Search Results (69)

Background: The perioperative context is characterized by high complexity and a significant risk of adverse events, requiring highly developed technical and non-technical competencies. Structured clinical supervision has been identified as a relevant strategy for professional development and for promoting the quality and safety of care, although the specific evidence in this context remains dispersed. Objective: To analyze the available scientific evidence on the impact of structured clinical supervision on nurses’ professional development and on the quality and safety of care delivered in the perioperative setting. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 recommendations. The search was performed in the PubMed, Web of Science, EBSCO, SciELO, BVS, and CONSENSUS databases and included studies published between January 2020 and October 2025 in Portuguese, English, or Spanish with full-text availability. The research question was structured according to the PICO strategy. Study selection was carried out in multiple stages (duplicate removal, screening by title and abstract, and full-text review), performed by two independent reviewers. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists. Data synthesis was conducted through thematic narrative analysis, given the methodological heterogeneity of the included studies. Results: Twelve studies were included, predominantly qualitative and observational in nature, as well as psychometric validation studies, one Delphi study, and one quasi-experimental study. The findings show consistent convergence regarding the association between structured clinical supervision and the development of technical and non-technical competencies, namely communication, leadership, teamwork, situational awareness, and decision-making. The use of structured assessment instruments demonstrated good psychometric reliability and improved the quality of supervisory feedback. Organizational factors, such as protected time, specific training for supervisors, and role clarification, were identified as determinants of the effectiveness of the supervisory process. However, the predominance of non-experimental designs and the scarcity of objective clinical outcomes limit direct causal inference between structured supervision and measurable reduction in adverse events. Conclusions: The available evidence suggests that structured clinical supervision is a relevant component for the professional development of perioperative nurses and for strengthening the safety culture in the operating room. Despite the high conceptual consistency of the findings, the overall strength of evidence is moderate, and experimental and longitudinal studies are needed to consolidate the impact of supervision on objective clinical indicators of care quality and safety. Full article

Background: Operating room nurses are exposed to high levels of occupational stress, making them particularly vulnerable to burnout. Psychological resources such as self-esteem may play a protective role; however, evidence in perioperative settings remains limited. Objective: This study aimed to examine the relationship between self-esteem and burnout among operating room nurses. Methods: A quantitative cross-sectional study was conducted among 261 operating room nurses working in public healthcare institutions in Vilnius, Lithuania. Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), and burnout was assessed using the Burnout Assessment Tool (BAT-23). Data were analyzed using non-parametric tests, Spearman’s correlation, hierarchical regression analysis, and Bonferroni correction for multiple comparisons. Results: A statistically significant negative association was found between self-esteem and burnout (p < 0.001). Higher self-esteem was associated with lower levels of exhaustion (r = −0.326), emotional distress (r = −0.357), cognitive impairment (r = −0.398), and psychological disengagement (r = −0.331). The strongest associations were observed for secondary symptoms (r = −0.420) and overall burnout (r = −0.410). In regression analysis, self-esteem remained a significant predictor of burnout (β = −0.438, p < 0.001), explaining a substantial proportion of variance. Conclusions: Self-esteem is a significant protective factor against burnout among operating room nurses. Interventions aimed at strengthening psychological resources may contribute to reducing burnout in high-intensity clinical environments. Full article

