Popcorn Party Pizza LIFE IN AND OUT OF THE OR SEPTEMBER 2022 PAGE 38 THE IMPORTANCE OF

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38 THE IMPORTANCE OF DIVERSITY Despite recent progress in equity hiring, representation of Black and Indigenous People of Color (BIPOC) nurses still lags in the health care industry. This is especially true in the operating room. OR TODAY | September 2022 OR Today (Vol. 22, Issue #9) September 2022 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: See address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and adver tisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2022 47 EQ FACTOR In my findings, the key to success is realizing that achieving a win-win outcome is much easier if one first develops a win-win mindset. 30 CE ARTICLE The goal of this course is to educate clinicians in acute care facilities with tools to aid in the care of patients with obsessive-compulsive disorder. 27 MARKET ANALYSIS Several studies examining the patient positioning market predict continued growth as the number of surgeries performed continues to increase. contents features 6 OR TODAY | September 2022 WWW.ORTODAY.COM

INDUSTRY INSIGHTS 08 News & Notes 16 AAMI: KILMER Conference 2022 Promises a Bright Future for Sterility Assurance 18 HSPA: Train and Gain: Are SPD Professionals Learning Most Effectively? 20 Rethinking Drapes as TAVR Becomes Go-To Option 22 ASCA: Growing Demand for Outpatient Surgery Re-Emphasizes Need to Remain Focused on Quality 24 CCI: The Potential of Portfolios 25 Webinars: SPD’s Inspection and Assembly Examined IN THE OR 27 Market Analysis: Patient Positioning Market Growth Predicted 28 Product Focus: Patient Positioning 30 CE Article: Obsessive Complusive Disorder (OCD) OUT OF THE OR 42 Spotlight On: Dr. David Spiegel 44 Health 46 Fitness 47 EQ Factor 48 Nutrition 50 Recipe 52 Pinboard 54 Index MD PUBLISHING | OR TODAY MAGAZINE 1015 Tyrone Rd., Ste. 120 Tyrone, GA 30290 800.906.3373 | Fax: 770.632.9090 Email: PROUDwww.mdpublishing.cominfo@mdpublishing.comSUPPORTERSOF Gift Card $25 TWENTY-FIVEDOLLARS 42 SPOTLIGHT ON Dr. David Spiegel 50 RECIPE OF THE MONTH Popcorn Party Pizza 52 OR TODAY CONTEST Win a $25 gift card! contents features PUBLISHER John M. Krieg john@mdpublishing.com VICE PRESIDENT Kristin Leavoy kristin@mdpublishing.com EDITOR John Wallace editor@mdpublishing.com ART DEPARTMENT Karlee Gower Taylor KamerynPowersJohnson ACCOUNT EXECUTIVES JaymeMeganMcKelveyCabotEmilyHise DIGITAL SERVICES Cindy KennedyGalindoKrieg EVENTS Kristin Leavoy ACCOUNTING Diane Costea WEBINARS Linda Hasluem EDITORIAL BOARD Hank Balch, President & Founder, Beyond Clean Vangie Dennis, MSN, RN, CNOR, CMLSO, Assistant Vice President, Perioperative Services with AnMed Health System Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education Development, Competency and Credentialing Institute David Taylor, President, Resolute Advisory Group, LLC Elizabeth Vane, Health Science Teacher, Health Careers High School September 2022 | OR TODAY 7WWW.ORTODAY.COM

Technology Instrumentation

“With a rich array of pre-clinical data, the Newton Knee is at the forefront of Exactech’s focus to improve clini cal outcomes by utilizing soft tissue balancing technology in total knee replacement patients,” according to a news release.Orthopaedic surgeons James Huddleston, MD, Stanford University; Raul Marquez, MD, Cornerstone Orthopedic Institute; and Jeffrey R. Ginther, MD, Rush Memorial Hos pital, were the first to perform the surgeries.

Exactech has announced the first surgeries leveraging the power of the Newton Knee, featuring new, user-friendly instrumentation and a modernized graphical user interface.

The Newton Knee technology is in pilot release with limited launch planned for the second half of the year.

Surgeries with New Newton Balanced Knee

“Optimal soft tissue balance, combined with personal ized implant placement, has the potential to improve on the historical outcomes of knee replacement,” Huddleston said. “Exactech is yet again leading the way with the New ton Knee, merging well-thought-out design and leadingedge technology to deliver real-time operative insights for balanced knee replacement results.”

INSIGHTSINDUSTRY news & notes

Reported

The Newton Knee platform features updated instru mentation that seamlessly integrates with the company’s Truliant system. The instruments offer surgeons additional ergonomically designed options that allow for intra-opera tive flexibility. According to Ginther, “Exactech has made continual ‘smart’ changes to evolve the instrument portfo lio into an even better and more user-friendly system. The integration of the new instrumentation provides critical intra-operative data regarding soft tissue balance, which I findTheinvaluable.”Newton Knee works in concert with the guidance system, ExactechGPS, which provides real-time feedback through its powerful, active technology at zero capital cost.

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MicroCare Appoints New Commercial Sales Manager

As part of a line extension, TouchPoint Medical has released a new countertop model of its F series automated medica tion dispensing cabinet. Any facility that is short on space or budget will benefit from the countertop model, according to a newsMedicationrelease. security and workflow efficiency are crucial to the medication delivery process. The medDispense F series automated dispensing cabinets’ single dose, single line item and linear mode drawer technology allows for maxi mum security of items including controlled drugs.

Countertop Medication Dispensing

“With more than a 380-item capacity over eight levels, the F countertop model offers customization that will rival any full-size ADC,” said Mark Rickert, product manager at TouchPoint Medical.

“Size is often of particular interest to the sub-acute market where security is essential and space is limited. In fact, countertop ADCs offer all the security and safety of a larger cabinet with the benefits of a smaller footprint – eas ily accessible to professionals working in all types of health care settings. Security is paramount in the new F countertop model from TouchPoint Medical. The cabinet has single dose compartments that ensures access only to the medication needed – one dose at a time. With single dose dispensing, once the dose is taken from the drawer, it is automatically removed from system inventory with no need for staff to count out what they have taken,” the release states.

MicroCare with over 10 years of experi ence selling industrial maintenance, repairs and operations (MRO) products and tools. Before joining MicroCare, he held upper-level management positions at Newell Brands, and most recently, as national accounts manager at Fein Power Tools.

INDUSTRYINSIGHTS news & notes

Ray Bellavance, MicroCare vice president of global sales and marketing, said, “Tyler brings a proven track record of success and will undoubtedly make a great contribution to the compa ny. His sales acumen and team management skills will certainly help add to the continued success of our organization.”

Cabinet Announced

MicroCare LLC recently announced that Tyler Longenecker has joined the company as commercial sales manager for its infection prevention platform. Longenecker is responsible for leading and implementing sales initiatives and activities with the MicroCare distributor network and end users to drive profitableLongeneckergrowth.joins

And in environments where space is limited, but security is still important – such as in operating, sub-acute, trauma and hospice centers – countertop models like this one make valuable ADC technology easily accessible, the release states.

Report Strengthens Case for Single-Use Medical Device Reprocessing

“Medline’s infrastructure is designed top to bottom to sup port the needs of health care facilities. This infrastructure allows health care facilities to have a realistic and viable reprocessing program that allows for improved budgeting and forecasting of fixed costs,” according to the release.

2. High-quality standards, adherence to ISO guidelines, and FDA clearances for a wide variety of medical devices to ensure that the reprocessed medical devices they receive will perform as well as possible.

A 2015 study featured in the Journal of Medical Devices found that OEM single-use bipolar and ultrasound diathermy devices were found to be defective 4.9 times more frequently than reprocessed devices regardless of the manufacturer. Single-use medical device reprocessing requires diverse re sources and skilled technicians enabled by cutting-edge technol ogy to effectively reprocess medical devices. This creates a high barrier to entry which hospitals cannot undertake on their own. With each step validated to FDA-recognized standards, singleuse medical device reprocessing includes cleaning, decontami nation, refurbishing, testing, inspection, packaging and steriliza tion; a process Medline has perfected through its 20 plus years of medical device reprocessing, according to a news release. Health care facilities are changing their reprocessing strategy for multiple reasons, including better adherence to industry laws and regulations, barriers to entry and budgeting. Initially, many health care facilities began to strategize on single-use device reprocessing to comply with new laws and industry regulations starting with the Medical Device User Fee and Modernization Act, 2002 (MDUFMA Act) in 2002 which set defined stan dards for re-using single-use devices to provide better products and process oversight in line with existing OEM requirements.

Health care facilities considering a change in their single-use medical device reprocessing should consider a variety of factors in selecting a partner, including:

A key driver in the adoption of single-use medical device reprocessing programs is cost savings, quality and environmental impact. Reprocessing helps reduce the waste sent to landfills, reduces new medical device purchases and reduces waste removal costs.

Reprocessed medical devices also help the health care ecosystem by building resiliency in the supply chain to reduce shortages of critical medical devices. To effectively reprocess medical devices, organizations have invested heavily in develop ing manufacturing facilities that can support the process from collection to sterilization, a skilled and well-trained workforce that can ensure the highest quality of reprocessing, and a robust support network that includes teams in the field to facilitate partner’s needs, national transportation and logistics infrastruc ture, and back end IT management to provide real-time data and access to program information.

Two aspects of single-use medical device reprocessing that are top of mind within health care facility leadership are the environmental impact and the quality of reprocessed devices. In many instances, reprocessed medical devices have been shown to be more reliable than new devices.

Recent analysis provided by the Association of Medical Device Reprocessors (AMDR) indicates that U.S. hospitals could save up to $2.28 billion a year. According to the report, in 2020 U.S. hospitals saved $372 million as reprocessed devices cost 25% to 40% less than new devices. These cost savings are in addition to the savings from a reduction in medical waste.

A recent study by the Fraunhofer Institute for Environmental, Safety and Energy Technology found that using reprocessed medical devices can reduce the global warming impact of medical devices by 40%, ozone depletion by 90% and the use of abiotic resources by 29%. In addition to the $372 million in savings reported, the AMDR analysis said that in the U.S. in 2020 over 9,000 health care facilities currently use reprocessed medical devices, includ ing all military hospitals and all U.S News & World Report Top Hospitals. In all, 31 million single-use devices were reprocessed in 2020, diverting 12 million pounds of medical waste diverted fromAccordinglandfills to the AMDR’s 2019 survey, 8,622 hospitals and surgical centers reprocessed medical devices, diverting over 18 million pounds of medical waste and saving over $20 million in waste disposal costs. This created over $544 million in overall savings while creating over 2,000 jobs.

3. Registered FDA manufacturing facilities with stateof-the-art facilities and technology to ensure quality, functionality and sterility.

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INSIGHTSINDUSTRY news & notes

1. Manufacturing validation on every device to ensure that the device was properly reprocessed.

HEMCO Offers HEPA Filtered Clean Rooms

September 2022 | OR TODAY 11WWW.ORTODAY.COM

INDUSTRYINSIGHTS news & notes

The HEMCO HEPA Filtered Clean Rooms feature a modular construction design that is cost effective and time efficient compared to traditional construction, according to a news release. An entire laboratory workspace is pre-engineered including the structure and the lab furniture/fume hoods to outfit the interior. The wall panels have a white fiber glass surface for chemical resistance and light reflectivity. Because of the modular construction, the structure can be easily assembled, modified in the future, or disassembled and moved if required. Ceiling HEPA filtration is designed to meet needs from just a cleaned-up area from the sur rounding environment to class 1000 (ISO 6). Door, lighting and electrical options are provided as requested.

Patient, Provider Experience

“The thin and light tablets are ideal for caregivers in acute settings at the patient bedside and in their homes and enable an improved patient experience when loaded with hospital engagement, educational and food service apps,” the release reads. “The large high-resolution 10-inch display makes it easy for nurses to read and add notes to a patient’s electronic health record as well as view the finest details of a photo or X-ray. The ET4x-HC also features a dedicated emergency alert button that can be programmed to call for additional help or launch an app to follow protocols in the event of a medical emergency.”

“Zebra’s first dedicated health care tablets are purpose-built to meet the needs of caregivers in demanding environments with healthcare-grade plastics, durability and functionality that will help improve care efficiency and safety,” said Julie Johnson, vice president and general manager of mobile computing, Zebra Technologies. “Offering everywhere connectivity and accessories designed for specific applications, the versatile ET4x-HC series is highly secure, fully configurable, simple to deploy and tailored to how caregivers work, resulting in increased productivity, responsiveness and ultimately a better patient and provider experience.”Zebraguarantees the ET4x-HC series will be available for purchase for up to three years, eliminating the complexities of managing a mixed device deployment that is more time-con suming and costly for IT departments to support. With Zebra’s optional OneCare Maintenance Plans, health care organiza tions can rely on service and support for their ET40-HC and ET45-HC tablets for up to six years, helping front-line workers to continue to perform at peak levels while also reducing device vulnerabilities, unbudgeted repair expenses and unexpected disruptions.TheET4x-HC series of tablets include select Zebra Mobility DNA software tools to improve communications, optimize workflows and usability for caregivers. These tools include Mobility Extensions (Mx), which adds powerful enterprise-class security and manageability features to the standard Android operating systems and StageNow, which allows IT organizations to stage a handful or hundreds of devices in seconds.

The cost-effective, rugged ET4x-HC series has an advanced medical-grade housing that can handle constant disinfecting from some of the harshest disinfectants to prevent the spread of germs and help ensure the safety of health care professionals and their patients, according to a press release.

Zebra Tablets Boast Better

INSIGHTSINDUSTRY news & notes

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Zebra Technologies Corporation recently announced the ET4xHC series, including the Android-based ET40-HC and ET45HC tablets, built to improve staff efficiency, care quality and the patient experience.

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The BIPOC award is just the public side of Whitman Partners’ efforts.

“In addition to making every search a diversity search, we are intentional about our attempts to recruit diverse candidates into our firm and onto our leadership team,” Whitman added.

“As recruiters for directors of surgical services, we’ve adopted the mindset that every search we do is a diversity search,” said CEO Josiah Whitman. “A diverse background in and of itself is a qualification that offers a tremendous benefit to potential employers. It should be explored with as much energy and curiosity as education, work history and other experience.”

INDUSTRYINSIGHTS news & notes

Award Recognizes BIPOC Perioperative Leaders

Recruiting firm Whitman Partners sponsors a series of rec ognition awards that includes “BIPOC Perioperative Lead ers to Know,” which highlights OR leaders from diverse cultural backgrounds who share their unique perioperative career experiences.

“We are advocates for the director of surgical services, a position that is often under-advantaged,” says Whitman. “Be cause of this, the core beliefs that guide our work center on promoting the disadvantaged and underprivileged. Our com mitment to diversity and inclusion is an extension of that.”

