AORN Journal RSS feed: Current Issue. AORN Journal provides registered professional nurses in the OR and related services with information based on scientific fact and principle. Articles cover the nurse's role before, during and after surgery and include patient teaching and preparation, use and care of surgical instruments and supplies, asepsis, sterilization, anesthesia, and related topics. Other areas include education for professional nurses, OR administration and communications. More than 40,000 perioperative nurses, managers and directors read AORN Journal for vital information about their profession. What's more, more than 84% of those readers make product recommendations and influence OR buying decisions...and they learn about OR products and services in the AORN Journal . The AORN Journal is read by more than 99% of the people who receive it, ensuring your advertising will be seen.http://www.aornjournal.org/?rss=yesElsevier Inc.en © 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved. AORN Journal0001-2092912February 2010 © 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.aornjournal.org/article/PIIS0001209210000025/abstract?rss=yes The year 2009 will be remembered as the year major efforts for health care reform began. This issue has created one of the most polarizing debates many of us have seen. Can anyone forget the contentious town hall meetings in August or the talk of “death panels,” through which the government would make life-and-death decisions about the fate of elderly patients?The Beginning of Health Care ReformPatrick E. Voight10.1016/j.aorn.2010.01.001AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3President's Message195196http://www.aornjournal.org/article/PIIS0001209209009314/abstract?rss=yesCritical thinking can be defined formally or informally. A formal definition described by Facione, Facione, and Sanchez refers to a process of making reasoned judgments based on the consideration of available evidence, contextual aspects of a situation, and pertinent concepts. I propose another, less formal and more skeptical definition of critical thinking: deciding what to do and when, where, why, and how to do it. I would suggest that the value of “skepticism”—questioning and doubting—to critical thinking lies in the importance of asking questions to clarify what is reasonable, what evidence is available, what is the context of a particular situation, and what is pertinent.Thinking CriticallyPatricia C. Seifert10.1016/j.aorn.2009.11.062AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Editorial197199http://www.aornjournal.org/article/PIIS000120920900982X/abstract?rss=yesI appreciated the Patient Safety First article “The code of silence” by Donna Watson, RN, MSN, CNOR, ARNP-BC (November 2009, Vol 90, No 5). It outlined the tragedy of a health care provider diverting drugs for personal use and passing on hepatitis C to patients through used needles. The article intimated that those who suspect an abusive colleague are obligated to report it. I don't disagree. We have an implicit code of silence in our perioperative culture. We work in close quarters not only physically but also emotionally because of the pain we knowingly inflict on patients in our environment. This engenders unusual demands on the perioperative team, which may cause team members to remain silent about a potential problem with a coworker. If this was the case in the situation Watson cited, it was clearly the wrong decision and brought harm to patients.Silence Can Hurt PatientsPatricia S. Stein10.1016/j.aorn.2009.12.013AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Letters to the Editor200200http://www.aornjournal.org/article/PIIS0001209209009831/abstract?rss=yesI am writing in response to the Guest Editorial by Cecil King, MS, RN, CNOR, APRN, titled “Primum non nocere: above all [or first] do no harm” (October 2009, Vol 90, No 4). As a nurse educator and certified perioperative nurse, I understand nursing's need for a well-defined and developed code of ethics. The American Nurses Association (ANA) Code of Ethics serves as nursing's formal articulation of the values and beliefs of the nursing profession and provides nurses with a framework for ethical decision making. It is interesting to note that many nurses claim to be ignorant of the existence of the ANA Code of Ethics or believe it is a document that is intended for use only by nursing students.Nursing's Code of EthicsCatherine A. Schmitt10.1016/j.aorn.2009.12.014AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Letters to the Editor200201http://www.aornjournal.org/article/PIIS0001209209009867/abstract?rss=yesPeriop 101: A Core Curriculum is a comprehensive, online program for educating new perioperative nurses that provides 40 continuing education contact hours. The curriculum covers 25 pertinent topics and is designed to be integrated with your facility's specific policies and procedures in a clinical practicum and preceptorship. Periop 101 will help you develop confident, better-educated, safety-conscious, entry-level perioperative nurses. For pricing and other information and a demonstration of the course, visit http://www.aorn.org/Periop101.Educational Opportunities10.1016/j.aorn.2009.12.015AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Educational Opportunities202205http://www.aornjournal.org/article/PIIS0001209209009752/abstract?rss=yesAORN is proud to recognize the talented authors who make the AORN Journal a respected source of quality information for perioperative nurses and managers. Anibal L. Acevedo, RN, MSN, CNOR, CDR, NC, USNSpecial Thanks to the 2009 AORN Journal Authors10.1016/j.aorn.2009.12.011AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Author