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Making joint commitments for decision making
JULY 2000,VOL 72, NO 1 EDITORIAL
Making joint commitments for decision making any tools and resources are available or developed for use in our professional settings that take the decision out of decision making. Rules, policies, protocols, regulations, standards, and guidelines make our lives and the processes required for providing patient care somewhat easier. They help streamline processes and provide consistency in our practices. They eliminate the time needed to deliberate over choices or the need to inform others and discuss every action. These tools help address the information that people need about the "way we are supposed to be doing things." They promote practicing in a standard manner by each of us as individuals. Many of these tools and resources were developed jointly by people representing multidisciplinary care provided in perioperative settings. These same tools and resources can result in frustration and conflict when all team members who are expected to implement processes do not have an equal level of understanding or knowledge. The availability of immense amounts of data and facts potentially increases the need for information-sensitive decisions in our perioperative settings. Whether simple or difficult, decisions require that nurses understand the information provided and the rationale for that information. In our multidisciplinary environments, that challenge is extended to require that we
determine not only what is best, but also ways of sharing the information with others.
CHANGING PRACTlCES Cost-saving measures have infused our health care settings and given us ample opportunity to drive the change processes. It seems that fewer changes are initiated because of research- or data-based information and even less frequently because we want to find a way to work harder. The easiest step in changing practice might be determining that there is a cost saving to be achieved. Identifying the means of changing the practices and implementing and maintaining the practices that have been changed are the more difficult steps in the processes and cannot be accomplished alone. Perioperative nurses are participants in analyzing and sharing information. The increasing volume and types of resources, external sources (eg, standards, guidelines), and opinions that drive change sometimes are barriers to change. Changes such as eliminating hospital-laundered attire for employees, attempting to bring smoke evacuation devices into the OR, and maintaining staffing ratios for RNs and RN first assistants are occurring throughout the country. Many nurses probably experience frustration each time they unexpectedly need a syringe that is in a locked area and with the need to restock extra syringes after every procedure. Some 14 AORN JOURNAL
changes are acceptable without question-thers are cause for concern. Some changes are ini- BRENDA s. tiated for all of GREGORY DAWES the right reasons in what might be perceived to be the most effective manner. An example is the timing and delivery of antibiotics. Several years ago, pharmacists worked with nurses to initiate programs to reduce inappropriate antibiotic use. The Centers for Disease Control and Prevention identified times when antibiotics should be considered for use.' To this day, that message has not permeated our health care settings, and there are many patients who are receiving antibiotics without consideration for timing and dosage. There are times when safe practices are initiated before conclusive evidence is gathered to validate the practice. An example is the recommendation to place tourniquets at sites with greater amounts of soft tissue and in a manner that reduces the risk for patient injury? We are afforded challenges by an increasing need for tourniquet placement on the lower leg and ankle in response to more patients desiring and requiring foot surgery. Responsible decision making and information gathering can help support decisions about practices that can and should be changed and to share
JULY 2000, VOL 72, NO I
information to ensure that safe practices are implemented. JOIN FORCES IN DECISION MAKING During the last decade, we were challenged to put sacred cows to pasture. Many are grazing, and others continue to survive in our midst whether we like it or not. The challenge at that time was not only related to eliminating unnecessary or outdated practices, but also to considering the uniqueness of our practices, settings, and patients and making concerted efforts to question practices. This challenge encouraged and forced nurses to become more involved in decision making. Today it is not a question of being involved-there are few choices about being involved if you actively participate as a health care professional. Different settings offer opportunities for involvement in making decisions and changing practices. Your setting might have committee involvement, or all staff members might be expected to participate. The question is how and where to find the necessary information, substantiate that information, share the information with all parties involved, and maintain relationships throughout the process.
Involvement with a commitment that results in progress is the formidable task in our professional lives. The complicated scenarios in which products and supplies and the needs of surgeons, employees, and patients are constantly changing and satisfying the customer is an expectation adds to the convoluted decision-making processes. How can nurses drive changes that might need to result in changes in medical practices? How can nurses communicate pros and cons to people who need the information (ie, surgeons, administrators, legislators)? Who will listen to decisions that are presented by nurses‘? These are a few of the questions that interfere with the ability or desire to be involved, even when there is an obvious need. Jump starting the process requires participation by everyone. It requires that nurses join forces to participate, gather and share information, and understand each other, their team members, and processes. It requires that we talk to each other and listen to each other. If our challenge is to make useful decisions that will make a difference to patients and to share that information, we will spin in circles if we try to function independently. In our health care
settings, we must support our peers. In our professional practices and organizations, we must communicate, develop relationships, and acknowledge each other. Overall, we should encourage those who are not joining forces to meet us head on. CHANGING TH€ FUTURE Nurses will remain in the ranks of others who are waiting for direction unless we each decide and become determined to influence our practices through commitment and decision making. We cannot predict the results of changes that we are asked or want to make. Tools and resources are wonderful assets, but they do not eliminate the need for using judgment and independent thinking skills. Our educational backgrounds, expert knowledge, and professional responsibility position us to put decisions in the forefront. By adding research, data, and common sense to the equation, along with the commitment of many, we could be in a position to not only make important decisions, but also decisions that make a difference in our praetices and our patients’ care. BRENDA S. GREGORY DAWES RN, MSN, CNOR EDITOR
hip/SSI/SSI_guideline.htni.Accessed 20 May 2000. 2. “Reconunended practices for use of the pneumatic tourniquet,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2000) 306.