The agreement will provide Premier’s 4,400 hospital members in the United States with even greater access to UVDI’s proven indoor air quality products, which are installed in more than 10,000 commercial facilities world wide, including in leading health care systems. UVDI’s indoor air quality technology included in the agreement includes the V-MAX Advanced UV-C Air Disinfection and Coil Cleaning technology. It also includes the V-PURE Portable Air Purifier.

INSIGHTSINDUSTRY news & notes

Nihon Kohden OrangeMed Inc. has received U.S. Food and Drug Administration (FDA) 510(k) clearance for its NKV-330 Ventilator System. The NKV-330 is a non-invasive ventilator that provides respiratory support to adult and pediatric patients. This system offers invasive and non-invasive ventilation, as well as high-flow oxygen therapy. In addition, it provides con tinuous monitoring of CO2 when using the cap-ONE NIV mask. The cap-ONE mask is an NIV interface that allows quality CO2 monitoring directly from the ventilator.“TheNKV-330 ventilator can help hospitals who face a limited choice of new non-invasive ventilator platforms for adult and pediatric patients,” said Eiichi Tanaka, president and CEO of Nihon Kohden America.

UVDI Inks Group Purchasing Agreement

The NKV-330 Ventilator System is distributed in the United States by Nihon Kohden America Inc. and is expected to begin shipping in July 2022. It has been available outside of the United States since 2019.

UltraViolet Devices Inc. (UVDI) has been awarded a group purchasing agreement with Premier Inc. in the category of indoor air quality products. Effective July 1, 2022, the new agreement allows Premier members, at their discretion, to take advantage of special pricing and terms pre-negotiated by Premier for UVDI’s proven UV-C air disinfection, air purification and HVAC coil cleaning products.

NKV-330 Ventilator System Receives FDA 510(k) Clearance

“This new platform offers a seamless transition be tween non-invasive therapy and high-flow oxygen therapy to meet the changing needs of patients. The continuous monitoring of ETCO2, the excellent por tability, dual HEPA filtration, ‘hot-swap’ battery, and many other features in the NKV-330 makes it a great choice for hospitals and health care providers.”

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call 800.541.7995 or visit keysurgical.com pro tip: don’t forget to stick out your tongue.

Another important thing to know is that Key Surgical now has more weights and sizes of double-bonded, SMS sterilization wrap than ever before. With sizes starting at 18" x 18" and up to 54" x 54" and weights from 100 to 600, wrapping the various size trays in SPD (making sure to always leave the ‘tongue’ out) will be easier said and done.

AAMI and PDA Take the Wheel In spirit of the continuity theme, AAMI President and CEO Pamela Arora and Glenn Wright, COO and president-elect of the Parenteral Drug Association (PDA), spoke about leveraging their respective association’s resources as leading neutral conveners to host future KILMER conferences.

The KILMER Conference has his torically served to exchange ideas with the brightest minds in sterility assurance and as a network to share best practices. In the last few years, the conference has prompted con versations about the need to connect the dots for sterility assurance from end-to-end in the product life cycle and the importance of collaborating to innovate. This year, the theme for this global forum was “CONTINU ITY: Fostering our Future.”

“As a long-time supporter of the conference and the home of the KILMER scholarship and grant pro gram, AAMI and the AAMI Foun dation remain committed to sup porting this high-level, high-impact work,” Arora said.

In describing the importance of this year’s theme, Joyce Hansen, vice president of sterility assurance for Johnson & Johnson and KILMER Conference Chair highlighted that, “to continue fostering the solutions that will help us solve our steriliza tion challenges and minimize risk to patients, it is imperative to sustain what is working well, and that we embrace change and support the industry’s growth while making sure that we develop our talent for the future.”

KILMER Conference 2022 Promises a Bright Future for Sterility Assurance

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INSIGHTSINDUSTRY AAMI

he Conference,11th KILMERhosted by Johnson & Johnson in Athens, Greece, brought together more than 300 microbiological quality and sterility assurance professionals from industry, academia, government agencies, notified bodies and healthcare organizationsdeliveryaround the world.

Of note, she discussed the wid ening scope of AAMI’s standards de velopment work in the sterilization field and the influence which ideas sparked at the KILMER conference and led by KILMER groups has on this important work. Wright high lighted PDA’s historied involvement with the conference, and how AAMI and PDA are ideally positioned with their differing focus areas to host futureWrightconferences.commented, “I can’t stress enough how strongly PDA feels regarding the importance of the KILMER Conference to the industry and the unique nature of its design and content. PDA, with its 76 years of service to the industry, has and remains a longtime supporter of the KILMER Conference and the KILMER Collaboration groups. It was great to be at the conference in Athens and see so many of my PDA colleagues in attendance. I was espe cially honored to be present as Maik Jornitz, a very active PDA member and past chairman of the PDA board of directors, was recognized with the KILMER Award.”

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“We are very much looking forward to working with AAMI to continue this important conference. I can’t think of a better collabora tion partner,” he said, “Like PDA, it is a leader in its focus areas and, like PDA, provides its members and the overall industry enormous value.”

“For digital innovations to work effectively in a clinical setting, they have to be evidence based, vali dated, actionable and connected,” he said. “To do that, you have to have physician input and expertise throughout the development and design cycles.”

AMA Elects AAMI AI Thought Leader Jesse Ehrenfeld to Top Spot

At its 2022 annual meeting, the American Medical Association (AMA) voted Jesse Ehrenfeld, MD, MPH, – anesthesiologist, senior associate dean at the Medical Col lege of Wisconsin, and co-chair of AAMI’s AI Standards Committee – as president-elect of the organiza tion. After a year as president-elect, he will serve as president of the AMA.“I’m honored to have been chosen by my physician col leagues across the country to step into this role,” he said. “It’s an exciting time to be a leader in medicine. It’s a challenging time to be a leader in medicine.” As president, Ehrenfeld plans to continue his focus on health equity – he has advocated on behalf of LG BTQ individuals for over 20 years –and digital health. He is also deeply committed to advancing the AMA’s goals around the Recovery Plan for America’s Physicians, an initiative that includes reducing physician burnout, reforming prior authoriza tion and Medicare pay, promoting physician-led care and supporting telehealth usage.

“It was the AMA’s urging that led to CMS temporarily removing restrictions on where patients could receive telehealth services under Medicare,” he said. “We are continu ing to push Congress and HHS to make those changes permanent. We think doctors should be licensed in the state where the patient is located, but there are exceptions. If I’m in Minneapolis on vacation and I need to call my doctor back home in Wisconsin, that should be a reasonable exception. We look forward to continuing to work with Congress to support adoption of telehealth and to ensure that there’s appropriate coverage and payment for telehealth Ehrenfeld’sservices.”appointment to AMA’s top slot comes after eight years serving on the organiza tion’s board of trustees, 16 in the house of delegates, and seven years on the LGBTQ advisory commit tee, among several other roles. Numerous professional organiza tions, committee service, awards and editorial activities are listed in his AddingCV. to his multiple clinical, academic and leadership roles, Eh renfeld co-chairs AAMI’s Artificial Intelligence Standards Committee, bringing important perspective around medical device develop ment and quality management.

In the shifting employment market, many health care organizations are having to fill more full- and part-time positions with inexperienced techni cians. This presents less of a drawback and more of an opportunity. After all, there are many people who want to work and contribute effectively. Some may lack experience (and some may not have even heard of SP), they can become crucial contributors as long as they receive proper training and possess a strong desire to learn and flourish.Some facilities pair inexperienced new hires with more senior techni cians for training. Other departments instead slowly introduce new hires into the fold in the hopes that they will eventually understand and learn the various roles and responsibilities.

Orientation also affords an opportu nity to set training expectations and desired outcomes.

Probation period evaluation

Even if an SPD lacks a dedicated educator, the department will still need a developed, focused SP training program that consists of orientation, initial evaluation, probation period evaluation, competencies, continued education and annual reviews. It also includes proper documentation at each of these intervals (training with out documentation will not provide proof of proper training). What fol lows are more details about each stage of employee training:

Competencies Competencies are documented records that demonstrate employees’ skills and knowledge, and some com petencies are required to comply with federal regulations or accreditation agency requirements. Individual com petencies are designed to be renewed periodically to assure knowledge (with the intent of reducing or preventing errors). They may also be used to doc ument whether training was successful and to track performance and growth. Competencies can be evaluated by demonstration, written assessment, verbal interview and observation (both announced and unannounced). Most departments perform competen cies once a year or more frequently, as needed. Competencies must be

By Tony Thurmond, CRCST, CIS, CHL, FCS

Beyond that, some elect to introduce new employees to one departmental area but then fail to complete dedicat ed training in other areas of the SPD. None of these approaches to new em ployee training are ideal, however. Fo cused, deliberate training is necessary to ensure employees have the knowl edge and skill sets needed to function productively, safely, consistently and in accordance with the latest standards, best practices, instructions for use, and internal policies and procedures.

An initial evaluation of one’s skills should be performed within the first week of an employee’s start date. The initial evaluation allows the SP leader or educator to document a starting point and allow for the development of a training program to familiarize the new employee with departmental and facility processes.

S terile processing (SP) professionals are in surging demand today because of a mix of retirement and pandemicrelated resignations. Still, a critical fact remains: work in the SP department (SPD) is still there, and the need for quality, dedicated and well-trained technicians is as essential as ever.

Train and Gain: Are SPD Professionals Learning Most Effectively?

INSIGHTSINDUSTRY HSPA

New employee orientation covers all tasks performed in the SP area(s). This includes an orientation of the depart ment and review of organizational policies and procedures regarding infection prevention, safety, proper attire, personal hygiene, and compli ance with state and federal regulations.

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Orientation

Initial evaluation

With any orientation period, new employees have a period where they are given ample time to show they are learning the processes and retaining the information. The new technician should not immediately be expected to perform on their own or be indepen dent in all tasks. During the proba tion period evaluation, however, the tasks they can perform well should be documented along with the tasks that require further training or additional experience. Proper and thorough docu mentation is required and must be filed with the employee’s training records.

INDUSTRYINSIGHTS

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Conclusion The ever-evolving, fast-paced SP disci pline demands that leaders and educa tors provide all employees with highquality, focused training and continuing education opportunities in order to keep up with changes, standards and best practices. SP leaders must develop com prehensive training and education for all staff members and best prepare their departments for any challenges that may arise. Such efforts will help foster better outcomes for the department, health care customers and patients.

Continuing education Departments must regularly provide educational opportunities to staff for continued growth and develop ment. Mandatory education (such as bloodborne pathogens and fire safety) must be completed without delay, and updates to regulations and standards must be delivered as soon as an update is released. Collaborating with another department on an educational inser vice may facilitate a closer interdepart mental working relationship.

retained in an employee’s record for a minimum of three years, although some organizations require that they be kept longer.

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Annual reviews Skills attained during an employee’s training period will be reflected in their evaluation. Did the employee complete their education in a timely manner? Were there tasks that were successful in competencies but errors that still occurred during the evalua tion period? Annual reviews can help pinpoint areas for improvement; therefore, improvement areas should be identified and addressed as they happen instead of solely during the annual review.

Tony Thurmond, CRCST, CIS, CHL, FCS, serves as Central Service Manager at Dayton Children’s Hospital. He is an HSPA Past-President and current mem ber of the Board of Directors and has served as an HSPA columnist since 2016. HSPA 800-201-3060remodel!

M edicine and innovation are something that we may take for granted, but in today’s world innovation is transformative and that’s exactly what we’ve seen with transcatheter aortic valve replacement (TAVR) procedures.

Rethinking Drapes as TAVR Becomes Go-To Option

ByINSIGHTSINDUSTRYAngelaCarranza

• Is the supplier a manufac turer or distributor of the product?

• Does the supplier maintain an inventory of the product or is it available only through custom order?

CarranzaAngela is a

TVAR may be an acronym that most people are not familiar with, how ever, 20 years ago patients diagnosed with severe aortic stenosis had very few options while complications and mortality rates were high. With dedication, perseverance, and grit scientists, engineers, and production specialists among others disrupted medicine in a life-changing way through the development of TAVR and transformed cardiac care.

A TAVR procedure allows for high-risk patients that may not be able to go on cardiopulmonary bypass or even under general anes thesia a life-saving option. Over the last 20 years, TAVR has become the predominant procedure to replace diseased valves, supplanting the more invasive open-heart surgery and resulting in shorter hospital stays and recoveries. In just shy of a decade over 300,000 TAVR procedures have been conducted since the procedure gained FDA approval in 2011. The goal of a TVAR procedure is to replace diseased aortic valves with a man-made valve by accessing the femoral artery with a catheter insert ed through the groin. Conducted in over 715 hospitals, TAVR procedures are complex, advanced procedures requiring highly skilled physicians to insert a man-made replacement valve into the groin and guide it through the femoral artery with a catheter until it reaches, and expands within, the diseased aortic valve to facilitate replacement. If an issue is uncovered during the procedure, there may be a need to quickly transition to an open heart procedure which could require additional equipment or preparation. Since TAVR procedures bring together the skill and expertise of both cardiologists and cardiothoracic surgeons, manufacturers like Med line had to consider how the way these experts perform procedures to develop an innovative sterile TAVR drape that fits their combined need to ensure these highly skilled clinical teams are prepared no matter what theyWhenencounter.selecting TAVR drapes, op erating room managers should look for options that feature two femoral access points for catheter insertion and a chest fenestration that enables a seamless, sterile transition to an open-heart procedure. As table sizes vary, TAVR drapes should span over 196 inches to cover various sizes of cath Lab or hybrid operating room procedure tables while offering absorbent reinforced material sur rounding all access points and dual liquid collection pouches for liquid control.When evaluating a supplier of TAVR drapes, operating room man agers should consider:

• Is the supplier positioned to serve your needs with regional supply chain infra structure?

• Can the supplier offer surgi cal packs customizable to their specific needs?

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Medline.managerresourceclinicalat

Featuring Two ASC-Focused Tracks: - Coding & Reimbursement - Management Essentials for ASC Administrators ascassociation.org/winterseminar May 2022 issue - Benchmarking.indd 1 7/20/22 5:26 PM INDUSTRYINSIGHTS September 2022 | OR TODAY 21WWW.ORTODAY.COM

A mbulatory surgery centers (ASCs) looking to grow as well as physicians and others interested in opening a new ASC received encouraging news this summer. In its 2022 Impact of Change report, Sg2, a subsidiary of Vizient Inc., projected that ASCs will see 15 percent and 25 percent growth from 2022 levels in the next 5 and 10 years, respectively. The Sg2 analysts also noted that the growth is expected across nearly every major ASC specialty.