Recognition206207http://www.aornjournal.org/article/PIIS0001209209009387/abstract?rss=yes Proposed dues increase2010 Forum and House of Delegates Agenda and Proposed Position Statements: Tuesday, March 16, to Thursday, March 18, 201010.1016/j.aorn.2009.12.007AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Congress208213http://www.aornjournal.org/article/PIIS0001209209009764/abstract?rss=yesAORN award recipients will be recognized at two Congress events. Individual achievement awards and the Award for Excellence will be presented during Opening Session on Sunday, March 14. Chapter Excellence Awards and Writers Contest Awards will be presented during the Perioperative QuizBowl session on Wednesday, March 17.AORN Awards: Sunday, March 14, and Wednesday, March 17, 201010.1016/j.aorn.2009.12.012AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Congress214214http://www.aornjournal.org/article/PIIS0001209209009740/abstract?rss=yesMany groups (eg, specialty assemblies, state councils, committees) officially organize at Congress each year. Ancillary meeting dates and times are provided in . The groups are listed alphabetically and all meetings will take place in the Colorado Convention Center unless otherwise noted. Dates and times are subject to change; please refer to the official Congress Program you receive at Congress for final schedules and room assignments. If your group needs a meeting room, you can obtain a meeting room request form online at http://www.aorncongress.org/GeneralInformation. All requests received will be granted on a space-available basis. Groups may also schedule meetings on-site, based on availability, by contacting personnel in the Headquarters Office at the Convention Center.Group Meetings Scheduled During Congress10.1016/j.aorn.2009.12.010AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Congress215216http://www.aornjournal.org/article/PIIS0001209209009399/abstract?rss=yesCongress exhibits are designed to enhance attendees' knowledge and expertise to improve patient care. While on the Exhibit Floor, attendees will have the chance to see the many products, services, and job opportunities available in the perioperative marketplace, as well as earn valuable continuing education contact hours ().Exhibit Floor Education: Monday, March 15, to Wednesday, March 1710.1016/j.aorn.2009.12.008AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Congress217217http://www.aornjournal.org/article/PIIS0001209209009375/abstract?rss=yesExhibiting companies will present their top products, services, and career development opportunities at the 2010 AORN Congress. Whether you are gathering information for your own knowledge or comparing and reporting on product benefits for your facility, the Exhibit Floor is the place to get your questions answered about the latest developments in surgical products, services, and education.Congress Exhibitor and Product Listings: Monday, March 15, to Wednesday, March 17, 201010.1016/j.aorn.2009.12.006AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Congress218223http://www.aornjournal.org/article/PIIS0001209209009223/abstract?rss=yesAbstract: After an increase in methicillin-resistant Staphylococcus aureus infections was discovered at a health care facility in Arizona, a multidisciplinary team convened to investigate the underlying problem and work toward eliminating surgical site infections. The team investigated environmental factors, held inservice sessions to reinforce sterile technique, and made important changes to the facility culture in efforts to eliminate surgical site infections. The team's efforts were put into practice on October 30, 2008, and only one surgical site infection was identified in the following seven months.Chasing Zero: Our Journey to Preventing Surgical Site InfectionRosemarie Roesler, Christine C. Halowell, Georgiana Elias, Julie Peters10.1016/j.aorn.2009.08.013AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Featured Articles224235http://www.aornjournal.org/article/PIIS0001209209005407/abstract?rss=yesAbstract: In Finland, there are no common guidelines or recommended practices for perioperative documentation. Thus, perioperative nursing documentation varies from one operating department to another. To create minimum criteria for nursing documentation in Finland, we conducted an investigation in a university hospital district in 2006. Purposive sampling was used to invite experts in perioperative nursing documentation (N = 42) to serve as a Delphi panel. The final criteria are 120 items, 71% of which are based on the AORN standards and recommended practices. These criteria may be used to educate students and new perioperative personnel and to enhance the quality of nursing practice. To ensure relevance and usability, the criteria should be tested in various perioperative settings with a variety of surgical patients.The Validation of AORN Recommended Practices in Finnish Perioperative Nursing DocumentationTeija Susanna Tiusanen, Kristiina Junttila, Tuija Leinonen, Sanna Salanterä10.1016/j.aorn.2009.06.027AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Featured Articles236247http://www.aornjournal.org/article/PIIS0001209209009259/abstract?rss=yesAbstract: Critical thinking is considered an essential skill for nurses by many, including major accrediting agencies, health care administrators, and AORN. This is in part because of the environment in which nurses function. Health care, medicine, technology, and nursing are dynamic and constantly changing. The perioperative environment is complex, fast paced, unique, and oftentimes unpredictable. Critical thinking skills enable perioperative nurses to function effectively and