Background: The Operating Room Management Attitudes Questionnaire (ORMAQ) is widely used to assess operating room (OR) staff attitudes toward patient safety and teamwork across diverse contexts. However, no validated French version currently exists, limiting its use in francophone settings. This study aimed to translate and culturally adapt the ORMAQ into French and to evaluate its psychometric properties, while also reporting OR professionals’ attitudes explored during the validation process. Methods: A cross-sectional methodological study was conducted among OR professionals, including surgeons, anesthetists, anesthesia nurses, operating room nurses, and residents. The original ORMAQ was translated into French using a standardized forward–backward translation procedure and pretested with 20 OR professionals. Content and concurrent validity were examined. Reliability was assessed through internal consistency, test–retest reproducibility, and dimension-level consistency. Construct validity was examined using both exploratory and confirmatory factor analyses (CFA). Results: The overall response rate to the survey was 76.5% (n = 303). The French ORMAQ demonstrated good internal consistency, as evidenced by both Cronbach’s alpha (α = 0.842) and McDonald’s Omega (ω = 0.98). For the individual dimensions, reliability values ranged from 0.597 to 0.891 for alpha and from 0.75 to 0.89 for Omega. Test–retest analysis showed excellent reproducibility (ICC = 0.96; 95% CI: 0.92–0.98). Factor analyses supported the eight-factor structure, with the CFA confirming good model fit and meaningful item loadings across dimensions, with standardized loadings ranging from 0.40 to 0.83. Conclusions: The French version of the ORMAQ showed satisfactory psychometric properties. It represents a robust tool for assessing safety and teamwork attitudes among OR professionals in francophone countries. Full article

Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population. Full article

Inpatient falls often occur at the bedside during unsupervised bed egress or bed exit attempts. Many artificial intelligence methods predict fall risk, but clinical value depends on workflow-ready decision support. This scoping review, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), mapped AI-driven inpatient fall prevention systems using continuous monitoring data that generate explicit action triggers. We searched PubMed, Scopus, and Web of Science Core Collection for English-language studies published between 2016 and 2026 on 15 February 2026. Of 200 records identified, 32 duplicates were removed, and 168 records were screened. Eighty-three full-text reports were assessed for eligibility. Thirty-eight studies were included in the Tier 1 synthesis as action-trigger decision support systems, and 20 were classified as Tier 2 prediction or detection only to characterize evidence gaps. Tier 1 systems clustered into room-based monitoring with direct nurse alerting, wearable or batteryless sensing for bed egress and bed or chair exit alarms, and bed-centered early warning. Reporting was often incomplete for implementation-critical metrics such as alert burden, false alarms, response times, alert routing, and downstream actions. We propose a minimum operational reporting set to support clearer evaluation and comparison of AI-enabled inpatient fall-prevention systems in real-world ward settings. Full article

The assignment of hospital rooms to patients is a critical operational decision that has a direct impact on patient safety, infection control, and staff workload. This study introduces HRPM–IRC, an epidemiology-aware hyper-heuristic framework developed to optimize room–patient matching by minimizing the risk of nosocomial infections, reducing travel and specialty mismatch costs, and promoting equitable nurse workload distribution. A mixed-integer linear programming model is formulated to capture infection transmission probabilities, isolation and cohorting requirements, and multi-ward capacity constraints. On top of this model, a bio-inspired hyper-heuristic adaptively selects and refines low-level heuristics, including cohort-first greedy allocation, risk-gradient swaps, and pathogen-aware local MILP refinement, on the basis of contextual epidemiological indicators and reinforcement learning. The framework was validated using a real-world dataset obtained from a tertiary hospital in Lebanon, comprising 142 anonymized patient admissions, 35 rooms, and six nursing teams. Results demonstrate that HRPM–IRC consistently reduces modeled infection risk and workload imbalance by up to forty percent compared to conventional assignment heuristics while maintaining near-real-time decision-making capabilities suitable for dynamic hospital operations. These findings underscore the effectiveness of epidemiology-aware hyper-heuristics in enhancing hospital resilience, improving infection prevention, and supporting fair resource utilization in data-limited healthcare environments typical of Lebanon and other middle-income countries. Full article