Meanwhile, as techniques and technol ogy continue to evolve and new infection control challenges arise, the most effective infection prevention programs need to evolve at the same pace. To help ASCs stay on top of all the new developments, meet related regulatory requirements and achieve their infection prevention goals, the Ambulatory Surgery Center Associa tion (ASCA) is offering a virtual course this summer titled “Infection Prevention for ASCs.”Thiscourse covers key principles of infection prevention that apply broadly across health care settings and targets the special needs of ASCs. It can help ASC staff implement and manage a compre hensive infection control program and help those interested in obtaining the CAIP credential prepare for that exam. The course is being offered in two half-day sessions on Monday, August 29, and Tuesday, August 30. On those dates, the speakers will be online to respond to any questions participants have in real time. Depending on when you read this article, you could still have time to register for the original presentation. If those dates have already passed, you can still

By Bill Prentice

The key takeaways from the Sg2 report shine a spotlight on the impor tant niche ASCs are filling in the U.S. health care system. They also serve as a reminder that managing the growing need for outpatient surgery expected in the U.S. in the next decade, and connect ing patients with the care they need, will require all outpatient surgery providers to be functioning at their best.

INSIGHTSINDUSTRY ASCA

The report also projects that while the shuffle of procedures between hospital outpatient departments, ASCs and physi cian offices will continue over the next decade, the amount of outpatient surgery being provided will continue to grow in each of those settings. Drivers of that increased demand will include increased payer scrutiny, cost-saving measures, hospital-based capacity and resource constraints, an aging population and an increase in chronic disease.

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Over the years, the ASC community has demonstrated the high priority it places on infection prevention in many ways. For example, ASCs worked for years to get the Centers for Medicare & Medic aid Services to implement an ASC quality reporting program. They even helped de velop meaningful outcomes measures for that program. More than 15 years ago, the ASC community also threw its support behind the creation of the ASC Quality Collaboration (ASC QC) – an organiza tion dedicated to quality and safety in the ASC setting. ASCs still support the work of that organization and are looking for ward to some new quality measurement and reporting tools it is developing now.

After Medicare adopted its current regulatory mandate requiring every ASC to identify an infection preventionist on staff, ASCs also came together to de velop the Certified Ambulatory Infec tion Preventionist (CAIP) credentialing program. This program helps ASC leaders demonstrate their mastery of the skills and knowledge needed to serve as an ASC infection preventionist and their commit ment to best practices in infection preven tion in the ASC setting.

Alongside its discussion of the grow ing need for outpatient surgical care, the Sg2 report makes another important projection that has captured fewer head lines. “As pandemic-era protocols decline, infectious disease will grow 3% next year before declining over the decade,” it states. While this projection does not speak directly to infections tied to outpa tient surgery, it is a reminder to all health care providers that they cannot become complacent where infection prevention is involved.ASCs have always adhered to the highest national and international standards of infection prevention, and the COVID-19 pandemic encouraged many to re-evaluate every aspect of their operations and, in some cases, expand or update the infection prevention programs they already had in place. The ability of ASCs to continue to provide surgery and outstanding patient outcomes – even in the most daunting days of the pandemic – is proof that the policies and procedures they are following work.

Growing Demand for Outpatient Surgery Re-Emphasizes Need to Remain Focused on Quality

IMPROVES OUTCOMES INCREASES VALUE Airisana’s construction was designed to support multiple care scenarios. From side-of-the-bed care to transfers with other patient care team members—such as respiratory and physical therapy—to repositioning and procedural needs on supports multiple assessments and treatments.

CROSS FUNCTIONAL THERAPY CARE AT BEDSIDE

CROSS-FUNCTIONAL THERAPY CARE AT BEDSIDE

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Airisana’s construction was designed to support multiple care scenarios. From side-of-the-bed care to transfers with other patient care team members—such as respiratory and physical therapy—to repositioning and procedural needs on supports multiple assessments and treatments.

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Airisana’s unique and new approach in alternating pressure and microclimate management addresses many of the obstacles to using a multitude of specialized therapeutic surfaces. Arisana improves patient outcomes, and reduces the challenge of managing complex patients.

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listen to the recorded version and receive CE credit until December 31, 2023. The seven sessions the course includes cover: • Program development, infection prevention (IP) risk as sessment, implementation and maintenance • Instrument/equipment cleaning, disinfection and sterilization • IP surveillance, monitoring, data collection and analysis • IP strategies and clinical rounding • Environment of care, environmental cleaning and point of care devices • Regulatory requirements and employee health • IP education and training Six of the seven faculty members are CAIP certified, two hold the Certification in Infection Control (CIC) credential and all have extensive experience in infection prevention. For more information, visit ASCA’s website at www.ascassociation.org/ip-course – Bill Prentice is the chief executive officer of the Ambula tory Surgery Center Association (ASCA). INDUSTRYINSIGHTS ASCA OPERATING ROOM SOLUTIONS Surgical Table Pads, 800.323.4282 • WWW.ALCOSALES.COM Casters, Mayo Stands and more! ALCO has your solution!

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FIVE-IN-ONE SURFACE

FIVE-IN-ONE SURFACE Airisana’s unique and new approach in alternating pressure and microclimate management addresses many of the obstacles to using a multitude of specialized therapeutic surfaces. Arisana improves patient outcomes, and reduces the challenge of managing complex patients.

CROSS FUNCTIONAL THERAPY CARE AT BEDSIDE

In 2021, CCI worked closely with the Association for Nursing Professional Development to launch the Nursing Pro fessional Development Advanced-Board Certified (NPDA-BC) credential. This certification can only be earned through a rigorous portfolio process judged by peer reviewers. As with CCI’s other certifica tions the program is administered by CCI staff, but the credential is not restricted to just perioperative nurses. The submis sion process is hosted in the CCI Learn ing Management System. As of July 1, 2022, we have had 102 nurses begin the portfolio submission process and 22 have earned this nascent credential. The CCI team is encouraged by the enthusiasm for the credential we saw at the recent ANPD national meeting in San Antonio. We be lieve that there is great potential in select circumstances for portfolios and we look forward to growing these programs.

Although there are numerous chal lenges to the use of portfolios this method does have some potential utility for nurs ing. For credentialing organizations, such as CCI, portfolios establish more diverse assessment methods to better meet the needs of stakeholders. CCI has admin istered examination-based certifications for over 40 years. The use of portfolios is cost efficient and allows greater reach to specialized groups of nurses such as the CRFNA community. Certifications which have low testing volumes (less than 100 per year) are challenged to earn accredita tion. Portfolio programs do not have these volume related concerns.

– James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E), is CEO of the Compe tency and Credentialing Institute (CCI). References Accreditation Board for Specialty Nursing Certification (2022). Accreditation Stan dards: Portfolio Assessment Certification.

Accessed June 28, 2022 at: science/article/pii/S2666142X2028,Nursingstudy.patientfullthefolioGagnon,Credentialing-Portfolio-6-21.pdfwp-content/uploads/2021/11/1-Building-a-2022aingabout-the-crnfa-professional-portfolio/2022Professionaltionorg/10.1111/j.1466-7657.2006.00432.xnursinginfluencingcompetence:A.portfolio-assessment-certificationorg/certification/accreditation-standards-https://absnc.Khomeiran,R.T.,Yekta,Z.P.,Kiger,M.,&Ahmadi,F.(2006).Professionalfactorsdescribedbynursesastheirdevelopment.Internationalreview,53(1),66–72.https://doi.NationalAssistantatSurgeryCertifica(NASC)(2020).AbouttheCRNFAPortfolio.AccessedJune28,at:https://nascertification.com/crnfa/SeacrestCompany(2021).CredentialPortfolios:Keyconsiderationstobuildcredentialingportfolio.AccessedJune28,at:https://www.seacrestcompany.com/St-Germain,D.,BélangerL.,Coté,V.,C.(2020).TheINSÉPArableporttooltosustaincontinuededucationandprofessionaldevelopmentofnursesforascopeofnursingpracticeandenhancedsafetycompetencies:AnethnographicVolume2.InternationalJournalofStudiesAdvances,2,AccessedJune2022at:https://www.sciencedirect.com/

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The Potential of Portfolios

By James X. Stobinski T he Seacrest Company, a leading consultant to certification boards, recently stated that, “Today’s workforce requires varied options to demonstrate expertise and attainment of job-related skills.” (2022). A common method to document ex pertise is to earn a voluntary credential like the CNOR credential administered by CCI. A computer-based test using multiple-choice questions is commonly used to ascertain knowledge and expertise. These types of certification exams are common and familiar, but there are other methods to grant credentials. This month, I would like to speak on professional portfolios, a salient example of one option to document job-related skills. A portfolio documents evidence of professional knowledge and practice and is commonly used in other professions such as teaching. A common misconception is that a portfolio method of assessment is less rigorous than a multiple-choice examination. That is not the case. The rigor and quality of any credential is as sured by the accreditation process. The Accreditation Board for Specialty Nursing Certification (ABSNC) has a process for accrediting portfolio-based certifications and there are psychometric standards for portfolios just as there are for certification examinations (2022). Nursing, as with other health care professions, has made some early efforts to utilize portfolios but these efforts have not been extensive or sustained. The IN SÉPArable portfolio program (St-Germain et al., 2020) being one example. Kho meiran and colleagues describe the use of portfolios in their examination of factors contributing to competence in Iranian nurses (2006). The use of portfolios has gained some recent traction in the peri operative community with the Certified Registered Nurse First Assistant (CRNFA) credential administered by the National Assistant at Surgery Certification (NASC). The use of portfolios by NASC exempli fies what is possible with portfolios. There are now 1,071 CRNFA certifi cants, but until very recently the CRNFA community had been shrinking and was troubled by low testing volume. NASC began using a professional portfolio as the means to earn the CRNFA credential in 2020. To date, 176 portfolios have been submitted and 142 nurses have earned the credential. The issue of low testing volume had endangered the accreditation status of this credential, but this recent growth has revived the CRNFA certification for the perioperative community.

The presentation reinforced the importance of continual training, teamwork and transparency/com munication for successful inspection and assembly. Zarembinski discussed common challenges and how to be proactive versus reactive. She was able to show what materials, tools and accessories are available, as well as explain the do’s and don’ts of inspection and assembly. The webinar was designed to em power individuals to use what they know about their department, team and resources and to apply industry standards/guidelines.Additionalinformation was shared during a question-and-answer session. One attendee asked, “What can the operating room staff do to assist with instrumentation when you discuss a proactive plan versus a reactiveZarembinskiplan?” mentioned that some prep items can be helpful and stressed the use of communication tools.Another question was, “Should we be documenting if we find rips or tears in a Zarembinskiwrap?”said this is some thing that she has been giving more thought to recently. She suggested that if one instrument or item seems to be coming back with rips or tears on a regular basis that it might be worth documenting and assessing if there is something that could be done differently to prevent theThedamage.webinar drew several health care professionals with 113 in at tendance for the live presentation. A recording of the session is available for on-demand viewing at ORToday Webinars.live.Attendeesshared their thoughts about the webinar in a survey that included the question, “How will to day’s webinar help you perform your regular tasks more successfully?”

SPD’s Inspection and Assembly Examined

By Staff report T he OR Today webinar

WEBINAR SERIES INDUSTRYINSIGHTS Webinars

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“I can better appreciate and ar ticulate all the steps and details that SPD does in preparing our sets and packages for customer use,” Sterile Processing Tech Dawee Van said.

Thank you sponsor:

“Inspection & Assembly: More Than Just ‘Prep and Pack’” was sponsored by Key Surgical and eligible for 1 CE credit. OR Today is approved and licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623 and Healthcare Sterile Processing Association, #222705. Presented by Jamie Zarembinski, CRCST, CER, CHL, clinical educa tor, sterile processing, the webinar explored the process of inspection and assembly. It is more complex than just “packing a container with instruments” and the webinar dove into the why/how/what/when. Dur ing the deep dive, Zarembinski ad dressed common challenges and how to avoid them.

“This webinar provided clearer understanding about the proper protocol for inspecting and packag ing OR instrumentation,” Clinical Manager Debra Lane said.

“The training today was a good refresher of things I studied for the CRCST exam not long ago. I learned a few new things and really like the instrument pouch idea. I also took notes to refer back to in order to stay fresh and not get complacent,” said Joshua Nielsen, CRCST. For more information, including a list of upcoming webinars, visit ORTodayWebinars.live.

ONE EARNCLICK.CE’s. When you join us for a FREE webinar. OR Today has been approved and is licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623. CBSPD CE credits when applicable. ORTODAYWEBINARS.LIVE THURSDAYS AT 2PM ET WEBINAR ARCHIVES ONLINE WEBINAR SERIES

Some drivers of the market include increasing cases of musculo skeletal disorders that are expected to boost the growth in the global single use disposable patient posi tioning products market. Furthermore, increasing number of orthopedic surgeries is expected to boost the growth in the global single use disposable patient posi tioning product market.

A medgadget.com article reports that the single use disposable pa tient positioning products market is estimated to surpass $168.6 million by 2028 with CAGR of 3.5%.

he global positioningpatientdevices market is anticipated to grow at a healthy rate, according to a MarketWatch report. The patient’s position can have a big impact on the outcome of surgery. Minor changes in positioning can have negative consequences, such as blood pressure drops or spikes, breathing issues, and cardiac problems. In dental and medical instruments, patient positioning devices are im portant, especially for radiotherapy and imaging. The rising prevalence of chronic diseases such as cancer, cardio vascular disease and kidney disorders, which necessitate diagnostics and sur geries, is propelling the global patient positioning devices market forward. According to a 2016 CDC report, the number of cancer cases reached about 2 million per year by 2020. Further, by 2030, it is projected that there would be about 26 million new cancer cases and 17 million cancer deaths per year. According to statistics from the National Council on Aging, 80 percent of adults aged 65 and older have at least one chronic disease, with 68 per cent having two or more. Chronic dis eases affect nearly 133 million people in the United States, accounting for more than 40% of the total popula tion, according to National Health Council data from 2014. By 2020, it reached 157 million people, with 81 million of them having multiple conditions. Furthermore, the market is expected to grow as more capital is invested in health care infrastructure to install technologically advanced equipment and devices in hospitals and clinics. In order to improve the quality of health infrastructure and address health service capacity gaps, the health care sector in developing economies has seen significant growth over the last decade.

For the safety of patients and sur geons’ simple access to the operating room, single-use disposable patient positioning products are widely used in a variety of diagnostic and surgical procedures. Arm cradles, table pads, cushions, headrests, and heel/elbow protectors are examples of single-use disposable patient positioning de vices. Compared to reusable patient positioning devices, these single-use disposable patient positioning solu tions provide a number of advan tages, including improved control of healthcare-acquired infections (HAIs), reduced cost-effectiveness, and convenience of use and time savings, according to a Coherent Market Insights report. Moreover, the position of the patient makes it simpler to reach the region that is beingThetreated.global single use disposable patient positioning products market size was valued at $127.7 million in 2018, and is expected to witness a CAGR of 3.5% over the forecast pe riod (2018-2026), according to the Coherent Market Insights report.

The global patient positioning system market is expected to secure a market value worth $1.8 billion while displaying a compound annual growth rate (CAGR) of 3.9% dur ing the forecast period from 2022 to 2032, according to a Future Market Insights Inc. report. The increasing geriatric population and the growing incidences of cancer are anticipated to play a key role in driving the pa tient positioning system market in the assessment period.