NOTES 1. Centers for Disease Control and Prevention, “Guideline for the prevention of surgical site infections, 1 999.” Available from http://www.cdc.gov.ncidod/
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16 AORN JOURNAL
Making joint commitments for decision making any tools and resources are available or developed for use in our professional settings that take the decision out of decision making. Rules, policies, protocols, regulations, standards, and guidelines make our lives and the processes required for providing patient care somewhat easier. They help streamline processes and provide consistency in our practices. They eliminate the time needed to deliberate over choices or the need to inform others and discuss every action. These tools help address the information that people need about the "way we are supposed to be doing things." They promote practicing in a standard manner by each of us as individuals. Many of these tools and resources were developed jointly by people representing multidisciplinary care provided in perioperative settings. These same tools and resources can result in frustration and conflict when all team members who are expected to implement processes do not have an equal level of understanding or knowledge. The availability of immense amounts of data and facts potentially increases the need for information-sensitive decisions in our perioperative settings. Whether simple or difficult, decisions require that nurses understand the information provided and the rationale for that information. In our multidisciplinary environments, that challenge is extended to require that we
determine not only what is best, but also ways of sharing the information with others.
CHANGING PRACTlCES Cost-saving measures have infused our health care settings and given us ample opportunity to drive the change processes. It seems that fewer changes are initiated because of research- or data-based information and even less frequently because we want to find a way to work harder. The easiest step in changing practice might be determining that there is a cost saving to be achieved. Identifying the means of changing the practices and implementing and maintaining the practices that have been changed are the more difficult steps in the processes and cannot be accomplished alone. Perioperative nurses are participants in analyzing and sharing information. The increasing volume and types of resources, external sources (eg, standards, guidelines), and opinions that drive change sometimes are barriers to change. Changes such as eliminating hospital-laundered attire for employees, attempting to bring smoke evacuation devices into the OR, and maintaining staffing ratios for RNs and RN first assistants are occurring throughout the country. Many nurses probably experience frustration each time they unexpectedly need a syringe that is in a locked area and with the need to restock extra syringes after every procedure. Some 14 AORN JOURNAL
changes are acceptable without question-thers are cause for concern. Some changes are ini- BRENDA s. tiated for all of GREGORY DAWES the right reasons in what might be perceived to be the most effective manner. An example is the timing and delivery of antibiotics. Several years ago, pharmacists worked with nurses to initiate programs to reduce inappropriate antibiotic use. The Centers for Disease Control and Prevention identified times when antibiotics should be considered for use.' To this day, that message has not permeated our health care settings, and there are many patients who are receiving antibiotics without consideration for timing and dosage. There are times when safe practices are initiated before conclusive evidence is gathered to validate the practice. An example is the recommendation to place tourniquets at sites with greater amounts of soft tissue and in a manner that reduces the risk for patient injury? We are afforded challenges by an increasing need for tourniquet placement on the lower leg and ankle in response to more patients desiring and requiring foot surgery. Responsible decision making and information gathering can help support decisions about practices that can and should be changed and to share
JULY 2000, VOL 72, NO I
information to ensure that safe practices are implemented. JOIN FORCES IN DECISION MAKING During the last decade, we were challenged to put sacred cows to pasture. Many are grazing, and others continue to survive in our midst whether we like it or not. The challenge at that time was not only related to eliminating unnecessary or outdated practices, but also to considering the uniqueness of our practices, settings, and patients and making concerted efforts to question practices. This challenge encouraged and forced nurses to become more involved in decision making. Today it is not a question of being involved-there are few choices about being involved if you actively participate as a health care professional. Different settings offer opportunities for involvement in making decisions and changing practices. Your setting might have committee involvement, or all staff members might be expected to participate. The question is how and where to find the necessary information, substantiate that information, share the information with all parties involved, and maintain relationships throughout the process.
Involvement with a commitment that results in progress is the formidable task in our professional lives. The complicated scenarios in which products and supplies and the needs of surgeons, employees, and patients are constantly changing and satisfying the customer is an expectation adds to the convoluted decision-making processes. How can nurses drive changes that might need to result in changes in medical practices? How can nurses communicate pros and cons to people who need the information (ie, surgeons, administrators, legislators)? Who will listen to decisions that are presented by nurses‘? These are a few of the questions that interfere with the ability or desire to be involved, even when there is an obvious need. Jump starting the process requires participation by everyone. It requires that nurses join forces to participate, gather and share information, and understand each other, their team members, and processes. It requires that we talk to each other and listen to each other. If our challenge is to make useful decisions that will make a difference to patients and to share that information, we will spin in circles if we try to function independently. In our health care
settings, we must support our peers. In our professional practices and organizations, we must communicate, develop relationships, and acknowledge each other. Overall, we should encourage those who are not joining forces to meet us head on. CHANGING TH€ FUTURE Nurses will remain in the ranks of others who are waiting for direction unless we each decide and become determined to influence our practices through commitment and decision making. We cannot predict the results of changes that we are asked or want to make. Tools and resources are wonderful assets, but they do not eliminate the need for using judgment and independent thinking skills. Our educational backgrounds, expert knowledge, and professional responsibility position us to put decisions in the forefront. By adding research, data, and common sense to the equation, along with the commitment of many, we could be in a position to not only make important decisions, but also decisions that make a difference in our praetices and our patients’ care. BRENDA S. GREGORY DAWES RN, MSN, CNOR EDITOR
hip/SSI/SSI_guideline.htni.Accessed 20 May 2000. 2. “Reconunended practices for use of the pneumatic tourniquet,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2000) 306.
NOTES 1. Centers for Disease Control and Prevention, “Guideline for the prevention of surgical site infections, 1 999.” Available from http://www.cdc.gov.ncidod/
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16 AORN JOURNAL