(1) Background: In hospitals, mattresses are often relocated for cleaning or patient transfer, leading to mismatches between actual and recorded bed locations. Manual updates are time-consuming and error-prone, requiring an automatic localization system that is cost-effective and easy to deploy to ensure traceability and reduce nursing workload. (2) Purpose: This study presents a pragmatic, large-scale implementation and validation of a BLE-based localization system using RSSI measurements. The goal was to achieve reliable room-level identification of smart mattresses by leveraging existing hospital infrastructure. (3) Results: The system showed stable signals in the complex hospital environment, with a 12.04 dBm mean gap between primary and secondary rooms, accurately detecting mattress movements and restoring location confidence. Nurses reported easier operation, reduced manual checks, and improved accuracy, though occasional mismatches occurred when receivers were offline. (4) Conclusions: The RSSI-based system demonstrates a feasible and scalable model for real-world asset tracking. Future upgrades include receiver health monitoring, watchdog restarts, and enhanced user training to improve reliability and usability. (5) Method: RSSI–distance relationships were characterized under different partition conditions to determine parameters for room differentiation. To evaluate real-world scalability, a field validation involving 266 mattresses in 101 rooms over 42 h tested performance, along with relocation tests and nurse feedback. Full article

Background: To ensure smooth surgical procedures, patient safety, and quality of perioperative care, perceived perioperative competence (PPC) is a daily and urgent requirement for operating room (OR) nurses. Understanding the status of PPC among OR nurses and its associated factors is essential for OR nurses/people in charge/researchers to pinpoint weaknesses and formulate interventions. Therefore, we aim to investigate the status of PPC and its associated factors. Furthermore, we explore the relationship between PPC, self-efficacy, and job burnout among OR nurses. Methods: Tertiary-A hospitals in various districts of Chengdu, China, were recruited using a stratified convenience sampling method. A cross-sectional survey was then administered to OR nurses in the selected hospitals. Data analysis included descriptive analysis, T-tests, one-way analysis of variance (ANOVA), multiple linear regression analysis, correlation analysis, and mediation analysis. Results: A survey of 640 OR nurses across 18 hospitals (with a 98.00% valid response rate) revealed an average PPC score of 3.66 ± 1.12/124.55 ± 26.54. Marital status, OR specialty education, and age significantly influenced PPC levels (p < 0.05). Self-efficacy was positively correlated with PPC, while job burnout was negatively correlated with PPC. Self-efficacy fully mediated the relationship between these two variables. Conclusions: The performances of PPC among Chinese OR nurses were acceptable. Marital status, OR specialty education, and age significantly influenced PPC levels. Self-efficacy fully mediates the relationship between job burnout and PPC. Full article

Background: Operating rooms are high-risk environments where ensuring patient safety is essential. Although research on patient safety has increased in recent years, comprehensive analyses of research trends and the core topics specific to operating room safety remain limited. This study aimed to analyze the core keywords and network structures in operating room patient safety, using a scope-based approach to provide suggestions for future research and practice. Methods: We conducted a scope-based keyword network analysis of studies on operating room patient safety published between 2020 and 2024. Data were collected from major academic databases, including CINAHL, MEDLINE, and PubMed. Keyword frequency and network centrality measures (degree, closeness, and betweenness) were used to identify major keywords and their interrelationships. Results: The analysis revealed ‘patient safety’, ‘operating room’, and ‘nurse’ as the most frequent and central keywords, highlighting their critical role in surgical safety research. Other highly connected terms—‘safety culture’, ‘infection control’, and ‘checklist’ emphasized systematic and organizational safety management. Emerging themes such as ‘leadership’, ‘teamwork’, ‘competency’, and ‘education’ reflected increasing attention to collaboration and professional capability, while ‘artificial intelligence’ and ‘telemedicine’ indicated growing interest in digital innovation. Conclusions: Research on patient safety in operating rooms demonstrates a multidimensional structure encompassing patients, healthcare professionals, systems, culture, and education. These findings underscore the need for integrated and multidisciplinary approaches to enhance safety in surgical environments and suggest directions for technology-driven and patient-centered safety models. Full article