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Patient Positioning Market Growth Predicted Staff report IN THE OR market analysis

Ansell SANDEL Pro-Form Patient Positioners

More than two million patients are af fected by pressure injuries each year and the treatment cost for a single pressure ulcer can reach up to $150,000. To help reduce the risk of pressure ulcers in the O.R., Ansell’s SANDEL Pro-Form Patient Positioners provide improved pressure relief compared to traditional foam po sitioning products. The Pro-Form Con toured Supine Head Positioner features memory foam and anatomical design for improved redistribution of weight and pressure. It also offers improved stability and is disposable to reduce the risk of cross-contamination and improve turn over time. It is bright orange to be highly recognizable in the O.R. For samples, please visit Ansell.com/SANDEL or e-mail sandel-cs@ansell.com.

ACTION O.R. Overlay

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IN THE OR product focus

The Action O.R. Overlay is a versatile polymer pad used for a wide range of procedures. Its shear re ducing qualities combined with the ability to distribute heat and pressure make it a valuable pressure management tool. Used in longer procedures or for patients with fragile skin integrity, it provides an affordable upgrade for basic foam table pads providing enhanced patient protection. The overlays are portable and can be exchanged between rooms as needed and are available in all standard OR table footprints in half-inch thickness.

The Shoulder-Float Adjustable Axillary Support Device helps anesthesia staff position and reposition a patient optimally during surgical proce dures performed in the lateral decubitus position. Invented by two an esthesiologists, the device can be adjusted throughout a procedure to maintain an even weight distribution, without having to manually lift or move the patient. It is easy to use. Health care professionals can simply slide the uninflated Shoulder-Float Device under the patient’s axilla and inflate enough to lift the shoulder off the table. It helps relieve a patient’s shoulder discomfort and reduces instances of staff and patient injuries due to lifting. It replaces the foam, beanbag or gel axillary rolls often used. It can be used with bariatric procedures.

Foam positioners provide patient position ing and pressure relief in the OR during the procedure and beyond for ongoing pressure management and patient comfort. They help to protect and position for prevention of pressure injuries and risk of nerve dam age. They provide collaborative support for the perioperative nursing team, surgeon and anesthesia team. Foam positioners provide pressure management with surfaces in the PACU through transition to inpatient care. They also provide postsurgical support for the ongoing management of care and recovery to promote circulation and assist with pressure injury prevention or treatment.

Encompass offers a wide range of patient positioners and support surfaces to fit oper ating and post operative needs.

For more Information, visit encompassgroup.com IN THE OR product focus

NEXT Medical Products Company

Shoulder-Float Adjustable Axillary Support Device

September 2022 | OR TODAY 29WWW.ORTODAY.COM

Encompass Group Patient Positioners

• Identify withandtherapeuticnonpharmacologicaltreatmentoptionsinterventionsforpatientsOCD.

• Recognize the clinical features of OCD.

• Relate incidence and genetic fac tors to the risk of acquiring OCD.

• Individuals may have sexual, reli gious, or aggressive obsessions that may be accompanied by mental rituals or other acts designed to neutralize the thoughts or urges.

• Summarize the roles of clinicians and support persons in the man agement of OCD. Relias LLC guarantees this educa tional program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 defines obsessions as unwanted intrusive and time-consuming thoughts, impulses, or images that cause marked anxiety or distress that interfere with normal social or occupational activities. The person may or may not realize that these thoughts and ac tions are unreasonable (American Psychiat ric Association, 2013). DSM-5 delineates compulsions as re petitive behaviors that a person feels driven to perform in response to an obsession or in accordance with rigidly applied rules. For example, a person who is obsessed with germs may have such a strong urge to avoid contamination that he or she compulsively engages in repetitive handwashing or avoids physical contact with other people. The

After taking this course, you should be able to:

See Page 37 to learn how to earn CE credit for this module.

O bsessive-compulsive disorder (OCD) is a condition characterized by uncontrollable thoughts and repetitive behaviors and is associated with varying levels of functional impairment.

1. •Contamination:Thisdimension involves fears of germs, feces, spoiled food, etc. that are often accompanied by cleaning or washing compulsions.

• Describe adversemanagementpharmacologicalofOCD,includingeffectsfrommedications.

Once thought rare, it is now recognized as one of the five most common causes of mental health disability worldwide (NIMH, 2017). OCD symptoms include a combination of distressing or unwanted intrusive thoughts (obsessions) with or without rituals performed to reduce dis tress (compulsions). OCD is a complicated disorder with a neurobiological basis in which serotonin plays a significant role (Lis semore et al., 2016). Some patients with OCD experience only obsessions; most experience both obsessions and compul sions.

compulsions are aimed at preventing or re ducing distress; however, they are not con nected in a realistic way with the thoughts they are trying to neutralize or prevent, and they are excessive and go beyond what people without OCD would do to avoid contamination (Baioui et al., 2013).

Complusive Disorder (OCD)

CE240-60 30 OR TODAY | September 2022 WWW.ORTODAY.COM

Obsessive

3. Unacceptable Thoughts:

• Identify assistive tools to diag nose OCD, as well as barriers to diagnosis.

•Harm:This involves concerns about Goal and Objectives

Symptom Dimensions in OCD While the specific content of the obsessions and compulsions can vary from person to person, there may be some common cen tral themes. The most commonly identified symptom dimensions or themes described in the literature are (Williams et al., 2013):

Performing these rituals provides only temporary relief from the obsessions, yet not performing them markedly increases anxiety. Some actions may appear to be purposeful behaviors compelled by rational reasoning, but they are primarily aimed at reducing anxiety, not accomplishing a task.

•Symmetry/Order:Thisinvolvesconcerns with objects appearing in a particular order or arrangement, often ac companied by compulsive arrang ing of objects. This dimension may also involve the need for things or situations to have a particular “just right” feeling, with repetitive behaviors or mental acts occurring until that feeling is produced.

The specific content of an individual’s symptoms may change over time. The intensity of a person’s symptoms also shifts over time. Generally, the prognosis worsens and the person experiences greater functional impairment over time when (Pittenger, 2017):

A. Excessive alcohol consumption B. Compulsive hand washing C. Emotional lability D. Difficulty sleeping Feedback

• The individual has other comorbid psychiatric conditions.

• The individual requires inpatient treatment because of their symp toms.

• The onset of symptoms occurs early in development.

Incidence OCD occurs equally among men and women. Data regarding age of onset shows bimodal peaks; one peak age of onset occurs prior to puberty (mean age of 10 years) with a second peak occurring during early adulthood (Pittenger, 2017). The onset differs with gender, with modal age of onset occurring in females in their 20s and in males during childhood and adolescence (Taylor et al., 2016). Family members of people with OCD have a greater risk of OCD. The risk for the general public is approximately 1% to 2% (Phillips et al., 2014). Predisposition Scientists at the National Institutes of Health have identified a genetic variation associated with the reuptake of serotonin (5-HT) that doubles a person’s risk for OCD. A dysfunction in neurotransmission and altered sensitivity of the 5-HT recep tors leads to the inhibition of connections between emotions and repetitive behaviors (Lissemore et al., 2016). Evidence also is emerging that points to a glutaminergic association with OCD (Nestadt et al., 2010; Ortiz et al., 2016). Sex-specific neurochemical differences in OCD occurrence associated with gluta mate levels in the brain are being explored.

Although people with OCPD strive for perfection, they can be inefficient, miss ing important steps or crucial pieces of information because of their rigid ap proach. Those with OCPD may have more difficulty recognizing their symptoms as problematic compared to individuals with OCD. A person with OCPD is also less likely to have true obsessions as defined by the DSM-5. It is possible for a person to have both OCD and OCPD, which together, drastically diminishes their ability to function (Gordon et al., 2013).

In one study, female patients with OCD had significantly reduced levels of glu tamate when compared with matched control patients. Levels of glutamate also correlated with clinical measures of OCD symptom severity in female, but not male, patients. This discovery may lead to a way to monitor patient progress using biologi cal markers and assess the effectiveness of treatments for OCD (Nestadt et al., 2010).

A link has been established between the incidence of OCD and streptococcus infections that have led to rheumatic fever. This link is theorized to be the result of an immune response that affects the central nervous system (NIMH, 2016). Similar research among people with irritable bowel syndrome supports that an immune response is associated with OCD incidence.

causing harm to others that may be accompanied by efforts to check that harm has not occurred or other actions to prevent harm from occurring.

Question #1

A 45-year-old man comes to the office at the insistence of his spouse who reports that he has been drinking excessively, emotionally labile, compulsively washing his hands, and has worsening difficulty sleeping. Which of the following symptoms exhibited by this patient best supports a diagnosis of OCD?

Additional recent evidence links exacer bation of OCD symptoms with female reproductive hormonal fluctuation. Meno pause, pregnancy, and the premenstrual time period have been linked to an increase in the severity of OCD symptoms in some studies. Approximately 25% of female patients with OCD report that symptoms of OCD began at menarche. Additionally, women who are pregnant or post-partum have an increased risk of new onset OCD that is 1 ½ to 2 times that of the general population (Mathes et al., 2019).

In one study, 35% of patients with OCD were also diagnosed with IBS (Ma

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Soft neurological signs, such as invol untary limb movements or twitching, and visual/spatial deficits (poor hand-eye coor dination), occur in almost all patients with OCD (Taylor et al., 2016). MRI scans that are sensitive to the orbitofrontal cortex-stri atal circuit, the area of the brain responsible for initiating hand-eye coordination, have even confirmed abnormal neurological activity when unmedicated patients with OCD are compared with individuals with out OCD (Jung et al., 2017).

• The individual responds poorly to initial courses of treatment. The signs and symptoms of OCD may be chronic and unremitting, and if left untreated, can grow progressively worse in intensity and frequency. Individuals with OCD may experience serious functional impairment across multiple domains. It is also associated with increased risk of suicide (American Psychiatric Association, 2013). However, recent research has found that many individuals have a positive response to treatment and are able to sustain periods of symptom remission for periods of 5 years or more (Burchi et al., 2018). Some individuals with OCD function at very high levels despite their symptoms. Differentiating OCD from OCPD Despite their similar sounding names, OCD and Obsessive-compulsive personal ity disorder (OCPD) are very different conditions. Patients with OCPD are rigidly focused on structure, lists, rules, and perfec tion. Patients with OCPD may be high achievers, but this is often at the expense of personal and professional relationships.

Course and Prognosis

[The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM5 defines obsessions as unwanted intrusive and time-consuming thoughts, impulses, or images that cause marked anxiety or distress that inter fere with normal social or occupational activities. DSM-5 delineates compulsions as repetitive behaviors that a person feels driven to perform in response to an obsession or in accordance with rigidly applied rules (APA, 2013).]

The Y-BOCS is a clinician administered scale that rates the severity of OCD by measuring these five factors: Time spent on obsessions and compulsions Interference from obsessions and compulsions Distress from obsessions and compulsions Resistance to obsessions and compulsions Control over obsessions and compulsions

•

A. A 45-year-old female with B.insomniaA75-year-old male with congestive heart failure C. A 22-year-old post-partum female with anxiety D. A 37-year-old male with difficulty concentrating Feedback [Women who are pregnant or postpartum have an increased risk of 1 ½ to 2 times that of the general population (Mathes et al., 2019)]

Pharmacologic Treatment, Side Effects, and Considerations

Healthcare providers may have difficulty identifying OCD symptoms. Although the same core symptoms are experienced by both children and adults, the specific content and domain of obsessions and compulsions vary based on age. Secrecy and shame often complicate the diagnosis (NIMH, 2017). For example, some patients may not admit readily to OCD symptoms, such as a fear of germs, sexual preoccupa tion, or harm-related obsessions. Others who come to healthcare settings with common OCD-related complaints may be labeled as hypochondriacs. The severity and intensity of OCD symptoms also can fluctuate, depending on the presence of stressful situations or comorbid disorders (Torres et al., 2016). The presence of comorbid disorders also makes the diagnosis difficult. For example, up to two-thirds of these patients also have depression (Taylor et al., 2016). Many people with OCD are diagnosed with other psychiatric disorders, includ ing panic disorder, social anxiety disorder, eating disorders, schizophrenia, attentiondeficit/hyperactivity disorder, substance use disorders, and Tourette’s disorder. Differ entiating between Tourette’s disorder and OCD can be challenging. It is often difficult to determine when repetitive behaviors reflect complex tics seen in Tourette’s versus the classic compulsions seen in OCD (NIMH, 2016; Mol Debes, 2013).

Screening Tools Psychiatric screening tools, such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) or the Obsessive-Compulsive Inventory Revised (OCI-R) can facilitate diagnosis by identifying thought processes and behavior patterns common to OCD (Macatee et al., 2016; Rapp, et al. 2016).

Barriers to Diagnosis

question #3 Which of the following BEST describes “ego-dystonia” as it relates to OCD?

A. Fluctuating severity of symptoms

•

sand et al., 2006). Researchers are investi gating the role of reducing immune triggers, possibly with antibiotic prophylaxis, to reduce the probability of developing OCD and related conditions, including Tourette’s disorder, or reducing their severity when diagnosed early (Murphy et al., 2010). Many studies seek evidence surround ing the correlation of OCD to environmen tal risk factors such as parental age or nur turing, sexual abuse, substance use, vitamin deficiency, brain injury, or infection. More research is needed to determine causation (Brander et al., 2016). However, some studies have found that OCD symptom severity is associated with adverse environ mental events such as experiencing abuse or neglect during childhood (Vidal-Ribas et al., 2015).

B. Suppressing, ignoring, or hiding

•

The tricyclic antidepressant clomipramine (Anafranil®) is one of the first medica tions approved for OCD. This drug must be used with caution, particularly with depressed patients who may be suicidal, because an overdose can be lethal (Sayyah et al., 2013). Selective serotonin reuptake inhibitors (SSRIs) are now the preferred agents (Sayyah et al., 2013). They in clude fluvoxamine (Luvox®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®), and fluoxetine (Prozac®). The U.S. Food and Drug Administration also approved fluvoxamine, sertraline, paroxetine, and clomipramine for use in children with OCD; however, the use of antidepressants

The test not only helps diagnosis but also can track therapeutic progress peri odically. The OCI-R is a patient-reported diagnostic tool. Patients rate a series of statements such as, “I find it difficult to control my own thoughts” on a 0 to 4 scale with 0 corresponding to “Not at all” and 4 corresponding to “Extremely”. A score of 21 or greater suggests a possible diagnosis of OCD. A comprehensive assessment by a li censed mental health professional is needed to make the diagnosis. The tool allows clini cians to discern severity of symptoms by categories (washing, checking, ordering, ob sessing, hoarding, and neutralizing) (Rapp et al., 2016). Separate versions of each of these tools are available to screen adults and children. These scales are also used to track responsiveness to treatment.

