Role of perioperative nursing in anesthesia: a national overview

To assess the actions performed by the operating room nurse during anesthesia and their behavior for patient safety regarding the reporting on adverse events, and to analyze their knowledge about anesthetic practices.

Method:

This is a cross-sectional study carried out using an electronic questionnaire consisting of socio-demographic, professional practice, knowledge in anesthesia, patient safety, and professional practice questions, conducted from January to March 2019 with operating room nurses.

Results:

One hundred nurses participated, 89 (89%) being women, with a mean age of 41.09 years (SD = 9.36), time of undergraduate completion of 14.33 years (SD = 8.34). The average attendance was 4.69 operating rooms (SD = 2.07) per nurse, with an emphasis on action before induction (49; 49%). Professionals reported performance of simultaneous activities (72; 72%) and insufficient number of employees (57; 57%) as difficulties of their daily practice. Among the participants, 77 (77%) correctly cited the periods of general anesthesia and 80.4% always reported the occurrence of an adverse event.

Conclusion:

Nurses identified their role in anesthesia, with limitations for assistance from multiple activities and lack of professionals.

DESCRIPTORS
Perioperative Nursing; Anesthesia; Patient Safety; Nurse’s Role; Operating Room Nursing; Professional Practice Gaps

Nurse assistance	Period of anesthesia
Nurse assistance	Before induction n (%)	Induction n (%)	Reversal n (%)
In all rooms under their responsibility	49 (49)	39 (39)	23 (23)
Only for critically ill patients	31 (31)	33 (33)	32 (32)
At the call of the medical and/or nursing team	20 (20)	28 (28)	42 (42)
Never	–	–	3 (3)

Professional	Checking	n (%)	Number of rooms Mean (SD*)	p^†
Nurse	Yes	38 (38)	4.18 (2.00)	0.04
Nurse	No	62 (62)	5 (2.07)	0.04
Nursing technician	Yes	86 (86)	4.73 (2.03)	0.75
Nursing technician	No	14 (14)	4.43 (2.41)	0.75
Anesthetist	Yes	41 (41)	4.49 (1.93)	0.34
Anesthetist	No	59 (59)	4.83 (2.17)	0.34

Assignments in induction	n	%
Patient identification	85	85
Surgical positioning	79	79
Peripheral venous access puncture	75	75
Ventilation/supply of laryngoscope and tube	72	72
Recording of complications	71	71
Patient monitoring	70	70
Performance of Sellick/BURP* maneuvers	60	60
Patient education	60	60
Terms checking	60	60
Reversal assignments
Perform SAEP^†	85	85
Shift change	75	75
Patient transfer from the operating table	66	66
Aspiration assistance	62	62
Recording of drains, dressings	59	59

Variable		n	%
Periods of general anesthesia are induction, maintenance, and reversal	Yes	77	77
	No	13	13
Types of regional anesthesia are subarachnoid, epidural, and blocks	Yes	84	84
	No	16	16
Types of general anesthesia: total intravenous, inhalation, balanced	Yes	52	52
	No	48	48
Difficult airway (DA) predictors
Short and wide neck		81	81
Head flexion/extension limitation		79	79
Mouth opening <3 cm		77	77
Mallampati classification >2		65	65

Limitation for reporting the adverse event		N (%)	Number of rooms Mean (SD*)	p^†
Work overload	Yes	43 (43)	4.98 (2.02)	0.18
Work overload	No	57 (57)	4.47 (2.21)	0.18
Disbelief in the possibility of improvements	Yes	25 (25)	4.44 (2.22)	0.47
Disbelief in the possibility of improvements	No	75 (75)	4.77 (2.03)	0.47
Communication difficulty	Yes	24 (24)	4.33 (2.26)	0.48
Communication difficulty	No	76 (76)	4.80 (2.01)	0.48
Absence of confidentiality	Yes	16 (16)	4.31 (1.85)	0.38
Absence of confidentiality	No	84 (84)	4.76 (2.11)	0.38
Lack of knowledge	Yes	12 (12)	4.42 (2.39)	0.65
Lack of knowledge	No	88 (88)	4.73 (2.04)	0.65
Fear of punishment	Yes	9 (11)	3.36 (1.96)	0.02
Fear of punishment	No	89 (89)	4.85 (2.04)	0.02

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Cassiane de Santana Lemos Av. Dr. Enéas de Carvalho Aguiar 419, Jardim Paulista 05403-000 – São Paulo, SP, Brazil cassilemos@usp.br