The rising demand for elderly care amid ongoing nursing shortages has highlighted the limitations of conventional alert systems, which frequently generate excessive alerts and contribute to alarm fatigue. The objective of this study is to develop a hybrid, context-aware nurse alerting framework for long-term care (LTC) facilities that minimizes redundant alarms, reduces alarm fatigue, and enhances patient safety and caregiving balance during multi-person care scenarios such as mealtimes. To do so, we aimed to intelligently suppress, delay, and validate alerts by integrating rule-based logic with Large Language Model (LLM)-driven semantic reasoning. We conducted an experimental study in a real-world LTC environment involving 28 elderly residents (6 high, 8 medium, and 14 low care levels) and four nurses across three rooms over seven days. The proposed system utilizes video-derived skeletal motion, care-level annotations, and dynamic nurse–elderly proximity for decision making. Statistical analyses were performed using F1 score, accuracy, false positive rate (FPR), and false negative rate (FNR) to evaluate performance improvements. Compared to the baseline where all nurses were notified (100% alarm load), the proposed method reduced average alarm load to 27.5%, achieving a 72.5% reduction, with suppression rates reaching 100% in some rooms for some nurses. Performance metrics further validate the system’s effectiveness: the macro F1 score improved from 0.18 (baseline) to 0.97, while accuracy rose from 0.21 (baseline) to 0.98. Compared to the baseline error rates (FPR 0.20, FNR 0.79), the proposed method achieved drastically lower values (FPR 0.005, FNR 0.023). Across both spatial (room-level) and temporal (day-level) validations, the proposed approach consistently outperformed baseline and purely rule-based methods. These findings demonstrate that the proposed approach effectively minimizes false alarms while maintaining strong operational efficiency. By integrating rule-based mechanisms with LLM-based contextual reasoning, the framework significantly enhances alert accuracy, mitigates alarm fatigue, and promotes safer, more sustainable, and human-centered care practices, making it suitable for practical deployment within real-world long-term care environments. Full article

This study presents a novel approach that integrates Discrete Event Simulation (DES) with Design of Experiments (DOE) techniques, framed within a stochastic optimization context and guided by a multi-objective goal programming methodology. The focus is on enhancing the operational efficiency of an emergency department (ED), illustrated through a real-world case study conducted in a Chilean hospital. The methodology employs Response Surface Methodology (RSM) to explore and optimize the impact of four critical resources: physicians, nurses, rooms, and radiologists. The response variable, formulated as a goal programming function, captures the aggregated patient flow time across four representative care tracks. The optimization process proceeded iteratively: early stages relied on linear approximations to identify promising improvement directions, while later phases applied a central composite design to model nonlinear interactions through a quadratic response surface. This progression revealed complex interdependencies among resources, ultimately leading to a local optimum. The proposed approach achieved a 50% reduction in the aggregated objective function and improved individual patient flow times by 7% to 26%. Compared to traditional metaheuristic methods, this simulation–optimization framework offers a computationally efficient alternative, particularly valuable when the simulation model is complex and resource-intensive. These findings underscore the value of combining simulation, RSM, and multi-objective optimization to support data-driven decision-making in complex healthcare settings. The methodology not only improves ED performance but also offers a flexible and scalable framework adaptable to other clinical environments seeking resource optimization and operational improvement. Full article

(1) Background: trays are surgery-specific sets of required materials and medical devices, assembled in consultation between manufacturer and user, and provided in a sterile package. (2) Methods: in a high-volume urological center performing 11,920 operations/procedures annually (2023), we prospectively evaluated the effect of trays compared with the standard approach in a comparative study of 64 operations conducted between 29 October and 30 November 2024. The primary endpoints were the amount of operating room (OR) waste (volume/cm³, weight/g) and setup time (minutes). The secondary endpoint was the workflow assessment by nursing staff, rated on a numerical score (0–10) across seven relevant domains. (3) Results: for endourological procedures, setup time was reduced by 35%, operating room (OR) waste by 34%, and waste volume by 19.0%. Workflow was positively rated with a mean score of 9.75/10. For major open procedures, setup time was reduced by 43%, waste weight by 24.8%, and waste volume by 32%. Workflow was positively rated with a mean score of 8.9/10. (4) Conclusions: Trays have a sustainable and significant impact on reducing OR waste, save nursing staff preparation time, and facilitate improved workflow in the operating room. Full article