•

D.managementEgo-syntonic behaviors Feedback [One of the cardinal features of OCD is that it is an ego-dystonic disorder, meaning the symptoms are unacceptable and worri some to the person. Therefore, the patient tries to ignore or suppress symptomatic thoughts and behaviors. Although many patients recognize their symptoms, they cannot stop them (Macatee et al., 2016).]

OCD may also coexist with temporal lobe epilepsy, traumatic head injury, and druginduced conditions. One of the cardinal features of OCD is that it is an ego-dystonic disorder, meaning the symptoms are unacceptable and worri some to the person. Therefore, the patient tries to ignore or suppress symptomatic thoughts and behaviors. Many individuals with OCD recognize the nature of their symptoms, but cannot stop them (Macatee et al., 2016). Worrying and sadness, as well as somatic complaints of fatigue and pain, may develop in these patients.

C.symptomsTakingpride in symptom

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•

question #2 Which of the following patients is at an increased risk of developing OCD?

•

including:•Drowsiness•Drymouth•Dyspepsia•Sexualdysfunction•Insomnia•Headache•Diarrhea•ConstipationPotentialforinteractions

which

•

memory impairment (Dold,

• Shame

Many of the second-generation antipsychotics are associated with a risk of metabolic syndrome (Chokhawala & Stevens, 2020). According to the American Heart Association, metabolic syndrome is characterized by a combination of any three of the following: Obesity Triglyceride level ≥ 150 mg/dL

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of symptoms, including: • Fatigue • Lethargy • Myalgia • Chills • Dizziness • Vertigo • Ataxia • Nausea and vomiting • Numbness and tingling in the hands and face • Insomnia • Crying • Anxiety • Agitation • Irritability • Mood changes • Inability

Some patients with OCD may discontinue pharmacotherapy because of unfavorable sexually related adverse effects, particularly with SSRIs, carbamazepine, lithium, alprazolam (Xanax®), and buspi rone. Providers should address this potential problem before therapy is started. Of the medications used for OCD, the lowest inci dence of sexually related adverse effects has been reported with clomipramine (Sayyah et al.,Additional2013). reasons for nonadherence to medication regimens include: Adverse effects The need for multiple daily doses The persistence of compulsions The length of time the disorder has been present The patient’s age The cost of medical care Concomitant chronic illness • Coexistent mental health disorders

Second-generation antipsychotics, including clozapine (Clozaril®), olanzap ine, aripiprazole (Abilify®), risperidone (Risperdal®), quetiapine, and ziprasidone (Geodon®), along with a combination antipsychotic/SSRI medication, olanzapine and fluoxetine (Symbyax®), also carry black-box warnings for increased incidence of mortality in elderly patients with demen tia-related psychosis. When patients with dementia are prescribed these medications for resistant OCD, alert their caregivers to monitor for signs of diminished cardiac function, including chest pain, edema, and shortness of breath (Sayyah et al., 2013).

•

Most antidepressant medications now carry “black box warnings” associating the medication with an increased risk of suicide in children and adolescents. As with any medication, a risk-benefit analysis should be performed by the provider, and closer observation is recommended, especially at the beginning of drug therapy and when a dose is adjusted. Behavioral symptoms to watch for include anxiety, agitation, irrita bility, hostility, panic attacks, and impulsiv ity. Physical signs for concern can include insomnia and extreme restlessness. Stressful social situations that occur during SSRI therapy, especially with paroxetine, may increase the risk for suicidal behavior.

Patients’ and healthcare providers’ attitudes also play a vital role in treatment. Establishing a trusting environment that fosters open communication should be a goal for any healthcare professional car ing for these patients. When medication therapy is part of OCD treatment, a collab orative approach is best. Obtaining consent to speak with family members and other individuals close to the patient to obtain information and engage their support can be not only therapeutic but also life-saving, especially when medications with risks are used, including antidepressants and antipsy chotics (Brady, 2014).

The risk for withdrawal increases with age and duration of treatment. The poten tial for withdrawal syndrome varies among the SSRIs, but it is greatest for paroxetine and fluvoxamine, and the lowest for citalo pram, fluoxetine, and sertraline (Sayyah et al., 2013).When SSRI therapy is used for OCD, patients need to know that the response is not immediate and that in fact, additional medications may be needed, including atypical antipsychotics, such as quetiapine (Seroquel®) and olanzapine (Zyprexa®) (Sayyah et al., 2013). This is true especially when OCD and Tourette’s coexist (Mol Debes, 2013). Standard dosages used for depression treatment may not be effec tive with OCD, and higher doses may be needed, particularly when OCD occurs with other disorders, such as Tourette’s syn drome, bipolar disorder, or anxiety. Patients respond differently to SSRIs, depending on the type of OCD (Sayyah et al., 2013).

IN THE OR continuingeducationamong children is increasingly associated with concerns regarding suicidal ideation (Sayyah et al., 2013). Therapy with SSRIs or clomipramine requires careful monitor ing and Combinationinstruction.pharmacotherapy is common, particularly when other disorders are present. Buspirone (BuSpar®) may be used along with SSRIs in patients diag nosed with both OCD and generalized anxiety. When OCD coexists with bipolar disorder, mood stabilizers, such as lithium, carbamazepine (Tegretol®), or valproic acid (Depakene, Depakote®), may be used in combination with SSRIs (Sayyah et al., 2013).Success for treatment-resistant OCD has also been shown with the combination of the antipsychotic risperidone (Risp erdal®) and the SSRIs (Dold, 2013). Many of the medications used for OCD have unpleasant adverse effects, with other drugs (Sayyah et al., 2013) Dosage timing adjustment should be considered for patients who experience daytime drowsiness from medication. Tak ing medication at night may help promote sleep.Patients need to know not to stop SSRI medications abruptly; instead, the dosage should be tapered (Sayyah et al., 2013). Abrupt discontinuation can trigger a flulike withdrawal syndrome up to 25% of patients, may include a wide variety to concentrate and 2013)

In extreme cases, electroconvulsive therapy (ECT) may be used for treatmentresistant individuals and those who also have severe depression. ECT involves a medical procedure in which the patient is placed under sedation and an electric current is passed through the brain via electrodes placed on exact locations of the head (NIMH, 2016).

Cognitive behavioral therapy (CBT) is a recommended first-line treatment for OCD (Wheaton, 2019). CBT can be delivered via individual or group therapy sessions. Group therapy provides mutual support and decreased social isolation. Mutual understanding and a sense of belonging are fostered, and coping mecha nisms are shared (Macatee et al., 2016). Advances in technology, including the use of electronic gaming and self-guided treat

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Surgical and Other Brain-Based Treatments

A. Risk of respiratory depression B. Risk of suicidality C. Risk of bleeding D. Risk of dependence Feedback [Most antidepressant medications now carry “black box warnings” associat ing the medication with an increased risk of suicide in children and adolescents. Behav ioral symptoms to watch for include anxiety, agitation, irritability, hostility, panic attacks, and impulsivity. Physical signs for concern can include insomnia and extreme restlessness.]

Clearance of warfarin is decreased when SSRIs are used; international normal ized ratio (INR) must be monitored closely, with dosage reduced as needed to prevent bleeding.Clearance of benzodiazepine drugs (alprazolam, midazolam [Versed®], and triazolam [Halcion®]) is reduced with SSRIs, and sedation prolonged.

question #4 Which of the following is a black-box warning specific to children and adoles cents taking SSRIs?

A surgical modality initially used for pa tients with Parkinson’s disease, deep brain stimulation, has emerged as an effective treatment for OCD, although placement and programming of electrodes has not yet been standardized (Morishita et al., 2014).

• HDL cholesterol ≤ 40 mg/dL (men) or ≤ 50 mg/dL (women) • Systolic blood pressure ≥ 130 mmHg; diastolic BP ≥ 85 mmHg • Fasting glucose ≥ 100 mg/dL Together,(2016)these factors increase patients’ risk for stroke, coronary artery disease, and type 2 diabetes (Perez Rodriguez et al., 2015). Blood glucose monitoring or frequent laboratory monitoring may be necessary. Patients and their caregivers re quire education about dietary choices and the warning signs of hyperglycemia.

Final points to remember when provid ing pharmacotherapy for OCD: Clearance of theophylline is reduced when SSRIs are used; monitor levels for necessary dosage reduction to avoid toxic ity.

Deep brain stimulation is more invasive than rTMS or ECT. The patient is initially awake, while holes are drilled into the skull and electrodes are placed directly onto the brain, most likely on the ventral striatum for OCD. The patient is then sedated while an implanted battery pack or neurostimula tor is placed. The electrodes then provide pulsations to interfere with brain functions that lead to OCD symptoms (NIMH, 2016).Severe OCD has even been treated with the psychosurgical intervention cingu lotomy, in which an electrode needle burns a lesion in the cingulum, the bundled nerve fibers that link the centers of emotion and thought on the cortex of the brain (Chang et al., 2013). Cingulotomy has also been performed in combination with deep brain stimulation; however, the combination procedure has not been found to be more effective than deep brain stimulation alone (Chang et al., 2013).

Non-Pharmacologic Therapy

Another potential side effect of anti psychotic use is extrapyramidal symptoms (EPS). These symptoms are more likely to appear with the use of first-generation antipsychotics. EPS present primarily as movement disorders such as dystonia, akathisia, tardive dyskinesia, or druginduced parkinsonism (D’Souza & Hooten, 2020). Educate patients to report any abnormal movement issues to the provider so that adjustments in the medication regi men can be made.

Use of monoamine oxidase inhibitors (phenelzine [Nardil®], tranylcypromine [Parnate®], and isocarboxazid [Mar plan®]) is contraindicated with all SSRIs andSymmetricalclomipramine.or asymmetrical pupillary dilation may be found on assessment of the pupils of a client taking paroxetine or sertraline.Monitor urine output and sodium lev els in individuals taking fluoxetine because the inappropriate secretion of antidiuretic hormone has been reported. Orthostatic hypotension and seizures can occur in patients on clomipramine.

The extent to which an effective treatment for OCD is being sought may be evidenced by the reports of studies investigating the use of psychedelic agents for treatment (Dos Santos et al., 2016; Wilcox, 2014). Recent behavioral and neuroimaging data show that psychedelics modulate the brain circuits that are implicated in mood and affective disorders and can reduce the clini cal symptoms of these disorders (Wilcox, 2014). Do not expect to see pharmaceuti cally engineered mushrooms used anytime soon, however, as safety data after longterm use must be evaluated first.

New Directions in Medication Treatment

Evidence has shown promise in the use of repetitive transcranial magnetic stimu lation (rTMS) to treat persistent OCD that is unresponsive to first line treatment with cognitive behavioral therapy (CBT), exposure with response prevention (ERP), and medications. rTMS is a non-invasive al teration of nerve activity, in which a helmet with a metal coil is placed onto the scalp and induces repetitive pulses over 20 to 60 minutes (Rehn et al., 2018). The purpose of rTMS is to generate excitation or inhibit nerve activity in a specific brain region. Patients do not need anesthesia and can be instructed that they will feel a tapping or light thumping on the head during treat ment. Side effects include muscle contrac tions of the face, scalp, or jaw, a headache, and soreness on the head at the location of the magnet (NIMH, 2016).

ment programs, also have influenced the way in which psychosocial treatments for OCD are delivered, with promising results for those who are unable or unwilling to attend sessions in person (Lenhard et al., 2014).CBT interventions for OCD typically emphasize exposure with response preven tion and cognitive strategies. Exposure with Response Prevention (ERP)Exposure refers to confronting imag ined or actual (in vivo) exposure to cues or situations that are related to the person’s obsessions and therefore are anxietyprovoking.Afterbuilding rapport and providing psychoeducation about the disorder and treatment rationale, the mental health professional and client work together to develop a personalized hierarchy consisting of exposure exercises that vary by degree of difficulty. The items selected for the hierar chy should represent some of the primary difficulties the person experiences in their life because of their symptoms.

Cognitive Strategies

Adjunctive Approaches to Treatment Yoga meditation is one alternative treat ment approach used with OCD. The spe cial techniques of Kundalini yoga induce a meditative state; energize the body; and de crease emotional stress, anxiety, and mental tension. Randomized controlled trials have found that Kundalini yoga can effectively reduce symptoms of OCD (ShannahoffKhalsa et al., 2019). This may prove to be a useful approach for individuals who refuse other treatments or for individuals who do not obtain adequate remission from first-line interventions. Physical exercise, including walking and aerobics, also may be effective adjunctive interventions to first-line recommended interventions in reducing OCD symptoms (DeBoer et al., 2012; Zschucke et al., 2013).

C. Exposure with response prevention Feedback [Of the choices, this is the most reasonable first-line intervention. He may also need treatment with an SSRI. SSRIs are also considered first-line interventions for OCD.]

D. Kundalini yoga Feedback [Given the severity of this individual’s symptoms and the fact that he is also experienc ing suicidal ideation, yoga may not be sufficient. It might be helpful as an adjunct to other treat ments though.]

The second component of ERP is response (or ritual) prevention. This refers to having the person refrain from engaging in compulsive acts that typically serve to reduce their obsession-related distress. ERP has been proven successful in treating both adults and children with OCD. Some studies have found it to be the key to successful treatment and that add ing medications to ERP did not add to its efficacy (Hezel & Simpson, 2019). A metaanalysis of outcome studies between 19932014 found that ERP was more effective than antidepressant medications (Öst et al., 2015). However, psychotropic medications may be needed for some individuals with OCD based on the person’s current level of functioning, insight, symptom severity, and other comorbid conditions.

Clinician Management Treatment of OCD is complex, indi vidualized, and multimodal. A treatment algorithm created by the American Psy chiatric Association may aid clinicians in a stepwise process to guide clinician care for OCD (Koran, Hanna, Hollander, Nestadt, & Simpson, 2007). Treatment aims to diminish the frequency of obsessions and compulsions and improve functional outcomes. Because OCD may impact mar riage and other interpersonal relationships, employment, and academic performance, treatment also affects those around the patient (Gordon et al., 2013). While many people with OCD believe their behaviors are well concealed, they are often obvious and affect those around them. Early detec tion and aggressive treatment of OCD in children can result in significant long-term improvement. It is especially important be cause an earlier age of onset often results in poor outcomes, particularly when hoarding symptoms occur (Palermo et al., 2011). Management of OCD varies with specialty. It may focus on the observa tion and documentation of ritualistic behaviors or shared thoughts, which can lead to diagnosis and treatment. After establishing a trusting relation ship, healthcare professionals should encourage people with OCD to seek care and follow their treatment plans. They should also reinforce therapeutic concepts and provide support for signifi cant others. A psychiatric nurse clinician, nurse practitioner, or physician may provide medication management. The Agency for Healthcare Research and Quality offers evidence-based practice guidelines for OCD. continuingeducation

question #5 A 26-year-old man has been experienc ing obsessions about contamination. He compulsively washes his body and has large patches of raw, bleeding skin as a result. He would become alarmed about contamina tion any time his wife came within a few feet of him and he would ask her to move away. She recently moved out of their home. He is now severely depressed and expresses suicidal ideation. Which of the following would be a reasonable first-line treatment for this individual?A.Clomipramine

IN THE OR

Feedback [This type of medication is not typically used as a first-line intervention. It must also be used with caution, particularly with depressed patients who may be suicidal, because an over dose can be lethal.]