evolve in this ever-changing environment. Nursing education programs are mandated to teach critical thinking skills. It is the practice arena, however, that refines, hones, and grows these skills. This article provides an overview of critical thinking in the context of nursing, as well as strategies and interventions designed to teach critical thinking skills.Developing Critical Thinking in the Perioperative EnvironmentJackie H. Jones10.1016/j.aorn.2009.09.025AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Featured Articles248256http://www.aornjournal.org/article/PIIS000120920900920X/abstract?rss=yesAbstract: Proteomic studies (ie, the investigation and identification of proteins found in biological samples such as blood and tissue) are at the forefront of the identification of disease biomarkers and the understanding of proteins. These studies promise to enhance diagnostic and prognostic analysis across all disciplines of clinical practice. As the practice of nursing and medicine becomes more preventative in nature and predictive in terms of patient care, successfully integrating and implementing proteomic research will become increasingly important, especially in the OR. It is imperative that perioperative nurses and researchers establish a collaborative process for specimen collection. Steps in establishing and maintaining a successful specimen collection program include implementing and evaluating a protocol, developing good communication, and keeping all participants up to date on the progress of the study.Steps for Successful Implementation of Proteomic Research in the ORChidima Tsion Martin, Linda Henry, Lisa Martin, Niv Ad10.1016/j.aorn.2009.09.023AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Featured Articles257264http://www.aornjournal.org/article/PIIS0001209209009211/abstract?rss=yesAbstract: High- and low-pressure vacuum drains are commonly used after surgical procedures. High-pressure vacuum drains (ie, sealed, closed-circuit systems) are efficient and allow for easy monitoring and safe disposal of the drainage. Low-pressure vacuum drains use gentle pressure to evacuate excess fluid and air, and are easy for patients to manage at home because it is easy to reinstate the vacuum pressure. Perioperative nurses should be able to identify the various types of commonly used drains and their surgical applications. Nurses should know how to care for drains, how to reinstate the vacuum pressure when necessary, and the potential complications that could result from surgical drain use.Surgical Vacuum Drains: Types, Uses, and ComplicationsRajaraman Durai, Philip C.H. Ng10.1016/j.aorn.2009.09.024AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Featured Articles266274http://www.aornjournal.org/article/PIIS0001209209009284/abstract?rss=yesAbstract: Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes.Managing a Chest Tube and Drainage SystemRajaraman Durai, Happy Hoque, Tony W. Davies10.1016/j.aorn.2009.09.026AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Featured Articles275283http://www.aornjournal.org/article/PIIS0001209209009247/abstract?rss=yesThe Institute of Medicine's report To Err is Human: Building a Safer Health System has been a catalyst for change, enabling health care professionals to tear down the wall of denial that nurses and physicians are infallible and building acceptance that humans are susceptible to committing errors. This report has influenced several patient safety initiatives on national and international levels (eg, the Universal Protocol, the Surgical Care Improvement Project, the Safe Surgery Saves Lives campaign). These initiatives emphasize the need to change the culture of health care and understand the sociological variables that contribute to a culture of patient safety.To Err is Human, to Drift is Normalization of DevianceCecil A. King10.1016/j.aorn.2009.10.020AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Patient Safety First284286http://www.aornjournal.org/article/PIIS0001209209009235/abstract?rss=yesThis Month: Continuously monitoring an open but unused sterile fieldKey words: procedural delay, continuous monitoring, sterile field.Documentation of skin status after pneumatic tourniquet useKey words: pneumatic tourniquet, skin assessment, perfusion status.Blanket warmer settingsKey words: blanket warming cabinets, fluid warming cabinets, temperature settings.Clinical Issues—February 2010Byron Burlingame, Carol Petersen, Bonnie Denholm10.1016/j.aorn.2009.11.059AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Clinical Issues287291http://www.aornjournal.org/article/PIIS0001209209009326/abstract?rss=yesThe American Nurses Credentialing Center's (ANCC) Magnet Recognition Program® acknowledges health care facilities that demonstrate nursing's unique contributions to quality patient care through nursing excellence and innovations in professional nursing practice. This article discusses the history and development of the Magnet Recognition Program and describes the new Magnet model. Specific examples are addressed regarding how perioperative nurses can demonstrate perioperative excellence during the Magnet™ application process.Magnet Recognition: Examples of Perioperative ExcellencePriscilla Jurkovich, Kathy Karpiuk, Cecil A. King10.1016/j.aorn.2009.11.063AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Magnet Insights292299http://www.aornjournal.org/article/PIIS0001209209009296/abstract?rss=yesStrict adherence to aseptic technique is essential to the prevention of surgical site infection (SSI). One component of aseptic technique is preoperative preparation of the skin before the surgical incision is made. Several skin preparation products approved by the US