Background: Efficient and safe discharge is critical in pediatric dental procedures performed under deep sedation in non-operating room anesthesia (NORA) settings. Traditional institutional criteria may delay discharge due to subjectivity. Objective: This study compared the Modified Aldrete Recovery Score (MAS) and institutional discharge criteria to determine which provides faster and reliable discharge decisions. Methods: In this prospective observational study, 100 children (ages 2–10, ASA I–III) undergoing deep sedation for dental treatment were evaluated. Two nurse anesthetists independently assessed discharge readiness every five minutes using either MAS or institutional criteria. Demographic data, BMI percentile, ASA class, anesthesia duration, and propofol dose were recorded. Discharge times were compared using Wilcoxon signed-rank and subgroup analyses and correlation tests. Results: MAS allowed significantly earlier discharge than institutional criteria (24.75 ± 7.33 vs. 36.79 ± 8.59 min, p = 0.01). The agreement between methods was poor (ICC = 0.06). Discharge time varied significantly by BMI percentile (p = 0.01); obese children had shorter recovery times, while time differences were greater in overweight children. No adverse events or readmissions occurred. Conclusions: MAS provides a quicker and equally safe discharge assessment in pediatric dental sedation. Its use may enhance workflow efficiency and standardize recovery decisions in NORA settings lacking formal PACUs. Full article

Background/Objectives: Operating room (OR) nurses are frequently exposed to high-stress environments, including verbal violence, which may induce post-traumatic stress (PTS). This study investigated the effects of verbal violence, resilience, and social support on PTS among OR nurses. Methods: A cross-sectional descriptive correlational study was conducted with 150 OR nurses who had at least one year of work experience. Data were collected via a mobile-based questionnaire and analyzed using SPSS Statistics 25. The main variables included experiences of verbal violence (from doctors and nurses), resilience, social support, and OR work satisfaction. Results: Exposure to verbal violence from doctors and nurses, as well as having 10 or more years of clinical experience, were significantly associated with higher PTS levels. In contrast, greater OR work satisfaction was associated with lower PTS. These variables collectively explained 36.6% of PTS variance (F = 8.64, p < 0.001). Conclusions: Verbal violence significantly contributes to PTS among OR nurses. Enhancing resilience and social support may mitigate the impact of PTS. Therefore, interventions such as structured peer-support systems, resilience training, and violence-prevention policies are recommended to reduce PTS risk. In addition, interventions to prevent verbal violence, and strengthen resilience and social support, and OR work satisfaction are crucial to protect nurses’ mental health and ensure patient safety. Full article

Background: Healthcare systems are increasingly strained by limited operating room resources and rising demand, a situation intensified by the COVID-19 pandemic. These pressures have resulted in overcrowded surgical departments, prolonged waiting times for elective procedures, worsened patient health outcomes, and increased hospital expenditure costs. Methods: To address these challenges, this study proposes a multi-objective mathematical optimization model as the analytical core of a decision support approach for OR resource allocation. The model considers multiple constrained resources, including OR time, intensive care units, medium care units, and nursing staff, and aims to minimize both elective patients’ waiting times and total incurred costs over a one-week planning horizon. Developed using real hospital data from a large facility in Thailand, the model was implemented in LINGO version 16.0, and a sensitivity analysis was conducted to assess the impact of surgical department priorities and overtime allowances. Results: Compared to current practices, the optimized OR schedule reduced average waiting times by approximately 7% and total costs by 5%, while balancing resource utilization. Conclusions: This study provides a data-driven tool to support hospital resource planning, improve OR efficiency, and respond effectively to future healthcare crises. Full article