Cognitive techniques help individuals with OCD learn to identify and evaluate mal adaptive thoughts that trigger and maintain symptoms. For example, these techniques might be used to help an individual learn how to more realistically evaluate their personal responsibility for outcomes. They may be used to help individuals recognize how they are overestimating the impor tance of having a thought, and that having a thought is not the same thing as acting on a thought. Cognitive therapy has been shown effective because it addresses mal adaptive beliefs (e.g., inflated responsibil ity), neutralizing strategies (e.g., reassurance seeking or rituals), and avoidance (Ponniah et al., 2013).

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B. Mood stabilizer Feedback [This is not considered a first-line intervention for OCD. It may be used if an in dividual has a comorbid disorder that would be treated with this type of medication, such as bi polar disorder.]

D. Urine output and serum sodium

Clinicians need to remember that the support system of those with OCD may already be strained. People with OCD may have difficulty maintaining relationships. Older patients are less likely to be married, and if so, they are typically highly depen dent on their

Which of the following statements indicates that the family of a patient with OCD understands their role in the support process?A.“I shouldn’t yell at my spouse for their behavior, but instead should keep providing reassurance that the outcome they fear will not happen.”

B. “My spouse is drinking heavily to cope with their OCD, but that’s ok because they are in therapy.”

Which of the following characteristics of OCD does Arthur exhibit?

A. Try to dissuade Arthur from his compulsions

B. Pretend they do not notice the behavior C. Encourage Arthur to seek profes sional assistance

C. “My spouse’s OCD is not going to disappear overnight, and I should do my best to be supportive without reinforcing their symptoms.”

Supportive counseling for family members and significant others is often helpful. The support systems of individu als with OCD may need education about the disorder, along with information about they can best assist the person with OCD. For example, family members can some times inadvertently reinforce compulsive reassurance-seeking or other habits that maintain symptoms. Family members need to understand that obsessions and compulsions cannot simply be willed away and that OCD symptoms can be frustrat ing for the patient and family members. Family cognitive behavioral therapy can help family members cope with their own frustrations and teach them skills to more effectively support their loved one (Free man et al., 2014). Family therapy does not involve using the family members to distract from the ritualistic behaviors or take on the role of the therapist. Only trained clinicians should attempt to initially modify ritualistic behav ior patterns. However, in time, therapists may enlist the support of family members for assisting with exposure and response prevention. Educating patients and family members to have realistic expectations is crucial. question #6

Alicia, an 8-year-old girl, and her par ents attend a parent-teacher meeting after receiving a note sent home labeling Alicia as a “difficult” child. Alicia’s teacher finds it difficult to get Alicia to transition to differ ent activities during the school day. If they are leaving the classroom, Alicia must tap the doorframe a certain number of times before leaving. If someone interrupts that process, she starts to cry and becomes se verely distressed. Her teacher feels she “day dreams” throughout the class lessons. Ali cia’s parents inform her teacher that Alicia is not actually day dreaming. She engages in elaborate mental rituals, such as repeating words and phrases a set number of times. Alicia often misses what is being said to her because she is focused on her mental ritu als. Her parents state they will bring Alicia to a doctor to discuss this further. After discussion with the physician, the decision is made to initiate treatment for Alicia with a combination of fluoxetine (Prozac®) and cognitive behavioral therapy. Which of the following should be monitored with the addition of fluoxetine?

A. Blood glucose

B. White blood cell count

Case Studies

Arthur, a 27-year-old man, has worked at no less than three jobs each year since graduating from high school, has been di vorced two times, and is meticulous in his attire. The few friends who visit him are required to remove their shoes at the door, and any utensils or glasses are snatched out of their hands to be washed before they are finished. Nothing is out of place, and when anything is disrupted, such as the stacking order of the magazines on the coffee table or the positioning of the couch pillows, he becomes visibly upset and yells “put that back!”.

Feedback [The support systems of individu als with OCD may need education about the disorder, along with information about they can best assist the person with OCD. For example, family members can sometimes inadvertently reinforce compulsive reassur ance-seeking or other habits that maintain symptoms. Integrated treatment that addresses both problematic substance use and OCD symptoms is important for the person’s overall wellness. Educating patients and family mem bers to have realistic expectations is crucial.]

The most significant contributions a healthcare professional can make to pa tients with OCD are maintaining an open and honest relationship, keenly assessing for OCD signs and symptoms, and referring individuals for early treatment. Healthcare professionals play a vital role in reinforcing continued therapy and adherence with medication. The treatments that are avail able can significantly improve outcomes for individuals with OCD, such that lasting periods of symptom remission, and even full remission are a realistic expectation (Burchi et al., 2018).

A. Hoarding B. Need for symmetry C. Avoidance of touch D. Acts of violence Feedback [Arthur exhibits a need for symmetry, or a compulsive need for things to be “just right” or in an exact organized place.]

D. Comply with the behavior, doing exactly as Arthur instructs Feedback [Arthur should be gently encour aged to seek professional advice. Participating in, ignoring, or admonishing the behavior is unlikely to lead to effective change. Patients with OCD often need assistance with evidence-based interventions, such as the use of SSRIs or CBT approaches like exposure with response prevention.]

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Family Support Considerations

use is impor tant in treatment due to the frequency of co-occurring substance use disorders. Integrated treatment that addresses both the individual’s OCD symptoms and their substance use is essential, along with emphasizing a strengths-based approach that targets overall wellness and recovery (Substance Abuse and Mental Health Services Administration, 2016).

Which of the following is an appropri ate action by Arthur’s friends?

C. Hemoglobin and hematocrit

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Summary Now that you have

1. 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.

1. Read the Continuing Education article.

Alicia’s parents call back to the physician’s office two weeks later. They are concerned because Alicia has been complaining of a dry mouth and constipation. Which of the following is the correct response?A. These symptoms are normal, Alicia can continue to take the B.medicationThese symptoms are not normal, Alicia should stop the SSRI are not normal, Alicia should begin to taper the medication to discontinue D. These symptoms are normal, but Alicia should take half of the prescribed dose to help stop the symptoms [While annoying, dry mouth and constipation, headaches are normal side effects of SSRI use and do not warrant stopping or tapering the medication. Alicia should continue the medication, sip water or suck on ice chips, and consider adding in a stool softener or laxative if constipation continues. Patients should never be instructed to immediately discontinue their SSRI.] finished risk of of OCD as well as barriers to adverse the manage

C.immediatelyThesesymptoms

F [Monitor urine output and sodium levels in individuals taking fluoxetine because the inappropriate secretion of antidiuretic hormone has been reported.]

acquiring OCD • Tools to assist in the diagnosis

Feedback

effects from medications • Nonpharmacological therapeutic treatment options and interventions for patients with OCD • The roles of clinicians and support persons in

ment of OCD Resources•Practice Guideline for the Treatment of Patients with ObsessiveCompulsive Disorder: raw/sitewide/practice_guidelines/guidelines/ocd.pdfhttps://psychiatryonline.org/pb/assets/ • National Alliance on Mental Illness: http://www.nami.org • National Institute of Mental Health (NIMH): https://www. nimh.nih.gov/index.shtml • International OCD Foundation Inc.: https://iocdf.org • NMIH Pages About Obsessive-Compulsive Disorder https://www.nimh.nih.gov/topics/topic-page-ocd.shtml(OCD): For the full list of references, visit ortoday.com

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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.

ONLINE YouNurse.comcantake this test online or select from the list of courses available. Prices subject to change. Questions Questions or for a complete listing of our courses

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CE240-60

viewing the course content, you should have learned the following: • The clinical features of OCD • Incidence and factors contributing to the

Answer:1,B.Compulsivehandwashing.2,C.A22-year-oldpostpartumfemalewithanxiety.3,B.Suppressing,ignoring,orhiding symptoms.4,B.Riskofsuicidality5,C.Exposurewithresponse prevention6,C.“Myspouse’sOCDisnotgoingtodisappear overnight,andIshoulddomybesttobesupportivewithout reinforcingtheirsymptoms.”

September 2022 | OR TODAY 37WWW.ORTODAY.COM

How to Earn Continuing Education Credit

eedback

diagnosis • Pharmacological management of OCD, including

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.

ReviewquestionANSWERS

2. 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.

By Don Sadler THE IMPORTANCE OF 38 OR TODAY | September 2022 WWW.ORTODAY.COM COVER STORY

“The nursing profession overall is lacking in racial diversity, which is also reflected in the OR,” says Katie Boston-Leary, Ph.D., MBA, RN, NEA-BC, the Director of Nursing Programs and Healthy Nurse, Healthy Nation for the American Nurses Association. “Having said that, many nurses and nurse leaders are moving from lack of awareness or acceptance of the status quo to action.”

Diversified Candidates Are Lacking

“I think when you don’t see yourself in a leadership role, you’re hesitant to aspire to become a leader,” says Dawson. “As our young nurses mature into periopera tive leaders, if they don’t see themselves represented in a leadership role, they have a tendency not to strive for those types of positions.”

“I’ve also experienced racially insensitive remarks from colleagues and managers that I would strategically ignore. And I’ve witnessed people genuinely be surprised when I would produce at a high level throughout most of my career.”

According to the Institute for Diversity in Health Management, an affiliate of the American Hospital Associa tion, the percentage of minorities in health care executive positions is currently 11% and the percentage of minorities in first and mid-level management positions is cur rently 19%.“AsI’ve spoken at numerous events or engaged with perioperative leaders, I’ve found that the majority of those in leadership roles are individuals from our majority ethnic group: Caucasian,” says Brian Dawson, MSN, RN, CNOR, CSSM, system vice president, perioperative services, patient care services at CommonSpirit Health in Denver, Colorado.Dawson attributes this to two main factors. The first is that organiza tions are hiring individuals who they feel comfortable with and are among their same ethnic group. “I believe this is not a conscious choice, but an unconscious bias,” he says.

espite recent progress in equity hiring, representation of Black and Indigenous People of Color (BIPOC) nurses still lags in the health care industry. This is especially true in the operating room.

“As our young nurses mature perioperative leaders,into if they don’t see themselves represented in a leadership role, they have a tendency not to strive for those types of positions.”

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“The biggest question,” Boston-Leary asks, “is what impactful steps need to be taken now to swing the pen dulum further versus small measurements of success?”

How Stereotyping is Manifest in the OR Racial stereotyping can manifest itself in the operating room in subtle and not-so-subtle ways. Stith says she

Brian Dawson

Change Happens Gradually Renae Wright, DNP, RN, CNOR, perioperative practice specialist with the Association of periOperative Regis tered Nurses (AORN), believes that underrepresentation of BIPOC nurses in the OR is like evidence-based practice. “The knowledge of what needs to be done is there, but it takes longer for us to actually see it in practice,” she says.

According to Keeli Stith, MSN, RN, NEA-BC, associate director, UH Perioperative at the Ohio State University, Wexner Medical Center, OR departments continue to see a lack of diversified candidates – despite internal and external recruitment efforts.

COVER STORY

“I believe that most organizations intend to improve representation of BIPOC nurses,” says Wright. “Indeed, they are publicly articu lating this in their mission, vision and values statements, and mar keting campaigns. Many organiza tions are working hard to make it happen, but these changes don’t happenBoston-Learyovernight.”has seen the under representation of BIPOC perioperative nurses throughout her career at conferences, in the C-suite and boardrooms and also as a CNO and nurse“I’veleader.hadpeople assume less of me despite my educa tional background and clinical competency,” she says.

“Human resources continues to forward resumes over to managers, but if nursing leaders do not challenge HR recruiters to be more intentional in reaching BIPOC nurses, we will continue to see the unbalanced scale of majority white nurses in the operating room,” Smith says.“In my personal experience as a BIPOC nurse in perioperative services, I was always in the minority,” says Edna Gilliam, DNP, MBA, RN, CNOR, senior director of perioperative services and SPD, DV at Nemours Chil dren’s Hospital, Delaware. “As I progressed into manage ment, there were more times than I can count where I was the only BIPOC leader in the room.”

Boston-Leary “Underrepresentationconcurs.of BIPOC perioperative nurses is even worse in leadership,” she says.

The second reason is more nuanced.

“The first is whether you get the interview because of your name pos sibly reflecting your ethnic back ground,” says Boston-Leary. “Many of us have had to Europeanize our names for this reason.”

Gilliam says that for many minor ity OR nursing candidates, the chal lenge starts with their name.

“Many of us have names that are associated with people of color so there is a fear that our names alone will exclude us as a potential candi date,” she says.

Creating a Diverse Perioperative Team Boston-Leary says the first step in creating a more diverse perioperative team is to make doing so a strategic imperative.“Oncethis is formally declared, one of the tactics should entail col lecting data on diversity at numer ous levels and positions within the organization, including entry, mid and senior level and the C-suite,” she says.

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“Determine the hot spots and gaps and craft two- to three-year plans to close the gaps that exist.” Gilliam also stresses the impor tance of making diversity hiring a pri ority. “Department leaders should be aware of their staff demographics and accountable to build diverse teams,” she says. “And there should be specific metrics and standard requirements for performance management.”

September 2022 has seen it manifest as “bullying” and “tough preceptor.”

Challenges Faced by BIPOC Nurses BIPOC candidates face a number of unique challenges when it comes to breaking into perioperative nursing and nursing leadership.

COVER STORY

“Then, you hope you are given an opportunity because of who you are and how you show up in person or over the phone,” says Boston-Leary. “Of course, professional dress or scrub attire is the standard, but anything that reflects my ethnicity could jeop ardize my chances. There are numer ous ideological gates to walk through well before competency and expertise are assessed to determine whether you are selected for the position.”

“There is also a concern about how much of our authentic selves we can express during the interview process,” says Gilliam. “For example, is it acceptable to wear our hair in certain styles like braids or dread locks? How relatable will we be to the individual or panel of individuals interviewingMeanwhile,us?”Wright says there are often limited opportunities for coaching to increase a BIPOC nurse’s marketability as a leader within an organization. “There are few mentors who are people of color at all levels of leadership, from the executive team all the way down to frontline leaders, and fewer still who are in perioperative services,” she says.

culturally insensi tive comments are made during a procedure, says Boston-Leary, “and you have decide whether you should confront it or assume risk. I’ve actu ally received a posting request for a patient who did not want any black nurses or staff taking care of her be cause she was allergic to what black people put in their hair.” In her experience as a KoreanAmerican transracial adoptee, Wright says it was not uncommon for racism and racial stereotyping to manifest in the OR in the form of microaggres sions. She says she has heard com ments such as “Where are you from?”, “Where are you really from?”, “Your name doesn’t sound Asian” and “Wow, you don’t have an accent.”