Food and Drug Administration are used in perioperative settings throughout the United States. These include a 4% chlorhexidine product, a 2% chlorhexidine and 70% isopropyl alcohol product, a 70% isopropyl alcohol product, povidone-iodine products, and an iodine povacrylex in isopropyl alcohol product.Evidence for PracticeGeorge Allen10.1016/j.aorn.2009.11.060AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Evidence for Practice300306http://www.aornjournal.org/article/PIIS0001209209008783/abstract?rss=yes As an RN first assistant on my facility's cardiovascular OR team, I am interested in the skill set needed by the surgical intensive care unit (SICU) RN who takes care of my patients after I have completed the hand-off communication. This book addresses the experienced RN's need to develop a more in-depth knowledge base about the newest advancements in cardiac surgery. The SICU RN who reads this book will obtain basic evidence-based knowledge about caring for cardiac surgery patients, along with other acute and critically ill patients who need advanced treatment modalities often provided in the intensive care setting. It also would be a comfortable read for the cardiac surgery OR nurse who has at least six months of experience, which is the usual time needed to complete most competencies for orientation. Finally, this book could be used as a resource for nurses preparing for the cardiac surgery certification offered by the American Association of Cardiac Care Nurses.Sue Goddard-Gerrald10.1016/j.aorn.2009.11.051AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Reviews307307http://www.aornjournal.org/article/PIIS0001209209008795/abstract?rss=yes This book is written primarily for nurse anesthesia providers, but there also are several chapters that would interest and educate perioperative nurses. The first edition of the book was published in the early 1990s to fill a need for a scientifically based, clinically oriented resource for nurse anesthesia. With many experts in the field as contributors, this fourth edition is presented as the most comprehensive text on nurse anesthesia.Susan A. Jensen10.1016/j.aorn.2009.11.052AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Reviews308309http://www.aornjournal.org/article/PIIS0001209209008801/abstract?rss=yes This book is useful for daily conversations and can be used not only as a tool to improve conversation skills but also as a way to make people feel more comfortable engaging in conversations that can be difficult because of the subject matter. This book emphasizes conversations that occur within the workplace. With workplace conversations, one may have to engage not only his or her peers but also managers and subordinates. The workplace climate requires conveying words and content in a manner that leaves both parties feeling understood.Sandra Lash10.1016/j.aorn.2009.11.053AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Reviews309309http://www.aornjournal.org/article/PIIS0001209209008813/abstract?rss=yes Crediting the skills he acquired as a nurse, author Patrick Hickey, DrPh, RN, CNOR, joined an elite group of about 100 people in the world when he achieved his dream of reaching the “seven summits of the world” (ie, the highest mountain on each of the seven continents). Dr Hickey's book is multifaceted and is difficult to put down. A self-proclaimed storyteller, Dr Hickey starts the first chapter on Mt Everest, his seventh summit. Having already reached the summits of the six other mountains, he explains his serious limitation: Dr Hickey is afraid of heights. With years of climbing experience under his belt, he still has to overcome this fear—a fear that “brings him to his knees when he encounters a narrow ledge or dangerous perch.”Elizabeth M. Edel10.1016/j.aorn.2009.11.054AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Reviews310310http://www.aornjournal.org/article/PIIS0001209209009302/abstract?rss=yesA 60-year-old woman with squamous cell carcinoma of the glottis underwent laryngectomy, anterior neck dissection, and pectoralis flap reconstruction of the anterior esophagus. Postoperatively, she was started on clindamycin for surgical site infection prophylaxis. On postoperative day three, increased drainage from the surgical site was noted. On postoperative day six, the patient had to return to the OR for exploration, and the site revealed purulent material with involvement of the jugular sheath. The surgeon cultured, irrigated, and reclosed the site.Staggered Sensitivity Results10.1016/j.aorn.2009.11.061AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3Perioperative Grand Rounds312312http://www.aornjournal.org/article/PIIS0001209210000189/abstract?rss=yesTable of Contents10.1016/S0001-2092(10)00018-9AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3FrontmatterA3A3http://www.aornjournal.org/article/PIIS0001209210000190/abstract?rss=yesEditorial Board10.1016/S0001-2092(10)00019-0AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3FrontmatterA6A6http://www.aornjournal.org/article/PIIS0001209210000207/abstract?rss=yesOrders, claims, online, change of address: Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043; telephone: (800) 654-2452 (United States and Canada), (314) 447-8871 (outside United States and Canada); fax: (800) 225-4030 (United States and Canada), (314) 447-8029 (outside United States and Canada); e-mail: JournalsCustomerService-usa@elsevier.com (for print support); JournalsOnlineSupport-usa@elsevier.com (for online support). Address changes must be submitted four weeks in advance.Information for Readers10.1016/S0001-2092(10)00020-7AORN Journal 91, 2 (2010)2010-02-01AORN Journal2010-02-01912S0001-2092(10)X0002-3FrontmatterA10A10