“Nurse and nurse leader diversity should be measured separately from other groups since they are the largest workforce in the organization and tend to have the most interactions with patients,” says Boston-Leary.

“The more you talk conversationslessdiversity,aboutthescarythebecomeforeveryone.”

“I have witnessed nurse manag ers working through a complaint issue from an African American staff member and the issue was first addressed as the preceptor was bul lying the staff member,” says Stith. “When I sat with the staff member to further investigate, the issue was reallyBoston-Learyracism.” says that implicit biases, which we all have, could impact how assignments are made in the OR, the specialty teams BIPOC nurses are placed on and whether BIPOC nurses get con sidered for leadership roles. “A surgeon or team member may not like you based on their biases and suddenly assignments are switched without a sensible explanation,” sheSometimessays.

Edna Gilliam

September 2022 | OR TODAY 41WWW.ORTODAY.COM

Dawson stresses the importance of making sure your organization has a diverse and inclusive selection panel. “I also think it behooves nurses like myself to reach out and mentor others who look like we do and make sure they understand that the oppor tunities to succeed are there if they want to take advantage of them.”

MSN, RN, CNOR, CSSM Edna Gilliam DNP, MBA, RN, CNOR James Fly RN, MSN, MBA, CLSSBB

COVER STORY

Renae Wright

DNP, RN, CNOR Keeli Stith MSN, RN, NEA-BC

“I recommend that OR managers get to know what their BIPOC staff would like to see in the department to make it more inclusive,” says Stith. “Attending workshops and networking with other OR managers who don’t look like them is a good place to start. “

Build a Culture of Inclusion Gilliam says that diversity is “the easy part. Building a culture of inclu sion for all team members is the challenging part. “I think we all as perioperative leaders need to get comfortable with being uncomfortable,” says Gilliam. “Give your team the necessary tools and training to support them. The more you talk about diversity, the less scary the conversations become for everyone. Ignoring diversityrelated issues only leads to bigger conflicts down the road.”

• Treat all employees the same, regardless of their race.

research tells us that we should be attracting BIPOC employees at a younger age and not waiting until they are in college,” says Fly. “For example, I’m part of the Big Brothers Big Sisters program and I recently brought my ‘little,’ who is Hispanic, to spend the day in surgery with me.”

Katie Boston-Leary

Ph.D., MBA, RN, NEA-BC

Fly says he’s encouraged about the Executive Order on Diversity, Equity, Inclusion and Accessibil ity in the Federal Workforce signed last year and its potential impact on BIPOC hiring in the private sector as well. The purpose of the order is to strengthen the federal workforce by promoting diversity, equity, inclusion and“Evidence-basedaccessibility.

James Fly, RN, MSN, MBA, CLSS BB, the director of surgical services for LMH Health in Lawrence, Kansas, has seen the percentage of his work force that’s BIPOC nearly doubled since he joined in 2018. He offers a number of suggestions for creating a culture of inclusion among all mem bers of the perioperative team:

• Use data to advocate for diversity.

“A lack of diversity is tied to negative health outcomes in BIPOC patients and may reflect negatively on the organization,” says Fly. “It’s important that patients have caregiv ers who reflect them and the com munity at large.”

Brian Dawson

Wright encourages hospitals to refer to benchmarks for more diverse hiring practices and then set incre mental goals that are achievable over time. “Change on this scale does not happen overnight,” she says. “So, it’s important to make sure that your goals are Hospitalsachievable.”shouldalso create or find IDE education that is engag ing and meaningful. “This education should be mandatory for all staff and providers, from the C-suite to base ment,” she says.

• Strive to create a “broad tent.”

• Organize team-building activi ties outside of work.

• Mandate Inclusion, Diversity and Equity (IDE) and sensitivity training for all staff.

Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, Medical Director of the Center for Integrative Medicine at the Stanford University School of Medicine

SPOTLIGHT ON:

Spiegel argues that self-guided hypnosis techniques can offer much lower-intensity intervention than treatments that rely on “incision, injection and ingestion.” Since the severity of pain is related to how the brain interprets the signals it receives from other parts of the body, hypnothera py can help manage those interpretations.

In addition to these, some patients were offered general emotional comfort from an attending nurse, and others re ceived care from a nurse or psychologist who taught them to use self-hypnosis. In all circumstances, patients were asked to rate their pain and anxiety levels, and researchers measured the amount of opioid doses they administered as well.

In sensory evoked potential electroencephalogram (EEG) studies, Spiegel’s research group has examined brain responses when subjects are given small electrical shocks versus responses when they are hypnotized and told that their hands are being placed in icy water. In the hypnosis condition, Spiegel said the brains of those participating in the

G rowing up in a household where both parents were psychiatrists and psychoanalysts, David Spiegel joked that his upbringing prepared him to become “whatever kind of psychiatrist I wanted to be.” After he saw the results his father demonstrated through learning and practicing hypnosis with his patients, Spiegel found his own interest in the technique piquing as well.

“I was thinking about being a surgeon,” he said. “I had really liked my surgical rotations in medical school. I was suturing people up in the ER; I liked fixing things, and they liked to talk.”

After completing his M.D. at Harvard Medical School, Spiegel began studying psychiatry and neurology. He wrote a book, “Trance and Treatment,” with his father, Herbert. And along the way, Spiegel continued to firmly establish methods by which hypnotherapy, one of his father’s most reliably leveraged practice tools, could help navigate the mind-body connections in clinical settings, including in the perioperative environment.

“I keep telling people that if it were a drug that did that, and you published a randomized trial like that in Lancet, everybody in the world would be using that drug,” he said. “It’s teaching people to manage their experiences better.”

Matt Skoufalos WWW.ORTODAY.COM42 OR TODAY | September 2022

Spiegel and his colleagues published some of these con cepts in the April 29, 2000, edition of Lancet. In a random ized trial, 241 subjects undergoing percutaneous vascular and renal procedures were offered intravenous access to opioids for their pain as part of standard interoperative care.

“After about an hour and a half, the hypnosis group had 20 percent of the pain that the standard care group did, and they were using half the amount of opioids,” Spiegel said. “There was about 25 percent of the complications, and the procedures got done 17 minutes faster. Not only were the patients less anxious, the medical staff were less anxious as well.”

“We use hypnosis to dissociate physi cal arousal from your anxiety,” Spiegel said. “One feeds the other. Changing your mental state will change your view of even the same problem.”

“If I were a joint surgeon, I would say [to the patient], ‘Use this app and train yourself to handle stress before the surgery if you’re anxious about it,’ ” he said. “If you can just get your body comfortable using self-hypnosis, you’re already controlling one aspect of the stressor: the fear of the surgery.”“Iwould have people use the app before surgery, or to go back to sleep if they wake up,” Spiegel said. “Many people having orthopedic surgery are already in pain. I’d have them prepare for the surgery that way. Afterwards, I would have people use the app as part of their rehabilitation. Instead of taking another OxyContin, practice for one or two hours if the pain gets worse.”

Lest anyone doubt that Spiegel prac tices what he preaches, he first discovered the utility of self-hypnosis after having had reconstructive shoulder surgery in his youth. Spiegel wasn’t taking the pain management medicine offered to him, and the surgical resident believed it was because he had suf fered little nerve damage from the proce dure. Instead, he was managing the discom fort with self-guided hypnosis.

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“I’m a physician; I use meds,” he said. “If it doesn’t work, then use your meds. But make it the last thing you do, not the first thing you do.”

To broaden access to the techniques that have helped the subjects in his clinical research, Spiegel and his colleagues developed a mobile application called Reveri that coaches users through guided hypnotic techniques to handle a number of conditions, from chronic pain and anxiety to insomnia and smoking cessation. From their initial proof of concept, which rolled out through the Amazon Alexa platform, the team now boasts 15,000 users on the Reveri“Withapp.hypnosis, either you feel better or you don’t, so you know right away whether it’s likely to help you,” Spiegel said. “With the people who use Reveri, we’re getting a 30 percent reduction in pain and stress in 15 minutes. We’re getting feedback from them using Google analytics. It doesn’t al ways work, but it works for a lot of people, and with far fewer side-effects than opioids.”

study demonstrated half the response to pain stimuli of subjects who weren’t hypnotized.

Spiegel believes that broader application of the Reveri app and related techniques in the perioperative environment could work to help reduce patient stress and pain, and to speed recovery times.

“That’s the way in which many people misunderstand pain, which is a combi nation of physical damage and mental reconstruction of the experience,” Spiegel said. “See if you can better control the un derstandable sensation that you have. It’s not hard, but it takes time. Prepare before, and use it afterwards.”

“We tend to treat most pain as if it were acute pain, where you don’t know what’s going on, and you’d better get out of danger and get it fixed,” he said. “We now have neuroimaging evidence that the brain does dramatic changes in all kinds of perception hypnosis. Functional magnetic resonance imaging (fMRI) studies have shown that you can reduce activity in the anterior cingulate cortex, a key region in the pain network, during hypnosis.”

Inducing hypnosis can take less than a minute, and Spiegel said that at least twothirds of the adult population is capable of being hypnotized. In simple terms, the subject is invited to slowly close their eyes, take a deep breath, let it out and imagine the body floating. If he’s working to treat pain, Spiegel will invite patients to imagine themselves in an icy mountain stream, or a warm bath, and picture the cold or warmth filtering out the pain.

“To the extent that people can do this, they start to become less anxious as well,” he said.For people who’ve experienced chronic pain or trauma, hypnosis can support them overcoming patterns in thought that can make things worse, Spiegel said. How the body deals with threats to itself, or the results of ill health, pain, and anxiety, involves disso ciation from such experiences. Hypnosis can help access those mental states that separate past experiences from things that are hap pening now. As Spiegel said, “It’s a way of distancing yourself from damage. “Every time you have an experience, your brain processes it through pattern rec ognition,” he said. “If you’ve had traumatic experiences, they will tend to color your reactions to situations that look somewhat similar to them. It’s our shorthand for figur ing out how to integrate novel information.”

The best way to know your blood pressure is to have it measured at least once per year by a health care profes sional and regularly monitor it at home then discuss the

Managing conditions like high blood pressure before get ting pregnant helps keep you and your baby healthy during pregnancy and beyond. In addition, your health during and immediately after a pregnancy can shape the lifelong health of you and your child. If you’re planning to become preg nant or are currently pregnant, it’s important to regularly monitor your blood pressure.

Cardiovascular disease, including stroke, is the leading cause of death among women, according to the Centers for Disease Control and Prevention (CDC), and 1 in 5 women will have a stroke. However, a large majority of strokes can be Caringprevented.for yourself by understanding your risk factors can help reduce your risk for stroke and provide a better quality of life. Start managing your stroke risk with these tips from the American Stroke Association, a division of the American Heart Association:

Monitor Your Blood Pressure

I t may not be widely known that women face unique risk factors for stroke throughout their lifetime. Things like pregnancy, preeclampsia and chronic stress can increase the risk for high blood pressure, a leading cause of stroke.

The first step you can take in reducing your risk for stroke is knowing your blood pressure and keeping it in a healthy range. High blood pressure is the No. 1 preventable cause of stroke, according to the American Heart Association.

Take Care of Your Mental Health

numbers with a doctor. For most people, a normal blood pressure should be 120/80 mm HG or less. In addition to properly monitoring blood pressure, maintaining a healthy weight, being physically active, eating healthfully and reducing or eliminating alcohol and tobacco usage can help control blood pressure. If you do develop high blood pressure, work with a health care professional on a plan to help manage it.

Plan for Pregnancy

Some stress is unavoidable but constant stress is not healthy. Chronic or constant stress may lead to high blood

OUT OF THE OR health By Family Features Photo courtesy of Getty Images

44 OR TODAY | September 2022 WWW.ORTODAY.COM

In the United States, high blood pressure during pregnancy is becoming more common, according to the CDC, and medical conditions including preeclampsia, gestational dia betes and blood clots during pregnancy all increase stroke risk during and immediately following a pregnancy.

What Women Need to Know About Stroke Risks

• Face drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?

OUT OF THE OR health pressure and other unhealthy behav ior choices, which can increase risk forBasedstroke.on findings in a Stress in America 2020 survey conducted by the American Psychological Associa tion, the top sources of stress are mon ey, work, family responsibilities and health concerns. Managing your stress and blood pressure can improve your overall health and well-being. Reclaim control of your schedule and build in time to invest in your health. Find 10 minutes every day to do something for you, like listening to music, meditating or going for a walk.

Learn the Warning Signs A stroke can happen to anyone at any point in life. Immediate treatment may help minimize the long-term effects of a stroke and even prevent death. Learn how to spot a stroke F.A.S.T:

September 2022 | OR TODAY 45WWW.ORTODAY.COM

EARN CE WEBINARCREDITS! SERIES ortoday.com/webinars

• Time to call 911 – If someone shows any of these symptoms, even if the symptoms go away, call 911 and get to a hospital immediately. Check the time so you’ll know when the first symp toms appeared. Talk to your doctor about ways to improve your well-being and help prevent stroke. Find more wellness tips at stroke.org

• Speech difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sen tence like “The sky is blue.”

• Arm weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

A strong and efficient moving shoulder needs a solid foundation. This is why you’ll see guys with big and strong muscles in their deltoids and weak rotator cuff or scapula control experience tears or dislocation. This is because most people tend to challenge the shoulder with too many heavy lifts instead of with some stability. This leads to shoulder instability and imbalances during certain repetitive and overly strenuous activity, potentially leading to injury. For example, even bad posture causes shoulder mobility to be compromised. The shoulder blades play a vital role in mobility and function of the shoulder itself. The three exercises in this column will help with alignment. The first exercise is a supine kettle bell press and torso rotation. This ex ercise will challenge the shoulder, however because of the kettlebell’s shape it feels significantly different and challenges stability. Nonethe less, a wonderful exercise to focus on strengthens and stabilizes while also taking the lower torso and legs through a different plan of motion. It really challenges the shoulders’ ability to be weight bearing during activity.

ShouldersforFoundationStrongBoulder OUT OF THE OR fitness

By Miguel J. Ortiz

46 OR TODAY | September 2022 WWW.ORTODAY.COM

The second exercise is the dumbbell shoulder scaption. This is a fantastic shoulder priming exer cise. It puts the shoulder in a com fortable position. It shouldn’t be very weight bearing as it will force other surrounding muscles (upper traps or chest) to assist in compen sation. During this movement, one should feel full deltoid (shoulder) focus with trapezius stability to support but cannot become a prime mover. Brace properly at your core, keep the weight under control and this exercise can be thrown in any upper body movement pattern warmTheup.third exercise is a half kneel ing kettlebell buttom up press. If you’re wondering why you have an inability to overhead press then I highly recommend trying this exer cise with very light weight. This will allow you to feel where compensa tions are being made. Because of the need to balance the kettlebell appropriately, it can cause one to recognize where stabilizing muscles might be weak. The ability to externally rotate the shoulder is important for proper alignment. Have fun with these movements. Stay active and remember to take care of those shoulders.

A n important concept in Stephen Covey’s book, “The 7 Habits of Highly Effective People,” is Habit 4: Think Win-Win. I believe more people struggle with incorporating this habit over any other. In my findings, the key to success is realizing that achieving a win-win outcome is much easier if one first develops a win-win mindset. It’s a way of thinking that doesn’t come naturally, so here’s a tip: one of the easiest ways to think win-win is to start every transaction seeking a win-win agreement. OK, so what is a win-win agreement? In practical terms, it means enter ing into any negotiation wanting to know what the “win” is for you, and also what the “win” is for the other person – then actively working to achieve both.

• Win-Lose Thinking. This is the idea that the only way you can get a win is if someone else loses. Unfortunately, this type of thinking is magnified in our soci ety, often due to the prevalence of sporting matches. Except in the rare case of a tie, there’s always a winner and a loser in sporting matches.

In other words, not only must you know how you define a win, but you must also want to know how the other person defines a win. If you can’t develop this desire, then you can’t establish a win-win agreement, and reaching a win-win outcome happens only be accident.

Other options include Lose-Lose Thinking, and “Win” Thinking. LoseLose Thinking can be seen when someone is holding a grudge and is willing to lose out on something so long as someone else also loses out. Think of a judge ordering a divorcing couple to sell an expensive sports car and split the money, only to have the husband sell the car for a dollar so he can give his wife 50 cents. In “Win” Thinking, a person sets out to win no matter what. It doesn’t matter if the other person wins or loses, but the “Win” person has the mindset that he or she is going to win. In Win-Win Agreements, the mind set is quite liberating. Think of it this way: “I want to win, and I want you to win. If we can’t find a way to make that happen, then let’s not do the deal.” Said another way, if we both can’t win, let’s just be agreeable that now is not the right time to move forward. Working under such an agreement creates a focus for true cooperation and progress. It’s different from how many people think, but it gives you the best chance at achieving a winwin outcome.

• Lose-Win Thinking. Another common thinking modality is when people believe they must be on the losing end so someone else can win. This kind of think ing is actually sad to me because people who subscribe to this mentality lack self-respect. Even though they deserve to get their needs met, they forfeit under the mistaken belief that they’re be ing helpful to others if they give up what they rightfully deserve.

They are:

Daniel Bobinski, who has a doctorate in theology, is a bestselling author and a popular speaker at conferences and re treats. 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 by email at DanielBobinski@ protonmail.com or 208-375-7606.

Victory is Found in Win-Win Agreements

September 2022 | OR TODAY 47WWW.ORTODAY.COM OUT OF THE OR EQ Factor

Other mindsets exist that will block your ability to think this way.

By Daniel Bobinski

by Kirsten

• Watermelon • Cantaloupe • Cucumber • Strawberries • Lettuce • Sweet Peppers • Cabbage • Strawberries • Grapefruit • Celery • Tomatoes • Portobello Mushrooms Fresh produce has added benefits

48 OR TODAY | September 2022 WWW.ORTODAY.COM

There are some hydration myths that need to be busted. The “you must drink 8 glasses of water” a day dogma is a myth. Your fluid needs vary. Let’s bust another hydration myth. You have likely heard that not only do you need 8 glasses, but that it must be water. Not true. Nearly all bever ages count (because they are mostly water.) The notable exception is al cohol. As I write this, I am sitting in a coffee shop with both a cold brew coffee and a sparkling water. They are both hydrating me. You need to be hydratring to fit your lifestyle and so that you do not feel thirsty. Because I am a farmer who spends a lot of time working and sweating in the heat, I am un yielding in my devotion to hydration. I learned the hard way. I have had extreme muscle cramps, lightheaded ness, chills and floaters in my vision from serious dehydration. In the heat of summer, I am drinking 8 glasses a day many times over and I am often adding electrolytes to replace all those I am sweating out. Really pay ing attention to your body is the best way to make sure you are getting the fluids you need. Some signs that you are not getting enough include thirst, fatigue, light-headedness, dry lips/ eyes, and dark and decreased urine. What’s in your cup is not the only way to hydrate. Food counts too! The abundance of fresh produce this time of year is not only ripe for the pick ing but also full of water. This list of fruits and veggies (and funghi!) are all over 90% water:

scorchingrecord-breakingheatacross the nation means your body is more in need of water than ever. Afterall, you are mostly water. (Men are about 60% water and women 55%.) Water is vital to all your bodily functions including removal of waste, 3thatInmovementoxygenation,andnourishment.fact,waterissoessentialwecanonlysurviveaboutdayswithoutit!

Water on Your Plate Serrano

OUT OF THE OR nutrition

It’s not surprising that highly processed foods like cook ies and chips are very low in water. It is one more way that our super-processed standard American diet is failing us. I often get asked what’s the one food change someone should make and I always give the same answer. My number one recommendation to everyone is to eat more produce. Nu trition recommendations are famous for flip flopping, but eating more produce will always be in style. Now, you have another reason to eat fresh fruits and vegetables. So, this September enjoy a slice of melon, a cucum ber salad, a thick slice of tomato on your sandwich, and your beverage of choice. You will reap the benefits of all that hydration. nutrition

Kirsten Serrano is a nutrition con sultant, 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. powered by 800-906-3373

ANNUAL CONFERENCE

SAVE THE DATE OCTOBER 202221-22 gacouncilnurse.org | events@mdpublishing.com |

September 2022 | OR TODAY 49WWW.ORTODAY.COM like fiber, vitamins, minerals and phytonutrients that are going to not only hydrate you but work together syner gistically to improve overall health. The humble tomato contains over 10,000 phytochemicals. Many have health benefits we have not even figured out yet! Plus, a tomato is 95% water. Think of it as a glass of water with 10,000 added benefits.

OUT OF THE OR

50 OR TODAY | September 2022 WWW.ORTODAY.COM OUT OF THE OR recipe Recipe the popcorn party pizza INGREDIENTS: • Nonstick cooking spray • 3 tablespoons butter • 1 bag (10 1/2 ounces) mini marshmallows • 2 quarts popped popcorn • 1 tube (0.68 ounces) red piping gel • 1 package red raspberry rolled fruit snack • green jellybeans (optional) • coconut (optional) • candy-coated chocolate pieces (optional) By Family features

POPcorn party pizza Yield: 8 slices

This Popcorn Party Pizza swaps out the classic pizza crust for popcorn – a whole grain that’s 100% unprocessed with no additional additives, hidden ingredients or GMOs – infused with gooey melted marshmallows and topped with childhood favorites.

5. Cut small circles (about 1 1/4-inch diameter) from rolled fruit snack and place on pizza for “pepperoni” slices.

Pop Up a Kid-FriendlySweet,Treat

2. In large saucepan over medium heat, heat butter. Stir in marshmallows until melted. Stir in popcorn until well coated.

OUT OF THE OR recipe

Visit popcorn.org to find more kid-friendly recipes to help children learn their way around the kitchen.

September 2022 | OR TODAY 51WWW.ORTODAY.COM

3. Spread mixture evenly onto prepared pizza pan.

After an adult melts the marshmallows and lines the pan with the marshmallow-popcorn mixture, kids can help create their own work of art with red piping gel as “pizza sauce;” rolled fruit snacks as “pepperoni” slices; and jellybeans, coconut and candy-coated chocolate pieces for the oh-so-sweet toppings.

6. Decorate with jellybeans, coconut and candies, if desired. Cool completely before cutting into wedges.

4. Drizzle red piping gel over “pizza” for “sauce.”

he next time your kids are begging for an indulgent snack after finishing chores or dessert following dinner, call them to the kitchen for a quick, delicious lesson. Teaching children to cook helps them get more comfortable with an important life skill while encouraging independence – all while having a little fun.

1. Spray 12-inch pizza pan with nonstick cooking spray; set aside.

WWW.ORTODAY.COM52 OR TODAY | September 2022 “Nurse: just another word to describe a person strong enough to tolerate everything and soft enough to understand everyone.” – Unknown QUOTE OF THE MONTH Everyone likes FREE stuff and we want to hear from our readers! It is a win-win for everyone involved. Please take a moment to tell us what you like about OR Today magazine. You could win a $25 gift card! Simply go to ORToday.com/Contest and fill out the short form for your chance to win! LOVE READING TELL US WHY! Win a $25 Gift Card scan me to enter CONTEST OUT OF THE OR pinboard “It is filled concerningup-to-datewithandinformativearticlestheORanditsenvirons.Ilovegettingmineeverymonthbecauseitshowsnewandprovenstrategiesaswellasnewproductsandevidencebasedpractices.” – Susan Schwartz, Operating Room RN Gift Card $25 TWENTY-FIVEDOLLARS Sentara Martha Jefferson Hospital

In January, Eurazeo announced a $75 million minority investment in Jaanuu Inc., a direct-to-consumer designer and manufacturer of premium, performance-oriented medical apparel and accessories. Jaanuu is one of the fastest growing brands in the multi-billion dollar medical apparel market as a result of its innovative designs which deliver maximum func tionality and comfort. Eurazeo’s investment brought Jaanuu’s total capital raised since its founding to approximately $100 million, according to a news release.

Jaanuu is establishing a new board of directors with decades of deep industry expertise to guide and support the company’s accelerated growth. The five-member board will include: Jill Granoff, Eurazeo managing partner and Brands CEO; Shaan Sethi, Jaanuu co-founder and CEO; John Kenney, Cult Capital co-founder and partner; Sean Collins, Goldfinch Partners man aging partner and former BCG Digital Ventures founder; and Anan Kashyap, Ethos CFO and former Poshmark CFO.

OUT OF THE OR pinboard By FAMILY FEATURES Maybe TLC Wants Scrubs Today September 2022 | OR TODAY 53WWW.ORTODAY.COM

The News and Photos that Caught Our Eye This Month

Eurazeo’s partnership with Jaanuu will support brand mar keting investments to build awareness and drive trial, as well as continued investment in product innovation. Eurazeo will also leverage its global network to support Jaanuu in growing its customer reach and geographical footprint. Jaanuu is the 12th investment by Eurazeo’s brands team, and the first in the consumer health care space. Jill Granoff, Eurazeo managing partner and Brands CEO, said, “Jaanuu is an authentic, doctor-led, digitally-native brand that is disrupting the traditional medical apparel market by delivering high-performing modern scrubs with the conve nience of online shopping. Shaan has assembled an impres sive and experienced management team to continue taking market share in the large medical apparel industry, and we look forward to partnering with the company to capitalize on its growthShaanpotential.”Sethi,Jaanuu co-founder and CEO, added, “We are excited to continue supporting all the health care professionals that put other people’s needs ahead of their own each and ev ery day. We created Jaanuu to provide health care professionals with scrubs offering superior design, comfort and performance, enabling them to provide better patient service. We are excited to partner with Eurazeo to increase our brand awareness and accelerate our global growth.”

T he popular TLC song “No Scrubs” describes a “scrub” as a “loser” for lack of longer definition. However, the members of the musical group behind the hit might be interested in a different kind of “scrub.” Whether you’re a medical professional or just want to kick back in a pair of comfy joggers, scrubs maker Jaanuu is posi tioning itself as the go-to wear for work and play, according to a recent article on The Fast Company website. Writer Rachel Kim Raczka writes that medical scrubs are hot right now. Hot in a fashion sense as a trendy option for men and women. The article is available at tinyurl.com/ynu4c9nv.

For more information, visit jaanuu.com.

Jaanuu — derived from the Hindi word for life, “Jaan” — was founded in 2013 by siblings Shaan Sethi and Dr. Neela Sethi to provide health care professionals with modern, techno logically advanced and stylish apparel that empowers them to perform at their best. The company is disrupting the medical apparel industry, which has traditionally been dominated by legacy brands sold via specialty brick and mortar retailers, by offering better fit, fabrics, functionality and comfort through accessible digital channels. The company has invested heavily in its leadership team in the past year as it plans for the next phase of global growth.

INDEX advertisers CATEGORICALALPHABETICAL AIV Inc. 4 ALCO Sales & Service Co. 23 ASCA 21 C Change Surgical 11 Cygnus Medical BC Encompass Group 23 Healthmark Industries Company, Inc. 5 I.C. Medical, INC. 55 Jet Medical Electronics Inc 45 Key Surgical 15 MD Technologies Inc. 19 OR Today Webinar Series 26 Ruhof Corporation 2, 3 SIPS Consults 13 ASSOCIATION ASCA 21 CARDIAC PRODUCTS C Change Surgical 11 Jet Medical Electronics Inc 45 CARTS/CABINETS ALCO Sales & Service Co. 23 Cygnus Medical BC Healthmark Industries Company, Inc. 5 CS/SPD MD Technologies Inc. 19 Ruhof Corporation 2, 3 DISINFECTION Cygnus Medical BC Ruhof Corporation 2, 3 DISPOSABLES ALCO Sales & Service Co. 23 ENDOSCOPY Cygnus Medical BC Healthmark Industries Company, Inc. 5 MD Technologies Inc. 19 Ruhof Corporation 2, 3 FALL PREVENTION ALCO Sales & Service Co. 23 Encompass Group 23 FLUID MANAGEMENT MD Technologies Inc. 19 GENERAL AIV Inc. 4 HOSPITAL BEDS/PARTS ALCO Sales & Service Co. 23 INFECTION CONTROL ALCO Sales & Service Co. 23 Cygnus Medical BC Encompass Group 23 Healthmark Industries Company, Inc. 5 MD Technologies Inc. 19 Ruhof Corporation 2, 3 SIPS Consults 13 INSTRUMENT STORAGE/TRANSPORT Cygnus Medical BC Key Surgical 15 Ruhof Corporation 2, 3 INVENTORY CONTROL Key Surgical 15 ONLINE RESOURCE OR Today Webinar Series 26 OTHER AIV Inc. 4 PATIENT MONITORING AIV Inc. 4 Jet Medical Electronics Inc 45 PATIENT WARMING Encompass Group 23 POSITIONING PRODUCTS Cygnus Medical BC REPAIR SERVICES Cygnus Medical BC Jet Medical Electronics Inc 45 REPROCESSING STATIONS MD Technologies Inc. 19 Ruhof Corporation 2, 3 SAFETY Healthmark Industries Company, Inc. 5 Key Surgical 15 SINKS Ruhof Corporation 2, 3 SMOKE EVACUATION I.C. Medical, INC. 55 STERILIZATION Cygnus Medical BC Healthmark Industries Company, Inc. 5 MD Technologies Inc. 19 SURGICAL MD Technologies Inc. 19 SIPS Consults 13 SURGICAL INSTRUMENT/ACCESSORIES C Change Surgical 11 Cygnus Medical BC Healthmark Industries Company, Inc. 5 Key Surgical 15 TELEMETRY AIV Inc. 4 TEMPERATURE MANAGEMENT C Change Surgical 11 Encompass Group 23 WASTE MANAGEMENT MD Technologies Inc. 19 54 OR TODAY | September 2022 WWW.ORTODAY.COM

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